Canton Asylum

Many Physicians Believed Insanity Stemmed from Physical Causes

Some of the new ideas about insanity and ways to prevent it helped doctors believe in cures after a long period in which they had resigned themselves to believing that most insanity was chronic. An article from the November 12, 1922 edition of The Washington Post quoted Dr. Toulouse, a renowned French alienist, who had founded the League for Mental Hygiene and Prophylaxis. He believed that “half the occupants of the world’s insane asylums are not mad, but diseased.” Like most other alienists, Toulouse also believed that early intervention was critical; he set up a clinic where people could go when they felt their “nerves giving way.”

Toulouse believed the three great causes of insanity were sorrow, thyroid deficiency, and vice. Patients at his clinic would be questioned at length so that Toulouse could arrive at a life history for the individual. A physical exam would then determine whether they “were born with an excess of thyroid matter” or whether they had become addicts to vice–including drugs. Though all three (main) causes of insanity could be cured, Toulouse felt that madness caused by sorrow was the most difficult to resolve successfully.

Sorrow caused by bereavement or crosses in love could be healed after time, but sorrow caused by loss of money was the hardest to cure. “Practically the only sedative for a person who has once been wealthy and who finds himself suddenly poverty-stricken is to provide him again with wealth,” said Toulouse. This was obviously an impractical course of treatment.

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Lister's New Disinfectant Method in Use

Important medical breakthroughs occurred during the 1800s. Especially important was the idea that disinfectants could help prevent the spread of disease in hospitals. Joseph Lister used carbolic acid to clean wounds and surgical instruments in hospitals, which brought deaths from infection down from 60% to about 4%. Many doctors scoffed at his ideas, but his success forced them to adopt his methods. Just a few years later, Louis Pasteur and Robert Koch developed the germ theory of disease. This was also revolutionary, since many doctors until then had no idea whatsoever about the mechanism of disease. Some thought illness generated spontaneously, while others thought the atmosphere could contain the elements of ill health or that certain personalities and physical attributes predisposed people to certain diseases.

In 1879, researchers developed a vaccine for cholera. Before the turn of the century, vaccines were developed for anthrax, rabies, tetanus, diphtheria, typhoid, and plague. It must have seemed that science had conquered–or would soon conquer–all the ills of mankind. It was a hopeful time, which led both medical doctors and alienists (specialists in treating diseases of the mind) to believe that few conditions were beyond treatment and cure.

Joseph Lister

Robert Koch, courtesy National Library of Medicine

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Male Ward at Athens Lunatic Asylum, courtesy Ohio University Libraries University Archives

There are only two or three pictures available of the Canton Asylum; since they are only of the outside, it’s difficult to get a good idea about the physical layout of the rooms or what it might have been like to live there. In 1910, there were eighteen buildings associated with the asylum. These included barns, sheds, granaries, and similar structures. The main building was two stories high, with jasper granite stone foundations. Underneath, a basement ran underneath the entire building. The basement was divided into several compartments by brick partition walls. The first and second stories had eleven foot ceilings, which should have made the inside look spacious.

The main building held four wards. Two were on the first and second floor of the east wing (males) and two on the first and second floor of the west wing (females). Each ward had an attendant’s room, plus three private rooms where patients could be secluded if necessary. The superintendent (Dr. Harry Hummer) and eighteen employees lived in the main building, though Dr. Hummer eventually got a detached cottage for his family. The asylum had electricity which came from a small electric plant about two miles away. The facility was heated via radiators and used hard well water, along with rainwater collected in two cisterns.

Physician's Bedroom at One of Willard Insane Asylum's Buildings (The Branch)

Cisterns Held Precious Rainwater Runoff

A nicely maintained lawn surrounded the building, and patients often sat outside during nice weather. Inside, the building was often stuffy and smelly. The hard water made it difficult to launder clothing and sheets and keep them really clean, and eventually the entire facility began to look shabby and rundown.

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A Book Written by a Former Asylum Patient

One of the worst kinds of abuse patients at insane asylums suffered occurred simply because of the situation. Many patients were tricked into accompanying relatives or friends to an asylum, or to a sanity commission that had been convened to arrange for commitment. Elizabeth Stone recounted her own commitment as this kind of deception. Her brother asked her to take a ride with him and conveyed her to McLean Asylum , where he abruptly left her without telling her where she was and what was going on. Stone was distressed beyond words when she finally realized what had happened, and later wrote: “O! That a dagger had been plunged into my heart in the midnight hour!”

Once in an asylum, many patients were frightened, angry, and bewildered. Many were distraught and emotionally overwhelmed by a sense of betrayal and shock at what had occurred. Women from sheltered homes were often terrified by the chaos around them. Patient accounts speak of real fear–of both patients and doctors whom they did not trust–and fear that they would never be released. Some learned to adapt and become model patients, hoping that by exhibiting desirable behavior, they might be set free. For far too many, the trip to the asylum was the last trip they would every make. By the time family members committed a person to an asylum, they were generally ready to be rid of him or her for a very long time.

