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.

Insanity is Lucrative

Oscar Gifford

Oscar Gifford

Early alienists tried to keep their profession closed from outsiders, both to maintain prestige and to ensure adequate salaries. They were very successful for many years, and superintendents of insane asylums were among the highest paid physicians in the field of medicine.

At a time when many family doctors earned annual salaries in the hundreds of dollars, asylum superintendents almost always earned at least two thousand.

 

Dr. John W. Givens, Idaho's First Licensed Alienist

Dr. John W. Givens, Idaho’s First Licensed Alienist

The superintendency of the Canton Asylum for Insane Indians was a plum position, particularly for the sparsely-populated area in which it was located. Its first superintendent, Oscar Gifford, was appointed strictly through political favoritism, since he was not a medical doctor. With only one or two exceptions over many decades, other asylum superintendents held medical degrees that were often from prestigious universities abroad.

Bloodletting As a Treatment for Agitation in Insanity, Essex Lunatic Asylum, 1860, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, Essex Lunatic Asylum, 1860, courtesy Burns Archives

In 1901, the Sioux Valley News triumphantly announced Gifford’s appointment while noting that it “was one of the best jobs in sight.” The position paid $2,500 annually. According to one inflation calculator, that salary would translate to $69,444.44 today. For someone without the proper education, training, or experience to hold it, the position was indeed a financial windfall. Gifford must have realized quite soon that he wasn’t qualified to run an asylum, but he held onto the job for as long as he could. His lack of medical knowledge cost at least one life, however, and the consequences of his mistakes eventually forced him out.

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Arbitrary Commitment

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Alienists were notorious for their self-confident belief that they knew what was best for anyone with mental illness. In an essay from the July,1868 issue of the American Journal of Insanity, the (anonymous) author makes a case for doing away with legal procedures for commitment: “. . . other diseases, except those of a highly contagious type, do not call for civil interference nor court publicity.

We do not demand a commission or an inquest to decide whether a man has a fever raging into delirium, or whether he has a general paralysis, or whether a surgeon shall be permitted to amputate his limbs or trepan his skull.”

The writer went on to point out that if anyone saw a person sick or wounded in the street, “we take him forthwith to the nearest hospital, without stopping to canvass our legal right to restrain him of his liberty.”

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

The author lamented that a patient stricken with insanity was sometimes met with a suspicious relative who wasn’t convinced of his illness even though his other relatives were. Because of this suspicion, the patient, “against the wishes and judgment of the rest,” was then liable to the “questioning of the law and its ministers.” This then led to publicity, which might be detrimental to the patient’s recovery.

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

 

Most people, of course, would not want to be committed involuntarily to an insane asylum, and welcomed legal safeguards to prevent it. It is amazing to consider how differently alienists and laypeople considered the matter–it almost certainly boiled down to who was in control of the situation.

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Intervention in Insanity

Eliza Josolyne, Insanity Caused by Overwork, courtesy Bethlem Royal Hospital Archives

Eliza Josolyne, Insanity Caused by Overwork

Alienists (early psychiatrists) believed in actively treating insanity. Most believed that it was beneficial to a patient to completely remove him or her from familiar surroundings; the change would allow new thought patterns and behaviors to form more easily.

Many times, asylums were the change in environment alienists selected, but some recommended travel as a way to change a patient’s surroundings and get his mind focused on new things. Of course, early intervention was paramount, since all alienists believed “acute” insanity (active, new cases) were easier to cure than chronic ones of long duration.

 

Children's Dayroom at Byberry (Philadelphia State Hospital), circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry (Philadelphia State Hospital), circa 1938

 

Dr. J. Parigot believed in the value of intervention to the extreme. Writing in 1864, he made the case that marriage should be avoided when undesirable traits were found in potential parents. This belief wasn’t strictly because he felt the traits would be inherited; it was additionally founded on a belief that parents with those traits couldn’t properly raise a child. He gave an example of intemperate parents who would have to be particularly careful to educate and develop their children so that they wouldn’t degenerate into intemperance themselves. Likewise, he said, “nervous and fidgety persons are incompetent to the direction and control of petulant and sometimes mischievous children.”

Children's Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

Children’s Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

To counteract the influence of tainted parents in cases of insanity, Parigot stated that: “Children who have inherited germs of mental disease should be separated from their parents, and educated under the eye of the psychiatrist. Sometimes their locality should be changed at the time of their birth. . . .”

