Archive for the ‘Medical treatments’ Category

The Chronic Insane

Thursday, December 4th, 2014
Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

Outagamie County Asylum for the Chronic Insane, Wisconsin, circa 1889

 
Alienists stressed that the prompt treatment of insanity was imperative to a cure. They cautioned the public that it was far wiser to bring an afflicted person to an asylum for a cure as soon as possible, rather than let the patient languish at home for years until an asylum became a last resort. By that point, the disease might have too strong a hold and never be shaken.

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

State Asylum for the Chronic Insane in Wernersville, Pennsylvania

 

Despite their sharp division of “acute” and “chronic” cases of insanity, few alienists wanted to shunt the chronic insane into separate asylums. First, few alienists wanted to be in charge of hopeless cases that gave them no scope for meaningful treatment and possible success. Second, alienists hated to pass sentence on patients, fearing that a “chronic” label would take away any chance for recovery that the patient might have had. Rather than give a patient a life sentence to custodial care, alienists preferred to keep these patients with their more hopeful cases on the remote chance that he or she could still make a recovery.

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Female Patients and Staff at Willard Asylum, courtesy Robert Bogdan Collection

Lawmakers did not often share the alienists’ concerns. Custodial care was far cheaper than active treatment, and state legislatures usually felt that chronic patients unlikely to respond to treatment should not use up the state’s precious monies in a facility that actively treated acute cases. Against most alienists’ wishes, several asylums for the chronic insane were built. (Willard Asylum for the Chronic Insane in New York is perhaps the most well-known of these.) And, as the alienists had foretold, most patients in them spent the remainder of their lives in custodial care.

 

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Evolution of Treatment for the Insane

Sunday, November 30th, 2014
Dr. Benjamin Rush's Tranquilizing Chair, courtesy National Library of Medicine

Dr. Benjamin Rush’s Tranquilizing Chair, courtesy National Library of Medicine

Most modern readers would consider the mid-1800s a fairly rough and rugged period, inhabited by correspondingly rough and rugged individuals. However, changes in the treatment of insanity during this period point to the idea that people in the middle 1800s believed they had declined from the vigor of their ancestors.

When Dr. Benjamin Rush began treating the insane during the late 1700s, most of his treatments were aimed at depleting patients. Because of the vigorous nature of American society at the time, physicians believed that men and women tended to be out of balance on the side of too much “excitement” in their bodies. Excitement irritated blood vessels and resulted in inflammation, fevers and breathing difficulties that could only be relieved by the intense bleeding and purging protocols that Rush practiced all his professional life. In contrast, people of the mid-1800s had become more lethargic, weak, and nervous. Treatments for the insane tended toward tonics, physical exercise, and regimented days full of activity to invigorate the patient.

A Caricature Sadly Based on Reality

A Caricature Sadly Based on Reality

Opium Was Used Routinely

Opium Was Used Routinely

 

 

 

 

 

 

 

 

 

 

 

 

Even though alienists’ views on why insanity occurred and how it affected the body changed over time, they still knew too little about the causes of insanity to do much more than treat its symptoms. Rush bled and purged his manic patients, while later alienists gave them opium and morphine to calm them. The emphasis on treating symptoms may be a reason for the multitude of techniques alienists used–they simply experimented until they found something that seemed to work.

 

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New Ideas

Thursday, November 20th, 2014
Chest Treatment With Electrostatic Generator

Chest Treatment With Electrostatic Generator, circa 1908

Food was not the only way to treat physical illnesses (see last few posts), though healthy eating may have been the least harmful way to ward off sickness.

The turn of the 20th century saw many innovations and experimental treatments by physicians who were working on new ways to help patients. The August, 1907 issue of The New Albany Medical Herald monthly journal ($1/year for a subscription) reported that:

A Tuberculosis Sanitarium

A Tuberculosis Sanitarium

“[Dr.?} Stuver has used galvanic electricity with splendid results in chronic rheumatism.

 

He uses a current of from 6 (?) to 20 mp. for a person, 20 minutes to a half-hour and says that the results are better if a thin layer of cotton, wet with a solution of cocaine, is placed under the positive pole.”

