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.

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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Early Madness

A Typical Way to Treat Lunatics, circa 1848

A Typical Way to Treat Lunatics, circa 1848

Early treatments for madness were as crude as those for physical ailments (see last two posts) and seldom involved physicians. Restraint would be a primary means of control. Households often chained a violent member or confined him or her in a strong building. No one gave much thought to the victim’s comfort, and reformers found many sad cases of men and women housed outdoors in winter without heat, proper shelter, or adequate clothing.

Thomas G. Hazard wrote in 1844 about the treatment of a lunatic named Abram Simmons in Rhode Island: “His prison was from six to eight feet square, built entirely of stone. . . the internal surface of the walls was covered with a thick frost, adhering to the stone in some places to the thickness of half an inch.”

Utica Crib, Another Notorious Restraining Device

Utica Crib, Another Notorious Restraining Device

The man’s bed was cloth sacking stuffed with straw. The flimsy cloth covering it was frozen stiff from the wall drippings, and the straw bed beneath it was wet through and through. The writer said the man lay in utter darkness (since the two iron doors to this dungeon didn’t admit light), and: “encased on every side by walls of frost, his garments constantly more or less wet, with only wet straw to lie upon, and a sheet of ice for his covering, has this most dreadfully abused man existed through the past inclement winter.”

Peabody Poorfarm, Kansas

Peabody Poor Farm, Kansas

The writer noted that the poor man constantly chattered: “Poor Tom’s a-cold!”

Public facilities like poor farms or jails could also house lunatics. In these, lunatics might at least find shelter and food.

 

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A Layman’s Doctorin’

A Book Any Layperson Could Reference

A Book Any Layperson Could Reference

Early settlers did not necessarily trust doctors (see last post) and were often able to circumvent seeing one by simply “reading up” on medicine, themselves. In this, they didn’t always lag so far behind a university-trained doctor, who may have only listened to a course of lectures before venturing into his profession. Several popular books were available to laypersons who wanted a reference to guide them; Every Man his own Doctor  or The Poor Planter’s Physician by Dr. John Tennent (American edition, 1734) was extremely popular.

Tennent began by condemning doctors’ high fees (whether they cured or killed the patient) and spoke of his great love for mankind as the reason for his publication. He launched into some of the commonest problems faced in the New World, such as “cough,” which he said was the foundation for many other “distempers” and therefore should be dealt with as quickly as possible.

James Gillray's 1801 Satiric Print of a Colonial Quack

James Gillray’s 1801 Satiric Print of a Colonial Quack

“It may be cured in the Beginning by riding moderately on Horseback every Day,” Tennent wrote. Additionally, the patient could take a little ground ivy tea sweetened with syrup of horehound at night before bed. If that did not effect a cure, the next measures followed the harsh cures of the time: “It will be proper to bleed Eight Ounces and be constant in the use of other Remedies.”

Woman Having the Vapours

Woman Having the Vapours

The “vapours” or “hysteric fits” should start with a stomach cleanse accomplished by dosing the patient with “Indian Physic” (a perennial herb called Bowman’s root, which induced vomiting.) Next, the (usually) female patient should have her bowels purged. Among other remedies, she was urged to not let the disappointments of the world weigh upon her, and to “be cheerful in Spite of a churlish Husband, or cloudy Weather.”

Tennent’s suggestions may not have cured every illness, but they were no worse than what any physician would have recommended.

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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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