Archive for the ‘Medical treatments’ Category

More Rules

Sunday, June 29th, 2014
Patients Demonstrate Hand Restraints, 1915, courtesy The Burns Archive

Patients Demonstrate Hand Restraints, 1915, courtesy The Burns Archive

The Indian Office provided rules for attendants working at the Canton Asylum for Insane Indians which were thorough and explicit; similar instructions were most likely the case in all other insane asylums. Patients were supposed to “preserve order” but only by using the mildest means possible. Rule 20 stated: “No kicking, striking, shaking, or choking of a patient will be permitted under any circumstances. Patients must not be thrown violently to the floor in controlling them, but the attendant shall call such assistance as will enable him to control the patient without injury.”

This rule was broken any number of times, and at least one male attendant was fired for committing unwarranted violence against patients. Mechanical restraints like cuffs and camisoles (straitjacket) were to be used only with the consent of the physician or superintendent, but employees did not follow this rule. Instead, they got restraints from the financial clerk simply by asking for them. Dr. Hummer, who later received very harsh criticism for the asylum’s excessive use of restraints, either permitted their use (though he often said restraints weren’t used) or he abdicated his responsibilities to the financial clerk. Either way, he had to know that employees were using restraints quite freely . . . unless he wasn’t making rounds often enough to catch it. Whatever the reason for all the restraints, Dr. Hummer was responsible for the situation.

Medical Staff at Willard Asylum

Medical Staff at Willard Asylum

Staff of Arizona State Asylum, 1914

Staff of Arizona State Asylum, 1914

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And the Patients’ Side

Thursday, June 26th, 2014
Patient Dining Room at West Virginia Hospital for the Insane, 1912

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

Employees at the Canton Asylum for Insane Indians had clear instructions concerning their duties, including the all-important attendants who were at the heart of patient care. (See last post.) They were charged with keeping rooms neat and clean, attending to their patients’ needs in terms of clothing and personal care–basically what anyone would expect of an institution set up to care for the insane. The reality was often different, and the conditions many patients lived under would have been disheartening.

Though foreign to their own experience on or off a reservation, patients arriving at Canton Asylum when it first opened would have walked into a spacious, light-filled building. Electricity and running water might have been exciting to use, and regular meals supplemented by garden produce would have been tasty and welcome. As the asylum deteriorated over the years, however, patient comfort declined. The early structure had been pretty and airy, with pictures on the walls and nice furniture. As time went on, the pictures disappeared; the floors, clothes, and bedding became dingy and worn; and the nourishing food evolved into a monotonous diet of starches and vegetables. Patients used chamber pots instead of toilets, which allowed human waste to create a stench and promote disease in the midst of crowded rooms.

By the time the asylum closed, one inspector likened patient care at the asylum to that of a prison. Patients who had been sent to the institution for mental problems received no mental health care at all–the whole purpose for the asylum. Ultimately, authorities concluded that almost no amount of money could make the asylum function  as it should and decided to shut it down.

Female Ward at Athens Lunatic Asylum, 1893

Female Ward at Athens Lunatic Asylum, 1893

Women's Sewing Room at Spring Grove, 1910s

Women’s Sewing Room at Spring Grove, 1910s

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Keeping Busy

Sunday, June 15th, 2014
Clarinda State Hospital

Clarinda State Hospital

Insane asylums tried to be self-sufficient, but in our modern era it can be hard to understand just how self-sufficient they were.  The Clarinda State Hospital in Iowa was one of many similar institutions that used patient labor for the dual purpose of keeping operating costs down and giving patients something to do. The asylum employed patients (under direction) to sew nearly all the clothing they needed, and to make shoes under the direction of a shoemaker. Patients also engaged in woodworking and made brooms from broom corn raised on the asylum farm. A bit more unusual was the facility’s mattress-making department, where all the new mattresses for the asylum were made.

“Mattress hair is bought and also a good quality of material for the cover, which is made up in the sewing room and afterwards filled by patients. . . . Soiled or worn mattresses in which the hair has become packed are taken apart, thoroughly renovated by steam, dried, thoroughly picked and the hair used over again.”

The writer ended his description of the asylum with the words that: “The general spirit of the institution is to have the asylum idea as much in the background as possible and to supply surroundings and influences as much like those at home as can be made.”