Tuberculosis Patients at J.N. Adam Memorial Hospital in Buffalo, NY, courtesy Edward G. Miller Library, University of Rochester Medical Center

Tuberculosis Patients at J.N. Adam Memorial Hospital in Buffalo, NY, courtesy Edward G. Miller Library, University of Rochester Medical Center

Another article in the same issue concerned the treatment of tuberculosis. The writer, a Dr. Thos. P. Cheesborough, from Asheville, NC, noted  that he usually received patients who were far along in the condition, due to their home physicians either missing the diagnosis entirely or being reluctant to tell their patients the bad news about their health.

 

Dr. Cheesborough then says, “One of the greatest disadvantages that I have found in treating this disease is that the poor unfortunate, when at last his disease has been diagnosed, and he has been sent from home and its comforts, has been advised by the home physician not to consult anyone here, but to exercise and drink whisky and to come home in a few months cured.”

Obviously, medical care could sometimes be hit or miss.

 

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Harvest at the Asylum

Sunday, October 19th, 2014
Western North Carolina Insane Asylum

Western North Carolina Insane Asylum

Non-urban communities had always held the harvest season in high esteem: good crops meant sufficient food for the winter; there was satisfaction in seeing hard work pay off; and perhaps not least, harvest meant an end to the constant labor involved with maintaining a healthy garden. Asylum patients who worked in institutional gardens–sometimes through force–undoubtedly felt the same mixture of relief and pride as any other agricultural worker.

Typical Farming in North Carolina Had Low Yields, courtesy North Carolina Department of Agriculture

Typical Farming in North Carolina Had Low Yields, courtesy North Carolina Department of Agriculture

From the ranks of only 139 patients at Southwestern Lunatic Asylum in 1887, those who were able-bodied enough to work produced 12,000 heads of cabbage, 1,102 dozen cucumbers, and 4,524 ears of green corn, among other items. The 512 patients at Western North Carolina Insane Asylum helped produce 1,849 bushels of sweet potatoes, 639.5 bushels of turnips, and 335 bushels of snap beans in 1888.

Gardening served several purposes for asylums: it gave patients exercise in the fresh air, kept them occupied to both help pass time and divert their thoughts if they were obsessive in nature, and helped contain food costs. The latter practice may seem exploitative, but most farming was on a near break-even basis. At Western North Carolina Insane Asylum, the proceeds of the farm ($8,967.88) outpaced the cost of running the farm ($7,471.28) by only $1,496.60. Considering that total expenditures for the year came to over $68,000, the savings/profits from patient-grown produce would not have warranted the expenses required for the farming operation if cost-saving were the only consideration.

Patients Working on the Grounds at the Buffalo State Asylum, circa 1890s, courtesy Buffalo Psychiatric Center

Patients Working on the Grounds at the Buffalo State Asylum, circa 1890s, courtesy Buffalo Psychiatric Center

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Too Much Change

Thursday, October 16th, 2014
Rosebud Indian Agency, courtesy South Dakota State Historical Society

Rosebud Indian Agency, courtesy South Dakota State Historical Society

The federal government had sought to integrate, or assimilate, Native Americans into the larger white culture for some time before the Canton Asylum opened. Policy-makers did not try to achieve this goal by meeting Native Americans halfway or by gradually introducing them to white values. Instead, their programs tended toward an immersion experience. Children were forced to attend boarding schools where staff tried to cut all ties to their previous cultural experience so they could more easily adopt the white way of life. Similarly, reservation life was permeated with federal influences on food, child-rearing, clothing, medical care, etc.

Patients in Sewing Room at Willard State Hospital for the Insane

Patients in Sewing Room at Willard State Hospital for the Insane

The government carried this immersion mentality–though probably not with any particular intention–into the Canton Asylum for Insane Indians. Though everyone involved in its physical planning strove to make the facility as nice as possible, authorities gave little consideration to how strange the asylum’s environment and routine would be to its residents. Everything from range toilets (see last post), electric lights, congregate meals in a dining room, sharing rooms with strangers, eating at set times, and so on, would likely be unfamiliar to them.

Patient Dining Room at West Virginia Hospital for the Insane, 1912

Patient Dining Room at West Virginia Hospital for the Insane, 1912

Instead of impressing or delighting patients, these things very likely contributed to at least an initial sense of disorientation. Many older patients would never have experienced the type of regimented days that the asylum imposed and which would have chafed anyone unused to appointed times for every activity. Very little at the asylum met its patients emotional and cultural needs, and probably contributed to its ineffectiveness in curing anyone who was not there with the mildest of issues.

