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.

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.

Facebooktwittergoogle_pluspinterestlinkedintumblr

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.

 

Facebooktwittergoogle_pluspinterestlinkedintumblr

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.

Facebooktwittergoogle_pluspinterestlinkedintumblr

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.

Facebooktwittergoogle_pluspinterestlinkedintumblr

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.

Facebooktwittergoogle_pluspinterestlinkedintumblr

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.”

Facebooktwittergoogle_pluspinterestlinkedintumblr

Limitations of Inspections

Living Quarters in an Insane Asylum

Living Quarters in an Insane Asylum

Many researchers have wondered how inspectors failed to note the shortcomings of the Canton Asylum for Insane Indians, since it was inspected many times over the course of its existence. Most asylums were inspected regularly, yet like visitors to the Canton Asylum, most outsiders failed to uncover problems that made life miserable for patients.

Moses Swan, a patient at the Troy Marshall Infirmary and Lunatic Asylum (New York) from 1860-71, offers a partial explanation. “You know but little how patients are treated by attendants and others. I have seen gentlemen and ladies visit this main house . . . and remark how nice it looked, and so it did.”

Attendants Could Be Quite Cruel to Patients

Attendants Could Be Quite Cruel to Patients

Swan explained that a nicely dressed visitor looked in on him once, saw the “nice white spread” on Swan’s bed and the presumably soft mattress under it, and said that Swan’s accommodations looked very nice. However, what the visitor couldn’t see were Swan’s sleepless nights as he listened to the cries and wails of disturbed patients, how frightened he was when he was locked in a room with an uncontrollable patient, or how cruelly the attendants treated him when they desired. Swan was kept continually locked in a cell for many months after arriving at the institution, had no liberty to leave the building, and received only a few visitors over the years.

Doctors Visit Patients Who Are Kept in Restraints

Doctors Visit Patients Who Are Kept in Restraints

In his writings after recovery, Swan tried to warn the relatives of those who considered sending a loved one to an asylum: “O Fathers! O, Mothers! keep your unfortunate sons and daughters from these places until a reform has been brought about . . . . I would say to one and all, know you are right before you transport any to an earthly hell.”

Facebooktwittergoogle_pluspinterestlinkedintumblr

Empty Yourself

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Early alienists typically believed that an insane person needed to eliminate something from the body in order to get well. Copious bleeding and/or purging were popular ways to deplete a maniac’s excessive energy or excitement, but many alienists soon came to believe the procedure was too extreme. Instead, they turned their attention to the bowels.

Samuel Woodward, former superintendent of the Massachusetts State Lunatic Hospital, wrote in 1846 that it was “common for the bowels to be constipated in mania,” and advised a round of laxatives to help solve the problem. He also urged that these laxatives be gentle, but unfortunately turned to poisonous mercurial compounds to do the job. A popular concoction was “blue pill” which was generally a mixture of about one-third mercury, one-third rose oil, and small proportions of licorice, milk sugar, and possibly another quarter portion of hollyhock or marshmallow derivative. Two or three of these pills might represent close to a hundred times the level of exposure that the EPA considers safe today.

Calomel Preparation, Flavored

Calomel Preparation, Flavored

Benjamin Rush's Bilious Pills

Benjamin Rush’s Bilious Pills

Mercury poisoning usually shows up first with headache, nausea, stomach pain, and later, with sore gums and loose teeth. Eventually, symptoms move on to the brain and cause loss of memory and insomnia, and often irritability, depression, and paranoia as well. Since the alienist’s goal for his patient was a daily evacuation of the bowels, patients could take something like calomel or blue pill for quite some time. And, the psychological type of symptoms as a result of mercury poisoning might well keep the sufferer both in an asylum and taking the medicine indefinitely.

Facebooktwittergoogle_pluspinterestlinkedintumblr

How to Commit

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

Few patients went to insane asylums voluntarily; most were committed by physicians called in once concerned family members decided a patient’s behavior had reached some sort of tipping point. Committing a patient to an asylum should have been a very serious affair, but it is evident that it was not always done with professionalism and discernment. In an article* published by the American Journal of Insanity (1876), Dr. A. E. MacDonald gave medical students some sound advice about how to examine a patient and determine whether or not to propose commitment.

Dr. Abraham Myerson, Dr. I Veron Brigg, and Dr. Earl K. Holt Examine Defendants, 1934

Dr. Abraham Myerson, Dr. I Veron Brigg, and Dr. Earl K. Holt Examine Defendants, 1934

Many states required the concurrence of two or more physicians to commit a person to an asylum. MacDonald noted that many times a physician–perhaps at the invitation of the family’s physician–was asked to commit a patient to an asylum, rather than to examine a patient. He likened the situation to that of a physician called in to prescribe medicine to a patient without examining him first to see if the medicine were needed. Families would seldom do such a thing, yet with a presumably insane patient, the verdict was often presupposed and the physician essentially called in to rubber-stamp the decision. MacDonald cautioned students to be careful, though, and to examine such a patient thoroughly with an eye to defending himself in a court of law should the patient later sue.

MacDonald went on to say that physicians often encountered two groups within the family: those who wanted the patient committed, and those who didn’t. He also emphasized that much of what he would hear concerning the patient from these family members would be either useless or untrue. He tried to give students a road map of pertinent questions to ask and a systematic way to approach the situation so they could assess a patient objectively.

He also had this bit of advice: “I advise you to make sure of being able at once to recognize your patient from those who may surround him, by learning before you enter the room, some particulars as to his dress or appearance. It is not a little awkward and embarrassing to address yourself to a bystander, under the impression that he is the patient, but it is a mistake that has happened, and might happen again.”

Ambulance Outside Bellevue Psychiatric Hospital, 1895

Ambulance Outside Bellevue Psychiatric Hospital, 1895

*From a lecture delivered before the students of the University of the City of New York, Medical Department, March 10, 1876.

Facebooktwittergoogle_pluspinterestlinkedintumblr

Early Thoughts on Insanity

Insane Asylum at Raleigh, North Carolina

Insane Asylum at Raleigh, North Carolina

The more settled eastern states generated most of the research and theory concerning insanity in the 1800s. Most asylum superintendents were both born and educated in the east, and the region produced and trained most asylum superintendents for many years. North Carolina, for example, did not even see a published paper on the topic of insanity from its state medical society until 1871. That paper, “Report of a Case of Violent Cerebral Excitement Relieved by Bromide of Potassium” involved a five-year-old boy. Only the standards of the time could have considered the child insane.

Death by Childbirth Insanity

Death by Childbirth Insanity

The next paper was entitled, “Mania Transitoria” and described momentary insanity that befell people who were otherwise aware of their surroundings and actions. The doctor believed that this transitory state of insanity was related to heredity and certain physical diseases. That theory makes the condition sound like epilepsy, but the author seemed to think that it was something else.

Hysterical Epilepsy, circa 1876

Hysterical Epilepsy, circa 1876

Dr. Grissom attributed the condition to masturbation and petit mal epilepsy as well as the former factors, so it is difficult to know what he is describing. Since many people suffering epilepsy were considered insane during this era, it is quite possible that these episodes of transitory mania sent many otherwise capable men and women to an insane asylum.

Facebooktwittergoogle_pluspinterestlinkedintumblr