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.

Overlooked

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A Typical Report from an Asylum's Board of Directors

McLean Asylum for the Insane and St. Elizabeths were two very different, yet for the most part, well-regulated insane asylums (see last two posts). And though they differed from each other in terms of funding and client base, they contrasted even more sharply with the Canton Asylum for Insane Indians. The Canton asylum was a government-funded asylum like St. Elizabeths, and both of these institutions focused on either indigent patients or those of moderate income. What really set the Canton asylum apart from McLean and St. Elizabeths, though, was the difference in oversight.

At McLean, trustees watched over the management of the asylum and a Visiting Committee “made it a point to see personally each patient in the asylum once a week, checking his name off a prepared list,” according to the editors of The Institutional Care of the Insane in the U.S.A. and Canada, published in 1916. This extraordinary degree of oversight took place well before 1900, when the facility had one nurse for every four patients. As the asylum grew, trustees could not keep to the same schedule, but they were still intensely involved with the asylum. Even at the turn of the twentieth century, trustees hired eminent architects for additional buildings, and doctors knew their patients and kept detailed histories on them.

The government hospital, St. Elizabeths, first fell under the scrutiny of a five-member board of charities, appointed by the President of the United States for terms of three years. Additionally, the President appointed a nine-member Board of Visitors. This board included representatives of the military and clergy, and many times included an acting or retired surgeon-general. In 1914, Brigadier General George M. Sternberg, a pioneer in battlefield wound treatment during the Civil War, was President of the Board, and the surgeon generals of the Navy and Army were also represented. The latter surgeon-general was William C. Gorgas, who had been responsible for wiping out yellow fever in Havana after Walter Reed’s discovery of the mosquito vector for it. Though St. Elizabeths had its share of detractors and investigations, that asylum and McLean were typically watched over by prominent locals who took their duties seriously and felt responsible for providing area patients with quality care.

In my next post, I will discuss oversight for the Canton Asylum for Insane Indians.

William C. Gorgas at the Time of the Panama Canal Construction, courtesy National Library of Medicine

General George M. Sternberg

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Putting a Name on It

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The Hudson River State Hospital Was a Kirkbride Building

Interest in mental health and how to care for the mentally ill heightened as time went on and professionals became more immersed in studying the intricacies of the mind and human behavior. In the United States, by the turn of the twentieth century large asylums were still the tool of choice for helping the insane become well, or for dealing efficiently with the chronic insane. As mental health specialists made advances in treatment, they continued to look at ways to present themselves and their work to the public in a positive way.

In 1854, the Association of Medical Superintendents of American Asylums for the Insane (AMSAAI) debated on what terms they should use to even describe the buildings where their patients lived. Dr. Thomas Kirkbride, a pioneer in asylum architecture, presented a paper at the AMSAAI’s ninth meeting: “On the Importance of Precision and Accuracy in the Use of Terms for Insanity and Instructions for its Treatment.” In it, he objected to worlds like lunatic, asylum, retreat, keeper, and cell to describe anything within the walls of what were commonly known as insane asylums. In many people’s minds, the word “hospital” was only a place for paupers and outcasts, so it was not suitable, either. “Insanery” seemed suitable to one doctor discussing the paper, since it resembled the British word “infirmary.” This particular alienist (mental health specialist) did not especially object to the terms asylum or lunatic, since the former signified a sacred place or sanctuary, and the latter had been in common usage for a long period.

By 1920, at the seventy-sixth annual meeting of the American Medico-Psychological Association, which had incorporated the old AMSAAI, words like cell and keeper had indeed been discontinued because of their negative connotations. Now the concern at hand was whether or not to change the name of their organization and the way they referred to insanity. In the end, the organization was re-named the American Association of Psychiatrists, and the word psychiatry was substituted for the words “the treatment of insanity.”

Dr. Thomas Kirkbride and His Book on Building Asylums

Philadelphia Hospital for the Insane, circa 1900, courtesy University of Pennsylvania

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Shell Shock

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A Shell Shocked Soldier is on the Left

Professionals and laypeople alike have probably always observed that war could affect those who went through it, both physically and mentally. After the Civil War, some people who tried to put their finger on what had changed with returning veterans, discussed the “soldier’s heart” phenomenon. This was a (usually) negative change they saw in their loved ones, which they were sure came from being in a war and exposed to combat. Observers primarily believed that physical changes in the heart were responsible for the changes they saw in the person, though they also believed that pining away for their homes during their period of service could bring on nostalgia-related mental symptoms. During WWI, “shell shock” was a descriptive term for the physical effects constant bombardment took on soldiers engaged in long bouts of trench warfare, but physicians also recognized a mental component that they termed “traumatic neurosis.”

