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.

Escape From Reality

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Dr. Clouston's Book

Dr. Clouston’s Book

Though most patients in insane asylums could not escape physically (see last two posts), doctors may have inadvertently caused them to lose touch with reality by dosing them with opium and other narcotics. In The Actions of Neurotic Medicines in Insanity (1871), Dr. T. S., Clouston described experiments he conducted on patients using medicines like bromide of potassium, opium, cannabis Indica (a more sedative variety of the cannabis family), along with Scotch whiskey and beef tea as controls. He particularly wanted to see how these substances acted on patients who were in a “maniacal” or excited state. (Perhaps to his credit, Clouston performed the experiments on himself and his assistant, as well.)

Clouston found that none of the substances created a narcotic effect in excited subjects, though they did produce what he called a “natural sleep.” He later experimented on chronic patients, giving them increasing doses of opium over twelve weeks,. Higher dosages quieted their levels of excitement, though the effect did not last. Clouston took careful notes about his subjects, and eventually combined a tincture of cannabis and a dose of bromide, which worked very well in most of the patients. He had continued this treatment for eight months at the time he wrote.

Clouston seems to have been very careful with his patients, noting their temperature, pulse, weight gain or loss, and so on, and adjusting medicines accordingly. He tried to give patients enough medicine to calm their manic states, without unduly sedating them, and he stopped treatment whenever he saw that a patient could not tolerate it well. However, given the ease of administering these powerful drugs to patients, who can say how many doctors indiscriminately dosed patients for the convenience of their asylum’s staff? In a period when little was known about the background causes for psychological problems, keeping patients in a narcotic haze may have been the easiest–and most common–thing to do.

Opium Held High Interest in the 1800s

Opium Held High Interest in the 1800s

Tincture of Cannabis

Tincture of Cannabis

Children At Crownsville Hospital for the Negro Insane

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Crownsville Hospital for the Negro Insane

It seems incredible to think of very young children being committed to insane asylums, but this idea was accepted many years ago. Children with misunderstood conditions (autism, epilepsy, etc.) might exhibit symptoms which seemed to indicate insanity; their parents might then believe that an insane asylum could offer better care than they could. Continue reading →

Another Disadvantaged Group

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Crownsville State Hospital for the Negro Insane

The Native American patients at the Canton Asylum for Insane Indians were at a disadvantage compared to their white counterparts at other asylums; Native Americans had few rights and little voice in what authorities might choose to do to “help” them. Another group with a similar disadvantage was America’s African-American population.

The Crownsville Hospital for the Negro Insane in Maryland was constructed in 1910, and used as a warehouse for the mentally ill, criminally insane, the feeble-minded, epileptics, children, and others who exhibited troublesome behaviors in society. Patient labor was used to help build the facility, and patients were later used in the institution’s workforce to help keep costs under control.

Like many asylums, the one at Crownsville began on a high note of modern conveniences and a commitment to provide psychiatric care for its patients. Overcrowding quickly became a problem. Children slept two to a bed, adults on mattresses on the floor, and some patients lived in a windowless basement. Medical care became equally appalling. Doctors tested drugs on patients without their consent, and patient cadavers were sent to Baltimore for medical research without the consent of families.

The facility closed in 2004, with its future use still under consideration. In my next post, I will discuss the asylum’s juvenile patients.

African-American Patients Sleeping in Hallway at Crownsville Insane Asylum

Patients Learning to Sew as Part of Their Treatment

 

Children in Mental Institutions

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Rockland State Hospital, courtesy asylumprojects.org

Not many patients looked back on their stay at an asylum with any fondness. Unfortunately, horrific experiences were not limited to adults or to the ancient past. One person wrote about his childhood confinement in the Rockland County (NY) Mental Institution: Continue reading →

Psychiatric Care Was Seldom Enjoyable

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Missouri State Lunatic Asylum

Though the Canton Asylum for Insane Indians offered little psychiatric care for its patients, they may have been better off without much of what was offered to patients elsewhere over the years. One patient at the Missouri State Lunatic Asylum wrote in 1957–well past the time of Canton Asylum’s operation–about that institution’s “help” for mental patients:

“Patients were generally on [electroshock] treatment twice a week–two days for the women (Mondays and Thursdays) and two days for the men (Tuesdays and Fridays). Promptly at 7:30 treatment patients were rounded up by the cry, ‘Treatment patients git to the door.’ Begging, pleading, crying, and resisting, they were herded into the gymnasium and seated around the edge of the room.

