Category Archives: St. Elizabeths Hospital

St. Elizabeths Hospital in Washington, DC was officially known as the Government Hospital for the Insane. It was founded by Dorothea Dix before the Civil War. It was turned into a hospital for the wounded during the Civil War. Soldiers didn’t want to write home from an insane asylum, so they used the name (St. Elizabeths) from the land grant on which the hospital served.

Suggested Changes From The Problem With Indian Administration

Patients Seated in Dining Room at Pennhurst, circa 1915, the Former Eastern Pennsylvania Institution for the Feeble Minded and Epileptic

Patients Seated in Dining Room at Pennhurst, circa 1915, the Former Eastern Pennsylvania Institution for the Feeble Minded and Epileptic

When The Problem With Indian Administration was delivered to the Secretary of the Interior by Lewis Meriam’s team (see last post), the report made many recommendations for the hundreds of schools, reservations, and hospitals the team had visited. These included increasing salaries of personnel who had direct contact with Indians (to attract better people to the Indian Service), more cubic feet per child at boarding schools, and adopting the standards established by the American College of Surgeons for accredited hospitals to all Indian Service hospitals.

The team recommended several specific improvements for the Canton Asylum for Insane Indians: Increase the personnel; put a graduate nurse in charge of each building with patients; provide additional laborers for the farm and dairy; segregate epileptics, children, and the tuberculous into three groups apart from the other patients; and improve equipment in the hospital, kitchen, and bakery. The team included a call for installing “a system of records conforming to accepted psychiatric practice in hospitals for the insane.”

Cottages 6 and 5, Epileptic Colony, Abilene, Texas

Cottages 6 and 5, Epileptic Colony, Abilene, Texas

Children's Dayroom at Byberry Mental Institution, circa 1938, courtesy Historical Society of Pennsylvania

Children’s Dayroom at Byberry,  Later the Philadelphia State Hospital,, circa 1938, courtesy Historical Society of Pennsylvania

Dr. Harry Hummer, superintendent at the Canton Asylum, did try many times to get a separate cottage for epileptic patients, but was never successful. However, a later inspector who was a psychiatrist–which no one on Meriam team had been–believed that most of the patients with convulsions were not even epileptic. Meriam’s team likely had to go by Dr. Hummer’s diagnoses, in which he had identified any patient with convulsions as epileptic.

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He Didn’t Even Try

Texas State Lunatic Asylum, circa 1861

Texas State Lunatic Asylum, circa 1861

By the end of what might be called the “asylum era,” most superintendents or administrators were buried under mountains of paperwork. Almost all public facilities were overcrowded and understaffed, which meant poor care and  more problems and incidents that needed the administrator’s attention than if they had been smaller and better manned. However, the situation at the Canton Asylum for Insane Indians was always somewhat different.

The asylum’s administrator, Dr. Harry Hummer, ran an extremely small facility. The organization of superintendents that developed standardized asylum care in the 1840s decided that 250 patients was the maximum that any good facility should contain. They later raised it to 500, which was still considered a manageable number. During the bulk of his time at the Canton Asylum, however, Dr. Hummer had well under 100 patients.

Canton Asylum for Insane Indians, courtesy Robert Bogdan Collection

Canton Asylum for Insane Indians, courtesy Robert Bogdan Collection

When Canton Asylum was inspected in 1933 by St. Elizabeths’ psychiatrist, Dr. Samuel Silk, he noted that Dr. Hummer could give him next to no information about most of his patients: “the patients’ behavior or other events which led to their admission. . . . Apparently Dr. Hummer did not consider such information necessary and he took no steps to obtain it.

“In the cases of various patients who were alleged to have assaulted others, Dr. Hummer knew nothing about the circumstances of such assault . . . . Many such patients have been in the institution six, eight or more years and for a number of years they have showed no abnormal behavior justifying their detention.”

Danvers State Hospital, circa 1893, Was Huge in Comparison to Canton Asylum

Danvers State Hospital, circa 1893, Was Huge in Comparison to Canton Asylum

Many of Canton Asylum’s patients would have been better off with a jail sentence for their behavior, since a sentence for assault would have come with a limit. At the asylum, Dr. Hummer’s indifference generally led to a life sentence unless some sort of outside intervention occurred.