It would be difficult to discover whether this aim had been achieved.

Men Working in Broom Factory at Oak Forest, IL Poorhouse, circa 1915, courtesy Library of Congress

Men Working in Broom Factory at Oak Forest, IL Poorhouse, circa 1915, courtesy Library of Congress

Patients Making Rugs, Hammocks, Baskets, etc. at Hudson River State Hospital in Poughkeepsie, NY, 1909

Patients Making Rugs, Hammocks, Baskets, etc. at Hudson River State Hospital in Poughkeepsie, NY, 1909

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Alienists’ Diagnoses Were Never Foolproof

Sunday, June 8th, 2014
Nellie Bly, circa 1890

Nellie Bly, circa 1890

Alienists’ assessments of their patients’ mental conditions could be suspect at the best of times. They were particularly suspect when alienists dealt with people who did not fit the norms of an Anglo-centric society. Newly arrived immigrants were vulnerable to a misinterpretation of their mental status, and of course, non-English speaking Native Americans could easily be misunderstood or be so frustrated and frightened that they couldn’t communicate effectively. One reporter’s experiment showed how easily alienists could be fooled.

In 1887 New York World reporter, Nellie Bly, posed as an insane woman by practicing “insane gestures” and later claiming she had amnesia. She was sent to Blackwell’s Island Lunatic Asylum after several doctors examined her and declared her definitely insane. She was, “Positively demented,” said one, “I consider it a hopeless case. She needs to be put where someone will take care of her.”

Worse than the alienists’ initial assessment was their later inability to see past it. Bly dropped her insanity act immediately and yet made no impression on the doctors who had decided she was insane. She wrote, “From the moment I entered the insane ward on the Island, I made no attempt to keep up the assumed role of insanity. I talked and acted just as I do in ordinary life. Yet strange to say, the more sanely I talked and acted, the crazier I was thought to be by all….”

When Nellie was released after ten days–and wrote about her experience in the New York World–embarrassed doctors could not explain how they had been so easily fooled. A New York grand jury promptly launched an investigation into conditions at the asylum, which Bly had written about in horrifying detail.

Blackwell's Island Lunatic Asylum

Blackwell’s Island Lunatic Asylum

Nellie Bly's Book

Nellie Bly’s Book

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Canton’s Patients

Sunday, June 1st, 2014
Canton Asylum with Swing Sets

Canton Asylum with Swing Sets

Few patient records from the Canton Asylum for Insane Indians are intact or complete. This is not unusual–many asylums destroyed their records over the years, since early administrators did not see any potentially historical value in them. The Canton Asylum’s records are especially problematic, though, since its superintendent, Dr. Harry Hummer, was faulted several times for a failure to even keep good records. What never existed cannot very well be found, in many cases. There are a few records that remain, and when patients were transferred to St. Elizabeths after the Canton Asylum closed, staff observed them for a period of time and then summarized the patient’s history and current behavior (see last post). Here is an example of their summation of a patient:

Nesba (Tribe – Navajo)

She was admitted to the Canton Asylum . . . at the request of the Superintendent of Southern Navajo Agency, Fort Defiance, Arizona. The medical certificate at the time stated, “The patient has been in present condition for past two years. Present symptoms, feeblemindedness, dementia.” The patient is a congenital defective suffering with cerebral palsies. . . . During her stay in the Canton Asylum she was infantile in her reaction, subject to tantrums during which she cried and yelled, sang, etc. These periods seemed to coincide with her menstrual periods. At one time during her stay there she was quite destructive to clothing . . . she mimicked people and seemed to delight in teasing other patients.

On her admission here the patient was passively cooperative but unable to stand alone due to her physical handicap. She is mute except for guttural noises which she makes in her throat. No definitive mental content can be elicited. She smiles at any attention received, is quite highly pleased at any effort of others to associate with her.

Other remarks continued to assess the patient’s physical condition and mental status, but staff said it was “impossible to determine whether she is oriented or if her memory is better.” She had been admitted to Canton Asylum in 1924 when she was about 20 years old, so would have been around 30 when she came to St. Elizabeths. Her physical condition probably brought her to and kept her in an asylum.

My next post will give one more patient history.

