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.

Empty Yourself

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Bloodletting As a Treatment for Agitation in Insanity, courtesy Burns Archives

Early alienists typically believed that an insane person needed to eliminate something from the body in order to get well. Copious bleeding and/or purging were popular ways to deplete a maniac’s excessive energy or excitement, but many alienists soon came to believe the procedure was too extreme. Instead, they turned their attention to the bowels.

Samuel Woodward, former superintendent of the Massachusetts State Lunatic Hospital, wrote in 1846 that it was “common for the bowels to be constipated in mania,” and advised a round of laxatives to help solve the problem. He also urged that these laxatives be gentle, but unfortunately turned to poisonous mercurial compounds to do the job. A popular concoction was “blue pill” which was generally a mixture of about one-third mercury, one-third rose oil, and small proportions of licorice, milk sugar, and possibly another quarter portion of hollyhock or marshmallow derivative. Two or three of these pills might represent close to a hundred times the level of exposure that the EPA considers safe today.

Calomel Preparation, Flavored

Calomel Preparation, Flavored

Benjamin Rush's Bilious Pills

Benjamin Rush’s Bilious Pills

Mercury poisoning usually shows up first with headache, nausea, stomach pain, and later, with sore gums and loose teeth. Eventually, symptoms move on to the brain and cause loss of memory and insomnia, and often irritability, depression, and paranoia as well. Since the alienist’s goal for his patient was a daily evacuation of the bowels, patients could take something like calomel or blue pill for quite some time. And, the psychological type of symptoms as a result of mercury poisoning might well keep the sufferer both in an asylum and taking the medicine indefinitely.

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Dance Therapy

Dance Therapy in New York State Asylum, 1920

Dance Therapy in New York State Asylum, 1920

Physical exercise was seen as therapeutic for mental illness, and the staff at insane asylums employed it in many ways. Patients often labored in asylum gardens and farms, took walks, joined in exercise programs, or otherwise used their bodies in healthful ways. Dancing was one type of movement that asylum managers used for entertainment, reward, and healing. Dancing not only released pent-up energy in an enjoyable way, but it also allowed patients a measure of self-expression. Some who participated in group dances were also able to form social bonds that helped them endure their stay in an asylum.

Edward Elgar

Edward Elgar

Composer Edward Elgar began his career at the Worcester County and City Lunatic Asylum in Powick, England in 1879, at age 21. As bandmaster, he composed many polkas, quadrilles, and minuets for the asylum’s 22-piece (asylum-staff) band; his music was “cheerful, charming, and appropriate to its setting.” Additionally, he and the band gave concerts that also brought the patients enjoyment. Later in his career, Elgar liked to shock listeners by referring to “when I was at the lunatic asylum.”

Music Recovered From Elgar's Early Career

Music Recovered From Elgar’s Early Career

Though he wrote no masterpieces during the five years he composed pieces at the Worcester Asylum, he later went on to write the Enigma Variations and the Pomp and Circumstances Marches.

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1906 Investigation

The Washington Herald, 1911

The Washington Herald, 1911

When the Medico-Legal Society leveled charges of abuse against St. Elizabeths’s staff in 1906 (see last post), the public was understandably outraged. However, when the Society would not assist in an investigation nor even let others review its supposed records of the abuse, it lost credibility.

The Washington Herald sent a reporter to St. Elizabeths to investigate one of the “horrors” the Medico-Legal Society had particularly mentioned, the needle bath. “Evidently the informant of the committee as to this particular instrument of torture, was one of those individuals who never take a bath unless it is forced,” wrote the Herald’s reporter. He then described the needle bath (a form of hydrotherapy) as a “scientific shower bath,” and said that a patient undergoing “this particular ‘torture’ seemed to enjoy it.”

Though it is likely that certain attendants were rougher than they needed to be, or disobeyed orders against restraining patients, a subsequent investigation showed that rampant abuse did not exist. A surviving letter from a patient to his sister asserted that “the reports you have seen in the papers in Boston are not so.”