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Social Interests

Railroad Depot in Canton, South Dakota

Railroad Depot in Canton, South Dakota

Throughout history, social ties have been important. Citizens in small towns certainly kept tabs on their neighbors, but even in large cities, prominent people were reported on in the “society pages.” Many small-town newspapers kept tabs on the comings and goings of the locals, and reported on visits from their relatives and friends. On September 30, 1910, the Sioux Valley News reported that:

— Ed L. Wendt took a trip up to Lake Preston Tuesday to attend to some business matters

— Col. Arthur Linn went to Hot Springs last Saturday to attend a meeting of the Soldiers’ Home board

Soldiers' Home in Hot Springs, South Dakota

Soldiers’ Home in Hot Springs, South Dakota

— Mrs. C. F. Neighbors came up from Sioux City Monday to spend a few days with her friend Miss Grace Hanson

— Miss Ethel McClanahan arrived in Canton a few days ago and has been a guest of Dr. Hummer and family at the Indian Asylum. Miss McClanahan was for a number of years chief nurse in St. Elizabeth’s hospital in Washington, D. C. . . .

Unidentified Asylum Nurses

Unidentified Asylum Nurses

McClanahan was working on a special case in the west at the time, and presumably stopped in to see Dr. Hummer on her way to  “visit friends further east” as the paper reported. Still, despite Dr. Hummer’s reputation for temper and haughtiness at the asylum, he could evidently be quite cordial to those he felt were his social or professional equals.

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A Case of Insanity

Dr. Isaac Ray, courtesy National Library of Medicine

Dr. Isaac Ray, courtesy National Library of Medicine

Alienists had many interesting theories about insanity and what caused it, and frequently had to explain their views to the public. Court cases involving an insanity defense could create heated debate on the topic, and an article in the October, 1866, issue of the American Journal of Insanity provided a platform for such a discussion.

The case involved Mary Harris, a citizen of the District of Columbia, who shot her former lover dead. She was acquitted and released because of her insanity at the time she committed the crime. Dr. Nichols, superintendent of the Government Hospital for the Insane (St. Elizabeths), testified to her insanity, but did not mean to imply that she was cured of it. There may have been no legal way to keep her confined, however, so she was “let loose upon the community” in the words of the article’s author, Dr. Isaac Ray.

A Gender-Based Cause of Insanity

A Gender-Based Cause of Insanity

Dr. Ray did not discuss the particulars of that case, but instead went on to discuss a “class” of similar cases, where women committed heinous crimes. Because of the “peculiar influence of those organs which play so large a part in the female economy,” said Ray, these criminal acts may have been prompted not so much by motive as by the woman’s physiology. Ray went on to say, “With woman it is but a step from extreme susceptibility to downright hysteria, and from that to overt insanity.” In his opinion, many women who committed crimes like murder (as revenge), had experienced “a strong moral shock and an irritable condition of the nervous system.” He asked, “Is it strange that a person thus situated, should become insane?” (In Harris’s case, he referenced her “uterine derangement.”)

Alice Mitchell Tried to Murder Freda Ward Due to the Exciting Cause of Thwarted Love and Jealousy; She Was Found Insane

Alice Mitchell Tried to Murder Freda Ward Due to the Exciting Cause of Thwarted Love and Jealousy; She Was Found Insane and Committed to the Tennessee State Insane Asylum

Though Ray’s views seem to be compassionate, they were bad news, indeed, for females accused of insanity who might come before him for assessment. Ray was too ready to believe that their gender made them susceptible to insanity, and that it took so little to push them over the edge.

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Inspection Details

In A Rake's Progress, Tom Rakewell Loses His Fortune to Drink, Gambling, and Women, and Ends Up in an Insane Asylum

In A Rake’s Progress, Tom Rakewell Loses His Fortune to Drink, Gambling, and Women, and Ends Up in an Insane Asylum

When insane asylums were inspected, nearly anything going on was fair game for examination. During St. Elizabeths’ 1906 investigation, Dr. Harry Hummer, who later became superintendent at the Canton Asylum for Insane Indians gave testimony concerning gambling at the asylum.

