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.

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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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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