Category Archives: Medical History

Theories concerning the cause and cure of disease have changed over thousands of years, and the medical community has shifted its approach to treatment as data concerning illness have changed. Heroic medicine, once the norm, pursued extreme forms of purging and bleeding that nearly killed patients, Later physicians rejected this approach, and tried gentler methods of relief, though they often relied on opiates and sometimes poisonous concoctions that harmed patients. The various treatments through the years make for an interesting study in what the human body has submitted to in the quest for health.

Difficulties in Examining Patients

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For Many Families, Asylums Offered Relief From Difficult Relatives

For Many Families, Asylums Offered Relief From Difficult Relatives

Dr. McDonald tempered his approval of New York’s more stringent commitment laws (see last post) with his recognition that even two qualified doctors called in by the family to make a diagnosis could run into problems. “As a rule you may divide the relatives of an insane person into two classes, those who want to send him to an asylum at all hazards, and those who want to keep him out at all hazards,” McDonald said.

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpetriere Hospital, 1887

Jean-Martin Charcot Demonstrating Hysteria in a Patient at the Salpêtrière Hospital, 1887

McDonald further stated that much of what physicians would hear from relatives would be untrue, irrelevant, guesswork, and blame, which did little to help make a diagnosis. Frequently, the various relatives would blame others for the breakdown; the husband of an insane wife would blame his in-laws for her condition, while they blamed him. For this reason, McDonald advised physicians to try and get information from a servant or family friend, who might be less biased. He also cautioned them not to give in to relatives’ requests for any kind of trickery, but to always present themselves as physicians.

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article From the Trenton Evening News, November 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

McDonald believed that nearly all the insane had delusions of some sort, which would confirm their condition if a doctor could get at what they were. However, he also wrote of a patient coming to his asylum who had been diagnosed with melancholia along with delusions of persecution and injury. The man improved greatly, but held on to a delusion that unknown enemies continually entered the house where he had lived and poisoned his food. Because of this delusion, McDonald and his staff kept the man in the asylum . . . until other members of the household told him that the story was actually true.

Model Law for Commitment of the Insane

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Mrs. Packard Was a Well-Known Victim of Coerced Commitment

Mrs. Packard Was a Well-Known Victim of Coerced Commitment

One of the great tragedies for people judged insane was the ease with which they could be committed to institutions. During certain periods in some states, all it took was the word of family members or “respectable citizens” to commit people to asylums–a practice certain to be abused for personal gain, spite, or control. In 1876, Dr. Alexander E. MacDonald, superintendent of the New York City Asylum for the Insane, explained the way that the state of New York had improved its commitment laws.

Referencing other states that didn’t require physicians to examine the person in question, or only required one doctor to determine insanity, MacDonald cited New York’s requirement that two reputable physicians had to testify that the person was insane and “unfit to be at large.” The latter provision was to protect “harmless” lunatics and chronic cases who weren’t endangering themselves and others. Additionally, the doctors called in to make the examination had to have been in practice at least three years. Though neither of these requirements could curtail all unjust commitments, they seemed to be a step in the right direction.

Illustration from Nellie Bly's Ten Days in a Mad-House

Illustration from Nellie Bly’s Ten Days in a Mad-House

Furthermore, the form physicians completed required them to state their reasons for determining that the person in question was insane. Theoretically, this forced doctors to give a somewhat in-depth examination to back up their opinions, and additionally, their remarks would help the doctor at the asylum decide what initial course of treatment to begin.

Hammond May Have Been an Alcoholic or Heavily Medicated

Hammond May Have Been an Alcoholic or Heavily Medicated

Though any of these requirements seem both obvious and fundamental, they came at a time when many doctors simply rubber-stamped family decisions for commitment. Any obstacles to easy, painless commitments had to be a good thing for the helpless people who were often shipped off to asylums for convenience.

Additional Markers of Insanity

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Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

In the April, 1879 issue of the American Journal of Insanity, Dr. Judson Andrews gave some tips for family physicians to use in monitoring the possible development of insanity in their patients (see last post). The physical symptoms were disturbingly commonplace, but Dr. Andrews seemed to hit a bit nearer the mark when he described certain mental signs that might indicate the development of insanity. (In general, he thought these mental symptoms would develop after the physical ones.)

— Emotions might be exaggerated (a little or a lot) or the person might be unable to control expression of the emotion even when he tried.There might not be a cause for laughing or crying in a situation, or the reaction might be out of character for the individual.

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

— Depression might develop, either as a loss of spirits or a “shading off from the natural cheerfulness of disposition.”

— Patients could experience “forebodings of some indefinite, indefinable evil impending, from which no way of escape lies open.”

–Later, patients would begin to be overly introspective; in reviewing their actions, they would judge themselves far too harshly and negatively.

— Patients could develop difficulty making decisions about simple tasks (like what to wear) and important ones alike; any course they decided upon then yielded to “agonies of doubt” or vacillation.

Other changes might be in personality, dress and personal appearance, and “exaltation or exaggeration.”

