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.

Long Distance Oversight

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William A. Jones was Commissioner of Indian Affairs When the Canton Asylum Opened

Few people ever wanted to enter an insane asylum, no matter how well run or up-to-date it was. And, like all institutions run by fallible human beings, asylums were not immune to mistakes and misjudgments on the part of their staffs. One problem the Canton Asylum for Insane Indians faced that St. Elizabeths and McLean didn’t (see last few posts) came as direct consequence of its long-distance oversight.

The Canton Asylum for Insane Indians was not under a trustee or board of visitors system like the other two asylums, though it is certainly untrue that this establishment was never inspected or investigated. However, the asylum was managed for the most part from thousands of miles away. The asylum’s superintendent in Canton reported directly to the commissioner of Indian Affairs in Washington, DC, and the seven commissioners who held the position during the time the asylum was open very seldom, if ever, actually visited the place.

Agents or inspectors from the Indian Office did come by fairly regularly, but none of these men were psychiatrists. They found it difficult to determine how well the patients were being treated  for mental health issues, and usually confined themselves to commenting on the state of the buildings and how efficiently the superintendent ran his farming operation. Medical staff from the Indian Office eventually began visiting much more often as the asylum grew in size and came to the notice of the commissioner through complaints. Dr. Emil Krulish became a frequent visitor and made numerous criticisms that honed in on treatment and the way the superintendent, Dr. Harry Hummer, managed his personnel and patients. However, his voice was ignored and Hummer continued to thrive in his position.

House of Indian Agent Will Hayes, circa 1920-1940, courtesy Library of Congress

Home of Indian Agent William Shelton, circa 1910, courtesy Denver Public Library

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Overlooked

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A Typical Report from an Asylum's Board of Directors

McLean Asylum for the Insane and St. Elizabeths were two very different, yet for the most part, well-regulated insane asylums (see last two posts). And though they differed from each other in terms of funding and client base, they contrasted even more sharply with the Canton Asylum for Insane Indians. The Canton asylum was a government-funded asylum like St. Elizabeths, and both of these institutions focused on either indigent patients or those of moderate income. What really set the Canton asylum apart from McLean and St. Elizabeths, though, was the difference in oversight.

At McLean, trustees watched over the management of the asylum and a Visiting Committee “made it a point to see personally each patient in the asylum once a week, checking his name off a prepared list,” according to the editors of The Institutional Care of the Insane in the U.S.A. and Canada, published in 1916. This extraordinary degree of oversight took place well before 1900, when the facility had one nurse for every four patients. As the asylum grew, trustees could not keep to the same schedule, but they were still intensely involved with the asylum. Even at the turn of the twentieth century, trustees hired eminent architects for additional buildings, and doctors knew their patients and kept detailed histories on them.

The government hospital, St. Elizabeths, first fell under the scrutiny of a five-member board of charities, appointed by the President of the United States for terms of three years. Additionally, the President appointed a nine-member Board of Visitors. This board included representatives of the military and clergy, and many times included an acting or retired surgeon-general. In 1914, Brigadier General George M. Sternberg, a pioneer in battlefield wound treatment during the Civil War, was President of the Board, and the surgeon generals of the Navy and Army were also represented. The latter surgeon-general was William C. Gorgas, who had been responsible for wiping out yellow fever in Havana after Walter Reed’s discovery of the mosquito vector for it. Though St. Elizabeths had its share of detractors and investigations, that asylum and McLean were typically watched over by prominent locals who took their duties seriously and felt responsible for providing area patients with quality care.

In my next post, I will discuss oversight for the Canton Asylum for Insane Indians.

William C. Gorgas at the Time of the Panama Canal Construction, courtesy National Library of Medicine

General George M. Sternberg

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Another Contrast

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Jones Building, St. Elizabeths, circa 1910 to 1925, courtesy Library of Congress

It perhaps isn’t quite fair to compare a federal insane asylum like the Canton Asylum for Insane Indians with a private institution catering to the wealthy. (See last post about McLean Asylum for the Insane.) However, the government did have another insane asylum, and it was also quite different from the one at Canton. St. Elizabeths had a training school for nurses, quarantine rooms, and a full hospital where operations ranging from appendectomies to hysterectomies were performed. It was one of the first asylums in the country to appoint a pathologist to its staff, and one of the first to institute therapeutic hydrotherapy.

