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.

Additional Markers of Insanity

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

Images of Different Types of Insanity by J.E.D. Esquinol, courtesy Wellcome Images images@wellcome.ac.u

In the April, 1879 issue of the American Journal of Insanity, Dr. Judson Andrews gave some tips for family physicians to use in monitoring the possible development of insanity in their patients (see last post). The physical symptoms were disturbingly commonplace, but Dr. Andrews seemed to hit a bit nearer the mark when he described certain mental signs that might indicate the development of insanity. (In general, he thought these mental symptoms would develop after the physical ones.)

— Emotions might be exaggerated (a little or a lot) or the person might be unable to control expression of the emotion even when he tried.There might not be a cause for laughing or crying in a situation, or the reaction might be out of character for the individual.

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

An Emotional Patient, Seacliff Lunatic Asylum, New Zealand

— Depression might develop, either as a loss of spirits or a “shading off from the natural cheerfulness of disposition.”

— Patients could experience “forebodings of some indefinite, indefinable evil impending, from which no way of escape lies open.”

–Later, patients would begin to be overly introspective; in reviewing their actions, they would judge themselves far too harshly and negatively.

— Patients could develop difficulty making decisions about simple tasks (like what to wear) and important ones alike; any course they decided upon then yielded to “agonies of doubt” or vacillation.

Other changes might be in personality, dress and personal appearance, and “exaltation or exaggeration.”

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 - 1919

Insanity Continued to be a Misunderstood Subject, from a Toronto Newspaper, circa 1915 – 1919

Unfortunately, many of these symptoms could develop so slowly they would be hard to detect; in other cases they might just be an intensification of the person’s normal personality and also hard to spot. At least, though, concluded Dr. Andrews, insanity had lost its mystery and dread, and “the insane man stands forth simply as a sick man: one, who by reason of cerebral disease, is unable to use his brain.”

This viewpoint was undoubtedly kinder than the fear and judgment insanity had faced in the past.

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A Medicine Show

Goodnight Is Credited With Inventing the Chuck Wagon

Goodnight Is Credited With Inventing the Chuck Wagon circa 1866

Medical care on the frontier came in a variety of forms. Doctors could provide care (see last post), but people also relied on their own herbal concoctions and traditional Native cures. Charles Goodnight (who with his partner established the first cattle ranch in the Texas panhandle) believed firmly in the power of buffalo fat. He and his wife made buffalo soap that Goodnight felt would cure almost anything: “I am satisfied it will relieve rheumatism. Try it for tuberculosis. I do believe it will work.”

Medicine shows provided more fun, though, and were always popular when they reached town. These shows might be only one-wagon affairs, or they might contain several wagons and a tent. Even the one-wagon show could cram in plenty of supplies and bottled “cures.”

A Small Medicine Wagon

A Small Medicine Wagon

The wagons were usually brightly painted and splashed with the name of the particular show, but it was mainly up to the pitchman to move products. This person might be a doctor, clergyman, or learned professor–or at least call himself one–and usually enhanced his character by dressing in a fancy long-tailed coat and tall silk hat. The voice was everything, and most pitchmen could whip a crowd into a passion for the alcohol-laden line of remedies they peddled.

Medicine Show Wagon

Medicine Show Wagon

Medicine shows were also shows, often featuring a female who might dance, sing, or play an instrument. A man might do magic tricks like eat fire, trade dialogue with the pitchman in a comedy routine of sorts, or show off with tricks like rope spinning. Early showmen often attacked the competency of the local doctor(s) in order to secure their own business; doctors countered by trying to get the shows run out of town. Later, the two entities learned to co-exist. Doctors quietly allowed the show to run its course, then sold the same (leftover) stock that had so impressed the locals.

 

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Rough and Ready Medicine

Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Office of Doctors Charles Hathaway and Ross Bazell, 1902, in Winslow, Arizona, courtesy Old Trail Museum

Medicine in the eastern United States was often hit-or-miss in the early 1800s, but those who pushed to the edge of the constantly changing western frontier were even more apt to suffer at the hands of physicians.

Frontier physicians often took on a variety of jobs: treating horses, pulling teeth, and concocting medicines, in addition to more traditional medical tasks like setting bones and performing simple surgeries. Many physicians were self-taught and consulted a medical manual or two for anything complicated. They relied heavily on substances like morphine; calomel, a compound containing mercury (which the World Health Organization has declared unsafe at any level); and tartar emetic, a toxic laxative containing the carcinogenic, antimony.

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Dr. H. M. Greene at Right, in a LaCrosse, Washington Saloon and Pharmacy, courtesy Oregon Health and Science University

Because they typically had few credentials, doctors in the West tried to impress patients with seemingly exclusive or “inside” evidence of their expertise. Doctors’ offices frequently displayed medical instruments and splints; jars of leeches; body parts bottled in alcohol; and beakers, flasks, and perhaps tubing that implied scientific experimentation or the ability to make mysterious concoctions.