Hummer was asked if he had heard of any case where “cards were played for money by the attendants and patients.” Hummer replied that he had heard of cases, though he did not believe attendants had been present. A police officer had informed Hummer that there was a game going on in the asylum’s smoke room under the bakery; Hummer called in the two patients and threatened to revoke their parole privileges (free time without attendants) if they did not stop. They said they would, but apparently shifted their game to an outdoor area. Hummer again threatened to revoke their parole privileges, but they swore they would not gamble again and he let them continue with their relative freedom.

Hummer was then asked if he had ever played cards at St. Elizabeths. Hummer said he had, generally about 3:00 p.m. with two of the night watchmen and perhaps a patient or two. They played a game called pedro. When asked if he ever played seven-up, Hummer replied, “I don’t believe so, sir–not as severe a game as that.”

Pedro (pronounced peedro) actually seems to be the more complicated game; it is difficult to understand why Dr. Hummer pronounced seven-up a “severe” game. The rules to both games can be found on the internet.

Men Playing All Fours, Also Known as Seven Up, Civil War Era

Men Playing All Fours, Also Known as Seven Up, Civil War Era

Men Playing Seven Up at a Boarding House

Men Playing Seven Up at a Boarding House

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Inspection Results

State Lunatic Asylum in Lincoln, Nebraska

State Lunatic Asylum in Lincoln, Nebraska

The two federal institutions for the insane (St. Elizabeths and the Canton Asylum for Insane Indians) were investigated several times. In 1926, the comptroller general of the United States listed his findings concerning the investigation into St. Elizabeths. They included the following:

— The laws under which persons …are committed to the hospital are not adequate or sufficiently definite.

— There are too many patients in some of the wards, resulting in a crowded and unhealthy condition.

— Dining rooms, sitting rooms, toilets, baths, and other facilities of some of the wards are quite inadequate and most unsatisfactory.

— The fire hazard in certain wards is too great, and there does not appear to be sufficient fire fighting equipment.

— Several findings concerned the proper accounting of patients’ monies and valuables, including the need for a place to safeguard them.

Some of these 1926 findings were similar to those at Canton Asylum (overcrowding, inadequate facilities, and fire hazards). However, St. Elizabeths had 4,340 patients in June 1926, well over 50 times the number of patients at the Canton Asylum. The facility was not perfect, but by no means did it have 50 times the problems of its sister asylum. Undoubtedly St. Elizabeths’ leadership had something to do with its better performance.

Asylums were frequently inspected and investigated, and most had similar problems. Appropriations were generally set for a certain time period and included set numbers of personnel positions. Because funding wasn’t based on actual patient populations or patient to staff ratios, overcrowding could set off a cascade of problems. Facilities became inadequate and attendants became overburdened. In turn, stressed attendants probably lost patience or reacted less professionally with difficult patients. A new (and possibly sufficient) cycle of funding may have given an institution a chance to catch its figurative breath, but a new cycle of overcrowding was almost certain to begin shortly thereafter. As the public became more comfortable using insane asylums, their demands on these institutions created perpetual overcrowding. Insane asylums were often victims of their own success.

Overcrowding at Byberry (Philadelphia State Hospital) from a 1946 Department of Welfare Report

Overcrowding at Byberry (Philadelphia State Hospital) from a 1946 Department of Welfare Report

Patients Had to Sleep in Chairs at the Camarillo Mental Hospital

Patients Had to Sleep in Chairs at the Camarillo Mental Hospital, courtesy Camarillo State Hospital Historical Society

 

 

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Asylum Comparisons

St. Elizabeths Hospital for the Insane of the Army, Navy, and District of Columbia

St. Elizabeths Hospital for the Insane of the Army, Navy, and District of Columbia

St. Elizabeths and the Canton Asylum for Insane Indians were investigated a number of times during the early twentieth century. Both were federal insane asylums, but they were also quite different. St. Elizabeths was very much a medical facility, while the Canton Asylum was run along Indian boarding school lines. In 1927:

— St. Elizabeths had an amusement hall (Hitchcock Hall) for patients; Canton Asylum did not.

— St. Elizabeths had specialized buildings like cottages for tubercular patients and quarantine buildings; Canton Asylum did not.

