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.

Asylums and Public Inspection

Staff at the Illinois Asylum for the Incurable Insane, 1903

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

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

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.

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A Deadly Fear

A Comforting Advertisement

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

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

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.

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Were Cures Worse Than the Condition?

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

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

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

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.

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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 App├ętit

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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