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.

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 InsaneĀ  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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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.”

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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.

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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.

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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.

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Lucid Lunatics

 

Life In An Insane Asylum Was Dangerous

Life In An Insane Asylum Was Dangerous

One of the most heartbreaking–and frightening–aspects of treatment in an insane asylum was that so many patients probably were not insane. Native American patients at the Canton Asylum for Insane Indians were rarely evaluated by any competent medical person before they were committed. Powerless and misunderstood, they were often railroaded into the asylum for convenience or spite.

Many white patients undoubtedly suffered the same fate. Women were also politically and financially powerless, and many inconvenient women may have been committed to asylums at the pleasure of their spouses, fathers, or other legal guardians. Diaries and letters that women wrote spoke passionately about how terrible asylums were, and how the rigid routines, loss of freedom, and frightening environment, were enough to make any sane person lose her mind. A woman who had little experience of the world, or who perhaps had never left her home without an escort, would be terrified in an asylum. One can only imagine the stress levels these wronged patients endured.

Patient at Surrey County Asylum, circa 1855, courtesy the Royal Photographic Society Collection, National Media Museum

Patient at Surrey County Asylum, circa 1855, courtesy the Royal Photographic Society Collection, National Media Museum

Diagnoses were also at fault. Medical conditions like epilepsy were considered a part of insanity, and patients who could be effectively treated today, would have spent their lives in insane asylums. Other reasons for commitment were just as tragic. Commitment papers for patients admitted to the Western North Carolina Insane Asylum in Morganton, North Carolina during the two years ending November 30, 1908 included reasons like:

— cigarette smoking

— desire to marry

— cocaine habit

— hard work and nose bleed

Western North Carolina Insane Asylum

Western North Carolina Insane Asylum

Though these diagnoses cannot tell the whole story, modern researchers have to wonder how much mental illness actually accompanied the patients’ conditions.

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Inspection Results

State Lunatic Asylum in Lincoln, Nebraska

State Lunatic Asylum in Lincoln, Nebraska

The two federal institutions for the insane (St. Elizabeths and the Canton Asylum for Insane Indians) were investigated several times. In 1926, the comptroller general of the United States listed his findings concerning the investigation into St. Elizabeths. They included the following:

— The laws under which persons …are committed to the hospital are not adequate or sufficiently definite.

— There are too many patients in some of the wards, resulting in a crowded and unhealthy condition.

— Dining rooms, sitting rooms, toilets, baths, and other facilities of some of the wards are quite inadequate and most unsatisfactory.

— The fire hazard in certain wards is too great, and there does not appear to be sufficient fire fighting equipment.

— Several findings concerned the proper accounting of patients’ monies and valuables, including the need for a place to safeguard them.

Some of these 1926 findings were similar to those at Canton Asylum (overcrowding, inadequate facilities, and fire hazards). However, St. Elizabeths had 4,340 patients in June 1926, well over 50 times the number of patients at the Canton Asylum. The facility was not perfect, but by no means did it have 50 times the problems of its sister asylum. Undoubtedly St. Elizabeths’ leadership had something to do with its better performance.

Asylums were frequently inspected and investigated, and most had similar problems. Appropriations were generally set for a certain time period and included set numbers of personnel positions. Because funding wasn’t based on actual patient populations or patient to staff ratios, overcrowding could set off a cascade of problems. Facilities became inadequate and attendants became overburdened. In turn, stressed attendants probably lost patience or reacted less professionally with difficult patients. A new (and possibly sufficient) cycle of funding may have given an institution a chance to catch its figurative breath, but a new cycle of overcrowding was almost certain to begin shortly thereafter. As the public became more comfortable using insane asylums, their demands on these institutions created perpetual overcrowding. Insane asylums were often victims of their own success.

Overcrowding at Byberry (Philadelphia State Hospital) from a 1946 Department of Welfare Report

Overcrowding at Byberry (Philadelphia State Hospital) from a 1946 Department of Welfare Report

Patients Had to Sleep in Chairs at the Camarillo Mental Hospital

Patients Had to Sleep in Chairs at the Camarillo Mental Hospital, courtesy Camarillo State Hospital Historical Society

 

 

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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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