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.

A Remarkable Woman

Susan La Flesche Picotte, courtesy Smithsonian Institution

Susan La Flesche Picotte was born in 1865 to the last recognized chief of the Omaha Indian tribe, Chief Joseph La Flesche (Iron Eye). She went to the Elizabeth Institute for Young Ladies in New Jersey and then returned to her reservation to teach at a Quaker school. She became interested in medicine and returned east to attend the Hampton Institute, and later, the Women’s Medical College of Pennsylvania. She graduated at the top of her class in 1889 and became the first Native American woman to receive a medical degree.

After an internship in Philadelphia, Picotte returned to her reservation where she provided health care at its boarding school. She was the only doctor on the reservation and served at least 1,244 patients while covering 1,350 square miles of territory to do so. She was also the nation’s first Indian medical missionary, and taught Sunday School, led hymn singing, and presided at funerals, amid her many other duties.

Left to Right, Nattie Fremont?, Mary Tyndall, Susan La Flesche, and Susan's Sister, Marguerite, 1880, courtesy Nebraska State Historical Society

Left to Right, Nattie Fremont?, Mary Tyndall, Susan La Flesche, and Susan’s Sister, Marguerite, 1880, courtesy Nebraska State Historical Society

Front Entrance, Dr. Susan La Flesche Picotte Memorial Hospital, Omaha Indian Reservation, National Historic Landmark Photogragh

Front Entrance, Dr. Susan La Flesche Picotte Memorial Hospital, Omaha Indian Reservation, National Historic Landmark Photograph

La Flesche resigned from her duties in 1893 due to her own poor health, andmarried Henry Picotte in 1894. They moved to Bancroft, Nebraska, where she set up a private practice. Picotte was passionate about improving the health of Native Americans; she was especially passionate about the evil effects of alcohol on her people and did everything in her power to prevent alcohol abuse on reservations. La Flesche eventually built a privately-funded hospital on the Omaha Reservation at Walthill, Nebraska. She died two years later at only fifty years of age, of bone cancer.

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Far Instead of Near

Quapaw Agency Office Near Wyandotte, Oklahoma, courtesy Columbia University

Quapaw Agency Office Near Wyandotte, Oklahoma, courtesy Columbia University

Though Congress had tried to site the Canton Asylum for Insane Indians as centrally to the majority of Indian reservations out West as possible, it was still a difficult place for families to visit. Many reservations were hundreds of miles away, and few relatives had the funds to visit regularly.

The family of Robert Thompson was probably typical. Thompson had been admitted to the Canton Asylum in 1907 at age 30, with a diagnosis of hemiplegia–meaning that he had paralysis on one (more typical) or both sides of his body. The condition could be due to several reasons, but because of his age, may have been from cerebral palsy or a tumor rather than a stroke. His diagnosis was later revised to epileptic psychosis.

Epilepsy Was a Feared Condition

Epilepsy Was a Feared Condition

In 1921, the superintendent of Quapaw Indian Agency in Oklahoma wrote to Canton Asylum’s superintendent, Dr. Harry Hummer, asking that he consider transferring Thompson to a facility closer to his family. Thompson’s sister and aunt had visited him within the year, and had offered to care for him at home. Hummer would not approve of this plan, so the women had contacted the state asylum at Vinita, Oklahoma, which was less than 30 miles away rather than Canton’s 500 miles.

Eastern State Hospital in Vinita, Oklahoma, courtesy Oklahoman Archive

Eastern State Hospital in Vinita, Oklahoma, courtesy Oklahoman Archive

The state asylum was willing to accept Thompson as a patient if the family could get a commitment for him from the county, but Hummer was apparently not so anxious to let him go. Thompson was not released from the Canton Asylum until more than two years later.

 

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Bon Appétit

Dr. William Whittington Herbert Force Feeding a Patient, 1894, courtesy Wellcome Images

Dr. William Whittington Herbert Force Feeding a Patient, 1894, courtesy Wellcome Images

Force was used far too often in U.S. insane asylums (see last post), but one of the worst acts of coercion had to be forced alimentation, or force-feeding. Some patients simply would not eat, either because they feared being poisoned, were too sick or stressed to have an appetite, or simply didn’t want to cooperate with attendants. Many superintendents did allow a certain amount of patient freedom in this area, but when they feared patients were going to actually hurt themselves by refusing to eat, they acted. Doctors had several ways to force food upon their patients.

— In cases of “great physical weakness,” they injected “nutritive substances” into the rectum

— One recommended practice was to force open the mouth, close the nostrils, and pour liquid food down the throat.

Tools That Could Be Used for Force Feeding

Tools That Could Be Used for Force Feeding

This practice was dangerous and resulted in more than one death by strangulation/drowning, and was terrifying for patients

— Another procedure involved securing the patient “so that resistance is impossible” and forcing his mouth open with screw wedge. The patient’s head would be thrown back and kept fixed in order to “introduce the gag, made of smooth wood”, which had a hole in the center. The doctor inserted a stomach-tube, and then liquid or semi-liquid food would be poured into the funnel shaped entrance of the tube to let it “readily pass into the stomach.”

— Finally, doctors could insert a tube through the nostril and down the throat into the stomach. In these cases, they could give the patient only very thin liquids.

