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.

Indian Health Programs

Leave a reply

President Taft Speaking at Manassas Court House, Virginia in 1911, courtesy Library of Congress

The Bureau of Indian Affairs tried to address the many health issues developing among tribes who had lost their traditional lands, lifestyles, and occupations. However, funds were always far too short to do much good, and healthcare was not provided with any kind of continuity. As time went on and the country began to use  surveys and statistics as a basis for action, the government surveyed reservations and schools to discover the extent of the sanitation and health issues which were being reported. When President Taft received the information, which showed a high incidence of tuberculosis and trachoma (an eye disease which often led to blindness), along with a scarcity of medical care, he was shocked.

“The death rate of the Indian country is 35 per thousand as compared with 15 per thousand–the average death rate of the United States as a whole . . .,” he told Congress in 1911. “Last year, of 42,000 Indians examined for disease, over 16 percent of them had trachoma . . . . Of the 40,000 Indians examined, 6,000 had tuberculosis.” Taft asked Congress for more money to go toward Indian health care. . . . “It is our immediate duty to give the race a fair chance for an unmaimed birth, healthy childhood, and a physically efficient maturity.”

Appropriations for Indian medical service rose from $40,000 in 1911 to $350,000 in 1918.

A Grandfather and Two of His Grandchildren Infected With Trachoma, Rincon Reservation, Californina in 1912, courtesy National Library of Medicine

Group Picture at the Phoenix Indian School Tuberculosis Sanitorium Phoenix, AZ, circa 1890-1910, courtesy National Institutes of Health

______________________________________________________________________________________

And For Everyone Else…

Leave a reply

Front View of Canton Asylum, courtesy National Library of Medicine

For non-wealthy patients entering an insane asylum, both admitting procedures and accommodations were much different than for the wealthy (see last post). Alienists did not have as much time to spend with new patients, and often took short personal histories  solely from family members’ who were often biased. Patients may then have been taken straight to their rooms and left by themselves to sort out their new, distressing situation. Some patients would first face a bath and delousing–neither of which would have been done with delicacy.

At the Canton Asylum for Insane Indians, language barriers would complicate the process for many patients. They, too, were frequently deloused and/or bathed. Their clothes were inventoried, and any money they had brought with them was taken for safekeeping. In many insane asylums, patients with similar behaviors were grouped together, and as patients recuperated, they would be moved to appropriate wards or floors. Canton Asylum never took that approach, partly because they never had a high concentration of single-gender patients who could be combined that way. Therefore, quiet patients might room with violent ones, or well-oriented patients be shut in with people who raved or hallucinated. This mismatch could only serve to make the experience worse for patients who were aware of their surroundings.

Committal Document from Ireland

A List of Patients in St. Louis Asylum

______________________________________________________________________________________

The Luxury of Time

Leave a reply

East House Dining Room, circa 1903, courtesy harvardmuseums.org

The wealthy at McLean Asylum for the Insane enjoyed many amenities that less affluent patients did not (see last post). Some patients lived in single-dwelling cottages with several bedrooms, a dining and living room, modern bathrooms, and sometimes even servants’ quarters. Typically, these cottages were paid for by the patient’s family and later deeded to McLean, in exchange for the relative’s care. Though many patients appreciated their surroundings, what they and their families benefited most from was the time that their alienists and physicians could give them.

Doctors caring for a wealthy patient had the time to give detailed instructions on how a particular person was to be treated; for instance, one patient’s entry stated that she could come and go from her cottage as she pleased, read whenever she wanted, and shampoo her own hair when it suited her. Alienists at McLean could take their time with patients’ histories, noting what pleased and displeased them, what might have caused the onset of their disorder, how they reacted to certain situations, etc. More than that, the nursing and attendant staff were not so hurried and harried. They could accompany patients on leisurely walks, talk to them and assist them in numerous ways, and retain the patience and kindness that other hospitals drove out of its staff by overwork. Many of McLean’s patients undoubtedly were helped simply by the respectful treatment they received.

First Graduating Class of McLean Nursing School, 1886, courtesy McLean Hospital

Hope Cottage at McLean Hospital, 1903, courtesy Harvard Art Museum

______________________________________________________________________________________

Wealth Has Its Privileges

Leave a reply

Room in a Cottage for Women at Michigan Asylum for the Insane, circa 1891, courtesy kalamazoo public library

The great majority of insane asylum superintendents did not set out to be deliberately cruel to patients. They understood that newcomers to the institution would be frightened and/or confused, and made an effort to meet new patients as soon as as possible so they could welcome and reassure them. Even when asylums grew too large to permit this, superintendents and staff looked at ways to make their asylum more homey and comforting. Some set up cottages or separate buildings where the number of patients could be kept small, or moved patients to wards where similar patients stayed. Quiet or reserved patients would therefore stay with others like themselves (no matter what brought on their condition) versus mixing with loud and/or violent patients who perhaps had the same complaint as theirs.

