Canton Asylum

Patients Working in Laundry Room at Texas State Lunatic Asylum, 1898

How much attendants were paid (see last post) mattered a great deal to superintendents, and generally not for the right reasons. The public began to exert extraordinary pressure on institutions to accept their afflicted family members, which resulted in overcrowding at nearly every insane asylum in the country. Doctors couldn’t cure patients when they had too many to properly care for, and asylums began to lose their roles as sanctuaries and restorative institutions.

With cure rates down, superintendents had to look for other reasons the public should continue to endorse the use of asylums. One argument was that it was much cheaper to keep patients at an asylum than at home or in jails. Many superintendents prided themselves on how cheaply they could run their asylums, and often compared their rates with unfavorably high rates at other asylums. Salaries were nearly always the largest single expense  at asylums, so superintendents had an incentive to hire the cheapest staff they could find. Unfortunately, as Beers pointed out, one could expect very little from an attendant who would work for eighteen dollars a month.

Patients on Floor in Eloise Women's Mental Ward in Michigan

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Commissioner of Indian Affairs, Cato Sells

Asylum superintendents were very powerful, but they were (theoretically) denied free rein. Most asylums had a board of directors or a board of commissioners to give oversight to the entire asylum, including the superintendent. Boards were often composed of local men who might be assumed to know what was going on, though sometimes board members had to travel from a distance to meet. Not all boards had direct hiring and firing authority, however, and could run into problems controlling or disciplining a superintendent protected by appointment.

At the Canton Asylum for Insane Indians, superintendents reported directly to the Commissioner of Indian Affairs on the other side of the country. No boards met on a regular basis to supervise the asylum, though visiting doctors within the Indian Service occasionally stopped by to inspect and report on the facility. Because they weren’t trained in psychiatry and therefore not competent to discuss patient treatment, most inspectors concentrated on the physical part of the institution, commenting more on its buildings and farming operation than anything else. Sometimes the inspectors were not even doctors, but merely field agents who happened to be in the area. Because of this situation, it was generally easy for superintendents Gifford and Hummer to explain away any problems inspectors might bring up.

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Canton Main Street

Just as in other workplaces, insane asylums had personnel problems that administrators had to deal with. Though some superintendents tried hard to find the best attendants possible, they had to ultimately accept the kinds of employees available in the marketplace. In 1895,the superintendent at  Kentucky’s Eastern Lunatic Asylum mentioned that he had been able to employ “four bright young men from the State College.” Other institutions, and probably Eastern Asylum as well, had to sometimes accept attendants who were just a step above criminals. With its demanding schedule and lack of freedom, a job as an asylum attendant was not likely to appeal to anyone who could find something better.

Both Gifford and Hummer, while superintendents at the Canton Asylum for Insane Indians, ran into the same personnel problems as other superintendents. The work they offered was demanding and difficult, and didn’t pay well. They faced an additional problem with the size of their labor pool. Canton was not large, and even though the city of Sioux Falls was not far away, it was too far away to expect many people there to find work at the Canton asylum desirable. Attendants were required to live on the premises, which also made the work less attractive to non-Canton residents.

Staff at Ridges

Attendants at Pennsylvania Hospital for the Insane, circa 1860s, courtesy University of Pennsylvania

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However, some experiments were simply cruel. In the 1940s, Dr. W. Paul Havens exposed mental patients in Connecticut to hepatitis as part of a series of experiments. In 1942, doctors experimented with flu vaccines on mental patients in Michigan.

In Nazi Germany, experimentation on the helpless flourished. When they needed to find a better way to kill prisoners than by shooting them, Nazis experimented first with explosives. They locked mental patients in bunkers outside Minsk and blew them up, but found the method time-consuming and inefficient. They then experimented with a poison gas on mental patients in  Mogilev, which proved to be a superior method. Beginning in 1934, Nazis sterilized people they thought shouldn’t have children, including the insane, but eventually just killed them as citizens unworthy of living. The U.S. sterilized women in mental hospitals as well, long before Nazis did. Indiana passed the country’s first sterilization law in 1907.

Nazi Dr. Josef Mengele (second to left)

Women Working on Farm as Part of Moral Therapy

In a general sense, patients at asylums were always an experiment in progress. Most alienists didn’t understand why people became insane, and didn’t really know how to cure insanity. Moral therapy, a relatively benign treatment, relied on the idea that a disciplined, busy schedule with plenty of sympathetic conversation, would take patients’ minds off their troubles and help them synch back up with society. Except for the situation itself (being in an insane asylum), this therapy was a fairly gentle attempt to help patients. Many, who perhaps only needed a change of scenery or some diversion to break a melancholy train of thought, probably did benefit from this therapy.

Some twentieth century therapies were more extreme.  The last stages of syphilis produced symptoms of insanity, and the condition was usually called “syphilitic insanity.” Doctors infected patients with malaria, hoping the high fever would stop syphilis’s progress. Julius Wagner-Jauregg won a Nobel prize for this therapy. Another leading psychiatrist gave schizophrenic patients high doses of barbiturates to induce deep sleep as a treatment. Another treatment for schizophrenia was insulin shock, in which doctors injected patients with large doses of insulin to produce comas. This therapy was used until the 1950s.