McLean Asylum for the Insane

Scene From New York Lunatic Asylum, Blackwell's Island, 1898 Woodcut

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Locks Were Common at Insane Asylums

From accounts by former patients, it seems probable that many cases of cruelty and abuse were deliberate. Attendants were often uneducated, uncaring, or of a type who found it impossible to get a job anywhere but in an asylum. Those who enjoyed dominating weak or helpless patients often had  little oversight to prevent their doing what they liked; patients reported beatings and punishments which were clearly typical and sustained rather than lapses in judgment or reactions during a crisis. However, attendants often used restraints and other methods of control because they were convenient. Attendants in a short-staffed ward might reasonably believe that it was better to restrain a violent patient or lock him up, rather than let him hurt himself or other patients. Attendants might force feed a patient that they feared would starve because she wouldn’t eat of her own accord. Many attendants undoubtedly did these kinds of things with a perfectly clear conscience.

At the Canton Asylum for Insane Indians, both types of abuse occurred. A few patients complained of witnessing cruel teasing that would make the targets upset, or of seeing patients treated with unnecessary force or bullied. Attendants more frequently treated their patients badly out of convenience. The asylum was usually short of attendants, particularly under Dr. Harry Hummer. One attendant might have to take care of an entire ward, or at night, an entire building. It was vastly easier to lock patients in their rooms or put them in a restraint, than forgo a meal or get behind on chores for which they would be disciplined if they didn’t complete. Though restraints were supposed to be used only with the permission of the superintendent, the restraints at Canton Asylum were kept in the financial clerk’s office and given out to any attendant who asked for one.

A DeKalb Crib, circa 1905, Used for Patient Restraint, courtesy Maryland State Archives

Exhibit of Patient Restraints From Glore Psychiatric Museum

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Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Institutes of Health

Though many abuses toward patients  were either condoned or ignored by senior staff, some doctors cared very much about patient abuse. When Dr. William A. White took over as superintendent of St. Elizabeths (the federal government’s hospital for insane soldiers, sailors, and citizens of Washington, D.C.), he immediately issued a terse letter absolutely revoking use of the saddle (a harness fashioned around a patient in bed and tied so that he/she could not raise up) as a restraining device.

Anna Agnew (see last post) witnessed an amazing scene when a new superintendent (Dr. Fletcher) arrived at the asylum where she stayed. Fletcher banned all restraints and then went a step further. He gathered up the various devices in the asylum and made a bonfire of them in front of the patients. Fletcher’s action to abolish restraints was generally applauded, except for the spectacular way he did it. Newspapers reporting on the incident suggested that the matter might have been handled with a little less sensation, though they agreed that restraints were usually a bad idea.

Picture of Patients Under Restraint, courtesy National Institutes of Health

Utica Crib, an Early Restraining Device

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Nervous Prostration Was a Recognized Condition; Ad circa 1895

Not all asylum patients resisted their incarceration. Some recognized that they were struggling with mental issues they could not control on their own, and did not resent the help that an asylum promised to provide. Like Catharine Beecher (see last post), Anna Agnew felt herself falling into a condition where she could not function. In 1876, Agnew remembers that she woke one morning “bathed in a cold, clammy perspiration (with an inexpressibly horrible sensation, as though falling–falling into some dreadful place of darkness!).” She couldn’t speak or move, and felt that a horrible, cold shadow had fallen upon her. She called her condition nervous prostration, and concluded that she was insane.

In her own words, she says that: “Unfortunately, for all concerned, I was not taken to the asylum for a period of several years.” Though this view seem incredible, Agnew explained that if she had been committed earlier or more quickly, she might not have had to eventually stay in an asylum for seven years. She felt that staying at home in her condition caused her to create misery for herself and those around her. Her family and friends treated her sometimes as a willful child, sometimes as a hypocrite, sometimes as a shirker, and sometimes as a woman “not wholly responsible.”

Once inside an asylum, Agnew saw many abuses which enraged her. Still, she appreciated her recovery and the privileges she enjoyed, such as access to the asylum’s medical libraries and the opportunity to earn a small sum through sewing.

Cottage at Willard Asylum

Patients in Sewing Room at Willard Asylum for the Insane

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Catharine Beecher

People who realized they were having problems coping with life often voluntarily sought cures for their mental distress. Catharine Beecher, sister of Harriet Beecher Stowe and later co-author with her of a very successful book entitled American Woman’s Home, or Principles of Domestic Science (1869), found the rigors of earning her living overly taxing. When she was twenty-three years old, Catharine supervised a school with 160 pupils, many of them boarders. After ten years of school-teaching, “the nervous fountain gave out entirely,” Beecher said. “I could neither read, write, or converse, nor even bear to hear conversation.”