As always, money made a difference. Wealthy families could often keep their family members at home, cared for by a private nurse or attendant. However, if the patient grew too violent or uncontrollable, even wealthy families might find it better to take their loved one to an asylum. The majority of asylums were state-run, and took patients at low-income levels; however, a few asylums catered to paying clientele. The McLean Asylum for the Insane was such an asylum, and its lush accommodations began with its exterior. Rain gutters were copper, views were spectacular, and the golf course was ready for play.

My next post will describe McLean further.

Portrait of John McLean, courtesy harvard.edu

Frederic Packard, a Member of McLean's Staff and Later Superintendent, circa 1920, courtesy harvard.edu

______________________________________________________________________________________

King George III’s Insanity

Leave a reply

King George III in His Prime, courtesy Library of Congress

King George III may have been a victim of misdiagnosed insanity–proving that even the highest birth and station could not exempt a person from the faulty reasoning of mad-doctors. When he was 50, King George III began exhibiting bizarre behavior which was perhaps triggered by a case of obstructive jaundice. He experienced hallucinations, fits somewhat like epilepsy, and foamed at the mouth after talking incessant nonsense. Court physicians blistered and purged him, kept him in an unheated room during winter, bound him in a strait jacket, or gagged and tied him to a chair. Dr. Francis Willis, who had experience with mental illness, finally began a course of more humane treatment. The king recovered, but slipped back into three more episodes of mental illness that eventually left him hallucinating and talking to unseen persons and to dead people. He died miserably in 1820, blind and deaf as well as apparently insane.

Many researchers have wondered whether or not King George III was actually insane, and evidence seems to lean against it. Though not universally supported, some doctors believe that the king could have had a rare blood disorder called porphyria, which can affect the nervous system. Some of the king’s symptoms indicate the condition, while others do not. One thing that does seem noteworthy is the presence of arsenic in a lock of the king’s hair, analyzed in 2005. Arsenic levels of 1 part per million can result in arsenic poisoning; King George’s hair analysis revealed 17 parts per million. He was probably poisoned through the liberal doses of emetic tartar he received for his varying illnesses, which undoubtedly made all his symptoms of mental illness worse. (At the very least, porphyria is often triggered by the ingestion of heavy metals.)  Sadly, the king was often forced or tricked into taking the very medicine that caused or exacerbated his apparent insanity.

Given Liberally to King George III

Lock of King George III's Hair, courtesy Wellcome Trust and Science Museum

______________________________________________________________________________________

Labels

2 Replies

Inmates at the Imbecile Asylum, Burlington NJ, circa 1886, courtesy National Library of Medicine, Image A019401

Men and women who were not insane could be labeled as such when authorities viewed their actions through inappropriate cultural filters that did not allow for deviations in behavior due to a non-Anglo upbringing. (See last two posts.) Immigrants and Native Americans were particularly vulnerable to this type of misdiagnosis, but the medical community’s enthusiasm for labeling put many other people at risk for possible imprisonment. People who seemed “slow” or had different ways of learning also risked labeling; feeble-minded, moron, or idiot were common terms for those who seemed to lack intelligence.

Society often wanted to segregate people they considered of lesser intelligence from the mainstream. Many people feared that those with lesser intelligence would pass on that undesirable trait to their children if they were allowed to marry “normal” partners. Some people feared that the unscrupulous would prey on these weaker members of society unless they were in an institution and under the care of  its staff. Most states set aside special homes for citizens they deemed unable to care for themselves due to a lack of intelligence. Unlike insanity, most authorities did not consider it possible to recover from feeble-mindedness or idiocy. Dismissal to a home designed to care for minds of lesser ability was usually a true life sentence.