Between them and the shock treatment table was a long row of screens. The table on the other side of the screen held as much terror for most of these patients as the electric chair in the penitentiaries did for criminals… In order to save time, one or more patients were called behind the screen to sit down and take off their shoes while the patient who had just preceded them was still on the table going through the convulsions that shake the body after the electric shock has knocked them unconscious.”

This patient quotation is taken from a history of the Missouri State Lunatic Asylum on the Missouri State Archives website.

Electroshock Therapy Required Several Staff to Administer

Early Electric Treatment for Psychological Effect, WWI era

 

Deficits in Care

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James McLaughlin

Inspectors regularly toured the Canton Asylum for Insane Indians, and generally found the buildings in order. Even non-medical men, however, could see early on that the institution wasn’t really fulfilling its purpose. A report by James McLaughlin in 1910 says: “The present facilities for care of the insane patients meet requirements as to baths, meals and sleeping accommodations, but for the proper treatment of those who might be benefited by some special course, there are no facilities.”

By this time, Dr. Turner had resigned from his duties at the asylum and his replacement, Dr. Hardin, had also resigned. Superintendent Dr. Harry Hummer was the only medical person on staff–the same situation Dr. Turner had been in under the asylum’s first superintendent. However, Dr. Hummer had to run the asylum as well as provide medical care, since the assistant superintendent’s position was never subsequently filled. Even though Dr. Turner’s attempts at psychiatric care had been modest at best, Dr. Hummer apparently let even these small efforts go by the wayside.

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

Psychiatric Patients in Steam Cabinets, circa 1910, courtesy American Psychiatric Association Archives

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Medical Attention at Canton Asylum

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Paralytic Dementia

At many asylums, medical attention was easier to give than psychiatric attention; the Canton Asylum for Insane Indians was no exception. In his 1906 report, the asylum’s physician, Dr. John Turner, describes both the mental and physical conditions of a few of his patients:

Turner describes a “raving” Bannock woman suffering from syphilitic dementia, who also had foul-smelling ulcers. “Under a course of treatment her ulcers all healed, she gained 19 pounds in weight, and became rational.”

A 65-year-old Pima man was admitted in 1903, with “arteria sclerosis, pulse weak and slow.” Turner said the man also had obstipation (obstructive constipation), anasarca (edema or water retention), and weighed 150 pounds. Turner added, “. .  . upon the occasion of his wife’s death, delusions and hallucinations appeared which rendered him dangerous to other persons. After I had relieved this man’s dropsy (the edema), by a combination of potass bitartras, potass et sodil tartras and digitalis, he weighed only 100 pounds and his mental condition was much improved. I then put him on cascara sagrada (a stimulant laxative and bowel cleanser) and nux vomica (a homeopathic medicine made from the seeds of the strychnine tree) and he now weighs 140 pounds, has no dropsy, and he is active and comfortable.”

It is telling that Dr. Turner usually found mental health improvement only after underlying physical problems were addressed. This raises the question as to how much of the mental illness Canton patients experienced was due simply to physical ailments.

A Woman With Dropsy, courtesy National Library of Medicine

Information About Cascara Sagrada

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Agency Report

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Chiefs of the Yankton Sioux With Their Indian Agents, courtesy W. H. Over Museum, University of S. Dak.

It is fascinating to read period reports from agents of the federal government (see last post) for insight into conditions and attitudes of the time. In a 1904 report to the commissioner of Indian Affairs, R. J. Taylor, United States Indian Agent, discusses his (S. Dak.) agency. He begins: “They [Indians] make little or no effort to improve insanitary home conditions or to better provide themselves with the healthful necessaries of life. The vice of idleness and the social customs of visiting, drinking, feasting, and dancing are most potent factors in their deterioration.”