Beecher traveled and consulted numerous medical men, who tried various remedies without success. She took pills, underwent galvanism (in which electrical pulses were applied to contract her muscles), visited a clairvoyant, and took the Water Cure. She was wrapped in a wet sheet “at four in the morning,” and kept in it for a few hours before being plunged into a cold bath. Then she had to walk as far as she was able, drink several glasses of cold water, stand under water falling from a height of eighteen feet, drink more water, and so on. She was wet all day.

Beecher related that she spent over ten years under various types of  medical treatment,  often returning to a mild water cure as the best restorative. She met many other women at these water cure institutions, and began to believe that American women were not as healthy as they should be. Beecher exhibited periods of extraordinary energy and productivity during her lifetime, and it could be that water cures gave her a form of “time out” to rest and assess her work. She made women’s health a great priority, and gave women common sense tips for dress and diet, as well as advice for efficiently running their homes. Unlike so many cases, Beecher’s treatments for her her mental maladies were voluntary, rather than coerced.

Pleasures of the Water Cure, 1857, courtesy National Library of Medicine

Water Cures Were Popular With Those Who Could Afford Them

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King George III in His Prime, courtesy Library of Congress

King George III may have been a victim of misdiagnosed insanity–proving that even the highest birth and station could not exempt a person from the faulty reasoning of mad-doctors. When he was 50, King George III began exhibiting bizarre behavior which was perhaps triggered by a case of obstructive jaundice. He experienced hallucinations, fits somewhat like epilepsy, and foamed at the mouth after talking incessant nonsense. Court physicians blistered and purged him, kept him in an unheated room during winter, bound him in a strait jacket, or gagged and tied him to a chair. Dr. Francis Willis, who had experience with mental illness, finally began a course of more humane treatment. The king recovered, but slipped back into three more episodes of mental illness that eventually left him hallucinating and talking to unseen persons and to dead people. He died miserably in 1820, blind and deaf as well as apparently insane.

Many researchers have wondered whether or not King George III was actually insane, and evidence seems to lean against it. Though not universally supported, some doctors believe that the king could have had a rare blood disorder called porphyria, which can affect the nervous system. Some of the king’s symptoms indicate the condition, while others do not. One thing that does seem noteworthy is the presence of arsenic in a lock of the king’s hair, analyzed in 2005. Arsenic levels of 1 part per million can result in arsenic poisoning; King George’s hair analysis revealed 17 parts per million. He was probably poisoned through the liberal doses of emetic tartar he received for his varying illnesses, which undoubtedly made all his symptoms of mental illness worse. (At the very least, porphyria is often triggered by the ingestion of heavy metals.)  Sadly, the king was often forced or tricked into taking the very medicine that caused or exacerbated his apparent insanity.

Given Liberally to King George III

Lock of King George III's Hair, courtesy Wellcome Trust and Science Museum

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Man With Apoplexy, courtesy National Institutes of Health, History of Medicine

Asylum doctors tried hard to share information about the developing field of psychiatry, and sometimes discussed interesting cases in journals. In the January, 1869, issue of the American Journal of Insanity, Dr. Judson Andrews gave details about a fifteen-year-old-boy brought into his asylum. The progression of his disease follows:

The boy was healthy and free of insanity until he developed typhoid fever and became delirious in April of 1868. He demonstrated mental disturbances by a change in his character, since he began stealing from neighbors’ gardens and hanging around with “evil associates.” He also became profane, was disobedient to his parents, and danced and sang comic songs. Later, he was hit in the head with a rock thrown by a comrade. The boy was admitted to the asylum that September, and gave no immediate indication of insanity. A few days later, however, he began to do odd things: wash his clothes in a bathtub, eat voraciously, and sometimes vomit food. Otherwise, he was obedient and “anxious to make himself useful.”

In November, he suddenly complained of headache and pain in his stomach, screamed, and passed into a convulsive state. On being examined, he became maniacal for about two hours and then was rational. He complained about a pain in his head, telling the staff that he felt at times “as though he had swallowed tobacco.” At four p.m., he died suddenly.

An autopsy sixteen hours later found a quantity of internal bleeding, and the doctors determined that the boy had died of apoplexy. Apoplexy originally meant any sudden death after the loss of consciousness, and usually indicated what we would call a stroke, today. Though they doctors involved acknowledged that it was unusual to see apoplexy in one so young, rather than revise the diagnosis of insanity that preceded the event, they believed, instead, that the maniacal fit had simply brought it on.

Apoplexy Was Mysterious

An Extraordinary Cure from a British Doctor, courtesy thequackdoctor.com

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