The patient went on to give a practical example of the care he was receiving. “Well, take me for a sample, I weigh more at present than I ever did before, then this should be sufficient to show that we have plenty to eat, and it is good, too.”

My next two posts will conclude the investigation.

Even a Useful Therapy Could be Misused and Abused

Even a Useful Therapy Could be Misused and Abused

A Style of Needle Shower

A Style of Needle Shower

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Investigations Elsewhere

Government Hospital for the Insane Administration Building

Government Hospital for the Insane Administration Building

The Canton Asylum for Insane Indians had its share of investigations, which often were a result of staff complaints. It was not unique in this respect–other asylums were also investigated with regularity, sometimes because of staff complaints, but often through outside intervention. In 1906, the Medico-Legal Society of the District of Columbia made a number of spectacular charges against the Government Hospital for the Insane (St. Elizabeths). The charges included allegations of brutal restraint through the use of “toweling” and the “saddle,” as well as “kicking and cuffing by attendants.”

Toweling involved placing dry towels around a patient’s neck and twisting from behind, to physically subdue a patient who was out of control. The allegations included a charge that the towels were twisted until the patient fell over semi-conscious. The saddle was a device which held patients in a reclining position, bound hand, foot, and neck, so that they couldn’t move at all; many were supposedly left for hours in this condition.

Patients were abused this way for their failure to obey orders or to do work properly, or for “taking an extra spoonful of beans” at table. Additionally, attendants were charged with using the feeding tube (which was pushed down through to nostril to feed patients who would not willingly eat on their own) as a punishment.

The charges were sensational, but were they true? St. Elizabeths’s board of visitors (its oversight group) asked the Medico-Legal society to help them investigate the charges they had made, but the group refused to appear before them or to submit its records concerning the abuse.

My next few posts will continue to discuss this investigation.

Utica Crib, Another Notorious Restraining Device

Utica Crib, Another Notorious Restraining Device

Force Feeding

Force Feeding

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Intervention in Insanity

Eliza Josolyne, Insanity Caused by Overwork, courtesy Bethlem Royal Hospital Archives

Eliza Josolyne, Insanity Caused by Overwork

Alienists (early psychiatrists) believed in actively treating insanity. Most believed that it was beneficial to a patient to completely remove him or her from familiar surroundings; the change would allow new thought patterns and behaviors to form more easily.

Many times, asylums were the change in environment alienists selected, but some recommended travel as a way to change a patient’s surroundings and get his mind focused on new things. Of course, early intervention was paramount, since all alienists believed “acute” insanity (active, new cases) were easier to cure than chronic ones of long duration.

 

Children's Dayroom at Byberry (Philadelphia State Hospital), circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry (Philadelphia State Hospital), circa 1938

 

Dr. J. Parigot believed in the value of intervention to the extreme. Writing in 1864, he made the case that marriage should be avoided when undesirable traits were found in potential parents. This belief wasn’t strictly because he felt the traits would be inherited; it was additionally founded on a belief that parents with those traits couldn’t properly raise a child. He gave an example of intemperate parents who would have to be particularly careful to educate and develop their children so that they wouldn’t degenerate into intemperance themselves. Likewise, he said, “nervous and fidgety persons are incompetent to the direction and control of petulant and sometimes mischievous children.”

Children's Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

Children’s Ward, 1927, Byberry (Philadelphis State Hospital), courtesy Historical Society of Pennsylvania

To counteract the influence of tainted parents in cases of insanity, Parigot stated that: “Children who have inherited germs of mental disease should be separated from their parents, and educated under the eye of the psychiatrist. Sometimes their locality should be changed at the time of their birth. . . .”

Fortunately, such thinking was not generally accommodated by the public.