 

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Sharp Contrasts

Thursday, October 9th, 2014
Sod Homestead Built in 1900 in Pennington County, SD, courtesy Library of Congress

Sod Homestead Built in 1900 in Pennington County, SD, courtesy Library of Congress

Much of the commentary concerning insane asylums tends toward the negative, and rightly so, since they were often places of confinement for people who were in them unwillingly. Treatments were also much too vigorous at times, and many patients must have felt a pervasive sense of potential violence within the institution. However, early alienists desperately wanted to cure their patients and sought to create an environment in which to do it. In that respect, the physical aspects of an asylum stood in sharp contrast to the experience of all but the wealthiest patients.

During the 1800s and even decades into the 1900s, the average family lived in a small home with few conveniences. Running water, electricity, telephones, and other modern amenities may have been invented by that time, but were still unavailable to many ordinary families. Households relied on an outhouse, chamber pots, a weekly bath, and fleeting washes from a pitcher and basin for hygiene.

Dining Room at McLean Asylum for the Insane

Dining Room at McLean Asylum for the Insane

Women cooked on wood or coal stoves with uneven heat, spent all day doing laundry, perhaps another day ironing or baking, and the rest of their time with relentless chores that wore them out. City dwellers had access to a few more conveniences than their rural counterparts, but often could not afford to  own homes. Instead, they lived in boarding houses and tenements, each of which had its own problems and deprivations.

A palatial insane asylum with beautiful landscaping presented a sharp contrast to the everyday lives of many of its patients, and it was designed and built to do just that. Early thinking concerning asylum architecture held that the patient must be taken out of his former environment completely so that old associations, habits, and acquaintances would not hinder recovery. These palaces also persuaded the public that their loved ones were in a positive environment, making it just a bit easier to leave them there.

Albert Useful Heart Family, Cheyenne River Indian Reservation, SD, 1922, courtesy National Archives in Kansas City

Albert Useful Heart Family, Cheyenne River Indian Reservation, SD, 1922, courtesy National Archives in Kansas City

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Practicing Medicine on a Frontier

Sunday, September 28th, 2014
Frontier Doctor Andrew Taylor Still

Frontier Doctor Andrew Taylor Still

Any reasonably ambitious man could become a doctor during the nation’s early years. Few licensing requirements existed, and men could choose to attend one of many substandard medical schools that were unbelievably slack in their requirements for both entry and graduation. Some men never went to school at all, but either “read” to be a doctor or served as apprentices under a practicing physician until they felt able to go out on their own.

Though some aspiring doctors took these routes to avoid overtaxing themselves mentally or financially, many others simply were not able to “go East” to an established medical school. They studied earnestly–probably harder than many of their college-educated peers. In Appalachia, many doctors took an interest in herbs and local healing folklore, and incorporated this knowledge into their practices.

Patent Medicines Thrived Despite the Availability of Doctors

Patent Medicines Thrived Despite the Availability of Doctors

 

Because it was so easy to become a doctor, physicians in the early 1800s often saturated their markets to the extent that nearly none of them could earn a real living. (This is one reason that a well-paid superintendency at an insane asylum was initially such a coveted position.)

Physicians moving into Appalachian territory often advertised their services, and sometimes offered testimonials from (supposedly) impartial and healed patients they had helped. Others made money on the side through the sale of medicines, or pulled teeth, preached, or farmed. Many physicians were paid in produce or livestock and found it difficult to actually earn cash.

Despite some undisputed charlatans and incompetents, frontier doctors in Appalachia and elsewhere were incredibly dedicated. Many doctors risked their lives to travel tremendous distances over dangerous terrain to attend patients who might pay them with fresh eggs and produce, or not at all.

Dr. Carl Hoffman, circa 1910, courtesy Orgeon Health and Science University Archives

Dr. Carl Hoffman, circa 1910, courtesy Oregon Health and Science University Archives

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The Push West

Thursday, September 25th, 2014
Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

Appalachian Homesteads Had Few Comforts, 1933, courtesy TVA archives

In April, 1750, “Colby Chew and his horse fell down the bank,” wrote Dr. Thomas Walker, an Appalachian explorer, in his journal. “I bled and gave him valatile [sic] drops and he soon recovered.”*

Pioneers going to the West encountered harsh conditions as they moved away from settlement and civilization  (see last few posts), but the western frontier itself was an ever changing border. It began in what we would now say was the East, and simply slid westward as the growing population overwhelmed their available land and resources.

