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.

Madness in a Modern World Part Two

Crowded Train Platform in Victorian Era

Crowded Train Platform in Victorian Era

Life has always been stressful, so what was it about the nineteenth-century world that increased stress so much that alienists thought it contributed to a rising rate of madness (see last post)? Change itself brings stress, of course, and nineteenth-century humans were experiencing a great deal of change.

As telegraphs, telephones, locomotives, trolleys, and the like infiltrated daily living, it meant that the pace of life picked up for most people. Additionally, the noise level of society rose considerably as machines became more prevalent (even simple changes like clattering typewriters replacing writing by hand in offices). Studies show that constant noise increases levels of cortisol and adrenaline, which then have their own negative consequences on the body.

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912

Interior of Magnolia Cotton Mills Spinning Room, Mississippi, circa 1912, courtesy NARA

Not everyone embraced and trusted all the new inventions, either. Doctors diagnosed “elevator sickness” and “railway neurosis” brought on when people experienced the physical novelty and/or stress of using these new technologies. “Dyspepsia,” a term used to describe intestinal troubles of various kinds, was rampant in the nineteenth century–probably as a reaction to stress. Nervousness with life in general sometimes led to “neurasthenia,” a term encompassing feelings of anxiety, depression, irritability, and other symptoms of mental distress.

Noisy, Crowded Life in a New York Tenement, circa1890

Noisy, Crowded Life in a New York Tenement, circa1890

One of the positive beliefs alienists embraced was that insanity was not an inevitable hereditary condition, as had been previously believed. Instead, they began to believe that certain people were perhaps disposed toward insanity, but that it would only manifest if conditions were right. In the nineteenth century, it appeared that conditions were right for troubling symptoms to appear in many people.

 

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Madness in a Modern World

Edison and Light Bulb

Edison and Light Bulb

Politicians who supported an asylum exclusively for Indians often justified the need by parroting the claims of alienists. These specialists in mental illness maintained that the pressures of the modern world led to an increase in insanity. The fact that reservation agents couldn’t even find a hundred “insane Indians” at the end of the nineteenth century did little to support that notion. However, the rate of insanity was increasing among the rest of the population. And, alienists may not have been completely off-track in their thinking.

From the earliest times, people had lived in much the same way: they walked or used animals and boats for transportation, wrote messages to one another by hand, and planned their daily activities by the rising and setting of the sun. Suddenly, around 1830, tremendous changes occurred.

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

The Tom Thumb, courtesy Bureau of Public Roads, Department of Commerce

In 1827, the Baltimore & Ohio Railroad began transporting people and goods mechanically with a little steam engine called the Tom Thumb. In 1869, workers completed the first transcontinental railroad, which reduced a difficult wagon or stagecoach ride of several weeks or months to one week. Samuel Morse patented the telegraph in 1840, Bell patented the telephone in 1876, and Edison introduced the light bulb in 1879. These changes absolutely revolutionized daily living, especially in cities.

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Horse-drawn Ambulance in Front of Fire Station on Race Street in Philadelphia, 1865

Even though these new inventions were embraced by the public, they also created distrust, stress, and fear as people began to accommodate and use them. An “Age of Anxiety” began in which there were new dangers everywhere–and the stress did indeed lead to mental breakdowns. (The prevalence of these inventions in cities is probably why alienists considered rural areas better for asylums.) My next post will examine this modern phenomenon further.

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You Get What You Pay For

Female Patients Farming in the early 1900s

Female Patients Farming in the early 1900s

The superintendents at most asylums had the best of intentions when it came to patient care. They understood (for that era) what kind of help patients needed and what kind of attendants could best provide it. Most asylums had rules of conduct for staff and lists of optimal behaviors they expected to see in them; if these desires had been met, most asylums would have been better places. However, superintendents were at the mercy of legislatures, which often underfunded public asylums. Except for the wealthiest private institutions, attendant staffing was never high enough to provide good–or sometimes even adequate–care.

Tennessee Central Hospital for the Insane

Tennessee Central Hospital for the Insane

Staffing issues were especially tough during WWI, when many doctors and nurses left private employment for military service. In 1918 the superintendent of Tennessee’s Central Hospital wrote about the problem he (and all asylums had) in attracting good workers: “We have from forty to sixty beds soiled each night, and the patients who soil the beds at night soil themselves often during the day and have to be dressed and attended to…and the great State of Tennessee says to our attendants, ‘We will allow you from twenty to thirty-five dollars a month for this.'”

