Archive for the ‘medical history’ Category

Insanity a Privileged Disease?

Sunday, August 31st, 2014
The Surge in Nervous Diseases Created Interest in the Public

The Surge in Nervous Diseases Created Interest in the Public

Though insanity would never be welcomed by either victims or their families, it was perhaps a comfortable notion to think that it primarily afflicted “civilized” people and nations. Nervous diseases did not affect “savages.” Furthermore, the upper, leisured class could sometimes ascribe their whims, phobias, and “nerves” to their sensitivity and developed intellect, even when the conditions bordered on insanity.

Wealthy women could be dainty, frail, and too refined to bear anything sordid or “common.” They could afford to be highly strung, indulging in hysteria, moodiness, nervousness, and hypochondria. Men shied away from hysteria, but they could manifest both hypochondria and melancholia without losing respect. People who had these nervous disorders, or neurasthenia, as coined by Dr. George Brown (see last two posts) could go to spas, travel, or take rest cures that might include bed rest, massage, and hearty meals. Sometimes for men, treatment would be vigorous outdoor exercise.

Though all these conditions caused distress and should not be considered false or amusing in any degree, only the leisured, wealthier class could manage to indulge in them without societal disapproval. A delicate blue-blood who could eat only the daintiest food was acceptable; a factory girl would be expected to eat what she was given. A wealthy man could afford to be melancholic and withdraw from business or social obligations, whereas a working man would incur only anger or exasperation for the same behavior. Finally, the wealthy could manifest these somewhat fashionable nervous conditions without acquiring the label of insanity or suffering the trauma of  commitment to an asylum. Because they had the means to help themselves in gentler ways via the advice and services of specialists, they could perhaps cope better with their condition so that it did not become worse, the way it might for a person in poverty and with no ability to get help at the onset of the problem.

Massaging Arm in the Rest Cure, circa 1890

Massaging Arm in the Rest Cure, circa 1890

Victorian Woman Fainting of Neurasthenia

Victorian Woman Fainting of Neurasthenia

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Insanity and Physical Causes

Thursday, August 28th, 2014
Charles Hamilton Hughes, Eminent Alienist, Founded and Edited The Alienist and Neurologist

Charles Hamilton Hughes, Eminent Alienist, Founded and Edited the Alienist and Neurologist

Alienists had long pondered the causes of insanity, and attributed some often-laughable (to modern sensibilities) reasons for its onset. They realized that sudden shocks, grief, worry, and other emotional traumas could at least temporarily affect a patient’s mind, but they also understood that insanity could derive from physical causes. Unfortunately for many patients, syphilis and epilepsy were two primary physical conditions behind much of the insanity found in insane asylums during this time. Sunstroke, fevers, and alcohol abuse could also damage the body enough to cause insanity.

In the 1870s, Dr. George Beard (see last post) made some important connections between stress and neurosis, attributing “American nervousness” to the sudden onslaught of a rapidly developing modern era which could overwhelm many people. However, he ultimately believed that insanity was due to physical causes.  “The central nervous system becomes dephosphorized, or perhaps, loses some of its solid constituents,” Beard wrote. In mental illness, the nervous system underwent morbid changes in its chemical structure, which diminished the patients “nervous force.” These changes could ultimately be viewed under a microscope in an autopsy, though Beard could not actually prove his theory. He was firm in his conviction, however, that all insanity was a result of some sort of diseased physical condition.

Conditions Like Anorexia Were Accepted by Physicians in the Industrial Age, photo circa 1900

Though Identified Much Earlier, Conditions Like Anorexia Became Widely Accepted by Physicians in the Industrial Age, photo circa 1900

Nerve Syrup

Nerve Syrup

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Industrialization and Mental Illness

Sunday, August 24th, 2014
Americans Sought Help for Nervous Diseases

Americans Sought Help for Nervous Diseases

Americans may have enjoyed many of the new inventions and opportunities the dawning industrial age offered, but many were also thrown off balance by the increasingly fast pace of the late 1800s. Dr. George Beard noticed that Americans were having difficulty coping with life as new forms of transportation, communication, and automation made their way into society. He tried to make sense of the physical symptoms cropping up in far too many ordinary, upper and middle-class people, and determined that they were caused by an “exhaustion of the nervous system.” He termed the syndrome neurasthenia.

