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.

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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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Bon Appétit

Dr. William Whittington Herbert Force Feeding a Patient, 1894, courtesy Wellcome Images

Dr. William Whittington Herbert Force Feeding a Patient, 1894, courtesy Wellcome Images

Force was used far too often in U.S. insane asylums (see last post), but one of the worst acts of coercion had to be forced alimentation, or force-feeding. Some patients simply would not eat, either because they feared being poisoned, were too sick or stressed to have an appetite, or simply didn’t want to cooperate with attendants. Many superintendents did allow a certain amount of patient freedom in this area, but when they feared patients were going to actually hurt themselves by refusing to eat, they acted. Doctors had several ways to force food upon their patients.

— In cases of “great physical weakness,” they injected “nutritive substances” into the rectum

— One recommended practice was to force open the mouth, close the nostrils, and pour liquid food down the throat.

Tools That Could Be Used for Force Feeding

Tools That Could Be Used for Force Feeding

This practice was dangerous and resulted in more than one death by strangulation/drowning, and was terrifying for patients

— Another procedure involved securing the patient “so that resistance is impossible” and forcing his mouth open with screw wedge. The patient’s head would be thrown back and kept fixed in order to “introduce the gag, made of smooth wood”, which had a hole in the center. The doctor inserted a stomach-tube, and then liquid or semi-liquid food would be poured into the funnel shaped entrance of the tube to let it “readily pass into the stomach.”

— Finally, doctors could insert a tube through the nostril and down the throat into the stomach. In these cases, they could give the patient only very thin liquids.

Force Feeding a Suffragette in Prison, 1912

Force Feeding a Suffragette in Prison, 1912

Doctors often did try to simply persuade patients to eat, allow a patient to have a favorite attendant assist at meals, or just give in to little quirks patients insisted upon before they would eat. However, when they made the decision to force-feed, it was traumatic for patients. Even worse, some attendants force-fed patients as a punishment, or threatened them with it to make them behave.

 

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The Mechanical Treatment of Insanity

Kings County Lunatic Asylum in Flatbush, NY

Kings County Lunatic Asylum in Flatbush, NY

Dr. William Hammond (who was not a fan of insane asylums) was appalled at the widespread use of restraints in U.S. facilities, comparing these institutions unfavorably with those in England which had just about abandoned the practice. He wrote: “At present [1883] ignorant and brutal attendants, some of them selected from the very lowest class, can, at their option, from whim, caprice, anger, or any other inadequate cause, order or place a lunatic in the camisole, crib, or other mechanical restraint.”

Hammond did not necessarily argue that all restraints be abolished, but his suggestions followed the course that British alienists used when they began to eliminate restraints. For patients who always took off their clothes, for instance, attendants could use “strong dresses which were secured around the waist with a leathern belt, fastened by a small lock.” Patients who were violent toward themselves or others, could wear “a dress, of which the sleeves terminated in a stuffed glove without divisions for the fingers and thumb.

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

Athens Female Ward, 1893, courtesy Athens County Historical Society and Museum

One of Hammond’s suggestions to the state of New York, which asked his advice as it investigated the management of its insane asylums, was to keep the decision to use restraints out of the hands of attendants. Only the medical officer should decide to use mechanical means of control, and Hammond said that even with that safeguard in place, every order for restraint should be documented in a record book. That book, in turn, should be open to inspection.

Postcard of the Athens Lunatic Asylum

Postcard of the Athens Lunatic Asylum

The only two asylums in the U.S. which did not use restraints at all at the time of Hammond’s writing were the Kings County Asylum at Flatbush, Long Island and one in Athens, Ohio (Athens Asylum for the Insane) which he did not specifically name.

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The Need for Treatment

Professional Nurses Would Have Looked Reassuring

Professional Nurses Would Have Looked Reassuring

Before the advent of insane asylums, most families by necessity had to simply accommodate a person’s mental health problems as best they could, and then wait to see what the future held. Once asylums became both established and accepted, medical intervention became much more the norm. Though some doctors believed strongly that many patients might not benefit at all from a stay in an asylum (one said that forcible confinement in an institution “would tend strongly to cause the disease to pass into some more intense form”), most saw institutional care as far superior to home care.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Alienists had several reasons for feeling this way. Most believed that the home environment was almost always at least partly to blame for an individual’s problem. Either something was going on that directly fed the mental problem, or associations the patient couldn’t get away from wouldn’t allow recovery. Doctors believed that simply getting a patient away from the situation and into a calm environment that didn’t make demands on him, would go a long way toward nipping the problem in the bud. They also felt that patients’ families didn’t have the knowledge or skill to handle mental illnesses, and certainly couldn’t make instant judgments concerning medicine, restraints, and the like.

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Alienists, themselves, had four basic forms of treatment: mechanical, moral, hygienic, and medicinal. My next few posts will explore these types of treatment.

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An Old Standby Treatment

FLorence Nightingale Suffered from Crimean Fever, Taking to Her Bed at Age 38 But Not Dying Until 90

Florence Nightingale Suffered from Crimean Fever, Taking to Her Bed at Age 38 But Not Dying Until 90

Many of us refer casually to hypochondria as a condition in which a person thinks he’s ill when he’s not. Though the victim’s friends or family may see perfect health, the hypochondriac constantly fears or suffers feelings of illness. Hypochondria has afflicted people through the ages, but alienists in the twentieth century differentiated its degrees of seriousness.

The first stage of hypochondria was entirely mental: the person thought he was ill when he was not. The second stage began when he started to act ill and displayed symptoms consistent with the particular problem he believed he had. The third stage occurred when the person started to suffer from the actual condition; as one alienist noted, “Real disease, is, therefore, induced.”

Jacobus Schroeder van der Kolk

Jacobus Schroeder van der Kolk

Dr. William A. Hammond recalled a woman who believed she had suffered a disease of the tongue which caused it to fall off. Of course,the tongue was still there, but Hammond could not persuade her that it really was. Eventually, he decided to treat her with an aloetic purge, which he had seen recommended by a European alienist, Jacobus Schroeder van der Kolk. This purge consisted of a succotorine aloe (a medicinal aloe from Africa), castile soap, and a simple syrup, along with whatever else a doctor might choose to mix in. It was essentially a harmless concoction, but fell right in with the era’s belief that a good purge could do a world of good.

Aloe Succotrina

Aloe Succotrina

The purge dislodged “large quantities of hardened fecal matter” and restored the woman’s menstrual cycle, and within a month, “she was entirely free from all perceptional, intellectual, or emotional derangement,” said Hammond. To his credit, Hammond didn’t clash wills with the patient, but instead worked in a way that accommodated her illness and caused her the least harm.

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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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