Laundry Room at Fulton State Hospital, 1910

Laundry Room at Fulton State Hospital, 1910

This was not much money for what was typically a 14-hour workday full of exhausting physical (and sometimes dangerous) labor. Workers in manufacturing earned around $48 weekly in 1914, unionized bricklayers in New York earned nearly $31 a week in 1913, and even notoriously underpaid female mill workers earned between $5 and $7 a week. The typical asylum attendant’s poor pay almost guaranteed that good workers would go elsewhere. Asylums were often left with attendants who for one reason or another could find work nowhere else.

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Off to the Poorhouse

Bradyville and Readyville Poorhouse Residents, circa 1903, courtesy http://cannonccp.weebly.com

Bradyville and Readyville Poorhouse Residents, circa 1903, courtesy http://cannonccp.weebly.com

Though early American society embraced self-sufficiency, people in authority did recognize that some people could not provide for themselves (widows/orphans/disabled) and that a person could fall upon hard times despite their best efforts. Churches and municipalities usually provided short-term relief in a person’s home, but a long-term situation was another matter.

Early on, the poor were simply auctioned off to the lowest bidder. The auction’s winner provided food, shelter, clothing, etc. to the pauper (and perhaps to his family) in exchange for the pauper’s labor. The arrangement was more like being an indentured servant than a slave, but it was definitely not anyone’s preferred way of life. As can be imagined, this system led to many abuses, and some auctioned paupers were badly treated, overworked, and nearly starved.

Peabody Poorfarm, Kansas

Peabody Poor Farm, Kansas

Poorhouses were set up (usually by counties) to be more efficient than this auctioning system. Authorities also hoped that the poor who resided in them could learn discipline and good habits so that they could get out and become useful citizens. They were not meant to be pleasant, but rather, to discourage residence by anyone who was at all capable of working. Children would be separated from parents, and wives from husbands. Many poorhouse inmates had to wear a dreary uniform that further shamed them. Residents were required to work, if able, often at the accompanying “poor farm.”

Fulton Country, Illinois, Poor Farm Residents

Fulton Country, Illinois, Poor Farm Residents

Going to the poorhouse was so dreadful that mournful poems and songs were written about the experience. One such effort by Will Carleton was called “Over the Hill to the Poorhouse” and ended with this stanza:

Over the hill to the poorhouse—my child’rn dear, goodbye!
Many a night I’ve watched you when only God was nigh:
And God’ll judge between us; but I will always pray
That you shall never suffer the half I do today. (1882)

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Cruel Through and Through

Cruelties Endured by a Patient in Brislington House Asylum, England, courtesy, The Lancet

Cruelties Endured by a Patient in Brislington House Asylum, England, courtesy, The Lancet

Insanity was a cruel condition, and its victims suffered doubly: their minds caused them unease or suffering, and then caretakers typically punished their bodies. Though physicians eventually discerned that mental illness was not an incurable disease, the treatments for it were sometimes stunning in their callousness.

In 1824, a young woman named Mary Sewall caused her father concern because she had wandered into the countryside with a confused intent to attend a religious meeting. He ordered a bunk “with a lid to shut down” to keep her confined, and kept her in it at night for over two months. He additionally kept his daughter sitting all day in a “confining chair” which prevented any physical movement. Her arms and legs were strapped down, and she was forced to remain all day on a seat with a hole in it and a bucket underneath to catch her bodily wastes. The misery she must have endured is hard to contemplate.

A Confining Chair

A Confining Chair

Circular Describing the Four Month Term at Yale Medical Institution

Circular Describing the Four Month Term at Yale Medical Institution

Modern readers might wonder how Mr. Sewall could possibly treat his own daughter this way.  Part of the reason might be that he could think of little else to do to keep her safe. And, doctors and other specialists often believed that people who had “lost their minds” had reverted to an animal state. Many people assumed that the mentally ill didn’t need the comforts that a human with an intact mind needed or wanted. Thus, it didn’t seem particularly cruel to keep a lunatic chained in a barn or outbuilding–just like one of a farm’s other animals. Unfortunately, it seemed that people often treated lunatics much worse than they would have treated any animal.