Though Beard’s observations were quite astute to some degree, he also perpetuated some stereotypes. He believed that “civilization” and its higher demands led to certain nervous conditions and physical complaints: “The savage can usually see well; myopia is a measure of civilization.” Likewise, American women, who were given the opportunity to socialize more easily than women in other countries, developed their “cerebral activity” more quickly. This, in turn, influenced their physical development, with the end result that American women were typically more beautiful and expressive than women in other countries.

Beard's Book on American Mental Illnes

Beard’s Chart on American Mental Illness

George Beard

George Beard

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New Century, Old Ways

Thursday, August 14th, 2014
New York Street Scene, 1903

New York Street Scene, 1903

Life was difficult around the turn of the twentieth century. A simple scratch or sore throat that developed into strep could still cause death since there were no effective antibiotics, most homes had no indoor plumbing, and heating fuel was dirty and inconvenient. Though most women no longer had to weave their own cloth, many were still cutting out patterns and sewing their family’s clothes. Farming was labor-intensive, with a lot of human-power to supplement whatever farm animals were available for plowing, planting, and other tasks. Canning food for the winter was hot, exhausting, and seemingly endless when the crops came in and food had to be processed right away.

It is little wonder that the townspeople in Canton, South Dakota were so proud and impressed with the new Canton Asylum for Insane Indians,with its electric lights and indoor plumbing. (The asylum had range toilets; these flushed at intervals rather than after each individual use, but were still a great convenience.) In an age when even very young children worked hard on farms or in dangerous factory and mining jobs, the public could feel gratified that an institution existed which could provide food, shelter, and medical care to people who were struggling to get through life.

Feeding Chickens in Montana, 1908

Feeding Chickens in Montana, 1908

 

Farm House in Nebraska, 1903, courtesy Library of Congress

Farm House in Nebraska, 1903, courtesy Library of Congress

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Tiny Steps

Thursday, July 24th, 2014
ield Matron and Assistants, 1905

Field Matron and Assistants, 1905

Most Europeans settlers believed that their respective cultures were superior to Native American ones, and set about imposing their own ideas upon native peoples as soon as they were able to do so. This thinking led to many tragedies, including reservations and assimilation, with all their cascading ills. The federal government made a concerted effort to stamp out Native American culture by making job security and food dependent on compliance and forcing children to go to boarding schools, among other strategies. Not everyone supported this thinking or behavior, but it ruled.

By the 1920s, significant protest to federal policy (and field experience) caused leaders to rethink some of their practices. In a paper from 1924, “Is the Indian Susceptible to Health Education,” Dr. A. J. Chesley pointed out that many problems with Indian health had to do with the lack of health education and resources available to native peoples. After discussing a few of the problems a colleague had discovered among Chippewa families, Chesley discussed one of the doctor’s major recommendations to improve their health.

“First, that Chippewa nurses be employed to undertake public health work,” advised the colleague, Dr. S. J. Crumbine. “Experience shows that little progress has been made by white nurses, field matrons, or other workers among the Indians. Considering that the Indian nurses know the customs of the people, understand their point of view and speak their language, it is believed they might earn the confidence of the Indians and induce them to do the things which would benefit the children.”

This suggestion seems like basic common sense to anyone at all sensitive to the cultural needs of other people, but it was evidently a novel  idea. Though a better suggestion might have been to allow traditional native healing practices rather than imposing Anglo-based ones, Dr. Crumbine had been speaking specifically about tuberculosis and the close living quarters which spread the disease. In this instance, information about contagion would have been helpful in preventing the spread of the disease, and certainly would be most effective if delivered by a Chippewa nurse.

A Havasupai Indian Woman Receiving an Injection in Knee From Public Health Service Officer, courtesy National Library of Medicine

A Havasupai Indian Woman Receiving an Injection in Knee From Public Health Service Officer, courtesy National Library of Medicine

An Indian Health Service Field Nurse Demonstrates X-Rays, courtesy National Library of Medicine

An Indian Health Service Field Nurse Demonstrates X-Rays, courtesy National Library of Medicine

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Paperwork

Sunday, July 20th, 2014
Record of Patients at St. Louis Insane Asylum, 1886

Record of Patients at St. Louis Insane Asylum, 1886

Running an insane asylum involved a great deal of administrative work, and it is no wonder that some records were not as meticulous as inspectors and latter-day researchers would have liked. Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, was often accused of poor-record keeping. However, not all of his records were badly kept; the problem lay in where he chose to put his efforts. A February, 1927 journal voucher lists 30 patients along with small sums spent on their behalf. These sums ranged from a few dollars to fifteen cents, yet Dr. Hummer kept track of them for reimbursement purposes. Conversely, he spent almost no time updating patient medical records during the asylum’s later years; he left that task to his attendants who often jotted repetitive, meaningless updates that were useless for diagnostic purposes. Perhaps Dr. Hummer put his energy only into those tasks he thought would benefit himself and contribute to the efficiency of the asylum.