Group of Female Patients, Eastern Hospital for the Insane, courtesy National Institutes of Health

Group of Female Patients, Eastern Hospital for the Insane, courtesy National Institutes of Health

 

Acute Insanity as Cause of Death

Acute Insanity as Cause of Death

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Make it Pretty

Sunday, May 25th, 2014
Exhibition of Fancy Work, 1908, courtesy Willard

Exhibition of Fancy Work, 1908, courtesy inmatesofwillard.com

Occupational therapy was an important part of patient care in nearly all asylums. Patients were encouraged to do skilled work that got their minds off their problems/issues and produced a tangible object in which they could take pride. Genteel ladies might do fancy sewing while men engaged in woodwork, even in an elite asylum such as the McLean Asylum for the Insane in Massachusetts.

Indian patients at the Canton Asylum for Insane Indians were also encouraged to do crafts like beadwork and basket weaving if they so desired, to help pass time. (Peter Thompson Good Boy spent time “beading” at St. Elizabeths during his stay there beginning in 1913.) Occasionally, patients like Lizzie Vipont earned a little bit of money with their beadwork by selling items to visitors. Necklaces and handbags seemed to be most popular–or at least are mentioned most often. One report mentions that men whittled wooden objects, but went on to say that women were the primarily crafters. The asylum’s second superintendent, Dr. Harry Hummer, also allowed these kinds of occupations, but apparently stopped encouraging it so that the practice fell by the wayside.

This photo appeared in USA Today. Artifacts left over from the Hiawatha Insane Asylum for Indians in Canton, S.D. are displayed at the Canton Public Library on April 23, 2013. Photo: Elisha Page, Sioux Falls, S.D. Argus Leader

This photo appeared in USA Today. Artifacts left over from the Hiawatha Insane Asylum for Indians in Canton, S.D. are displayed at the Canton Public Library on April 23, 2013. Photo: Elisha Page, Sioux Falls, S.D. Argus Leader

 

Occupational Therapy, Toy Making in WWI-Era Psychiatric Hospital, courtesy Otis Historical Archives, National Museum of Health and Medicine

Occupational Therapy, Toy Making in WWI-Era Psychiatric Hospital, courtesy Otis Historical Archives, National Museum of Health and Medicine

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Policies and Procedures

Thursday, May 15th, 2014
Full Men's Ward, Fergus Falls State Hospital, 1900

Full Men’s Ward, Fergus Falls State Hospital, 1900

No asylums had an overabundance of staff, and asylum administrators walked a fine line between doing what was necessary and convenient for their personnel, and what was best for patients. A 1906 article in The American Journal of Insanity discussed the pros and cons of hiring night nurses and unlocking patients’ doors at night. The superintendent of the Missouri State Hospital No. 2 wrote that after doing away with the system of night watches–who passed through the halls and wards once an hour–and going instead to a full staff of night nurses, the incidence of suicide immediately dropped. Patients were also much more comfortable and quiet.

“The idea of locking one, two …seven or eight patients in a room or dormitory, expecting patients to remain quiet, to sleep well, and to get well, is not only absurd,but is inhuman,” Dr. C. R. Woodson wrote. “The morbidly suspicious should certainly not be blamed for imagining that there was danger when locked up in a remote room of an institution with those who may or will domineer over them.”

Woodson went on to say that even violent patients responded well to the unlocked door policy. “The fact that a patient can get up and go to the toilet-room when he wants to, get a drink of water, or even get up and look down the hall, is a source of satisfaction; it makes him less rebellious, less obstinate, and less violent.”

Woodson was doubtlessly correct, and it is strange that it would have taken practitioners in the field so long to circle back to Philippe Pinel’s discovery in the early 1830s that removing chains from the madman did much to subdue his violence.

Restraints for Patients, courtesy National Library of Medicine

Restraints for Patients, courtesy National Library of Medicine

Nursing Students at Minnesota's Third Hospital for the Insane, 1900s

Nursing Students at Minnesota’s Third Hospital for the Insane, 1900s

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Escape From Reality

Thursday, February 20th, 2014
Dr. Clouston's Book

Dr. Clouston’s Book

Though most patients in insane asylums could not escape physically (see last two posts), doctors may have inadvertently caused them to lose touch with reality by dosing them with opium and other narcotics. In The Actions of Neurotic Medicines in Insanity (1871), Dr. T. S., Clouston described experiments he conducted on patients using medicines like bromide of potassium, opium, cannabis Indica (a more sedative variety of the cannabis family), along with Scotch whiskey and beef tea as controls. He particularly wanted to see how these substances acted on patients who were in a “maniacal” or excited state. (Perhaps to his credit, Clouston performed the experiments on himself and his assistant, as well.)