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

Huge Trees Led to Extensive Lumbering in Appalachia, photo circa 1895, courtesy of Shelley Mastran Smith and foresthistory.org

As might be expected, medicine and medical care on these borders were crude and unenlightened, though not much more so than what was seen  in cities. Bleeding a patient after a physical injury, as Walker did, sounds counterproductive today but was a common response to almost any illness during Walker’s time.

As each new frontier settled a bit and doctors moved into regions like Appalachia, they brought a variety of experiences, philosophies, and training with them. Doctors were not required to have licenses or even to attend medical school, and they thrived or failed upon the public’s perception of their success. When patients lived through bleeding, dosing with calomel (a toxic compound of mercury chloride), narcotics, and other dangerous concoctions, doctors–rather than the patient’s robust constitution–received credit for the recovery.

* Quoted from Frontier Medicine by Ron McCallister.

Medicine Wagon Allowed Traveling Medical Care

Medicine Wagon Allowed Traveling Medical Care

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The Rest Cure

Thursday, September 4th, 2014
Dr. Silas Weir Mitchell

Dr. Silas Weir Mitchell

The rest cure was probably the most fashionable of responses to a condition of “nerves” or neurasthenia (see last three posts). Only the wealthy could afford such a complete withdrawal from obligations or work, let alone take on the obvious expenses of accommodations and treatment involved in the cure. Women took the treatment in disproportional numbers from men, but may have been kept out of asylums with its help. Even though some patients deplored this cure, surely it was better for both reputation and psyche than a stay in a madhouse.

Dr. S. Weir Mitchell was the leading authority on treatment through the rest cure, and was highly influential in popularizing it during the late 1800s. The rest cure worked in two ways: like a stay in an asylum, the rest cure took patients out of their homes and isolated them from whatever atmosphere, people, or situation had caused the problem; the cure secondarily worked on their body and mind by keeping patients at rest in a pleasant, cheerful environment.

Patients were literally forced to rest in a bed for six to eight weeks; massage and electrical stimulation helped keep their muscles toned during the enforced inactivity. Patients were washed by nurses, who also fed them a milk-based diet; milk alone might be given for the first week, or raw eggs if a patient couldn’t tolerate milk. Feeding was nearly continuous, and patients could be force-fed if they would not voluntarily down the quantities the staff tried to give them. Sometimes patients were not allowed to read, talk, or enjoy even the most minimally physical amusements. This probably separated the patient who merely wanted a change of pace or sanctioned escape from an unpleasant household situation from patients who truly needed care.

Patient Undergoing Rest Cure

Patient Undergoing Rest Cure

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

Dr. Mitchell at the Infirmary for Nervous Diseases, Philadelphia, 1902, courtesy National Library of Medicine

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Keeping Up

Thursday, July 31st, 2014
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Outlines of Psychiatry

Outlines of Psychiatry

 

Like most people, Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, had a number of contradictory traits. Though he was accused of poor record-keeping on his patients and of a failure to institute any kind of mental health plan for them, he was clearly interested in maintaining expertise in his field. In January, 1913, he requested the following books for his office library:

1. Outlines of Psychiatry (William A. White)

2. Three Contributions to Sexual Theory (Sigmund Freud)

3. Mental Mechanisms (William A. White)

4. Manual of Psychiatry (J. Rogues De Fursac)

5. Treatment of Nervous and Mental Diseases (William A. White and Smith Ely Jelliffe)

Influential Psychiatrist, Sigmund Freud

Influential Psychiatrist, Sigmund Freud

 

 

Hummer was also accused of wanting to run his asylum “from a desk,” rather than from personal contact with patients and involvement with their care. That would certainly be possible through books, and studying–rather than doing–likely appealed to his natural inclinations.

On a rather ironic note, three of these books were written by his former boss at St. Elizabeths, Dr. William A. White. Every time Hummer looked at the titles, he may have been reminded of the success he hadn’t, himself, attained.

 

 

An Industrious Asylum Superintendent, Thomas Kirkbride

An Industrious Asylum Superintendent, Thomas Kirkbride

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