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How to Test for Insanity

Alienists Sought Help for the Insane

Alienists Sought Help for the Insane

Insanity is an elusive condition, and alienists (early psychiatrists) spent time and effort studying ways to detect it. In an article in the October, 1865 issue of the American Journal of Insanity, Dr. John Tyler admitted that “men differ so widely in their conduct and habits, that what would be manifest insanity in one man, might only be the natural and healthy and common conduct of another.” He also noted that insanity could be recognized more easily than described…one could look at deviations in a person’s normal behavior and recognize insanity. It was much more difficult to describe the person’s insanity in absolute or factual terms, however.

That did not stop Tyler from going on to give some guidelines for assessing insanity in a person:

1. Though he may not abandon friends or former occupations, the insane person begins to see the world and hold ideas only through his own inner lens or “personal laboratory.” Tyler said that these convictions were “coined by him, and not received by another.” That person will be inwardly convinced of something, rather than persuaded to it by outside facts or situations.

2. The madman is inconsistent. Tyler described a patient who insisted he was dead, yet ate, talked, and did other things inconsistent with being dead.

3. The insane person will have a “changed and peculiar expression of the countenance, of the eye, of the manner, movements, attitudes, etc.” Tyler admitted that this type of proof was hard for the layperson to recognize, but that it could be learned through “an acquaintance and domiciliation [sic] with the mentally diseased.”

There was certainly a prevalent belief at that time that a trained professional could detect an insane person just by looking at him. Eccentricity or a vibrant personality may have been a bit dangerous under the watchful eye of one of these self-confident alienists.

Isaac Ray, Asylum Superintendent and Alienist

Isaac Ray, Asylum Superintendent and Alienist

Depiction of Various Types of Insanity by J.E.D. Esquirol

Depiction of Various Types of Insanity by French alienist  J.E.D. Esquirol

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Interesting Cases

Alienists Could Be Prominent Public Figures

Alienists Could Be Prominent Public Figures

Alienists (psychiatrists) wanted to provide good care for the insane in their midst, and in the early years offered assistance primarily  through therapeutic stays at insane asylums. These doctors’ favored regimens of rest, occupational therapy, and structured time probably served many patients well, but such programs could not help everyone. Alienists were still exploring the causes and treatments of insanity, and some of their thoughts missed the mark widely.

In an 1871 paper on mental disease (reported in the Transactions of the Medical Society of the State of North Carolina), the author described a “case of violent cerebral excitement” in a 5-year-old, which had been relieved by an oral dose of bromide of potassium. This case of “mental disease” seems to be clearly a case of epilepsy, and we can only wonder if the child was tagged for life as insane.

Another paper in the same publication discussed “Mania Transitoria,” or insanity of very short duration. During this type of mania, people could be fully aware of their surroundings (or not) and actions. It was brought on by such things as physical disease or the “accumulation of harbored feelings over a number of years.” The author seems to be describing explosions of temper or momentary passionate outbursts, but he attributed this type of insanity’s cause–or attributed it at least in part–to masturbation and petit mal epilepsy.

Craig Colony for Epileptics, courtesy museumofdisability.org

Craig Colony for Epileptics, courtesy museumofdisability.org

Cures For Epilepsy Were Plentiful

Cures For Epilepsy Were Plentiful

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Early Problems Providing Mental Health Care

Civil War Soldier Angelo Crapsey, 1861, Who Committed Suicide in 1864 After a Period of Mental Illness, courtesy Kutztown University of Pennsylvania

Civil War Soldier Angelo Crapsey, 1861, Who Committed Suicide in 1864 After a Period of Mental Illness, courtesy Kutztown University of Pennsylvania

Leaders in many states recognized early on that they needed to provide treatment for mental illness at public expense. The North Carolina Hospital (Raleigh) opened in 1856, but an influx of patients after the Civil War forced the state to find other places for care, such as in private homes. It is likely that this increased need for care occurred just as families were hurting for cash: Fraud became so widespread that the state  had to pass laws requiring counties to care for the insane, instead.

Early care in North Carolina’s asylum consisted primarily of rest, occupational therapy, and treatment for physical problems. Cure rates during this period were in the neighborhood of 30 – 40 percent. Though high, these cure rates may be accurate. After the trauma of fighting during the Civil War, patients who were former soldiers may have been truly helped by a stay in a calm, well-regulated environment where not much was demanded of them.

