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.

Many Asylums Have Stood the Test of Time

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Dr. Isaac Ray, First Superintendent of Butler Hospital

Though the medical era they represented is usually dismissed as inferior nowadays, the actual physical structures where treatment for the insane took place retain respect. Many asylums from the 1800s still stand, and represent a type of architecture which is impressive, interesting, and, for the most part, unlikely to be duplicated. Anyone who has enjoyed the grandeur of older public buildings like banks, capitol buildings, libraries, and the like, know that modern architecture is all too often merely utilitarian rather than beautiful or majestic.

Efforts to keep old asylums intact, or to restore them, are constant. A nomination form to place Butler Hospital on the National Register of Historic Places discusses the institution’s buildings in detail. The hospital had been expensive to build because its supporters wanted spacious, uncrowded rooms with good ventilation and heating–unlike the prison atmosphere so prevalent in facilities for the insane up to that point. One of the structures on the premises was the Richard Brown house, built circa 1731, and one of the first brick homes in Providence, Rhode Island.

Butler Hospital, courtesy City of Providence

The hospital grew and added structures over the years, and some the architectural detail the writer discussed included: frontal gables with glazed carriage entrances, octagonal columns, and a “three-story crenelated stairtower.” Building styles included Tudor, Colonial Revival, and Gothic Revival, set within beautifully landscaped grounds.

Description of the Butler Hospital for the Insane, courtesy National Library of Medicine

Though few people would willingly go to an asylum, Butler Hospital’s original champions seemed to have made every effort to ensure the building was as beautiful and comfortable as its patient population would allow.

Asylums and Public Inspections, part 2

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Pamphlet for Visiting Board Members

When Drs. Billings and Hurd created a short pamphlet with suggestions for Boards of Hospital and Asylum Visitors (see last post), they were anxious to help these independent “eyes and ears” of the public understand what they should look for during their inspections. Though they urged these visitors not to come in with preconceived ideas or to be excessively judgmental, the doctors did urge them to take their responsibilities seriously and really look at conditions.

One detailed admonition was for visitors to “rub or press a surface [such as the tops of cabinets and shelves or the valves of fresh air registers] with the tips of the fingers, or with a white handkerchief,” to see whether the surface had been actually cleaned, rather than merely dusted. Visitors were to take note of odors and try to discover what caused them: “. . . iodoform or some other drug; to a recent discharge from the bowels; . . . or is it merely a vague, slightly dusty odor, which gives a sense of oppression, indicating insufficient ventilation?” The authors asked them to note whether rooms were neat and clean, if bedside tables were in the proper position, whether dishes or clothes were ever rinsed in the bathroom tubs, etc. First-time offenses should be brought to the attention of the superintendent so he could have a chance to correct them, rather than immediately to outside authorities.

Dr. Henry M. Hurd

When Billings and Hurd moved on specifically to asylums, their concern for the well-being of patients was evident. Many questions concerned attendants. Besides asking if they were well-trained, tactful, and respectful, the doctors asked: “Do they have the manner of nurses upon the sick, or of guards in a house of detention?”

Boards of Visitors Were Created to Prevent Scenes Like These at Byberry Farms in 1938, courtesy Historical Society of Pennsylvania

The answer to this question would have likely made all the difference in the world to patients.

Asylums and Public Inspection

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Staff at the Illinois Asylum for the Incurable Insane, 1903

Public insane asylums and hospitals were monitored in part by committees whose members inspected the facilities and made recommendations for changes and improvements. These committee members were laypeople who took an interest in a particular institution and volunteered their time to visit and inspect it.

Sometimes outsiders get a different sense of a situation than people who are immersed in the field, and can be useful in pointing out conditions professionals have gotten used to seeing. However, asylum and hospital professionals were wary of these public “visitors” simply because they didn’t understand institutions and their limitations. In 1895, two physicians (Dr. John S. Billings and Dr. Henry M. Hurd) created a short pamphlet with suggestions for hospital visitors. They urged these laypeople to come “in a friendly spirit”–not to find fault or with preconceived notions, but with an open mind that sought to understand what was going on.

John Shaw Billings, circa 1896

The authors explained that any visitor would find shortcomings. “No hospital, however wealthy it may be, has means sufficient to furnish the best known means of treatment and the best care to all who apply to it for relief,” they acknowledged. Few, if any, hospitals (or asylums) had all the medical equipment its doctors wanted, or served the best food, and so on. With these limitations in mind, the authors asked visitors to go through the institution with the idea that they could help its administrators improve its function.

