Archive for the ‘medical history’ Category

The Insane as News Items

Thursday, December 11th, 2014
Doctor's Parlor, Willard Asylum for the Chronic Insane

Doctor’s Parlor, Willard Asylum

Though early alienists did a great deal to de-stigmatize insanity and help families feel better about seeking help for their mentally ill members, insanity was still a delicate subject that most families preferred to keep private. Asylum superintendents understood this. They tried to be as soothing and discreet as possible, often bringing families into nice parlors for a private chat to quiet their embarrassment and fears and to find out more about the patient’s problem. Many asylums also had fences around them, not just to keep patients inside, but to keep the curious public out while patients walked or worked on the grounds.

A Work Train Transporting Patients at Willard Insane Asylum

A Work Train Transporting Patients at Willard Insane Asylum

When patients were transferred from one asylum to another, as often happened when a new asylum opened to alleviate overcrowding, the public usually came out in force to watch the transfer. When the East Tennessee Insane Asylum received fifty female patients from the Nashville institution, the Knoxville Daily Journal (March 21, 1886) said that, “The curiosity of about one hundred men, women and children, who had hovered around Erin station all yesterday afternoon was gratified when the train of female lunatics arrived at 4:00 o’clock.”

Postcard of Patients at Asylum Number 3, in Missouri

Postcard of Patients at Asylum Number 3, in Missouri

A few weeks later, the same paper ran an article about two new patients–referred to as inmates–brought to the asylum. A woman was brought by her daughter, and a man by the sheriff of Campbell county. A third person who had gone “crazy about religion” had been tied hand and foot in a train that then passed through town on its way to Wytheville (Virginia) where the man was to be incarcerated. He was accompanied by two sisters and a brother, but spent his time sitting in his seat “singing, cursing and gesticulating frantically.”

The paper called the latter a sad case, but went ahead and printed the man’s name–as well as the names of the other two patients–and as many details about them as it could. It surely did not make anything easier for these patients or their families to receive so much publicity about a situation they would rather have remained private.

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Public Interest in Insane Asylums

Sunday, December 7th, 2014
Asylum for the Insane in Nashville

Asylum for the Insane in Nashville

The construction of an insane asylum was usually a welcome event for most towns or cities, since the work meant jobs and a continued money flow into the local economy. Newspapers had little but praise for these projects, as the Knoxville Daily Journal  demonstrates:

An article titled “The New Asylum Opened,” and dated March 18, 1886 begins, “. . . the East Tennessee Insane Asylum, which is a branch of the main asylum at Nashville, and is located at Lyon’s View, the most lovely spot in the part of the world.” It continues, “A brief description of the magnificent structure, as it now stands overlooking the Tennessee river and surrounding country commanding some of the most enchanting views in the south . . . . The main front entrance, through a neatly constructed verandah and vestibule, is by means of marble steps, into a broad and stately hall-way, provided with suitable furniture.”

East Tennessee Insane Asylum

East Tennessee Insane Asylum

Readers are left to imagine the particulars of the building, but they could scarcely do otherwise than think that the new institution was a fine place for the “unfortunates” who would live there. “Altogether, there are about 185 rooms in the building and annexes, and there are ample accommodations for about 225 patients.” With so much room and an additional 300 acres that would be improved and beautified over time, the asylum sounded almost luxurious.

In summation, readers were told that “this grand structure looms up as a monument to the sound judgment and executive ability of the three able commissioners, who certainly performed the work assigned to them honorably and well . . . .”

Undated Photo of East Tennessee Insane Asylum

Undated Photo of East Tennessee Insane Asylum

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The Chronic Insane

Thursday, December 4th, 2014
Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

 
Alienists stressed that the prompt treatment of insanity was imperative to a cure. They cautioned the public that it was far wiser to bring an afflicted person to an asylum for a cure as soon as possible, rather than let the patient languish at home for years until an asylum became a last resort. By that point, the disease might have too strong a hold and never be shaken.

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

 

Despite their sharp division of “acute” and “chronic” cases of insanity, few alienists wanted to shunt the chronic insane into separate asylums. First, few alienists wanted to be in charge of hopeless cases that gave them no scope for meaningful treatment and possible success. Second, alienists hated to pass sentence on patients, fearing that a “chronic” label would take away any chance for recovery that the patient might have had. Rather than give a patient a life sentence to custodial care, alienists preferred to keep these patients with their more hopeful cases on the remote chance that he or she could still make a recovery.

