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.

Worse Than Waterlogged

Ladislas Meduna, courtesy University of Illinois Archive

Ladislas Meduna, courtesy University of Illinois Archive

Much of the therapy for insanity was experimental, and a number of treatments likely inflicted a great deal of harm and discomfort on patients. Something like Pilgrim’s Tub Therapy (see last post) may have resulted in a waterlogged and weakened patient, but would not have otherwise imposed great trauma, particularly since the treatment was almost always voluntary. On the other hand, shock treatments could be both violent and frightening.

In the 1930s, psychiatrists began experimenting with various kinds of treatments that threw the body into convulsions. For some reason–and they did not know why–convulsions often helped patients with depression and other problems. In 1933, Ladislaus (also Ladislas) von Meduna began inducing convulsions through intravenous drugs. He had noticed that schizophrenia and epilepsy could not seem to co-exist, and believed that controllable convulsions would cure schizophrenics.

Preparation for Shock Therapy

Preparation for Shock Therapy

Meduna began experimenting with camphor, but didn’t get reliable results. He moved on to strychnine, thebain, pilocarpin, and pentilenetetrazol, the latter also referred to as metrazol or cardiazol. He injected these substances intramuscularly, but only got reliable results with metrazol. This substance induced quick, violent convulsions that Meduna reported “cured” 50 percent of his subjects. Unfortunately, the convulsions that metrazol induced were so violent that they also caused spinal fractures in 41 percent of Meduna’s patients. Many patients also reported feelings of “impending death and sudden annihilation” before the convulsions started.

Shock Treatments Could be Violent and Frightening

Shock Treatments Could be Violent and Frightening

Eventually another psychiatrist (A. E. Bennett) combined metrazol with curare (a muscle paralyzing agent) to make the convulsions less violent. Later practitioners also sedated patients so they didn’t go through this treatment while conscious–such an obvious step that it should not have taken nearly a decade to hit upon. Eventually, insulin shock therapy won out over the metrazol injections, and they in turn gave way to electroconvulsive shock therapy.

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Tub Therapy

Dr. Charles Pilgrim, 1908

Dr. Charles Pilgrim, 1908

Physicians used hydrotherapy (various sorts of baths and showers) extensively in the treatment of the insane. The treatments could sometimes be helpful; a nice, warm bath might relax a patient or help him sleep, or a bracing shower could stimulate a patient who felt sluggish and tired. Dr. Charles Pilgrim, however, took water treatments to an extreme with what he called “Tub Therapy.”

Dr. Pilgrim arrived at the Hudson River State Hospital from the Willard Asylum in1893. He quickly made physical improvements to the institution, installing electric lights to replace the gas lamps, and building new 50-bed cottages for patients, a new mortuary, and a lab. In 1908, Pilgrim introduced Tub Therapy, a form of the continuous bath. Patients entered the tub room and reclined on a canvas hammock in a tub of warm water, a rubber pillow behind their necks for additional comfort. Water temperature was monitored so that it remained at the proper therapeutic level.

Tub Therapy at Pilgrim State Hospital, the Former Hudson River State Hospital

Tub Therapy at Pilgrim State Hospital, the Former Hudson River State Hospital

Most patients would have enjoyed this for an hour or two, but Pilgrim’s treatment was of much longer duration. A September 17, 1908 article in The Beaver Herald (Oklahoma) stated: “You sleep for six hours . . . next morning breakfast is served to you in the tub, then dinner, then supper.” Occasionally the doctor would come in to chat or take a blood sample, and the patient grew calmer, more rested, and more cheerful all the while. After at least several days (the title of the article was “Live for Weeks in the Bathtub”), the patient finally got out of the tub with the help of a nurse and found him or herself well again.

This treatment was primarily for patients who felt madness coming on, either just fearing a breakdown or actually close to one in their own or others’ opinion. The therapy was voluntary, though it is hard to see anyone in good physical health actually enjoying the forced inactivity.