Patients Playing Billiards at Bryce Hospital in Alabama, 1916

Though Drs. Billings and Hurd may have begun their pamphlet sounding as though they wanted to protect medical institutions from hard scrutiny, they made it plain that visitors were to examine the place thoroughly. Some of the things visitors were to look out for will be mentioned in my next post.

A Deadly Fear

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A Comforting Advertisement

Doctors’ competency during the 1800s was not always comforting to patients facing a dire illness, and Victorians developed a great fear of being buried prematurely. Though a well-known device called Bateson’s Revival Device or Bateson’s Belfry, is actually a fictional account (by author Michael Crichton in The Great Train Robbery) of a device to rescue patients buried during comas and so on, many “safety coffins” did exist.

Dr. Johann Gottfried Taberger in Germany invented an elaborate system of ropes that linked a corpse’s limbs and head to an above-ground bell. Theoretically, if the “corpse” woke from a coma or similar state, he or she could alert the living to come to the rescue. One problem with this device was that decomposition and the bloating that accompanied it would shift the body and cause the bell to ring. Rescuers were undoubtedly horrified with these false alarms, and Taberger’s invention fell out of favor.

Dr. Taberger’s Safety Coffin

A system that made more sense had already been invented by Duke Ferdinand of Brunswick in the late 1700s. He incorporated a window and air tube in his coffin, along with a lid with a lock (rather than one nailed shut) that included a key to keep in the pocket of his shroud. This was a private device for his own burial, but it must have provided good ideas to others.

Franz Vester of Newark, New Jersey invented an improved coffin that included a tube which allowed an interested person to see the corpse, and through which the revived “corpse” could climb to escape. It also included a bell in case the victim was too weak to climb the provided ladder.

Franz Vester’s Burial Case

Though modern fears are not as pronounced as in the Victorian era, they still exist–a U. S. patent for a portable alarm system was filed January 7, 2013. The system includes a signal-transmitter secured in the coffin or tomb and a light source to keep the victim from panicking; a receiving device is monitored by security or other personnel. After a predetermined period, the system can be removed from the coffin for reuse.

Were Cures Worse Than the Condition?

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Medicine Chest circa 1850, and Pocket Pill Case circa 1820, courtesy University of Virginia Historical Collection at the Claude Moore Health Sciences Museum

By the middle and late 1800s, so-called “heroic” medicine (in which extraordinary measures to cure a condition often endangered the patient) had been abandoned. However, patients were sometimes little better off calling a doctor than if they had simply endured the illness they suffered.

To treat diarrhea, for instance, doctors may have first ordered a cathartic–a medicine to accelerate the evacuation of the bowels, and then followed it with laudanum, Dover’s powder (a combination of ipecac and opium), or morphine. The latter concoctions probably relieved distress, and opium does slow the gut so that it will treat diarrhea, but they certainly shouldn’t have been taken for any chronic condition.

Popular Cathartic Medicine

Head lice were common in crowded living conditions, and patients were advised to soak the hair on their heads with kerosene and wrap it up in a cloth for 24 hours. Since smoking was also common during this era, patients would have to take great care that nothing worse happened to their hair than an invasion of lice.

Calomel

Doctors commonly used arsenic and mercury–both deadly–to treat syphilis in the 1800s. They also used mercury to treat typhoid fever, parasites, depression, cholera, teething pain in babies, and scurvy, usually through a mercury-based compound called calomel. Heroin, opium, and morphine were commonly used by physicians and dispensed readily (and without prescriptions) by town druggists; these ingredients permeated common medicines or what we now call “patent” medicines, sold over the counter throughout the country.

A Remarkable Woman

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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

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.

Far Instead of Near

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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

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

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.

Bon Appétit

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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

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

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.

The Mechanical Treatment of Insanity

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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

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

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.

The Need for Treatment

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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

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

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

Indians, Insanity, and American History Blog

Asylums And Insanity Treatments 1800 – 1935

Category Archives: Medical History

Many Asylums Have Stood the Test of Time

Asylums and Public Inspections, part 2

Asylums and Public Inspection

A Deadly Fear

Were Cures Worse Than the Condition?

A Remarkable Woman

Far Instead of Near

Bon Appétit

The Mechanical Treatment of Insanity

The Need for Treatment