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.

TB and Native Americans

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Crowded on a Reservation, courtesy Library of Congress

Though TB existed in the pre-Columbian Andean population, there doesn’t seem to be any definitive proof that TB existed in the continental U.S. before Europeans arrived. (Some skeletal remains indicate that it could have existed, however.) What we do know is that explorers and early settlers brought the deadly infection with them, and then spread it to Native Americans. Once Indians were relocated and forced to live on reservations in the 18th and 19th centuries, the disease became much more prevalent.

TB is especially difficult to control when people are crowded together, since the bacteria can live in exhaled breath and transfer to a healthy individual breathing nearby. Crowded reservations and boarding schools became hotbeds of disease, and by the late 1880s, Native Americans had the highest mortality rates from TB ever recorded–ten times the rate of Europeans during their worst epidemics.

Indian Health Service Nurse Showing X-Ray and Explaining TB Treatment to Members of Navajo Nation, courtesy Library of Congress

Sun Treatment for TB at the Jewish Consumptive Relief Society, late 1800s

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Physical Ailments

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Death of Chopin by Consumption

Tuberculosis (TB) was often known as “consumption” during the Victorian era, and novelists conjured up romantic images of beautiful young women wasting away until they offered a last, gentle breath in the arms of their loved ones and suffered no more. The Bronte siblings (Anne, Emily, Branwell, and perhaps Charlotte) died of TB, as did Eugene O’Neill, Dylan Thomas, Henry David Thoreau, Alexander Graham Bell, and Doc Holliday. There was nothing romantic about dying of TB, though. Symptoms could be subtle at first, with coughing, weight loss, and fever very common. Eventually, TB patients developed pockets and cavities in their lungs that could become infected and filled with pus, or bleed. Breathing became extremely difficult and, without intervention, the disease would eventually prove fatal.

Dr. Hummer wanted a separate cottage for epileptics at the Canton Asylum for Insane Indians, but he really needed to separate TB patients from others. He was faulted as late as 1933 for his staff’s sloppy monitoring of TB and their failure to isolate patients with possible TB from healthy ones. Since a healthy person can catch TB by inhaling bacteria exhaled by an infected person, allowing patients with TB to mingle with healthy patients was a serious matter. Isolating TB patients was such an elementary precaution that Hummer’s failure to do so was inexcusable.

TB Anti Spitting Campaign

TB Sanitorium at Phoenix Indian School circa 1890 to 1910, courtesy National Archives

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And More Statistics

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Menominee Indian Family, 1931

The government always liked to gather statistics (see last post), and Dr. Hummer was forced to complete many reports for the Commissioner of Indian Affairs. A report from June 30, 1924 gives a good snapshot of the institution. There were 50 males and 47 females from 31 different tribes; six patients were of unknown tribal affiliation. At the time of the report, the Sioux and Chippewa tribes were disproportionally represented; 19 patients were Sioux, and 14 were Chippewa. Statistics since opening told the same story: 68 Sioux had been admitted since 1902, 40 Chippewa, and 20 Menominee.

Though Hummer continually advocated for an epileptic cottage, epilepsy did not seem to be his biggest problem. Before the asylum closed, an independent doctor from St. Elizabeths noted that Hummer had lumped patients with any kind of convulsions into “epileptic” status, even though they were not truly epileptic. What Hummer really needed were good protocols and staff to care for lung issues. By 1924, the asylum had had 143 deaths. Fifty-one of them were from tuberculosis, and another 17 from some type of pneumonia. Only 14 patients had died of epileptic convulsions, with another four dying from exhaustion following convulsions.

Chippewa Indians in Ceremonial Dress, courtesy University of Minnesota, Duluth

Calvin Coolidge Meets with Sioux Indians from Rosebud Reservation on Lawn of White House, 1925

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Insanity on the Rise

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Government Statistics About Insanity

Because it was more cost-effective to house many patients rather than a few, insane asylums tended to grow larger and house more patients over time. Dr. Harry Hummer of the Canton Asylum for Insane Indians felt his disadvantage in numbers very keenly. He strove continually to find ways to cut costs, and to increase his number of patients. The latter required an increased capacity for his institution, which Congress did not necessarily support. Hummer repeatedly made a case for more buildings, more farmland, and more patient beds.

Though no one ever conclusively settled the question of whether or not Indians had as much, more, or less insanity than whites, statistics about the growing number of insane were on Hummer’s side. The various states had compiled statistics on the number of insane for many years, and the rate per 100,000 rose steadily each decade of the census. In 1840, 50.7/100,000 of the population were reported as mentally ill, while 169.7/100,000 were reported so by 1890.