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Treating Morbid Impusles

Surgeon General William Hammond

Surgeon General William Hammond

In A Treatise on Insanity (1883), author William Hammond (former surgeon-general of the Army) described various cases of intellectual objective morbid impulses and how he had treated them. In one case, a young man developed an overwhelming desire to throw vitriolic acid over women’s beautiful gowns. He considered his actions “immoral and degrading,” but told Dr. Hammond that “a handsome dress acts upon me very much as I suppose a piece of red cloth does on an infuriated bull: I must attack it.” The young man had managed to throw vitriol on three women’s dresses without being caught, but wanted desperately to stop doing it. He could not determine where the impulse came from, but simply found it impossible to control.

Tilden's Bromide of Calcium

Tilden’s Bromide of Calcium

Dr. Hammond examined the man, and could find no disease other than “wakefulness.” Hammond prescribed a bromide of calcium (a sedative) and “insisted on his removing himself from further temptation by taking a sea voyage on a sailing vessel upon which there were no women passengers.” The young man did so, and came back after three or four month free of his impulse to ruin women’s dresses with vitriol.

According to Hammond, an intellectual objective morbid impulse is an idea that occurs to a person which is contrary to his sense of right and wrong, urging the person to do something “repugnant to his conscience and wishes.” As in the case of the young man just described, such an impulse “if yielded to . . . is often of a character as to demand the serious consideration of society.” In his case, the man would probably have ended up in an asylum if he had not had his condition nipped in the bud.

Dr. Hammond's Book

Dr. Hammond’s Book

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Trauma Care for the Insane

How to Care for the Insane

How to Care for the Insane

Many asylum patients were ill with various chronic conditions, but accidents and self-inflicted injuries also kept doctors busy. In How to Care for the Insane by Dr. William Granger (1886), the author discusses some particular issues that nurses might confront:

A cut throat: Patients may cut their throats from ear to ear and do really little injury, or they may make a small stabbing wound and divide a large blood-vessel and die almost immediately, or they may cut the windpipe and not cut the blood-vessels. Little can be done by the attendants to stop the flow of blood, even if the great blood-vessels are not cut. The head should be kept bent forward and the chin pressed against the chest.

Injury from Eating Glass: Patients sometimes eat glass . . . In the treatment do not give an emetic or a cathartic. Such food as has a tendency to constipate the bowels, and such as will also enclose the glass and coat its sharp edges, is to be given. Potatoes, especially sweet, oatmeal, or thick indian-meal pudding, are appropriate. Cotton, which is generally at hand, will, if swallowed, engage the glass in its fibres, and so protect from injury.

Patients and Nurses in Female Ward B, Weston State Hospital, 1924, courtesy West Virginia& Regional History Collection

Patients and Nurses in Female Ward B, Weston State Hospital, 1924, courtesy West Virginia & Regional History Collection

State Hospital Nurses, circa 1914, courtesy Missouri State Archives

State Hospital Nurses, circa 1914, courtesy Missouri State Archives

Injury with Needles: This is a self-injury, but it may be severe and require immediate attention. Patients may open a vein or an artery with a needle, or plunge it into the eye. But the more common way is for a patient to stick many needles under the skin, sometimes to the number of several hundred. Sometimes patients introduce them near the heart or lungs, and as a needle will often “travel” when in the flesh, it may work its way into a deeper part, and so a number get into the lungs or the heart, causing death . . . An attempt or desire to so injure one’s self should be guarded against by the attendants, and if accomplished should be at once reported to the physician, that efforts may be made to extract the needle.

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Common Sense

Annie Payson Call

Annie Payson Call

Laypeople were interested in mental health, and by the early 1900s had recognized that their lives might be happier if they could overcome and control some of the mental distress which seemed rampant in their complex and hurried world. Annie Payson Call wrote articles for the Ladies’ Home Journal in which she offered advice to women who suffered various nervous afflictions. In her book Nerves and Common Sense (1909), she gave a case study of a woman’s problem and cure in her relationship with an irritable husband.

A brokenhearted woman complained to a friend about her husband’s unkindness and hard heart; after hearing her out, the friend helped her understand that the situation was essentially her own fault. Because she had been trying to please her husband and he didn’t notice her efforts, she had become emotionally distressed. “Now it is perfectly true that this husband was irritable and brutal,” said Call. However, because the woman was “demanding from her husband what he really ought to have given her as a matter of course,” she was wearing herself out and suffering to no avail.