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Lawmakers did not often share the alienists’ concerns. Custodial care was far cheaper than active treatment, and state legislatures usually felt that chronic patients unlikely to respond to treatment should not use up the state’s precious monies in a facility that actively treated acute cases. Against most alienists’ wishes, several asylums for the chronic insane were built. (Willard Asylum for the Chronic Insane in New York is perhaps the most well-known of these.) And, as the alienists had foretold, most patients in them spent the remainder of their lives in custodial care.

 

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Evolution of Treatment for the Insane

Sunday, November 30th, 2014
Dr. Benjamin Rush's Tranquilizing Chair, courtesy National Library of Medicine

Dr. Benjamin Rush’s Tranquilizing Chair, courtesy National Library of Medicine

Most modern readers would consider the mid-1800s a fairly rough and rugged period, inhabited by correspondingly rough and rugged individuals. However, changes in the treatment of insanity during this period point to the idea that people in the middle 1800s believed they had declined from the vigor of their ancestors.

When Dr. Benjamin Rush began treating the insane during the late 1700s, most of his treatments were aimed at depleting patients. Because of the vigorous nature of American society at the time, physicians believed that men and women tended to be out of balance on the side of too much “excitement” in their bodies. Excitement irritated blood vessels and resulted in inflammation, fevers and breathing difficulties that could only be relieved by the intense bleeding and purging protocols that Rush practiced all his professional life. In contrast, people of the mid-1800s had become more lethargic, weak, and nervous. Treatments for the insane tended toward tonics, physical exercise, and regimented days full of activity to invigorate the patient.

A Caricature Sadly Based on Reality

A Caricature Sadly Based on Reality

Opium Was Used Routinely

Opium Was Used Routinely

 

 

 

 

 

 

 

 

 

 

 

 

Even though alienists’ views on why insanity occurred and how it affected the body changed over time, they still knew too little about the causes of insanity to do much more than treat its symptoms. Rush bled and purged his manic patients, while later alienists gave them opium and morphine to calm them. The emphasis on treating symptoms may be a reason for the multitude of techniques alienists used–they simply experimented until they found something that seemed to work.

 

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What Caused Insanity?

Sunday, November 23rd, 2014
Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1854, courtesy Missouri State Archives

The causes for insanity that early alienists compiled can seem amusing–as well as appalling–to modern readers. Almost anything, from disappointment in love, financial reverses, over-study, improper diet, use of alcohol or tobacco, and masturbation could derail mental health, it seemed. However, most of these causes really stemmed from one primary cause: civilization.

An eminent statistician who was deeply interested in insanity, Edward Jarvis, explained that the growth of knowledge, increased comfort, more refined manners, better appreciation of art, opportunities for indulgence, and so on that arose from an advancing civilization, did not themselves lead to mental disorders. However, their effects could.

Edward Jarvis

Edward Jarvis

The astonishing strides in civilization present in the mid-nineteenth century also gave people “more opportunities and rewards for great and excessive mental action, more uncertain and hazardous employments and consequently more disappointments . . . more dangers of accidents and injuries, more groundless hopes, and more painful struggle to obtain that which is beyond reach . . .” The mental anguish these byproducts of civilization could cause created more cases of insanity than possible when people had lived with more limited lives and opportunities.

Many Asylums Were Modeled After Thomas S. Kirkbride's Linear Plan

Many Asylums Were Modeled After Thomas S. Kirkbride’s Linear Plan

Alienists agreed with Jarvis’s premise, and therefore saw a need for more insane asylums and more alienists to meet the needs of a country  which was both moving toward an even higher degree of civilization and quickly expanding its population.

 

Their position seemed to be correct, for most asylums filled up almost as soon as they could be built. While there are many other reasons for the popularity of asylums during the 1840s and beyond, there is no denying that these institutions filled a perceived need within that period’s society.

 

 

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New Ideas

Thursday, November 20th, 2014
Chest Treatment With Electrostatic Generator

Chest Treatment With Electrostatic Generator, circa 1908

Food was not the only way to treat physical illnesses (see last few posts), though healthy eating may have been the least harmful way to ward off sickness.