At about the time that the Canton asylum opened, Dr. William A. White arrived at St. Elizabeths. He created a clinical director position, and organized a scientific department which eventually included a pathologist, psychologist, histopathologist, and a number of assistants. The department published their research in the form of an annual bulletin. St. Elizabeths also trained surgeons from the Public Health Service and Marine Hospital Service to work on Ellis Island (helping discover insane immigrants). The hospital shared its research with the U.S. Army and Navy to help bring military psychiatry into their respective branches. The Canton Asylum for Insane Indians was much smaller than St. Elizabeths and perhaps couldn’t be expected to do the same things. However, its staff could have done much more research on mental health issues in a unique population than it did, and been much more involved with its peer organizations that it was. Instead, the asylum’s most significant staff member, Dr. Harry Hummer, allowed the facility to stagnate into a backwater institution that helped its patients very little.

Patient Room in Center Building, 1905, courtesy National Archives

Wrapped Patients at St. Elizabeths, courtesy National Archives

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Room for the Shell-Shocked

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Main Building, St. Elizabeths, circa 1910-1925, courtesy Library of Congress

In 1917, the National Committee for Mental Hygiene (see last post) canvased various hospitals to see where soldiers and sailors could be treated for mental conditions created by the war. They naturally turned to government facilities like veterans’ hospitals and the government’s two existing insane asylums. The larger of these latter facilities, St. Elizabeths, was already charged with the care of insane military members. Its superintendent, Dr. William White, submitted his thoughts on the matter to the Secretary of the Interior, saying that a large influx of insane patients would require a correspondingly large increase in facilities. The plan in place was to ask for statutory authority “to distribute the overflow from the present organization [St. Elizabeths] to the several State hospitals.” Using caution before commitment, White asked how many patients might be expected, and whether or not the Secretary wanted them housed in temporary or semi-permanent structures.

Dr. Harry Hummer, superintendent at the government’s other insane asylum, the Canton Asylum for Insane Indians, offered his own thoughts about the ability of St. Elizabeths to care for mentally unstable soldiers. He wrote to the commissioner of Indian Affairs: “It occurs to me that with the already overcrowded condition at St. Elizabeth’s Hospital, Washington, D. C., it will be impossible for the authorities of that institution to care for the rather sudden accession of cases of mental disease which the present war will necessarily entail. . . . . It is barely possible that the federal government will decide that each State shall care for its own insane. In that event it will be necessary for the State of South Dakota to care for its insane, either at the Asylum at Yankton or otherwise.”

Hummer asked the practical question concerning the number of patients  who might need care, and provided his own tentative calculations for the commissioner. Hummer estimated that 20-25 percent of South Dakota’s soldiers and sailors might become incapacitated during the war, and that of that number, ten percent would be mental cases. Therefore, he thought that one-fortieth of the men enlisted from the state would need to be cared for at one of its institutions.

Hummer added: “I am sorry that your Office decided that we should not build the proposed epileptic cottage, as this would have given us additional beds which might have been used for the purpose now in question.”

Insane Asylum at Yankton, South Dakota

Wounded British Soldiers in a Trench, courtesy Library of Congress

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Shell Shock

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A Shell Shocked Soldier is on the Left

Professionals and laypeople alike have probably always observed that war could affect those who went through it, both physically and mentally. After the Civil War, some people who tried to put their finger on what had changed with returning veterans, discussed the “soldier’s heart” phenomenon. This was a (usually) negative change they saw in their loved ones, which they were sure came from being in a war and exposed to combat. Observers primarily believed that physical changes in the heart were responsible for the changes they saw in the person, though they also believed that pining away for their homes during their period of service could bring on nostalgia-related mental symptoms. During WWI, “shell shock” was a descriptive term for the physical effects constant bombardment took on soldiers engaged in long bouts of trench warfare, but physicians also recognized a mental component that they termed “traumatic neurosis.”

WWI era medical professionals had enough information about war-related mental trauma (now called PTSD) that they anticipated its occurrence. In 1917, the National Committee for Mental Hygiene  formed a task group called “the committee on furnishing hospital units for nervous and mental disorders to the United States Government” which began to canvas likely facilities in which to house mentally ill soldiers. Veterans Hospitals were obvious sites, and the committee also contacted the superintendents of the government’s two insane asylums: St. Elizabeths in Washington, DC and the Canton Asylum for Insane Indians in South Dakota.

My next post will examine their responses.