Though these words are negative, the agent’s following words show more compassion than might have been expected: “Some room should be provided to care for the sick, especially so that infectious cases could be isolated and others saved needless suffering. The Indians could be saved much expense and needless suffering . . . in many cases if needed medicines were supplied [by] agency physicians. When medicine is needed nothing but the best should be supplied; nothing else would be tolerated for a moment by the whites when they need a doctor or medicines.”

Rosebud Indian Agency, courtesy South Dakota State Historical Society

Man in a Medical Supply Room at an Indian Boarding School, location unknown, circa 1900, courtesy Minnesota Historical Society

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Reports on Many Subjects

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St. Vincent's Institution for the Insane, near St. Louis, Mo., circa 1910

Many people involved with “Indian Affairs” made reports to the Commissioner of Indian Affairs, who then consolidated them into a report to the Secretary of the Interior. These people might be inspectors, superintendents of schools, reservation superintendents, Indian agents, and so on. Though my own research was largely confined to the Canton Asylum for Insane Indians, I found interesting material adjacent to the entries I actually needed to see. A 1907 report from the Indian Inspector for the Indian Territory provided this information:

The act of April 28, 1904 . . . provided that insane Indians should be sent to the Government asylum at Canton, S. Dak. In accordance with this act a contract was entered into with St. Vincent’s Institution for the Insane at St. Louis County, Mo., . . . providing for the care, maintenance, and support of insane persons from Indian Territory, not Indians, at the rate of $300 per annum, which includes all necessary medical attendance, nursing, treatment, medicines, clothing, washing, and board and care for the insane persons in a proper and humane manner.”

Per annum cost at the Canton Asylum for Insane Indians was $366 in 1907, and an extraordinary $394 in 1908. This may not seem like much today, but the overage was almost 20-25 percent higher than the government allowance for non-Indians at St. Vincent’s. In 1910, the average annual cost for the institutionalized insane throughout the country was $175–which makes the figures from Canton seem especially high. Dr. Hummer, Canton Asylum’s superintendent, knew his figures were high and struggled constantly to get them down.

Three Shoshone Women and A. Fred Caldwell, Superintendent of the Fort Hall Agency, courtesy Idaho State Historical Society

Indian Agent Heinlein Issues Blankets, Tents, and Clothing to the Paiutes in Exchange for their Land, courtesy Benton County Museum, Oregon

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Asylum Activities

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Yankton Indian Homes, courtesy Smithsonian Institution

When the Canton Asylum for Insane Indians had a small patient population, physical care was very likely good. The asylum’s physician, Dr. Turner, had as thorough a knowledge of general medicine as any other regional practitioner, and was enthusiastic about working in Canton’s unique facility. He gave patients standard medications (see last post) for their physical ailments, and both he and the asylum’s superintendent set up a system of mental health treatment similar to those in other asylums. Able-bodied patients worked in the gardens and took walks outside, while women more typically helped in the dining room and kitchen, cleaned floors, and went to classes which Turner referred to as “numbers” and “object lessons.”

The asylum’s report for these activities was dated August 29, 1903. A report from another South Dakota agency (Indian Training School, Yankton) made by James Staley that same year, indicates a number of health problems for residents there. Dr. O. M. Chapman, the agency physician begins: “The health of these people has been just about that of the average of former years.” Though he noted that contagious diseases were not a problem–except for a few cases of measles–he also stated that the number of people were declining since there had been 68 deaths and only 60 births. Forty percent of the deaths had been due to tuberculosis, which Chapman called “alarming.”

“The death rate was about 40 per 1,000,” Chapman says. “This is a death rate at least four times what it would be among an equal number of whites.”

Tuberculosis Sanitorium Buildings, Phoenix Indian School, courtesy National Institutes of Health

Group Picture at the Phoenix Indian School Tuberculosis Sanitorium Phoenix, AZ, circa 1890-1910, courtesy National Institutes of Health

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