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Early Madness

A Typical Way to Treat Lunatics, circa 1848

A Typical Way to Treat Lunatics, circa 1848

Early treatments for madness were as crude as those for physical ailments (see last two posts) and seldom involved physicians. Restraint would be a primary means of control. Households often chained a violent member or confined him or her in a strong building. No one gave much thought to the victim’s comfort, and reformers found many sad cases of men and women housed outdoors in winter without heat, proper shelter, or adequate clothing.

Thomas G. Hazard wrote in 1844 about the treatment of a lunatic named Abram Simmons in Rhode Island: “His prison was from six to eight feet square, built entirely of stone. . . the internal surface of the walls was covered with a thick frost, adhering to the stone in some places to the thickness of half an inch.”

Utica Crib, Another Notorious Restraining Device

Utica Crib, Another Notorious Restraining Device

The man’s bed was cloth sacking stuffed with straw. The flimsy cloth covering it was frozen stiff from the wall drippings, and the straw bed beneath it was wet through and through. The writer said the man lay in utter darkness (since the two iron doors to this dungeon didn’t admit light), and: “encased on every side by walls of frost, his garments constantly more or less wet, with only wet straw to lie upon, and a sheet of ice for his covering, has this most dreadfully abused man existed through the past inclement winter.”

Peabody Poorfarm, Kansas

Peabody Poor Farm, Kansas

The writer noted that the poor man constantly chattered: “Poor Tom’s a-cold!”

Public facilities like poor farms or jails could also house lunatics. In these, lunatics might at least find shelter and food.

 

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A Layman’s Doctorin’

A Book Any Layperson Could Reference

A Book Any Layperson Could Reference

Early settlers did not necessarily trust doctors (see last post) and were often able to circumvent seeing one by simply “reading up” on medicine, themselves. In this, they didn’t always lag so far behind a university-trained doctor, who may have only listened to a course of lectures before venturing into his profession. Several popular books were available to laypersons who wanted a reference to guide them; Every Man his own Doctor  or The Poor Planter’s Physician by Dr. John Tennent (American edition, 1734) was extremely popular.

Tennent began by condemning doctors’ high fees (whether they cured or killed the patient) and spoke of his great love for mankind as the reason for his publication. He launched into some of the commonest problems faced in the New World, such as “cough,” which he said was the foundation for many other “distempers” and therefore should be dealt with as quickly as possible.

James Gillray's 1801 Satiric Print of a Colonial Quack

James Gillray’s 1801 Satiric Print of a Colonial Quack

“It may be cured in the Beginning by riding moderately on Horseback every Day,” Tennent wrote. Additionally, the patient could take a little ground ivy tea sweetened with syrup of horehound at night before bed. If that did not effect a cure, the next measures followed the harsh cures of the time: “It will be proper to bleed Eight Ounces and be constant in the use of other Remedies.”

Woman Having the Vapours

Woman Having the Vapours

The “vapours” or “hysteric fits” should start with a stomach cleanse accomplished by dosing the patient with “Indian Physic” (a perennial herb called Bowman’s root, which induced vomiting.) Next, the (usually) female patient should have her bowels purged. Among other remedies, she was urged to not let the disappointments of the world weigh upon her, and to “be cheerful in Spite of a churlish Husband, or cloudy Weather.”

Tennent’s suggestions may not have cured every illness, but they were no worse than what any physician would have recommended.

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Pioneer Medicine

Doane Robinson, courtesy Rapid City Journal

Doane Robinson, courtesy Rapid City Journal

American medical doctors in the nineteenth century were not the respected professionals they are today, mainly because their training was so poor. The public had little confidence in their abilities; many people with experience and a few good reference books felt quite as capable as a doctor to assist their families during illness. These people weren’t far off, as many times doctors trained solely by following another physician around and reading a few books.

In his 1904 History of South Dakota, historian Doane Robinson described the difficulties doctors faced in earning a living in this western region: “Up to this time (1865) not a single Dakota doctor had been able to sustain himself solely by his profession,” Robinson wrote. He went on to describe the first law of Dakota which affected physicians. “[It] exempted him from jury duty, but it (at) the same time made him guilty of a misdemeanor if he poisoned a patient while intoxicated, if the life of the patient was endangered thereby, but if the poison killed the patient then the physician was to be deemed guilty of manslaughter in the second degree.”

Deadwood During the Dakota Territory Gold Rush

Deadwood During the Dakota Territory Gold Rush

The 1868-69 legislative session passed another law concerning physicians, which regulated their practice. It was unlawful to practice medicine or surgery for pay, unless the person had first taken “at least two full courses of lectures and instruction and graduated from a medical college.”