Ladies' Home Journal Offered Women Advice

Ladies’ Home Journal Offered Women Advice

“She was a plucky little woman and very intelligent once her eyes were opened,” said Call. “She recognized the fact that her suffering was resistance to her husband’s irritable selfishness, and she stopped resisting.

“As his wife stopped demanding, he began to give,” Call related. “As his wife’s nerves became calm and quiet his nerves quieted and calmed.” It turned out that business worries had been at the root of his brutishness; once his wife stabilized her emotions he suddenly turned to her and confided his troubles. After that, all was well.

Patent Medicines Helped Nerve

Patent Medicines Helped Nerve

Call’s advice must at times have been trying in the extreme to her readers, but since she wrote many articles of this sort, they were obviously well-received enough that Ladies’ Home Journal continued to publish them. Many of her suggestions urged changes in attitude and thought, which probably worked well for readers who could not visit alienists (experts in mental health) or find sympathy at home.

 

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The Front Line

Clifford Beers

Clifford Beers

Though administrators and superintendents get most of the recognition for asylum care, attendants were the really critical employees. Their skills and strengths, their attitudes and moods, affected patients profoundly. Clifford Beers, a Yale graduate who suffered a mental breakdown in the early 1900s and later wrote about it in A Mind That Found Itself, described his treatment at the hands of the attendants at his well-regarded institution.

Attendants Could Often Be Violent With Patients

Attendants Could Often Be Violent With Patients

Beers had been at odds with his attendants because they were so indifferent and deliberately cruel to him: refusing to give him a glass of water when he requested one, neglecting to bathe him, and the like. Beers retaliated with small acts of defiance, mainly verbal, which goaded his attendants into telling him they were just waiting for a chance to beat him.

Man Being Restrained in West Riding Lunatic Asylum

Man Being Restrained in West Riding Lunatic Asylum

Beers recorded that on November 25, 1902, he politely asked an attendant for a drink, was refused with curses, and then answered in kind. This was the opportunity his attendants had been waiting for; one held a lantern in Beers’ dark room while the other knocked him down, kicked him, and choked him. They stopped when he pretended to be unconscious, and left him “to live or die for all they cared,” Beers wrote. Beers showed the attending physician his bruises the next day, but neither attendant was fired for his actions.

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You Get What You Pay For

Female Patients Farming in the early 1900s

Female Patients Farming in the early 1900s

The superintendents at most asylums had the best of intentions when it came to patient care. They understood (for that era) what kind of help patients needed and what kind of attendants could best provide it. Most asylums had rules of conduct for staff and lists of optimal behaviors they expected to see in them; if these desires had been met, most asylums would have been better places. However, superintendents were at the mercy of legislatures, which often underfunded public asylums. Except for the wealthiest private institutions, attendant staffing was never high enough to provide good–or sometimes even adequate–care.

Tennessee Central Hospital for the Insane

Tennessee Central Hospital for the Insane

Staffing issues were especially tough during WWI, when many doctors and nurses left private employment for military service. In 1918 the superintendent of Tennessee’s Central Hospital wrote about the problem he (and all asylums had) in attracting good workers: “We have from forty to sixty beds soiled each night, and the patients who soil the beds at night soil themselves often during the day and have to be dressed and attended to…and the great State of Tennessee says to our attendants, ‘We will allow you from twenty to thirty-five dollars a month for this.'”

Laundry Room at Fulton State Hospital, 1910

Laundry Room at Fulton State Hospital, 1910

This was not much money for what was typically a 14-hour workday full of exhausting physical (and sometimes dangerous) labor. Workers in manufacturing earned around $48 weekly in 1914, unionized bricklayers in New York earned nearly $31 a week in 1913, and even notoriously underpaid female mill workers earned between $5 and $7 a week. The typical asylum attendant’s poor pay almost guaranteed that good workers would go elsewhere. Asylums were often left with attendants who for one reason or another could find work nowhere else.