Fortunately, such thinking was not generally accommodated by the public.

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Other Ills at the Asylum

Blankets Infected With Smallpox Were Distributed to Native Americans to Start an Epidemic, courtesy sphtc.org

Blankets Infected With Smallpox Were Distributed to Native Americans to Start an Epidemic, courtesy sphtc.org

Though there is no mention of any smallpox epidemics at the Canton Asylum for Insane Indians, the threat of this terrible disease was very real. Smallpox had devastated Native American communities once Europeans arrived, since native peoples had no immunity to a disease they had never encountered. Mortality estimates range from 50% for the Cherokee, Catawba, and Huron, and as high as 90% for the Mandan after first contact.

Native Americans did not immediately connect smallpox to the Europeans who brought it. Plains tribes thought the disease was the Bad Spirit appearing, while the Creeks and Cherokees thought it came to them because they had violated tribal laws. Missionaries and Jesuits were later blamed for smallpox because of their religious paraphernalia and concern about dying, and they may well have carried infection to the various peoples they visited in the course of their work.

By the early 1900s, Native Americans were well aware that Europeans had brought this tremendous disaster with them. In 1914, Dr. Harry Hummer vaccinated 48 patients and five employees against smallpox. (Another five employees had previously contracted smallpox, and 13 refused the vaccination.) Hummer askedĀ  the Commissioner of Indian Affairs what he should do about the employees who had refused the vaccine, and he had a right to be concerned. Considering the frail health that many of his patients endured, smallpox would have been an overwhelming illness for them to fight.

Smallpox Prevention Poster Distributed by the Minnesota Department of Health, circa 1924

Smallpox Prevention Poster Distributed by the Minnesota Department of Health, circa 1924

A Navajo Hogan is Burned After Occupation by a Smallpox Victim, Leupp Indian Reservation, circa 1890 to 1910, courtesy National Library of Medicine

A Navajo Hogan is Burned After Occupation by a Smallpox Victim, Leupp Indian Reservation, circa 1890 to 1910, courtesy National Library of Medicine

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Grimes Was Not Impressed

Morningside Hospital Patient Ward, circa 1935

When Dr. John Maurice Grimes inspected mental institutions in the U.S. (see last two posts), he discovered that the federal asylum in Washington, DC, (St. Elizabeths) was overcrowded. Continue reading

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Federal Facilities for the Insane

Life During the Great Depression for Many Men

Life During the Great Depression Was Tough for Many Men

When Dr. John Maurice Grimes published Institutional Care of Mental Patients in the United States at his own expense (see last post), he was able to speak freely about his findings.

His comments about Veterans Administration hospitals which treated mental patients were heartening: on the whole, he found VA facilities almost always situated on pleasant plots of land with room for necessary buildings and recreational activities. Continue reading

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Misery on Display

The Public Outside Utica State Lunatic Asylum

The Public Outside Utica State Lunatic Asylum

Most patients, of course, did not want to be in an asylum, and moving into one very likely added to whatever problem that had brought them there. Doctors’ management of their conditions may or may not have alleviated their distress (see last post), since much of the available medication in the 1800s and early 1900s had undesirable or unpleasant side effects.

Continue reading

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A Delicate Balance

Southwestern Lunatic Asylum, Marion, Virginia

Southwestern Lunatic Asylum, Marion, Virginia

Superintendents at insane asylums had every incentive to cure patients, since high cure rates brought both prestige and validation to their institutions. This is one reason that they urged families to get their loved ones into an asylum quickly, before the mental illness became established and more difficult to alleviate or cure. Continue reading

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What Do You Learn?

Female Patient (West Riding Pauper Lunatic Asylum)

Female Patient (West Riding Pauper Lunatic Asylum)

Modern researchers sometimes pass judgment on whether or not a person should have been committed to an insane asylum–but It isn’t always an easy call. Reading patient notes can lead one to believe that disruptiveness rather than insanity caused a commitment (see last post), or that patients were committed for conditions that we realize today have nothing to do with insanity, such as epilepsy. Continue reading

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So Easy to Leave

Southwestern Lunatic Asylum, Marion, Virginia

Southwestern Lunatic Asylum, Marion, Virginia

Certain patients with mental illness were more difficult to manage than others, and families often grew tired of coping with a disruptive member who perhaps drained them physically and emotionally. An asylum offered a wonderful solution to the problem, and some families were quick to leave a relative at one and never look back. Continue reading

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