Railroad Being Built in Dakota Territory, circa 1871

Railroad Being Built in Dakota Territory, circa 1871

This depth of instruction was not beyond a studious layperson’s abilities, so it is not surprising that many families felt they could help themselves rather than pay for a doctor.

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Reasonable Rehabilitation

Amariah Brigham was Utica Asylum's First Superintendent

Amariah Brigham was Utica Asylum’s First Superintendent

The change in attitude between the old-style treatment of the insane and the new moral treatment’s philosophy (introduced by Pinel and Tuke) cannot be emphasized enough. Though some of the worst cruelties and neglect had fallen out of favor by Benjamin Rush’s time (December 24, 1745 – April 19, 1813), the man considered the “Father of American Psychiatry” believed that any physician treating an insane person had to first dominate that individual–usually through fear. Hence, threats and coercion were considered perfectly acceptable ways to gain the necessary control and authority.

One of the pioneers in American psychiatry, Dr. Amariah Brigham (December 26, 1798 – September 8, 1849) urged a completely different style of treatment. He and others of like mind developed the (then) modern insane asylum, which was capable of putting their ideas into action. For instance, Brigham believed that mental occupation was useful in effecting a cure, and suggested engaging patients’ minds in learning. He urged every institution to have something of a school within it, containing books, maps, scientific apparatus, and so on. Patients could learn reading, writing, drawing, music, arithmetic, history, philosophy, etc. The instructors in these schools would engage with patients constantly: they would teach, of course, but would also eat with patients, join them in recreational activities, and generally become their comrades. This type of engagement was for patients who were curable.

Interior of Shoe Shop, Willard Asylum for the Insane

Interior of Shoe Shop, Willard Asylum for the Insane

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

Patients Making Rugs, Hammocks, etc. at Hudson River State Hospital, 1909

For those who weren’t (the chronic insane), manual tasks such as farm work, basket-weaving, sewing and embroidery, painting, printing, shoe-making, etc. would go a long way toward engaging patients’ attention and re-directing their thoughts in a positive manner. The physical work would also preserve their health by keeping them active.

In either type of patient, this kind of moral management, with its regular schedule, mental diversions, and lack of coercion, could be expected to help patients much more than the fear-based management of preceding philosophies. If the public had provided enough money to implement these programs effectively, the early hopes of the new psychiatric profession might have been realized.

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Investigations of Little Value

Dr. Carlos McDonald, circa 1915

Dr. Carlos McDonald, circa 1915

Very likely, all insane asylums were inspected on a fairly regular basis, and because of that, it would seem impossible that terrible conditions could continue to exist as they obviously did in many places. However, investigators had to care enough to make strong reports, and people in authority had to care enough to act upon them.

In 1876, Dr. Carlos McDonald became superintendent of the State Asylum for the Criminally Insane  in Auburn, New York. He stated in his first report that he had never seen the equal to the poor sanitation he found there upon arriving, that the place was a “stench in the nostrils,” that bugs crawled all over the patients’ beds, that the bread was sour and the food poor, and that patients were regularly punished, among other observations.

Believed to be Picture of Auburn Asylum for Insane Criminals

Believed to be Picture of Auburn Asylum for Insane Criminals

McDonald told an investigating committee that he had a patient who had a pistol ball in his arm “that had been shot in by my predecessor.” An attendant told him that this previous superintendent had also “blacked the eye of a patient and did not think anything of doing it himself.” Upon the orders of the assistant physician, attendants paddled patients on their bare skin with a piece of thin oak stick “about as thick as a piece of heavy sole-leather and about two and a half inches wide, with a handle.” Patients were handcuffed, chained, and shackled regularly.

Prisoners at Auburn State Prison, Not Insane, circa 1840

Prisoners at Auburn State Prison, Not Insane, circa 1840

The amazing thing that came out in McDonald’s testimony, is that the “association of the superintendents of insane asylums” (the professional organization, AMSAII) had met in the summer of that year in Auburn just before McDonald took charge. They had toured the facility and then had testified to finding the whole asylum “in the best condition.”

McDonald’s statements were made before A Special Committee of the New York State Senate, which had been appointed in May, 1880 to investigate “abuses alleged to exist in the management of insane asylums.”

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