The number of insane in hospitals (all races) had risen to 252.8/100,000 by 1920, though the census also shows that Indian hospitalization was only 104.5/100,000. The figures for Native Americans may have been skewed due to a lack of access to mental health care, or lack of room at state mental institutions or at the Canton Asylum. The Native American population stood at 244,437 in 1920. Even with their remarkably low rate of hospitalization for insanity (it was 259.8 for whites) Hummer could have conservatively estimated the number of insane Indians to be around 250. In 1920, Hummer had only 86 patients.

Patient Beds in Hallway Due to Overcrowding, Colorado Insane Asylum

Patients Working in Fields at Western North Carolina Insane Asylum, courtesy Western Piedmont Community College

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The Low Cost of Care

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Norwich State Hospital for the Insane

Taxpayers today cry out against waste and unchecked expenses within the public health care system, and demand value for each health care dollar. It was the same a hundred years ago, and state insane asylums felt constant pressure to keep their expenses down. Care at that time was largely custodial, and patients eased their institution’s expenses somewhat by contributing labor in gardens, kitchens, and laundry rooms. Today’s strides in medical care and the curtailment of patient labor make comparisons between the eras difficult, but it is plain that life in an institution was never luxurious.

The average income a hundred years ago was $1,033. A gallon of gas cost seven cents, and a loaf of bread five cents; a medium-priced home was $2,750. The cost of living sounds great, but in 1912, Alabama insane asylums were confined to a per capita expenditure of $3.25 per week, or $169 per year. (In today’s dollars, that would be a little over $77 per week, or $4,004 per year.) That weekly $3.25 had to pay for food, clothing, entertainment, and medical treatment; wages for physicians, nurses, and attendants had to be covered; and utilities, equipment, tools, supplies, and repairs to the buildings also came from that sum.

The more patients in an asylum the lower the per capita costs. The Norwich State Hospital for the Insane in Connecticut began operations in 1905 with an average pf 77 patients and a weekly per capita cost of $6.58. By 1915, it had 1,109 patients and had dropped its weekly costs to $3.51. The Canton Asylum for Insane Indians, which held fewer than 100 patients, could not compete cost-effectively with larger institutions. Its superintendent faced the constant danger that Congress would decide to close the institution for financial reasons and disperse its patients to their respective state insane asylums.

Dairy Herd, State Lunatic Asylum No. 1, circa 1900, courtesy Missouri State Archives

Bryce Hospital for the Insane in Alabama

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Recent Insanity

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Patent Medicine Like Nervuna Cured Nervous Weakness and Physical Exhaustion

Alienists made a distinction between chronic insanity, which was difficult to cure, and insanity which had only recently manifested and might be cured through quick intervention. An article written in 1900 by Dr. C. B. Burr, medical director of the Oak Grove Hospital for Nervous and Mental Disorders, explained the steps alienists ought to generally take when confronted by a potentially curable case of insanity. The first step was to reduce excitement. That meant that patients should lie in bed in a quiet room, under the observation of a day nurse and night nurse. Family members should be excluded from the sickroom.

Burr then discussed the chronic constipation found among Americans at that time, saying that neglect of the bowels led to a large percentage of nervous diseases. The first order of the day, then, was to administer calomel (a toxic mercury compound) to purge the insane person’s body of impurities, and then to keep it purged with laxatives and/or enemas.

Cocaine Products Were Sold Over the Counter in the U.S.

“Tonics and remedies to promote tissue building are needed in all cases,” continued Burr. Among milder preparations like eggnog and milk punch, Burr also recommended “the bitter tonics and strychnine, capsicum, and nux vomica” (a strychnine preparation). Burr discussed depression separately, saying that general treatment remained the same as for other types of insanity, but “certain drugs like kola, coca, and caffein, are useful also in painful emotional states.”

Nurse at South Carolina State Hospital Nursing School

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Understanding Insanity

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Alienist Dr. Allen McLane Hamilton, 1910

Alienist Dr. Allen McLane Hamilton, 1910

Even though alienists (the term for early psychiatrists) treated insanity with vigor and resolution, they usually could not say with any certainty what had caused the condition.

An 1879 article, “Early Indications of Insanity,” in The American Journal of Insanity stated that in general, the cause of all insanity could be found in the neglect of, or an infraction of, the “established laws of physical or mental health.”