Force Feeding a Suffragette in Prison, 1912

Force Feeding a Suffragette in Prison, 1912

Doctors often did try to simply persuade patients to eat, allow a patient to have a favorite attendant assist at meals, or just give in to little quirks patients insisted upon before they would eat. However, when they made the decision to force-feed, it was traumatic for patients. Even worse, some attendants force-fed patients as a punishment, or threatened them with it to make them behave.

 

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The Mechanical Treatment of Insanity

Kings County Lunatic Asylum in Flatbush, NY

Kings County Lunatic Asylum in Flatbush, NY

Dr. William Hammond (who was not a fan of insane asylums) was appalled at the widespread use of restraints in U.S. facilities, comparing these institutions unfavorably with those in England which had just about abandoned the practice. He wrote: “At present [1883] ignorant and brutal attendants, some of them selected from the very lowest class, can, at their option, from whim, caprice, anger, or any other inadequate cause, order or place a lunatic in the camisole, crib, or other mechanical restraint.”

Hammond did not necessarily argue that all restraints be abolished, but his suggestions followed the course that British alienists used when they began to eliminate restraints. For patients who always took off their clothes, for instance, attendants could use “strong dresses which were secured around the waist with a leathern belt, fastened by a small lock.” Patients who were violent toward themselves or others, could wear “a dress, of which the sleeves terminated in a stuffed glove without divisions for the fingers and thumb.

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

One of Hammond’s suggestions to the state of New York, which asked his advice as it investigated the management of its insane asylums, was to keep the decision to use restraints out of the hands of attendants. Only the medical officer should decide to use mechanical means of control, and Hammond said that even with that safeguard in place, every order for restraint should be documented in a record book. That book, in turn, should be open to inspection.

Postcard of the Athens Lunatic Asylum

Postcard of the Athens Lunatic Asylum

The only two asylums in the U.S. which did not use restraints at all at the time of Hammond’s writing were the Kings County Asylum at Flatbush, Long Island and one in Athens, Ohio (Athens Asylum for the Insane) which he did not specifically name.

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The Need for Treatment

Professional Nurses Would Have Looked Reassuring

Professional Nurses Would Have Looked Reassuring

Before the advent of insane asylums, most families by necessity had to simply accommodate a person’s mental health problems as best they could, and then wait to see what the future held. Once asylums became both established and accepted, medical intervention became much more the norm. Though some doctors believed strongly that many patients might not benefit at all from a stay in an asylum (one said that forcible confinement in an institution “would tend strongly to cause the disease to pass into some more intense form”), most saw institutional care as far superior to home care.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Alienists had several reasons for feeling this way. Most believed that the home environment was almost always at least partly to blame for an individual’s problem. Either something was going on that directly fed the mental problem, or associations the patient couldn’t get away from wouldn’t allow recovery. Doctors believed that simply getting a patient away from the situation and into a calm environment that didn’t make demands on him, would go a long way toward nipping the problem in the bud. They also felt that patients’ families didn’t have the knowledge or skill to handle mental illnesses, and certainly couldn’t make instant judgments concerning medicine, restraints, and the like.

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Alienists, themselves, had four basic forms of treatment: mechanical, moral, hygienic, and medicinal. My next few posts will explore these types of treatment.

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Worse Than Waterlogged

Ladislas Meduna, courtesy University of Illinois Archive

Ladislas Meduna, courtesy University of Illinois Archive

Much of the therapy for insanity was experimental, and a number of treatments likely inflicted a great deal of harm and discomfort on patients. Something like Pilgrim’s Tub Therapy (see last post) may have resulted in a waterlogged and weakened patient, but would not have otherwise imposed great trauma, particularly since the treatment was almost always voluntary. On the other hand, shock treatments could be both violent and frightening.

In the 1930s, psychiatrists began experimenting with various kinds of treatments that threw the body into convulsions. For some reason–and they did not know why–convulsions often helped patients with depression and other problems. In 1933, Ladislaus (also Ladislas) von Meduna began inducing convulsions through intravenous drugs. He had noticed that schizophrenia and epilepsy could not seem to co-exist, and believed that controllable convulsions would cure schizophrenics.

Preparation for Shock Therapy

Preparation for Shock Therapy

Meduna began experimenting with camphor, but didn’t get reliable results. He moved on to strychnine, thebain, pilocarpin, and pentilenetetrazol, the latter also referred to as metrazol or cardiazol. He injected these substances intramuscularly, but only got reliable results with metrazol. This substance induced quick, violent convulsions that Meduna reported “cured” 50 percent of his subjects. Unfortunately, the convulsions that metrazol induced were so violent that they also caused spinal fractures in 41 percent of Meduna’s patients. Many patients also reported feelings of “impending death and sudden annihilation” before the convulsions started.

Shock Treatments Could be Violent and Frightening

Shock Treatments Could be Violent and Frightening

Eventually another psychiatrist (A. E. Bennett) combined metrazol with curare (a muscle paralyzing agent) to make the convulsions less violent. Later practitioners also sedated patients so they didn’t go through this treatment while conscious–such an obvious step that it should not have taken nearly a decade to hit upon. Eventually, insulin shock therapy won out over the metrazol injections, and they in turn gave way to electroconvulsive shock therapy.

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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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