Distilling Devices Known as Alembics Impressed Patients

Distilling Devices Known as Alembics Impressed Patients

The local populations would be impressed, but they were equally impressed by Native American remedies and tonics touted in traveling medicine shows. The medical profession itself did not have any kind of a monopoly on public trust or faith.

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Food for Thought

Farm With Hospital Buildings on Western North Carolina Insane Asylum, circa 1886

Farm With Hospital Buildings at Western North Carolina Insane Asylum, circa 1886

A man suffering from acute melancholia and admitted to Stockton State Mental Asylum (likely in the late 1890s or early 1900s) mentioned  that his first noon dinner (lunch) consisted of soup, beans, and potatoes. His 6:00 p.m. supper was only tea and bread. This meager menu was a far cry from the original intentions of asylum founders, who strove to provide nourishing meals to patients as part of their treatment programs.

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Weston Insane Asylum Farm, circa 1892, courtesy West Virginia and Regional History Collection

Farms were usually incorporated into asylum grounds, both to provide fresh produce for patients and staff, and to provide useful “occupational therapy” for able-bodies patients. Superintendents proudly reported the pounds of produce they had raised, as in Dr. Harvey Black’s report for Southwestern Lunatic Asylum (Virginia) at the end of fiscal year 1887. He noted that their gardens had produced 400 bushels of turnips valued at 25 cents/bushel, 12,000 heads of cabbage at 5 cents each, and 62 dozen squash at 15 cents/dozen. Altogether, the gardens produced nearly $2,000 worth of goods for the asylum’s kitchen.

Piggery at Athens Asylum

Piggery at Athens Asylum

Since the asylum had treated only 162 patients that year, the amount of food grown (Black mentions 16 different crops) probably allowed for a reasonably healthy diet–perhaps better than some patients were able to get at home. Though working on a farm sounds distasteful today, some patients undoubtedly enjoyed it: they got outside, the work was meaningful, and they could both see, share, and enjoy the fruits of their labor.

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Healthy Minds and Bodies

Oregon State Insane Asylum, circa 1900

Oregon State Insane Asylum, circa 1900

Factors in the way alienists (early experts in mental health) treated the insane arose from the medical field’s understanding of the mind. In certain ways, physicians (and alienists) were surprisingly ahead of their time, since they believed that the mind profoundly affected the body. However, they often over-emphasized this aspect of the mind-body connection to arrive at simplistic or sometimes surprising conclusions.

In her 1906 book, The Perfect Woman, Mary R. Melendy discusses this mind-body connection during pregnancy. ” . . . we met with a youth who had finely molded limbs and a symmetrical form throughout,” she says. Melendy stated that the mother did not have this same symmetry or beauty and then continued, “The boy is doubtless indebted for his fine form to the presence of a beautiful French lithograph in his mother’s sleeping apartment, and which is presented for her contemplation the faultless form of a naked child.” Melendy likewise attributed the presence of so many beautiful Italian girls to the prevalence of Madonna images throughout the country.

Melendy's Book on Womanhood

Melendy’s Book on Womanhood

Gibson Girls Were Considered Ideal Images for Womanhood in the 1800s

Gibson Girls Were Considered Ideal Images for Womanhood in the 1890s

This belief that the mind could affect the body so profoundly was one reason alienists felt it was important to take patients from their homes–where their mental illness originated–and shelter them in asylums. There, new habitats and calming scenery could lead disturbed minds toward a new perspective. Recreational activities, mild distractions, and (and at least in the early days of asylums) quality time with a sympathetic asylum physician, were ways to divert a patient’s thoughts from “wrong” views and toward a more beneficial outlook.

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Could Healthy Bodies Lead to Healthy Minds?

Broughton Hospital, courtesy the University of North Carolina

Broughton Hospital, courtesy the University of North Carolina

Early specialists in mental health (alienists) firmly believed that patients’ physical environment impacted their minds. Asylum superintendents tried to site their institutions in the countryside (thought to be healthier than cities) and advocated for buildings that were spacious, well-ventilated, and accessible to clean water. They urged patients to spend time outdoors working if possible, or simply strolling through landscaped grounds if they could or would not work. Before asylums became too overcrowded for this routine to continue, superintendents seemed to get results with this idea of fresh air and a restful environment.

An 1891 article about Broughton Hospital in Morganton, NC extolled the benefits of its country environment. “The present year shows the number of its cures to be fifty per cent. of it’s [sic] admissions, which last numbered 148 persons,” the writer proclaimed. Even more astounding was the institution’s death rate of only four per cent–half the death rate at most other institutions. “No better testimonial can be offered as to the unrivaled excellence of the Piedmont climate than these simple figures furnish.”