Since this could encompass almost anything, the writer went on to the core of his article, which was how to determine that someone was going insane. Continue reading →

Hiawatha Asylum

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Canton Asylum for Insane Indians

One institution that Canton’s “boosters” hoped would put the town on the map was the Canton Asylum for Insane Indians, which was usually called Hiawatha or Hiawatha Asylum by locals. Large asylums for the mentally ill were still the norm across the country, and Hiawatha’s unique patient population seemed to promise renown. Alienists (mental health experts) tended to be very forceful and positive about their field of study, and were eager to add to their knowledge. Town leaders hoped that specialists would come to Canton to study the Indians there, or even conduct their own research.

The facility was smaller than most asylums, but still impressive. It was shaped like a cross, 184 feet long and 144 feet wide, with jasper granite foundations. The outside was of pressed brick with white stone trim on the windows and doors, and inside, a cement-floored basement ran across the entire floorprint. The building had over 100 light fixtures, as well as radiator heat and a modern sewage system. There were also tiled bathrooms and water closets which used range toilets. (This was a unified system which shared a common pipe–toilets flushed at intervals rather than after each use.) Hundreds of trees and bushes were planted on the facility’s acreage, and except for the seven-foot fence around the grounds, nothing indicated that it was a type of prison. Especially for a rural area, Canton’s asylum was a noteworthy structure.

One of the primary reasons the town fought the asylum’s closing was because of the blow it meant to Canton’s economy. During the Depression, the asylum was a reliable source of jobs, and could pay real money for the goods and services it procured. Except for a few local asylum opponents, no one wanted to see the institution shut down.

Center Building, St. Elizabeths, Another Government Insane Asylum

Colorado Insane Asylum, circa 1890

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Continued Futility

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Cottages 6 and 8, Epileptic Colony, Abilene, Texas

As much as Dr. Harry Hummer wanted to expand the Canton Asylum for Insane Indians, he was seldom supported simultaneously by all the people he needed to help him. If he could get a commissioner of Indian Affairs on his side, the Secretary of the Interior wouldn’t help him. If he could get a government inspector to recommend expansion, he couldn’t get the commissioner to go along, and so forth. One of the expansion/improvement projects Hummer most wanted was an epileptic cottage. At any given time, approximately 20% of his patients were epileptics, and they created a great deal of work and need for oversight. Hummer wanted to keep all these patients in a dedicated facility to make their care more manageable.  In 1922, Chief Medical Inspector, R. E. Newberne, recommended both expansion and an epileptic cottage, saying that additional land could possibly be paid for “from the sale of alfalfa and hogs.” This suggestion surely came from Hummer rather than his own analysis.

At the time of Newberne’s inspection, from a total of 90 patients, 21 had some form of epilepsy, 25 had dementia praecox, (later called schizophrenia by Dr. Emil Kraepelin) and 22 were imbeciles. Hummer also had three patients under 10 years of age, 9 patients between the ages of 10 and 19, and four who were between 70 and 79. Though it would seem that caring for the children and elderly would also be demanding, Hummer did not seem to refer to their special needs when speaking to inspectors or to the commissioner.

Emil Kraepelin

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

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Women’s Lives in Asylums

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

Going to an asylum was psychologically difficult at the best of times, but women could be expected to suffer a bit more . . . after all, many asylum patients had been homemakers unused to much interaction outside their own houses. Ironically, the paternalistic society in which women lived, with all its “protections” gave them few skills to cope with sudden changes to their routines and environments. Of course, women have responded heroically to all sorts of negative situations, but it seems reasonable to assume that between the two genders, women would have been less exposed to communal living and interactions with strangers during the 19th century. In general, women had been taught to seek protection and rely on others, and to find their satisfaction in home, family, and close friends. Their feelings of abandonment and friendlessness upon entering an asylum would be dependent upon how strongly they had adhered to this “womanly” ethic.

A letter from Mary Page to her sister (in 1871) speaks to the anguish many forgotten women felt:

“It has been a long and trying time since I saw or heard from you or any of the rest of your family or any of my relations. . . . Almost four years have this band of enemies been at work on me with foul play . . . . You all can pity my condition and picture to yourselves my sad fate all too unjustly committed. I have never given anyone in this whole world the first cause for themselves to fight poor me . . . ”

The letter is written from Williamsburg Hospital in Virginia, probably referencing Eastern Lunatic Asylum. Though the letter is somewhat rambling and makes a series of bitter comments and accusations against “unjust enemies” (which may have been the result of hallucinations/paranoia and the reason for her commitment), the woman’s pain is evident. Undoubtedly men were sent to asylums and forgotten, too, but given their social conditioning, women would have felt it more keenly.

Eastern Lunatic Asylum

Female Department, Michigan Asylum for the Insane, 1892, courtesy Kalamazoo Public Library

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