Many asylums have not retained all their patient records (or have deliberately destroyed them), so Canton Asylum’s incomplete patient records does not present an unusual situation. One inadvertent benefit to Hummer’s attention to detail in certain areas is that it is at least possible to cull patient names from these types of documents.

By going through vouchers and reports, researchers can fill in gaps that might exist in the records they would prefer to have, or uncover tidbits of information that present a clearer picture of  their subject matter. For instance, a payroll list from June 1923 shows that Dr. Hummer’s father, Levi, and his son, Harry Hummer, Jr. were employed at the asylum; additionally, a separate letter to the Indian Office that same month shows that Dr. Hummer’s other son, Francis, acted as an escort for patients coming to the asylum from Taos, New Mexico. It would certainly be interesting to speculate or do further research on the dynamics of this family employment.

Death Certificate From Western State Hospital

Death Certificate From Western State Hospital

Patient Record From Nineteenth Century

Patient Record From Nineteenth Century

 

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A Difficult Life for All

Sunday, June 22nd, 2014
People Seated on a Bench Near Van Deusen Cottage, Kalamazoo State Mental Hospital

People Seated on a Bench Near Van Deusen Cottage, Kalamazoo State Mental Hospital

Though patients undoubtedly had wretched experiences at most asylums, the life of an attendant was also difficult. Even in the first decades of the twentieth century, it was usual for attendants and other staff (including physicians) to reside at the asylum where they worked. In some ways the arrangement was a benefit, since it eliminated commutes and gave employees housing and food; however, it added to employee stress because they could never get away from constant reminders of their job. The Canton Asylum for Insane Indians followed this pattern, and some employees even had to share a room.

Stressful as it was to be an attendant, though, their duties were clear. The Indian Office had provided governing rules and regulations for Canton Asylum’s employees, though its first superintendent had not passed them out. Dr. Harry Hummer did, and the instructions provided were comprehensive:

“[Attendants] will see that the patients are at all times kept as comfortable and clean as their condition will permit. They will keep them comfortably clothed, bathing them and changing their clothing as frequently as required for the purpose. They shall keep their apartments at all times clean and neat, and free from every contamination which is unpleasant and injurious to health. They shall look carefully after every portion of the housekeeping, including bed making, sweeping, dusting, brightening of floors, hardware, plumbing fixtures, etc.”

The preceding is only one small segment taken from several pages of instruction, and it is easy to see that an attendant with 15 or more patients could be easily overwhelmed. Many inspectors found the patients’ quarters woefully neglected, dirty, and disordered; the condition likely came about because attendants had to choose between caring for rooms and caring for people.

One of St. Elizabeths Dorm Rooms, 1905

One of St. Elizabeths Dorm Rooms, 1905

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

Patients and Staff at Christmas Party at State Hospital, Jamestown, courtesy Historical Society of North Dakota

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A Patient’s Work is Never Done

Thursday, June 19th, 2014
Gardner State Colony for the Insane

Gardner State Colony for the Insane

Insane asylums used patient labor for both occupational therapy and cost-containment (see last post). However, that labor didn’t always start after the facility had been completed and simply needed to be maintained. Asylum administrators often brought in patients after only a limited space was ready for occupancy, and then used them to help build the rest of the asylum.

In October of 1902, Governor Crane of Massachusetts declared its newest asylum, the Gardner State Colony, ready to receive patients and admitted five men from the Taunton Insane Hospital. Five more men were transferred from Westborough two months later, and over the winter these male patients worked in the woods to cut down 46,000 feet of lumber. That summer, they worked on the farm and excavated for the asylum’s water supply; in 1904 the institution received 111 patients.

