Category Archives: Medical treatments

Medical treatments for insanity were often harsh and punitive. They included the liberal use of narcotics. Doctors and attendants used drugs to sedate patients to make them easier to manage. Physical restraints were often used.

Water Treatments

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Continuous Bath Room, Kalamazoo Psychiatric Hospital, 1918, courtesy Kalamazoo Public Library

Patients entering an asylum were frequently given sedatives or tonics, depending upon their physical state, as well as a strong laxative to clean them out. Warm baths were thought to be calming and were frequently prescribed for agitated patients. However, what might have begun as a soothing experience could develop into something close to torture in the extreme treatment called continuous bathing, which could last for hours or days.

Cold water was generally thought to be invigorating, acting as a non-pharmaceutical tonic. Cold water might also be used to “shock” patients out of a certain behavior. Wet pack treatments were versatile in that they acted as both a shock and a sedative. Patients were wrapped in wet sheet and shocked by the cold, but the thinking was that the body would soon warm the layer of air directly beneath the sheets and create a calming effect. Attendants particularly favored wet packs, since their supposed calming influence was enhanced by the fact that the patient couldn’t move and struggle if they tied the sheet to the bed.

None of these treatments seem to have been specifically invented for asylum patients. However, there was a world of difference when a patient took a treatment willingly and in relative luxury as part of a medical cure –as the wealthy did at medical spas–or were forced to endure a treatment they did not want, as often happened in asylums. Some treatments were so uncomfortable–or could be made so–that they were viewed as punishments by patients. Since there are many instances of attendants threatening patients with these water treatments, they were obviously misused in this way.

Wet Sheet Pack, 1902

Wet Sheet Pack, 1902

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

Patients Were Restrained For Hours During Some Hydrotherapy Treatments

 

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Water Therapy

Taking the Waters at the Columbian Springs

Taking the Waters at the Columbian Springs

Water therapies, known collectively as hydrotherapy, were popular forms of treatment for insanity. Most people today have relaxed under the influence of a warm, soothing soak in a tub, but it is interesting to note that bathing for health or medical reasons was popular long before bathing as a sanitation practice became nearly universal. Even after bathing for cleanliness was adopted, unless a family had running water, plenty of pots, a means to heat large quantities of water, plus a large enough container to sit in, bathing in a tub was either impossible or a huge undertaking. (Dedicated bathrooms piped for washing were not the norm in most homes until the 20th century.) Washing with a cloth from a basin would have met most people’s needs.

This may be one of the (many) reasons why asylum hydrotherapy was sometimes fearfully or passionately resisted by patients. Wealthy families were more familiar with immersion bathing at mineral spas and the like, but ordinary people from a crowded city or even a home in the country may have been more used to soaking their feet in a foot-bath each night, or scrubbing up once a week from a basin or small tub. It would have been intimidating to walk (or be forced) into an asylum’s hydrotherapy room with its strange-looking equipment and gushing streams of water.

My next post will look at the reality of various forms of hydrotherapy.

Various Forms of Water Treatment

Various Forms of Water Treatment

Spray Hydrotherapy Room, courtesy University of Western Ontario

Spray Hydrotherapy Room, courtesy University of Western Ontario

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Gender Inequality

Portrait of An Insane Woman, Hugh Welch Diamond, 1852

Portrait of An Insane Woman, by Hugh Welch Diamond, 1852

Treatment for mental disorders was generally hit-or-miss in most insane asylums, and many superintendents embarked on experimental procedures simply because there weren’t any reliable ways to help patients. Some treatments were more bizarre than others, and unfortunately, some of the treatments aimed at female patients were based on mistaken physiology-based causes of insanity.

Many doctors in the nineteenth century believed that the reproductive organs caused insanity, and removed female patients’ ovaries to abate symptoms that seemed to appear during the menses. (Hysteria was another type of female insanity attributed to physiology.) Some doctors applied electrical current to a patient’s uterus, or injected the vagina with hot water. For women who masturbated–often considered a cause of insanity–doctors ensured that the patient would find it extremely painful by cauterizing her clitoris.