Caning Chairs at a Massachusetts School for the Feeble-Minded, 1903, courtesy Harvard Art Museums

Laundry Class in Massachusetts Home for the Feeble-Minded, 1903, courtesy Harvard Art Museums

______________________________________________________________________________________

Language Barriers

1 Reply
Public Health Service Staff Inspecting Immigrants. All idiots, insane persons, etc. were to be excluded from the country, courtesy National Institutes of Health

Public Health Service Staff Inspecting Immigrants. All idiots, insane persons, etc. were to be excluded from the country, courtesy National Institutes of Health

As asylums grew larger and lost their ability to integrate mentally ill or temporarily distraught citizens back into society, they became warehouses for people who could not cope with or mesh into the current culture. Most asylums assumed a custodial role, rather than a therapeutic one. Continue reading →

Attitude Is Everything

1 Reply

Officials Wanted to Keep Unfit People Out of the U.S., courtesy missouri.edu

Many people, both lay and professional, passionately debate the very essence of insanity. Some people believe that insanity is mainly a social construct, which can change over time as society itself changes. That is, what was once considered insane is now accepted as normal, or vice versa. Are there truly “insane” behaviors which every society, in every time period, agrees are insane? If not, how can insanity really be established if its definition changes over time?

This societal construct particularly gave trouble for those who didn’t fit mainstream society and weren’t protected by laws or tests which took culture or country into account. Early immigrants often faced criticism as they tried to integrate into American culture. Their different ways were either seen as merely odd or “foreign” and tolerated, or were actively disdained and suppressed. The real problem arose when someone with particularly odd behavior came to the attention of authorities. When the question of insanity arose, the standard that immigrants were judged against was not their own culture and what was accepted within it, but by the Anglo-based white culture in their new country. When immigrants came before an insanity commission or a typical alienist, they often did not present themselves to advantage. If the suspected lunatic could not speak English well, acted out nervousness and fear in odd ways, or refused to answer questions due to fear or confusion, he  helped build a case for his insanity.

Ellis Island, courtesy Library of Congress

Immigrants Waiting Examination, courtesy Library of Congress

______________________________________________________________________________________

Case Study

Leave a reply
Man With Apoplexy, courtesy National Institutes of Health, History of Medicine

Man With Apoplexy, courtesy National Institutes of Health, History of Medicine

Asylum doctors tried hard to share information about the developing field of psychiatry, and sometimes discussed interesting cases in journals. In the January, 1869, issue of the American Journal of Insanity, Dr. Judson Andrews gave details about a fifteen-year-old-boy brought into his asylum. Continue reading →

What Do They Say?

Leave a reply

American Journal of Insanity

Their own writings provide fascinating insights into the mental health profession’s ever-changing understanding of insanity and how to treat it. Although it was not the only vehicle by which to express current thoughts on the topic, the American Journal of Insanity did have the backing of many authorities in the field. Articles in it ranged from purely practical matters to theoretical speculation concerning the root causes of insanity. My next few posts will give a sampling of what was on the minds of leading alienists in the nineteenth and early twentieth centuries.

In 1863, Dr. John Bucknill wrote an article, “Modes of Death Prevalent Among Insane,” in which he advocated consistency in the way asylum superintendents registered cause of death. Bucknill found that the term exhaustion served as a catchall word that gave little clue as to the actual disease or condition that  took a patient’s life. Reading from asylum obituary tables, Bucknill noted that at one asylum a physician attributed 30% of deaths to exhaustion. “In another report, I find a number of deaths attributed to ‘prostration,’ which is perhaps a synonym for exhaustion; while in another report the terms ‘gradual decay’ or ‘general decay’ appear often to be used to express the same facts.”

The vagueness of words like exhaustion and decay kept asylum physicians from keeping accurate records concerning causes of death among their patients. Bucknill urged physicians to give the names of the disease that killed their patients, and then simply add the precise mechanism that shut them down if they wished. Bucknill gave an example of a patient who died from refusing food because of his delusions. Under the system he currently saw, doctors would say the person died of exhaustion, but Bucknill urged, instead: “Let us say that the patient died of acute mania, or acute melancholia, adding, if we think fit, that the mode of death was anemic syncope from refusal of food.”

Though Bucknill’s concerns might seem trivial today, he was part of a movement to bring consistency and order to a field which had little science or tradition behind it. Because psychiatry was a new field, early practitioners had to hammer out details on such fundamental issues as how to build insane asylums, what to call them, and then how to classify the illnesses they saw within their walls. Actual therapeutic treatment was then another huge issue.

Dementia Praecox Patients, from Emil Kraepelin's textbook, 1899 edition

Religious Melancholia and Convalescence, from John Conolly's book, Physionomy of Insanity, 1858, courtesy Brown University

______________________________________________________________________________________