North Carolina’s constitution mandated that the state care for all of its “insane, blind, and deaf-mute persons.” However, there was still a great deal of stigma attached to insanity and public acknowledgement of it by families. By 1884, the general population–though it recognized the need for care–wanted it provided at home. Consequently, many family physicians found it necessary to study insanity so they could at least recognize and provide some sort of treatment for it among their patients.

Peaceful Scene at North Carolina Hospital, 1924

Peaceful Scene at North Carolina Hospital, 1924

 

Drug Room at North Carolina Hospital, 1924

Drug Room at North Carolina Hospital, 1924

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Combating Smallpox

Lokata Sioux Winter Count Showing Smallpox Outbreak, courtesy National Institutes of Health

Lokata Sioux Winter Count Showing Smallpox Outbreak, courtesy National Institutes of Health

Smallpox decimated Native Americans (see last post) after Europeans arrived and spread this virulent disease on a population with no immunity to it. However, the disease was not simply accepted and endured. Though native peoples did not immediately connect smallpox with Europeans, they did understand illness and how to treat it.

Native Americans first turned to traditional medical practices to help combat smallpox. Drums, rattles, and incantations helped patients rally, while fasting and dreaming also followed traditional healing ways. Herbs and oils were used to alleviate discomfort. Unfortunately, the common use of the sweat lodge in treatment may have made a patient’s condition worse, since heat and steam caused sweating and dehydration, while cold water plunges may have overly shocked the body.

The Cherokee developed a Smallpox Dance in the 1830s, and other tribes formed curing societies and developed healing rituals. Families eventually stopped their traditional practice of crowding around a sick patient and allowed a quarantine for those with smallpox; people also avoided traveling to places with active cases, and burned (or thoroughly cleaned) homes where someone had died of smallpox.

The smallpox vaccine was available as early as the 1700s, though Native Americans were not routinely vaccinated. When the vaccine was offered, however, many native peoples took advantage of it. The Bureau of Indian Affairs (BIA) was the official vaccination administrator, but missionaries and  traders also urged vaccines. Traders, especially, who cared little for Washington politics and did not need to put white settlers’ needs ahead of their trading partners’, were probably just as successful in helping the vaccination effort as the BIA.

The Mandan Tribe Suffered Greatly From Smallpox

The Mandan Tribe Suffered Greatly From Smallpox

Medicine Man Administering to a Patient, courtesy National Institutes of Health

Medicine Man Administering to a Patient, courtesy National Institutes of Health

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Material Improvements

Operating Room at Georgia State Lunatic Asylu

Operating Room at Georgia State Lunatic Asylum

For such a small institution dependent on government funds, the Canton Asylum for Insane Indians had a surprisingly robust building program. Dr. Harry Hummer constantly requested new buildings, upgrades to old ones, new farm acreage (and then new outbuildings to accommodate more livestock and feed), as well as new patient buildings. Near and dear to his heart were two buildings in particular: an epileptic cottage and a hospital.

 

Virginia State Epileptic Colony Cottage for Feeble-Minded Women

Virginia State Epileptic Colony Cottage for Feeble-Minded Women

Dr. Hummer never received his epileptic cottage, though he requested one many times. He did get the hospital, which presumably made more sense to the appropriations committee which designated money for such projects.

When the hospital was approved for construction, Dr. Hummer received full credit for it: “The entire enterprise owes its inception, development and consummation to Dr. Hummer,” said a writer for the Sioux Valley News. The paper went on to say that when the two-story, brick and concrete building was completed, “the sick will be provided with the best that science means and experience can contribute.”

Epilepsy Was Considered a Form of Insanity, so Cures Were Widely Sought

Epilepsy Was Considered a Form of Insanity, so Cures Were Widely Sought

When Dr. Samuel Silk inspected the hospital in 1929, its operating room had “no equipment whatsoever, except for a surgical table, a slop sink and two wash bowls.”

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