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A Rational Solution

Almshouse Occupants at Meal Time, circa 1911

Almshouse Occupants at Meal Time, circa 1911

Wealthy families with an insane member could usually afford to pay someone to care for their unfortunate relative; they also had accommodations for him or her. It was an entirely different matter for the poor or even the middle class, whose homes were often small and cramped by today’s standards. A working family found it almost impossible to spare an able-bodied member to care full-time for someone who was sick, whether physically or mentally. Consequently, illness of any kind sometimes drove a family into poverty, or into the dreaded poorhouse.

Residents of an Almshouse Making Shoes, courtesy Library of Congress

Residents of an Almshouse Making Shoes, courtesy Library of Congress

Poorhouses were set up to care for people who had no one else to support them. Mentally ill people with no support also wound up in poorhouses, and nobody benefited when that happened. The insane person disrupted the routine of the poorhouse and very likely frightened the other people in it. That person could get no real help, either, because a poorhouse wasn’t set up to help people with mental illness. Consequently, no one benefited from the arrangement, and the victim of insanity often suffered terribly when the poorhouse caretaker simply confined him or her to a room or an outbuilding (see last post).

Kings County Almshouse, Brooklyn, NY, circa 1900, courtesy the Museum of the City of New York

Kings County Almshouse, Brooklyn, NY, circa 1900, courtesy the Museum of the City of New York

One of the arguments for asylums was that jailers and poorhouse managers didn’t have the accommodations to adequately care for the insane, or the expertise to do it even if they had the space. Asylums, where trained personnel in buildings constructed specifically for keeping the insane comfortable, were supposed to be an enlightened solution to an age-old problem.

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Natural Medicine

Woman Digging Roots

Woman Digging Roots

Before modern pharmaceuticals, people looked to nature for their cures. The Chippewa, for instance, used numerous plants to treat ailments, often in conjunction with special songs and music. Red baneberry treated the “diseases of women,” giant hyssop treated cough and pain in the chest, and jack-in-the-pulpit was useful for sore eyes. Other plants, like wild sarsaparilla and white mugwort, could be used for both medicine and as charms.

Medicine Man Preparing Medicine, courtesy National Library of Medicine

Medicine Man Preparing Medicine, courtesy National Library of Medicine

Isabelle Thing, a Kumeyaay Indian Traditional Healer

Isabelle Thing, a Kumeyaay Indian Traditional Healer

Chippewa plant names often indicated the appearance of the plant, the place where it grew, one of its properties, or its use. Blue cohosh was called becigodjibiguk; becig meant “one” and djibiguk meant “root,” thus “the plant having a tap root.” Often, one plant had several names, and individual gatherers often gave a plant a name, as well. Sometimes when a medicine man taught someone about a plant, he would show the person the plant without telling its name, in order to keep it secret.

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Cruel Through and Through

Cruelties Endured by a Patient in Brislington House Asylum, England, courtesy, The Lancet

Cruelties Endured by a Patient in Brislington House Asylum, England, courtesy, The Lancet

Insanity was a cruel condition, and its victims suffered doubly: their minds caused them unease or suffering, and then caretakers typically punished their bodies. Though physicians eventually discerned that mental illness was not an incurable disease, the treatments for it were sometimes stunning in their callousness.

In 1824, a young woman named Mary Sewall caused her father concern because she had wandered into the countryside with a confused intent to attend a religious meeting. He ordered a bunk “with a lid to shut down” to keep her confined, and kept her in it at night for over two months. He additionally kept his daughter sitting all day in a “confining chair” which prevented any physical movement. Her arms and legs were strapped down, and she was forced to remain all day on a seat with a hole in it and a bucket underneath to catch her bodily wastes. The misery she must have endured is hard to contemplate.

A Confining Chair

A Confining Chair

Circular Describing the Four Month Term at Yale Medical Institution

Circular Describing the Four Month Term at Yale Medical Institution

Modern readers might wonder how Mr. Sewall could possibly treat his own daughter this way.  Part of the reason might be that he could think of little else to do to keep her safe. And, doctors and other specialists often believed that people who had “lost their minds” had reverted to an animal state. Many people assumed that the mentally ill didn’t need the comforts that a human with an intact mind needed or wanted. Thus, it didn’t seem particularly cruel to keep a lunatic chained in a barn or outbuilding–just like one of a farm’s other animals. Unfortunately, it seemed that people often treated lunatics much worse than they would have treated any animal.

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