St. Elizabeths had a 10,000 volume library and subscribed to 35 periodicals; in 1925 the Congressional Library began to send its surplus magazines to the asylum (about 1,000 a month); Canton Asylum received subscriptions to about half a dozen magazines.

St. Elizabeths had a furlough program which allowed patients to go home on trial visits; a social worker followed up on patients during these short visits; Canton Asylum actively discouraged furloughs for any reason. St. Elizabeths created an out-patient department for veterans who had been discharged from the military shortly after commitment. This department helped some patients find employment and tried to help them find a home so that they would not be overwhelmed when they were released. Canton Asylum did not help its patients this way.

A typical menu for a Tuesday midday meal at St. Elizabeths showed: bean soup, beef pot roast, gravy, browned potatoes, cucumbers, bread, oleo, and tapioca cream pudding. A menu for Canton Asylum (from the 1928 Meriam Report) showed: a stew of meat and carrots, with more fat and bones than anything else, thin apple sauce, bread, and coffee.

St. Elizabeths was significantly larger than the Canton Asylum, which gave it justification for some of its specialized facilities. However, its placement in Washington, DC and its patient population (veterans and citizens of the District of Columbia) also mattered. The American Red Cross, veterans’ groups, and the Knights of Columbus, as well as other civic organizations had easy access for volunteer work and aid of various kinds; the Canton Asylum had to depend on the kindness of small-town organizations like volunteer ministers and the Canton Band to help its patients.

However, both organizations had areas of weakness that investigations brought to light.

Dining Room at McLean Asylum for the Insane

Dining Room at McLean Asylum for the Insane

Bear Cubs at St. Elizabeths' Zoological Gardens

Bear Cubs at St. Elizabeths’ Zoological Gardens

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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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A Cost Analysis

Lincoln County Courthouse, circa 1902, located in Canton

Lincoln County Courthouse, circa 1902, located in Canton

Interested parties (mainly in South Dakota) wanted an asylum established exclusively for insane Indians, and tried to make a case for it. They met with a complete lack of support from the superintendent (William W. Godding) of the only other federal institution for the insane, St. Elizabeths. Godding pointed out that the costs to maintain the few insane Indians at St. Elizabeths was less than $3,000 a year, while the proposed asylum in South Dakota would cost $150,000 and need an annual expenditure of at least $25,000 to run it. (See last post.)

However, the Indian Office supported the idea of an asylum, and began to gather figures to show how badly it was needed. St. Elizabeths reported that it had seven Indians in care in 1897 (two had been there close to ten years) for a total cost of $9,506.50 for their entire time as patients. The acting Commissioner of Indian Affairs had no figures as to how many insane Indians might actually need a new asylum’s services, but thought that “an asylum that would accommodate fifty patients would be ample.”

Government Hospital for the Insane of the Army, Navy, and District of Columbia, known commonly as St. Elizabeths

Government Hospital for the Insane of the Army, Navy, and District of Columbia, known commonly as St. Elizabeths

When the Commissioner, William Jones, later canvassed the various reservations to ascertain the number of insane Indians on them, most had none. Of the reservation agents who responded, only 58 Indians were found to be insane, with 7 of that number already in asylums. Agents mentioned other Indians as being “idiotic,” but tellingly, not needing help. One agent said that “a few” on his reservation were slightly insane but not requiring restraint in an asylum. (His estimate is not included in the preceding figure.) Of the 51 potential patients actually on reservations, the agents felt only 34 might need asylum care.

Even if all 58 patients had been taken to St. Elizabeths at a cost of $91/quarter ($364 annually), the total annual cost would have been only slightly over $21,000 a year. That was still under the figure Dr. Godding suggested would be needed to run an asylum in South Dakota each year. Clearly, anyone who did the math could see that even with the added transportation costs to St. Elizabeths, a new asylum really wasn’t worth the money for the few patients that might make use of it. Even paying extra at local state asylums (to offset transporting patients to Washington, DC where St. Elizabeths was located) would have been cheaper.

Yet, the asylum was built, staffed, and infrastructure put in place to support it. A later inspector called the Canton Asylum for Insane Indians a “magnificent political gesture” that had done little good for the recipients it had promised to help.

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