Fever Therapy

Insulin Shock Therapy

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West Virginia Hospital for the Insane

In comparison with whites, few African-Americans were sent to insane asylums. Some asylums did not want to accept black patients at all, while others put black patients in separate wards. Some states created separate asylums entirely for the “colored insane,” apparently subscribing to influential alienist Thomas Kirkbride’s view that “colors and classes” should not be mixed in insane asylums.

The West Virginia Hospital for the Insane was fairly typical. Its board of directors recognized the need to provide care for “colored” patients, yet didn’t feel the asylum could accept them until it had room to separate the races. The asylum did begin to accept black patients sometime in the late 1880s, placing them in separate wards from whites. In 1893, the board of directors asked for $6,000 to build a colored hospital. Shamefully, this request was made even though the asylum only had 44 colored patients. In 1900, when the asylum housed 1,001 patients, only 68 of them were African-American.

Eastern Asylum for the Colored Insane, Goldsboro, NC

Mount Vernon Hospital for the Colored Insane, courtesy Reynolds Historical Library

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Johnson County (Iowa) Poor Farm and Asylum, courtesy Johnson County Historical Society

The U.S., like most countries,  had groups of people who failed to be self-sufficient. Widows and orphans, the unemployed, the elderly,  the sick (and sometimes criminals), fell into this category  when they had no families to help sustain them. England had usually looked to workhouses to take this population off its hands. Though they were seldom of the same punitive nature as English workhouses, a few American workhouses placed inmates in cells or put them in chains.

Like the English, Americans tended to resent people who fell upon public aid or did not do their share to sustain themselves.  In the U.S., many communities relied on poor farms to aid people who were unable to find work or keep a home for their families. Farm work was something the population understood, and even children could contribute their share by helping with tasks suited to their age and ability. There was still a great deal of shame and stigma attached to “going to the poor farm,” and most people wanted to avoid it.

Before large public asylums became more available, insane people were often sent to workhouses and poor farms when they had no one to care for them. These places  could offer nothing in the way of therapy, and these unfortunates were often doomed to a life spent in unhappy conditions.

Men Working in Broom Factory at Poorhouse circa 1915

Poor Farm in Buckheart Township, Illinois

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Morningside Hospital, courtesy Library of Congress

Though most asylum superintendents believed that their home environments had caused patients’ insanity, superintendents also realized that establishing a type of normalcy in their institutions was important for a cure. Many boasted, of course, that their institutions had a homelike atmosphere and that the patients and staff were like a large family. Just like families, then, patients had routines that included regular schedules, chores, and the occasional festive break.

It was normally too difficult to take patients to church, but most asylums held some sort of church services on a regular basis. They also tried to provide occasional entertainments like dances, plays, and lectures, and celebrate holidays. Their hearts may have been in the right place, but it surely added to their patients’ heartache to spend a special occasion in an insane asylum instead of at home.

Christmas at Morningside Hospital, Portland, Oregon, circa 1920s, courtesy Oregon Historical Society

Inside Morningside

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Western Lunatic Asylum Medical Staff, 1896

Attendants had a difficult job in any asylum, and the ones at the Canton Asylum for Insane Indians were no exception. Besides their special duties when new patients arrived (see last post), they were in charge of general housekeeping on their wards. They were in immediate charge of the nursing of their patients, including the dispensing of medicine and changing surgical dressings. They had to make complete notes about the physical and mental condition of every patient at least once a month.

Attendants were to keep patients comfortable and clean, bathing and changing them as necessary. They had to look after bedding, sweeping, dusting, brightening the floors, hardware, plumbing, fixtures, etc. in their patients’ rooms, as well as clean the lavatories and toilets. Attendants had to accompany patients who could take outdoor exercise, and direct patients in any work tasks they were able to do. Attendants also waited table during meals, submitted a report to the superintendent each morning on any changes in their patients, and accompanied the superintendent and/or physician while he made his rounds.

In 1907, male attendants were paid $480 annually, and female attendants $420. This amounts to $11,500 and $10,100 in today’s dollars, using a Consumer Price Index calculator.

Attendants at Pennsylvania Hospital for the Insane, circa 1860s, courtesy University of Pennsylvania

Nurses at St. Elizabeths, 1917, courtesy Library of Congress

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Oscar S. Gifford

Superintendents felt strongly that only one person could be in charge of an asylum. They wanted no interference from boards of directors or trustees, or from the public, since they felt that no one but themselves really knew their business. Superintendents also disliked sharing power–patients and staff should have no doubt as to who was in charge. Superintendents often fought a running battle with outside forces who wanted to provide oversight or help them. Superintendents frequently got their way, but that meant they were also inundated with administrative tasks that ate up their time.

Oscar S. Gifford, the first superintendent of the Canton Asylum for Insane Indians, had to personally accept and receipt for $14 and $2, the property of patients Miguel Maxcy and Arch Wolf, respectively, when they were transferred from St. Elizabeths in January, 1903. He personally took patients to church at times, escorted new patients from their reservations to the asylum, and picked up escaped patients after they were caught and detained. He wrote annual reports, corresponded with the Indian Office, and reviewed employment applications among other duties. Despite his extremely small institution, small staff, and few patients, Gifford eventually ran into trouble because he could not manage to supervise any of them effectively.

Sample Asylum Report, courtesy University of North Carolina

Patients in St. Elizabeths

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