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 - 1919

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 – 1919

Unfortunately, many of these symptoms could develop so slowly they would be hard to detect; in other cases they might just be an intensification of the person’s normal personality and also hard to spot. At least, though, concluded Dr. Andrews, insanity had lost its mystery and dread, and “the insane man stands forth simply as a sick man: one, who by reason of cerebral disease, is unable to use his brain.”

This viewpoint was undoubtedly kinder than the fear and judgment insanity had faced in the past.

Predicting Insanity

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An Article from the Trenton Evening New, Nove 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

An Article from the Trenton Evening New, Nov. 7, 1898, Showing a Change in Behavior Leading to an Insanity Diagnosis

Toward the latter part of the nineteenth century, mental health specialists (alienists) began to alter their approach to diagnosing insanity. Instead of looking at specific behaviors in patients and making a diagnosis from them, doctors thought it made more sense to look at changes in patients’ ordinary behaviors. To paraphrase one expert: Performing a dangerous tightrope stunt would not be considered insanity in a circus performer, but might be in someone who had never done such a thing and suddenly decided to try it.

Of course, neither alienists nor families wanted to wait until someone actually became insane before they intervened. Could there possibly be ways to predict the development of insanity? An article in the April, 1879 issue of the American Journal of Insanity gave some tips for family physicians to use in monitoring the possible development of insanity in their patients. In the words of the article’s author, Dr. Judson Andrews, early indications that might be considered precursors of insanity included:

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

Front Entrance, New York State Lunatic Asylum Where Dr. Andrews was Assistant Physician

— morbid dreams

— impairment of sleep

— a symptom cluster that included loss of appetite and indigestion, with pain, belching, flatulence, heartburn, and offensive breath

— a symptom cluster that included an increased action of the heart, full and strong pulse, a flushed face and slightly elevated temperature of the skin; the appetite might remain the same or even increase, but there would almost always be weight loss

— diseases which might cause the heart to “fail to supply the amount of blood necessary for the nutrition of the brain” or the lungs to “supply the purifying and exhilarating oxygen”

— headache [descriptions of the types of headache people might experience are similar to migraines]

— restlessness in either the extremities or “in the general movement of the whole body”

American Journal of Insanity

American Journal of Insanity

Though it might be alarming to consider any of these physical symptoms an indication of impending insanity, the emotional tips–discussed in my next post–actually could have been red flags.

 

A Medicine Show

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Goodnight Is Credited With Inventing the Chuck Wagon

Goodnight Is Credited With Inventing the Chuck Wagon circa 1866

Medical care on the frontier came in a variety of forms. Doctors could provide care (see last post), but people also relied on their own herbal concoctions and traditional Native cures. Charles Goodnight (who with his partner established the first cattle ranch in the Texas panhandle) believed firmly in the power of buffalo fat. He and his wife made buffalo soap that Goodnight felt would cure almost anything: “I am satisfied it will relieve rheumatism. Try it for tuberculosis. I do believe it will work.”

Medicine shows provided more fun, though, and were always popular when they reached town. These shows might be only one-wagon affairs, or they might contain several wagons and a tent. Even the one-wagon show could cram in plenty of supplies and bottled “cures.”

A Small Medicine Wagon

A Small Medicine Wagon

The wagons were usually brightly painted and splashed with the name of the particular show, but it was mainly up to the pitchman to move products. This person might be a doctor, clergyman, or learned professor–or at least call himself one–and usually enhanced his character by dressing in a fancy long-tailed coat and tall silk hat. The voice was everything, and most pitchmen could whip a crowd into a passion for the alcohol-laden line of remedies they peddled.

Medicine Show Wagon

Medicine Show Wagon

Medicine shows were also shows, often featuring a female who might dance, sing, or play an instrument. A man might do magic tricks like eat fire, trade dialogue with the pitchman in a comedy routine of sorts, or show off with tricks like rope spinning. Early showmen often attacked the competency of the local doctor(s) in order to secure their own business; doctors countered by trying to get the shows run out of town. Later, the two entities learned to co-exist. Doctors quietly allowed the show to run its course, then sold the same (leftover) stock that had so impressed the locals.

 

Rough and Ready Medicine

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Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Medicine in the eastern United States was often hit-or-miss in the early 1800s, but those who pushed to the edge of the constantly changing western frontier were even more apt to suffer at the hands of physicians.

Frontier physicians often took on a variety of jobs: treating horses, pulling teeth, and concocting medicines, in addition to more traditional medical tasks like setting bones and performing simple surgeries. Many physicians were self-taught and consulted a medical manual or two for anything complicated. They relied heavily on substances like morphine; calomel, a compound containing mercury (which the World Health Organization has declared unsafe at any level); and tartar emetic, a toxic laxative containing the carcinogenic, antimony.

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Because they typically had few credentials, doctors in the West tried to impress patients with seemingly exclusive or “inside” evidence of their expertise. Doctors’ offices frequently displayed medical instruments and splints; jars of leeches; body parts bottled in alcohol; and beakers, flasks, and perhaps tubing that implied scientific experimentation or the ability to make mysterious concoctions.