WWI era medical professionals had enough information about war-related mental trauma (now called PTSD) that they anticipated its occurrence. In 1917, the National Committee for Mental Hygiene  formed a task group called “the committee on furnishing hospital units for nervous and mental disorders to the United States Government” which began to canvas likely facilities in which to house mentally ill soldiers. Veterans Hospitals were obvious sites, and the committee also contacted the superintendents of the government’s two insane asylums: St. Elizabeths in Washington, DC and the Canton Asylum for Insane Indians in South Dakota.

My next post will examine their responses.

Doctor Attempting to Cure Shell Shock Through Hypnosis

Private Read Was Buried By a Shell in 1917, Which Resulted in Constant Swaying and Nose Wiping

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Nurse Training

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Linda Richards

The Women’s Hospital of Philadelphia, established in 1861, began a training program for nurses in 1863. It is probably the first in the country to have offered any kind of formal training in the profession. The New England Hospital for Women and Children in Boston was founded in 1862, and established a school for nurses in 1872; this school is generally considered the first nursing school in the country. Linda Richards (1841-1930) was one of the first students to enroll in the New England Hospital’s school, and became the country’s first formally trained nurse when she graduated in 1873 from its year-long program. Also in 1873, three more nursing schools were established: the Bellevue Hospital Training School in New York; the Connecticut Training School in New Haven; and the Boston Training School in Massachusetts General Hospital.

Even after female nurses were accepted by the medical establishment, they were often seen as workhorses more than professionals. Student nurses learned their profession at hospitals rather than universities and for the most part, represented cheap labor to these institutions; during their training, they swept, mopped, dusted, washed dishes, and performed many other menial tasks. Even when they moved on to more clearly medical duties, they still had little scope for independence. They might sterilize equipment, make up boxes of bandages, sharpen needles, and dress bandages, but all of this work was done under close supervision. Doctors expected complete deference to their decisions and authority.

Bessie Simpson With Supply Cart at the New England Hospital for Women and Children, courtesy Jamaica Plain Historical Society

Nursing Students at the New England Hospital for Women and Children, courtesy Jamaica Plain Historical Society

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Gender Issues

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Contract Nurses in Cuba, courtesy Naval History and Heritage Command

Like blacks (see last post), women found it hard to enter the medical profession; in the U.S., women were kept out of hospitals almost entirely until the strain of caring for the wounded during the Civil War showed how valuable they were. Though a sprinkling of female doctors gained attention during the mid to late 1800s, most females in medicine were nurses. However, most did not consider work in mental institutions, where patients could be violent and destructive. Asylum nurses were usually men during much of the 1800s, though married couples sometimes worked together in wards. When female nurses did begin to work at large institutions, they did as much grunt work as compassionate care. Nurses were often expected to sweep and mop their wards, and perform many other housekeeping tasks. It is little wonder that they wanted and accepted help from patients. They had little time off, and were expected to follow doctor’s orders without argument.

By the turn of the century, alienists began to rethink their position on the use of female nurses in asylums. An article by Dr. Charles R. Bancroft (medical superintendent at New Hampshire State Hospital) in the October, 1906 issue of the American Journal of Insanity discussed how to use female nurses effectively. The author believed that it would be best to follow the example of regular hospitals, which gave head nurses both responsibility and authority. “There must of necessity be men attendants, but their position should be that of the general hospital orderly whose duty it will be to execute the orders of the head nurse,” said Bancroft. The doctor displayed both chauvinism and insight when he stated: “Woman are naturally better housekeepers than men,” and later, “. . . they are better nurses than men, but their qualifications never show for what they are worth unless the women are in the superior position.”

Navy Nurse Corps, 1908, courtesy Naval History and Heritage Command

Infirmary Nurses in a Toronto Insane Asylum, circa 1910, courtesy Queen Street Mental Health Centre, Archives of Ontario

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Segregated Medicine

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From Howard University's Graduating Class of 1900, courtesy Library of Congress

Though white doctors sometimes had a poor education and few skills, they did not face the discrimination that African-Americans trying to enter the medical field did. In the U.S., black medical students generally went to missionary schools or proprietary schools (owned by doctors who were paid through student fees), or to schools in Canada. Even the few northern schools in the U.S. that would accept black students typically treated them shabbily. Black physicians did not have admitting privileges to hospitals, and because of this, many black patients preferred white doctors.

Many black medical students attended Howard University College of Medicine in Washington, D.C., established  in 1868. It was named for Major General Oliver O. Howard, a Civil War officer who was helped found the university and who was the commissioner of the Freedmen’s Bureau. (Howard University received much of its financial backing from this agency.) Whites controlled most aspects of the university; it did not have a black president (Dr. Mordecai Wyatt Johnson) until 1926. However, Dr. Alexander Thomas Augusta, a free-born African-American from Virginia who attended Trinity Medical College in Toronto, was among the university’s founding staff. He was the first African-American to serve on a medical school faculty in the U.S.