Clouston found that none of the substances created a narcotic effect in excited subjects, though they did produce what he called a “natural sleep.” He later experimented on chronic patients, giving them increasing doses of opium over twelve weeks,. Higher dosages quieted their levels of excitement, though the effect did not last. Clouston took careful notes about his subjects, and eventually combined a tincture of cannabis and a dose of bromide, which worked very well in most of the patients. He had continued this treatment for eight months at the time he wrote.

Clouston seems to have been very careful with his patients, noting their temperature, pulse, weight gain or loss, and so on, and adjusting medicines accordingly. He tried to give patients enough medicine to calm their manic states, without unduly sedating them, and he stopped treatment whenever he saw that a patient could not tolerate it well. However, given the ease of administering these powerful drugs to patients, who can say how many doctors indiscriminately dosed patients for the convenience of their asylum’s staff? In a period when little was known about the background causes for psychological problems, keeping patients in a narcotic haze may have been the easiest–and most common–thing to do.

Opium Held High Interest in the 1800s

Opium Held High Interest in the 1800s

Tincture of Cannabis

Tincture of Cannabis

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Children At Crownsville Hospital for the Negro Insane

Sunday, February 9th, 2014

Crownsville Hospital for the Negro Insane

It seems incredible to think of very young children being committed to insane asylums, but this idea was accepted many years ago. Children with misunderstood conditions (autism, epilepsy, etc.) might exhibit symptoms which seemed to indicate insanity; their parents might then believe that an insane asylum could offer better care than they could. During hard times, parents sometimes sent their children to orphanages and insane asylums because they couldn’t care for them at home. Children living in insane asylums often died there as well, since their conditions seldom improved. Even more vulnerable than the rest of the patient population, children were at the mercy of doctors and staff at insane asylums.

A 1955 report by the Department of Mental Hygiene reported 35 patients in the nursery and 169 under 16 at the Crownsville Hospital in Maryland (see last post). The children’s areas were crowded; in the feeble-minded wards, their beds were 12 inches apart rather than the standard 36. Children had nothing to play with and often didn’t go to school.  Baltimore Sun articles in the 1940s and 1950s describe epileptic children lying on bare floors, and small boys alone in a room, naked and spilling food over themselves as they ate. Conditions could–and did–get worse: children were injected with hepatitis as late as 1963, according to several newspaper sources.

Patients Making Baskets at Crownsville, courtesy Crownsville Hospital Collection

 

 

Patients Living in the Cottage for Colored Women, Maryland, 1906

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Another Disadvantaged Group

Thursday, February 6th, 2014

Crownsville State Hospital for the Negro Insane

The Native American patients at the Canton Asylum for Insane Indians were at a disadvantage compared to their white counterparts at other asylums; Native Americans had few rights and little voice in what authorities might choose to do to “help” them. Another group with a similar disadvantage was America’s African-American population.

The Crownsville Hospital for the Negro Insane in Maryland was constructed in 1910, and used as a warehouse for the mentally ill, criminally insane, the feeble-minded, epileptics, children, and others who exhibited troublesome behaviors in society. Patient labor was used to help build the facility, and patients were later used in the institution’s workforce to help keep costs under control.

Like many asylums, the one at Crownsville began on a high note of modern conveniences and a commitment to provide psychiatric care for its patients. Overcrowding quickly became a problem. Children slept two to a bed, adults on mattresses on the floor, and some patients lived in a windowless basement. Medical care became equally appalling. Doctors tested drugs on patients without their consent, and patient cadavers were sent to Baltimore for medical research without the consent of families.

The facility closed in 2004, with its future use still under consideration. In my next post, I will discuss the asylum’s juvenile patients.

African-American Patients Sleeping in Hallway at Crownsville Insane Asylum

Patients Learning to Sew as Part of Their Treatment

 

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