Distilling Devices Known as Alembics Impressed Patients

Distilling Devices Known as Alembics Impressed Patients

The local populations would be impressed, but they were equally impressed by Native American remedies and tonics touted in traveling medicine shows. The medical profession itself did not have any kind of a monopoly on public trust or faith.

Healthy Minds and Bodies

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Oregon State Insane Asylum, circa 1900

Oregon State Insane Asylum, circa 1900

Factors in the way alienists (early experts in mental health) treated the insane arose from the medical field’s understanding of the mind. In certain ways, physicians (and alienists) were surprisingly ahead of their time, since they believed that the mind profoundly affected the body. However, they often over-emphasized this aspect of the mind-body connection to arrive at simplistic or sometimes surprising conclusions.

In her 1906 book, The Perfect Woman, Mary R. Melendy discusses this mind-body connection during pregnancy. ” . . . we met with a youth who had finely molded limbs and a symmetrical form throughout,” she says. Melendy stated that the mother did not have this same symmetry or beauty and then continued, “The boy is doubtless indebted for his fine form to the presence of a beautiful French lithograph in his mother’s sleeping apartment, and which is presented for her contemplation the faultless form of a naked child.” Melendy likewise attributed the presence of so many beautiful Italian girls to the prevalence of Madonna images throughout the country.

Melendy's Book on Womanhood

Melendy’s Book on Womanhood

Gibson Girls Were Considered Ideal Images for Womanhood in the 1800s

Gibson Girls Were Considered Ideal Images for Womanhood in the 1890s

This belief that the mind could affect the body so profoundly was one reason alienists felt it was important to take patients from their homes–where their mental illness originated–and shelter them in asylums. There, new habitats and calming scenery could lead disturbed minds toward a new perspective. Recreational activities, mild distractions, and (and at least in the early days of asylums) quality time with a sympathetic asylum physician, were ways to divert a patient’s thoughts from “wrong” views and toward a more beneficial outlook.

And the Living Wasn’t Easy

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Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

Lewis Hines Photo of Oyster Shuckers in Port Royal, South Carolina, early 1900s, courtesy Library of Congress

When reformers first began to champion the use of insane asylums in the 1830s, these institutions really did tend to operate as the havens they were meant to be. Life was harsh everywhere for most people: there were few protections for workers, public aid for the weak or disabled scarcely existed, and bodily comfort might mean no more than a slice of bread and a straw-filled sack to sleep on.

It was an age when a professor at the Paris Faculty of Medicine could safely state: “The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it . . . Knife and pain are two words in surgery that must forever be associated in the consciousness of the patient.”

When surgeons scoffed at the idea of easing pain for (presumably) paying patients, what comfort could lunatics–who supposedly did not feel pain, cold, or hunger–expect? When Dorothea Dix began her crusade to provide compassionate care to the insane, she wrote graphically about the filth and misery she found in jails and outbuildings where the mentally ill were held as prisoners. Once asylums were established, however, these patients could expect decent food, clean bedding, warmth and ventilation, and human attention.

Reformer Dorothea Dix

Reformer Dorothea Dix

Health Newspaper Ad

Health Newspaper Ad

Conditions deteriorated quickly as families filled asylums with relatives they either did not want or could not handle. Some asylums became little better than the dark and filthy jails they had replaced, and certainly did not help their patients to recover. Coming full circle, reformers again began to agitate on behalf of the insane–to release or “de-institutionalize” them.

 

The Patient’s Voice

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Reverend Chase's Book

Reverend Chase’s Book

A number of [insane] asylum patients eventually wrote about their experiences once they were released. A commonality that many of these accounts reveal is the lack of due process in the commitment process. In 1868, Reverend Hiram Chase wrote about his experience:

“. . . on the 20th of August, 1863, about 9 o’clock in the morning, I was called out of my room to dress and take a ride as far as the depot. . . I got into the wagon with three men besides myself. As I got into the wagon and saw my trunk, I enquired where they were going. Mr. Harvey told me I was going to the asylum in Utica.”*

Postcard of the Utica State Hospital for the Insane, 1907

Postcard of the Utica State Hospital for the Insane, 1907

Chase had previously described what was probably an episode of deep depression, brought on by hearing some unkind gossip about himself from church members. His own physician and another one had called upon Chase, and discussed an incident in which he had tried to get rid of a solution of silver nitrate, fearing that it would harm someone or some animal. His wife and family may have thought Chase had obtained the bottle of silver nitrate solution in order to hurt himself, though he had evidently made it abundantly clear he was getting rid of the contents. Regardless, the doctors got a warrant from the local judge after this interview, to take Chase to Utica.

Utica Crib, a Restraining Device Developed at the Utica

Utica Crib, a Restraining Device Developed at the Utica

Chase ends his first chapter with this: “We arrived there the same day, and I was locked up in the third story of the building, with about forty raving maniacs. Others may judge of my feelings when I sat down and looked around me. . . .”

*Two Years in a Lunatic Asylum; Van Benthuysen & Sons’ Steam Printing House.