Fire Brigade at Broughton Hospial, Staffed by Patients and Employees, courtesy Broughton Hospital Public Safety

Fire Brigade at Broughton Hospial, Staffed by Patients and Employees, courtesy Broughton Hospital Public Safety

The writer went on to say that though the managers of the Hospital used the “most advanced and scientific methods known to the moderns and utterly discard the wretched system of physical restraint,” they did not attribute their impressive success from “any marked superiority in their treatment over all the rest of their professional brethren.”

Post Card of Broughton State Mental Hospital

Post Card of Broughton State Mental Hospital

Instead, the “eloquent figures” quoted (particularly the death rate) showed “what this pure atmosphere will do for men, half dead when they come here.”

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Still A Prisoner

Asylum Ward, New York, 1866, courtesy History of Disability in America

Asylum Ward, New York, 1866, courtesy History of Disability in America

One of the best reasons reformers gave for creating asylums was that the insane were often housed in jails despite having committed no crime. With this argument, reformers in the 1830s pleaded for more humane places (and ways) to treat people who were merely sick rather than criminal. For a period, patients likely reaped the benefit of this new stance; they were taken from prisons and punitive treatments and given the rest, wholesome food, and attention they needed to get well. Then, conditions changed.

Sometime in the 1870s, a female patient named Adeline Lunt gave her perspective on asylums. In discussing the so-called convalescent galleries, which had a pleasant appearance to visitors, Lunt said: “To-night that lady will be bound, chest, arms, hands, will be compressed, tied into a sleeved corset . . . ” When the miserable woman doesn’t sleep well as a result, Lunt said, her attendants report that she has had no sleep and the patient is consequently locked into the building the next day.

Types of Restraining Devices

Types of Restraining Devices

In Lunt’s opinion, patients were detained far too long, merely against the possibility that something negative could happen to them or that they might do something risky. However, the detention itself could bring apathy, hopelessness, or an inability to function. In her words, there should be a dictionary entry that said:

Restrained Female Patient, courtesy LIFE

Restrained Female Patient, courtesy LIFE

“Insane Asylum. A place where insanity is made.”

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Were Cures Worse Than the Condition?

Medicine Chest circa 1850 and Pocket Pill Case circa 1820, courtesy University of Virginia Historical Collection at the Claude Moore Health Sciences Museum

Medicine Chest circa 1850, and Pocket Pill Case circa 1820, courtesy University of Virginia Historical Collection at the Claude Moore Health Sciences Museum

By the middle and late 1800s, so-called “heroic” medicine (in which extraordinary measures to cure a condition often endangered the patient) had been abandoned. However, patients were sometimes little better off calling a doctor than if they had simply endured the illness they suffered.

To treat diarrhea, for instance, doctors may have first ordered a cathartic–a medicine to accelerate the evacuation of the bowels, and then followed it with laudanum, Dover’s powder (a combination of ipecac and opium), or morphine. The latter concoctions probably relieved distress, and opium does slow the gut so that it will treat diarrhea, but they certainly shouldn’t have been taken for any chronic condition.

Popular Cathartic Medicine

Popular Cathartic Medicine

Head lice were common in crowded living conditions, and patients were advised to soak the hair on their heads with kerosene and wrap it up in a cloth for 24 hours. Since smoking was also common during this era, patients would have to take great care that nothing worse happened to their hair than an invasion of lice.

Calomel

Calomel

Doctors commonly used arsenic and mercury–both deadly–to treat syphilis in the 1800s. They also used mercury to treat typhoid fever, parasites, depression, cholera, teething pain in babies, and scurvy, usually through a mercury-based compound called calomel. Heroin, opium, and morphine were commonly used by physicians and dispensed readily (and without prescriptions) by town druggists; these ingredients permeated common medicines or what we now call “patent” medicines, sold over the counter throughout the country.

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A Favorite Project

Epilepsy Was a Feared Condition

Epilepsy Was a Feared Condition

Dr. Harry Hummer, superintendent of the Canton Asylum for Insane Indians, almost continually made and implemented plans to expand the facility. One building that he especially wanted and never received was a separate cottage for epileptics. Though it came out near the end of his career at the asylum that he had erroneously classified anyone with seizures as “epileptic,” Hummer definitely wanted patients with these symptoms separated from the others.

In a letter dated January 15, 1916, he discussed his vision for such a cottage: “The structure should be two-story, one for males and one for females, and the sleeping-space should be an open dormitory arrangement, with one room for disturbed cases and one room for the employee, on each floor. If possible, it would be an excellent plan to surround the structure on three sides with sleeping porches, and we should have a day (living) room, separate from the dormitories.” Hummer asked that the building be constructed of brick and stone or brick and concrete so that it would match the other buildings on site.

Epileptic Hospital in Kansas

Epileptic Hospital in Kansas

Epileptic Asylum in Abilene, Texas

Epileptic Asylum in Abilene, Texas

Hummer’s rationale for a separate building was that: “All institutions for the insane make an effort to segregate the patients, and it [is] a well known fact that epileptics get along much better when to themselves than when housed with other classes.”

His first statement was probably true, but the second had little data to support it.

 

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