The turn of the 20th century saw many innovations and experimental treatments by physicians who were working on new ways to help patients. The August, 1907 issue of The New Albany Medical Herald monthly journal ($1/year for a subscription) reported that:

A Tuberculosis Sanitarium

A Tuberculosis Sanitarium

“[Dr.?} Stuver has used galvanic electricity with splendid results in chronic rheumatism.

 

He uses a current of from 6 (?) to 20 mp. for a person, 20 minutes to a half-hour and says that the results are better if a thin layer of cotton, wet with a solution of cocaine, is placed under the positive pole.”

Tuberculosis Patients at J.N. Adam Memorial Hospital in Buffalo, NY, courtesy Edward G. Miller Library, University of Rochester Medical Center

Tuberculosis Patients at J.N. Adam Memorial Hospital in Buffalo, NY, courtesy Edward G. Miller Library, University of Rochester Medical Center

Another article in the same issue concerned the treatment of tuberculosis. The writer, a Dr. Thos. P. Cheesborough, from Asheville, NC, noted  that he usually received patients who were far along in the condition, due to their home physicians either missing the diagnosis entirely or being reluctant to tell their patients the bad news about their health.

 

Dr. Cheesborough then says, “One of the greatest disadvantages that I have found in treating this disease is that the poor unfortunate, when at last his disease has been diagnosed, and he has been sent from home and its comforts, has been advised by the home physician not to consult anyone here, but to exercise and drink whisky and to come home in a few months cured.”

Obviously, medical care could sometimes be hit or miss.

 

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Food Woes

Sunday, November 9th, 2014
Smoking Fish for Preservation

Smoking Fish for Preservation

Choices concerning Bran Flakes and Shredded Krumbles (see last post) weren’t the only food problems patients at the Canton Asylum for Insane Indians suffered. They, like most Native Americans, had already lost a basic underpinning of life–their traditional foods. This loss led to nutritional deficiencies and diseases that had never affected them before encountering the white man’s culture.

Native American diets had been varied, nutritious, and plentiful until they lost control over their food. Depending upon the part of the country they inhabited, tribes ate liberally of the “Three Sisters” (beans, corn, and squash), wild rice, nuts, berries, fish, and game of all sorts. Besides hunting and gathering food from the surrounding area, many tribes cultivated crops, as well.

Native American Woman Preparing Food on a Stone Slab, circa 1923, Edward S. Curtis

Native American Woman Preparing Food on a Stone Slab, circa 1923, Edward S. Curtis

When Native Americans were forced to live on reservations, they lost their homes, their cultures, and their independence. Along with that, the quality of their food immediately deteriorated. Reservation land which they were forced to farm was usually so poor that tribes became dependent on government rations.

Rations typically included flour, tea, sugar, coffee, salt, beans, and other staples. These foodstuffs were a far cry from the unrefined, whole foods that Native

Americans had previously eaten. Beef replaced buffalo as a meat source, and Native Americans had to learn to cook new foods which were drastically different and of inferior nutritive value from their traditional foods. Their health began to suffer almost immediately.

 

Receiving Rations at San Carlos Agency, AZ, circa 1892, courtesy National Park Service

Receiving Rations at San Carlos Agency, AZ, circa 1892, courtesy National Park Service

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Unfired Foods

Sunday, October 26th, 2014
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George Julius Drews

George Julius Drews

As generations move away from them, old ideas become new again. Just as foraging has become popular in the past few years (see last post), so has the idea of eating raw foods. George J. Drews wrote about “unfired food” in 1912 in Unfired Food and Trophotherapy. (Troph simply means “preparing and combining provisions for the unfired diet.”) His ideal dinner consisted of soup, salad, a “brawnfood” (such as two ounces of unfired wafers with nut butter or three ounces of unbaked bread or cake) nibblers, and fruit.

Drews' Book About His Food Beliefs

Drews’ Book About His Food Beliefs

Drews also anticipated today’s juicing craze with his “health drinks.” Besides typical “ades” like lemon and limeade, he suggested a tonic drink of beet juice, rhubarb juice, honey and water.

A bit more unappetizing was his suggestion for oatmeal fruit soup: 6 1/2 ounces of grape juice, 1 ounce oatmeal, and 1/2 ounce of olive oil, beaten together and left to soak for five minutes before serving.