Dr. Daniel Hale Williams (1856-1931) founded Provident Hospital and Training School for Nurses (Chicago) in 1891; it was the first black owned and operated hospital in the United States. He also founded the National Medical Association in 1895, after black doctors were excluded from the older American Medical Association. This organization was originally known as the National Negro Medical Association.

Dr. Alexander Thomas Augusta

Ohio Chapter of the National Negro Medical Association, 1895

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Medical News

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Typical Newspaper Ad

Medical ads in the early 1900s were imaginative, and sometimes a bit deceptive. Many were disguised as news articles that led readers to think they were getting a legitimate story, only to discover that a medical “cure” was at the heart of the piece. Continue reading →

Turn of the Century Medical Advances

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Pediatric Ward, Bellevue Hospital, New York, 1900, courtesy Smithsonian Institution

Pediatric Ward, Bellevue Hospital, New York, 1900

Though there was still little that doctors could do to cure insanity or even alleviate its symptoms, there were advances in the medical field. A vaccine for typhoid fever came out in 1896, and was followed by a vaccine for plague in 1897. Karl Landsteiner explored the issue of blood compatibility and created a system of blood typing in 1901. Continue reading →

More Study on Insanity

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Some Ocular Manifestations of Hysteria, Walter Baer Weidler, 1912, courtesy Wellcome Institute Library

As Freud and other medical men tried to delve into the treatment of insanity (see last post), another group of experts had already made inroads into the blossoming field of early psychiatry. Asylum superintendents were mainly concerned with the management of asylums and how they could help patients within asylum walls. Though treatment in the early years of asylum reform recommended that patients have regular talks with knowledgeable physicians, overcrowded facilities eventually made that impossible. Superintendents had to focus on how schedules, work, and medicine–within the confines of the asylum community–could best be used for patients’ treatment and management.

Some physicians believed that insanity arose from problems within the nervous system. They were confident that study and research would develop new treatments for insanity that would be much better than the care most patients received in asylums. These new doctors were called neurologists. Eighteen neurologists in the U.S. formed the American Neurological Association in 1875, and used the Journal of Nervous and Mental Disease as its mouthpiece. They focused on scientific methods and discoveries, versus the sometimes nebulous criteria old-school alienists used as a basis for diagnosis and treatment.

In an article in the March, 1902 issue of the Journal of Nervous and Mental Disease, author F. Savary Pearce discussed a case of hysteria in a 17-year-old girl. She had stopped eating, believed that x-rays were being used upon her, and that “blood had been taken from her head and that her head had been ‘sewed up’.” The doctor caring for her isolated her from her family, force-fed her through a stomach feeding tube, and gave her static electricity treatments and massage.

She apparently improved greatly under this treatment, which was not much different (if at all) from what she would have received at an asylum. At the end of his article and after a longer discussion of hysteria and its treatment, Pearce recommended institutionalization for cases which did not clear up within about thirty days, or when patients appeared suicidal.

Woman Diagnosed as Insane Due to Anxiety, courtesy Bethlem Royal Hospital Archives

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

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Getting to the Core of Insanity

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Sigmund Freud

When the Canton Asylum for Insane Indians opened at the end of 1902, scientists and researchers were already striving to find ways to treat insanity other than by confinement in an asylum. Sigmund Freud, born in Moravia in 1856, was one of many scientifically-minded academics interested in mental health who did not necessarily want to become traditional, asylum-connected alienists (the nineteenth-century term for mental health specialists). He enrolled in the University of Vienna’s medical school in 1873, and received his medical degree in 1881. He decided to make a career in medicine with a specialty in neurology.

At the time, “hysteria” was a catch-all term for a host of physical symptoms that doctors felt likely originated in the mind. After studying in France with Jean-Martin Charcot, a neurologist researching the use of hypnotism, Freud became interested in the use of hypnotism to treat hysteria. Freud used the technique in his practice, but eventually felt that the procedure couldn’t ensure long-term success. He instead became intrigued with a treatment devised by a medical school colleague, Josef Breuer. Breuer had discovered that allowing hysterical patients to talk freely often abated their symptoms.

Freud came to believe that most neuroses originated from deeply traumatic events. Allowing patients to confront and discuss these traumas (in safe conditions) proved beneficial and relieved symptoms. Freud found that drugs and hypnosis weren’t necessary for the treatment to be effective; just allowing someone to get comfortable and talk was all that was needed. His “talking cure” proved popular with the public, who found much to like about its gentler approach–as opposed to a stay in an asylum. In 1906, Freud and seventeen other men formed the Psychoanalytic Society, which soon fell apart due to the divergent paths members took as they continued to study mental health.

Jean-Martin Charcot

Studies on Hysteria, by Breuer and Freud

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