Feeble-minded Subjects for Sterilization, courtesy Truman State University

Feeble-minded Subjects for Sterilization, courtesy Truman State University

At the Canton Asylum for Insane Indians, neither superintendent favored these extreme treatments. However, Dr. Harry Hummer firmly believed that female patients in their child-bearing years should not be released unless they could be sterilized.

Since he had no means to do that, he decided to keep many female patients who were otherwise candidates for discharge. Hummer was sometimes overruled in these types of decisions if a woman had a strong advocate, but his policy was most often unchallenged.

Account of A Woman Declared Insane Apparently After a Fortune-Telling

Account of A Woman Declared Insane Apparently After a Fortune-Telling

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Asylum Adjustment

Wet Sheet Pack, 1902, Used to Calm Patients

Wet Sheet Pack, 1902, Used to Calm Patients

No one could be pleased to find him or herself unexpectedly in an insane asylum (see last post) and it is remarkable that so many patients (who later wrote about their experiences) managed to stay calm enough to protect themselves. Patients able to keep their cool and observe the situation quickly saw that protests did them no good, nor did stubbornness or resistance in any form. Those who learned the rules and complied with them generally got along much better with doctors and attendants, and convinced these authority figures of their “progress” toward a cure. Asylums were one place where defiance got a person absolutely nowhere.

Attendants and Employees, Detached Building No. 4, Willard Hospital for the Insane

Attendants and Employees, Detached Building No. 4, Willard Hospital for the Insane

Attendants from both early and late periods were undoubtedly overworked and beset by unruly patients, but just as assuredly, many attendants were unkind and sometimes brutal to patients. Attendants frequently showed indifference toward their patients’ misery, confusion, and unhappiness. Attendants beat patients with their hands or with any handy object, tied them up, poured water over them and refused to let the freezing patient change into dry clothes, and forcibly restrained them for disobedience.

Attendants, Detached Building No. 1, Willard Hospital for the Insane

Attendants, Detached Building No. 1, Willard Hospital for the Insane

Patients often referred to asylums as prisons, and their attendants as jailers. Unfortunately, an insane person had an open-ended sentence rather than the definite, limited one given to most criminals.

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Focus Of Inspections

Interior, First Floor, Staircase and Gallery, Welfare Island, Insane Asylum, New York, New York County, courtesy Library of Congress

Interior, First Floor, Staircase and Gallery, Welfare Island, Insane Asylum, New York, New York County, courtesy Library of Congress

The Canton Asylum for Insane Indians was inspected many times throughout its life. However, inspectors tended to focus on “things” rather than people. In a January, 1912 report that discussed some sewer problems at the asylum (see last post), Inspector Jacob Breid also discussed–in detail–the physical condition of the building.

“The floors are hard maple but they have not been oiled. They have been scrubbed frequently and the dirty water has gotten into the spaces between the boards and caused the edges to become dark. This gives the floor a dirty appearance . . . .” Breid suggested that the spaces between the boards be filled with a material like wax and the floors oiled. (He also suggested that these floors be mopped with a “cloth moistened with kerosene” rather than with soap and water.)

View of Taunton State Hospital, Interior

View of Taunton State Hospital, Interior

In the wards, Breid noted that the beds didn’t have castors and therefore scratched and marred the floors whenever they were moved. He suggested using pegs with rounded ends in each bed post and oiling them so that they would glide across the floor. Most of Breid’s comments and suggestions concerned the physical state of the asylum.

Asylum in Kalamazoo, Michigan in 1870s

Asylum in Kalamazoo, Michigan in 1870s

 

 

So far as patients were concerned, Breid made a list of how many patients held various diagnoses. He also noted that several patients had tuberculosis and needed to be isolated to a greater degree than the building allowed. Breid completed his review of patients with the hopeful thought that the asylum’s new hospital would be erected soon and alleviate this problem of isolating contagious patients.

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The Chronic Insane

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

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

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

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

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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