Drews was convinced that natural foods could prevent disease and help heal the body; he also had a high distrust of medical drugs and their effects on the body. He scoffed at people who ate unnatural cooked foods and who were then willing to swallow “nauseating drugs irrespective of the dangerous after effects the expected cure may lead to.”

Grocery Stores of the Period Were Full of Unnatural Foods

Grocery Stores of the Period Were Full of Unnatural Foods

 

Drews may have been an unwitting feminist, since he characterized housewives as “imprisoned vassals” who were tied to the kitchen because of the unnatural American diet. “She must stand over a miniature furnace for an hour in the morning and breathe the poisenous [sic] odor of broiling flesh, and spend another hour among the grease and slime of pots . . . . “

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Water Closets

Sunday, October 12th, 2014
An Old Outhouse, courtesy Library of Congress

An Old Outhouse, courtesy Library of Congress

Ordinary homes during the late 1800s and well into the 1900s had few conveniences (see last post); unlike homes today, a dedicated bathroom was a luxury. A largely rural population typically used an outhouse, which could be indifferently built at worst and an uncomfortable distance from the home at best. Cold in winter and hot in summer, outhouses could smell unpleasantly, attract flies and other insects, and offer little comfort in the way of washroom amenities and hygiene.

A Package of Toilet Paper, circa 1887 - 1900

A Package of Toilet Paper, circa 1887 – 1900

 

In contrast, insane asylums often provided indoor toilets that included the benefit of indoor plumbing for both flushing and washing. The Canton Asylum for Insane Indians was no exception, even though it opened the last day of 1902 in a remote area of the country.

Canton Asylum’s system used range toilets, which shared a common pipe and flushed all at once. If they weren’t flushed regularly, unpleasant odors (and presumably bacteria) could build up and make the room distasteful to use and unhealthy as well. Unfortunately, attendants were sometimes lax in their flushing intervals, and the toilet area did become distasteful to use.

A Tenement Toilet in Douglass Flats in Washington, circa 1908

A Tenement Toilet in Douglass Flats in Washington

 

Some patients may not have known how to use the toilet properly, and sometimes violent patients destroyed part of the equipment. The toilets and lavatory areas were a perpetual headache for asylum superintendent Dr. Harry Hummer, and surely for many of the attendants as well. In time, the washroom system degraded into the fallback use of chamber pots, which were even more unpleasant and unhealthy because they were allowed to fill to overflowing.

 

 

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In the Long Run

Sunday, October 5th, 2014
Pliny Earle, courtesy National Library of Medicine

Pliny Earle, courtesy National Library of Medicine

 
Insane asylums were initially embraced because they held out the hope of curing the insane, rather than merely incarcerating them. Recovery rates were high at first, in the typically small asylums where doctors could devote themselves to patient care and set up individualized plans.

That initial hope gave way to pessimism, however, as institutions became larger and alienists (psychiatrists) found themselves as involved in administration as in practicing medicine. When noted 19th-century alienist and asylum superintendent, Pliny Earle, showed that earlier “cure rates” had been inflated, alienists everywhere accepted the fact that most of their patients were not going to recover, after all.

 

A Common Restraint for Patients Who Remained in Asylums

A Common Restraint for Patients Who Remained in Asylums

However, the new pessimism was almost as unwarranted as the earlier enthusiasm. One of the field’s few longitudinal studies showed that there could indeed be hope for patients. Between 1858 and 1870, Arthur Mitchell studied 1,297 patients in a Scottish asylum. He found that 53% either stayed resident at the asylum or died there during the time involved, but that nearly half of the discharged remainder (44.9%) had remained sane. This “half of the remaining half” only represents a cure rate of about 25%, but that rate might really have been higher; Mitchell could not get information concerning 32% of the discharged patients. Similarly, Dr. John G. Park  of the Worcester State Lunatic Hospital, followed discharged patients for nearly 15 years in the late 1800s and found that more than half (58%) of those who had been discharged as recovered were never again institutionalized. This may not have meant that the discharged patients never had further psychological problems, but it did show that they had been able to function suitably enough to let them remain with family or friends.

Worcester Hospital for the Insane

Worcester Hospital for the Insane

 

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