Archive for the ‘Medical treatments’ Category

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. 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.

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

 

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.

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. 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.

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

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

Patients in Sewing Room at Willard State Hospital for the Insane

Patients in Sewing Room at Willard State Hospital for the Insane

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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. 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.

Dining Room at McLean Asylum for the Insane

Dining Room at McLean Asylum for the Insane

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.

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.

Patent Medicines Thrived Despite the Availability of Doctors

Patent Medicines Thrived Despite the Availability of Doctors

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. 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

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

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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
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)

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

Influential Psychiatrist, Sigmund Freud

Influential Psychiatrist, Sigmund Freud

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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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