A case can surely be made that patients enjoyed certain types of occupational therapy such as fancy needle-work or light gardening, but tasks such as building roads, chopping down trees, clearing fields, working in hot laundry rooms, etc. were not for their benefit. Though some administrators (and the public) may have seen the practice as simply expecting able-bodied men and women to work for their room and board, there is really no way to know what kind of coercive measures were used to get some of the more difficult and undesirable tasks completed.

Photo of Patients Collecting Maple Syrup from Trees on the Grounds of the London Asylum for the Insane

Photo of Patients Collecting Maple Syrup from Trees on the Grounds of the London Asylum for the Insane

Male Patients at Spring Grove Hospital

Male Patients at Spring Grove Hospital

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Who Says You’re Crazy?

Thursday, June 12th, 2014
Dedicated Alienists Tried to Stay Informed

Dedicated Alienists Tried to Stay Informed

One of the major problems with the Canton Asylum for Insane Indians was that commitment rules were so lax. Like most asylums, there were patients incarcerated because they were inconvenient to others or created problems for civil authorities, but there were also some patients who genuinely needed help. In either case, few patients admitted to the asylum had actually been evaluated by a physician of any kind, let alone one who specialized in mental illness. Instead, they were usually sent to the asylum on the assessment of only a layperson (Indian agent or reservation superintendent) which was terribly unfair. Abuses of power could, and did, take place, because even if these lay persons were actually trying to help someone, they weren’t necessarily right in their opinion of the person’s mental state.

Though abuses of power probably occurred everywhere at times, patients in other states and institutions often had stronger protections. Massachusetts had always been a progressive state when it came to helping its citizens facing mental health issues, and its commitment laws were fairly strict. In 1916, the editors of Institutional Care of the Insane in the United States and Canada wrote: “Commitment [in Massachusetts] may not be made unless there has been filed with the proper judge or justice a certificate of the insanity of the person by two physicians nor without an order signed by the proper judge that he finds the person insane.”

The judge could see and examine the person if he thought it needful, could also call in a third physician, and could summon a jury of six men to hear and judge whether the proposed patient was insane or not. Furthermore: “A physician making a certificate of insanity must be a graduate of a legally chartered medical school, in actual practice for three years and for the three years last preceding, and be registered. His standing, character and professional knowledge of insanity must be satisfactory to the judge.”

Though there could certainly be an “old boy” system that would allow a motivated complainant the opportunity to have a family member or enemy committed to an insane asylum, it was still much more difficult for two physicians and a judge to collude against a person than it was for one layperson to decide that an Indian was crazy.

Newpaper Story Argued Whether the Woman Was Insane From Booze or Religion

Newspaper Story Argued Whether Man Was Insane From Booze or Religion

Danvers State Hospital, circa 1893

Danvers State Hospital, circa 1893

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Alienists’ Diagnoses Were Never Foolproof

Sunday, June 8th, 2014
Nellie Bly, circa 1890

Nellie Bly, circa 1890

Alienists’ assessments of their patients’ mental conditions could be suspect at the best of times. They were particularly suspect when alienists dealt with people who did not fit the norms of an Anglo-centric society. Newly arrived immigrants were vulnerable to a misinterpretation of their mental status, and of course, non-English speaking Native Americans could easily be misunderstood or be so frustrated and frightened that they couldn’t communicate effectively. One reporter’s experiment showed how easily alienists could be fooled.

In 1887 New York World reporter, Nellie Bly, posed as an insane woman by practicing “insane gestures” and later claiming she had amnesia. She was sent to Blackwell’s Island Lunatic Asylum after several doctors examined her and declared her definitely insane. She was, “Positively demented,” said one, “I consider it a hopeless case. She needs to be put where someone will take care of her.”

Worse than the alienists’ initial assessment was their later inability to see past it. Bly dropped her insanity act immediately and yet made no impression on the doctors who had decided she was insane. She wrote, “From the moment I entered the insane ward on the Island, I made no attempt to keep up the assumed role of insanity. I talked and acted just as I do in ordinary life. Yet strange to say, the more sanely I talked and acted, the crazier I was thought to be by all….”

When Nellie was released after ten days–and wrote about her experience in the New York World–embarrassed doctors could not explain how they had been so easily fooled. A New York grand jury promptly launched an investigation into conditions at the asylum, which Bly had written about in horrifying detail.

Blackwell's Island Lunatic Asylum

Blackwell’s Island Lunatic Asylum

Nellie Bly's Book

Nellie Bly’s Book

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