Doctor Attempting to Cure Shell Shock Through Hypnosis

Private Read Was Buried By a Shell in 1917, Which Resulted in Constant Swaying and Nose Wiping

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More Hardship

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Volunteers at St. Elizabeths Hospital who Worked With Shell Shocked Vets, courtesy George Washington University

Dr. Hummer faced other difficulties associated with the war effort (see last post), particularly a troublesome personnel shortage. He told the commissioner of Indian Affairs that “it is extremely difficult to fill the existing vacancies and I am compelled to keep two or three employees who should be separated.” Since Hummer was typically just fine with a bare-bones staff, his situation at this point was dire; in August, 1918, he had only one male and one female attendant on staff (he should have had three of each). Hummer suggested an increase in pay as a possible solution to his problem, to $40/month with board and lodging for male attendants, and $35/month with board and lodging for females.

A project near and dear to Hummer’s heart also gave way to the war effort: the Indian Office denied his request for an epileptic cottage. This was partly because the asylum still had some vacancies and didn’t seem to need additional rooms. More importantly, as the assistant commissioner of Indian Affairs pointed out, the administration was already in the middle of a huge building program that “will of necessity withdraw carpenters from every section of the country.” Hummer may have been able to counter this with an offer by locals to help with construction, but even he could not argue with E. B. Meritt’s second consideration: there was a need for economy elsewhere in the expenditure of public funds “in order to more successfully prosecute the war.”

U.S. Troops Cross Moselle Into Germany, courtesy Notre Dame University

Classroom of American Red Cross Students, 1917 or 1918, courtesy Library of Congress

Hummer had perhaps anticipated this emphasis on war concerns when he made the following suggestion: “It is possible that the present war will necessitate the construction of another building at this place to care for the insane Indian soldiers or sailors, provided your Office deems this proper.” One way or another, the superintendent wanted additional buildings and patients.

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Doctors and Nurses

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Oregon State Insane Asylum, circa 1905, courtesy Mental Health Association of Portland

Doctors at insane asylums were recognized authorities in their fields, and most believed they should have total control of their institutions. They expected the utmost deference from staff, including their nurses. Dr. Harry Hummer had many problems with his staff, not only because of his egocentric personality, but also because of his own background and training. He had come from a large institution whose staff interaction was patterned after the etiquette and tradition of the military; he also had servants and “colored” help to whom he could speak as he wished. When he got to the more independent-minded West, his staff resented his high-handedness and bad temper. Some were terrified of Hummer, but others actively spoke against him.

When discontent at the Canton Asylum for Insane Indians prompted a thorough inspection, supervisor Charles L. Davis discussed the reasons behind some of Hummer’s problems. “He is fully imbued, as are many others who have never been east [Davis’ error] of the Allegeheny [sic] mountains, that the people of the central west are an uncouth,- ill-mannered and ignorant class.” With this attitude at the ready, Hummer could not help but rub his staff the wrong way.

Davis continued, “He has also evidently been accustomed to speaking to the help about his home and possibly in the hospital where he has served in the manner of master to servant, and has maintained a similar matter of address toward his employees.”

Not much in Hummer’s background and personality boded well for harmony within the Canton Asylum for Insane Indians.

Popular Depiction of Nursing Care at Insane Asylums

Nurses' Uniforms Emphasized Appearance Over Functionality

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And More Statistics

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Menominee Indian Family, 1931

The government always liked to gather statistics (see last post), and Dr. Hummer was forced to complete many reports for the Commissioner of Indian Affairs. A report from June 30, 1924 gives a good snapshot of the institution. There were 50 males and 47 females from 31 different tribes; six patients were of unknown tribal affiliation. At the time of the report, the Sioux and Chippewa tribes were disproportionally represented; 19 patients were Sioux, and 14 were Chippewa. Statistics since opening told the same story: 68 Sioux had been admitted since 1902, 40 Chippewa, and 20 Menominee.

Though Hummer continually advocated for an epileptic cottage, epilepsy did not seem to be his biggest problem. Before the asylum closed, an independent doctor from St. Elizabeths noted that Hummer had lumped patients with any kind of convulsions into “epileptic” status, even though they were not truly epileptic. What Hummer really needed were good protocols and staff to care for lung issues. By 1924, the asylum had had 143 deaths. Fifty-one of them were from tuberculosis, and another 17 from some type of pneumonia. Only 14 patients had died of epileptic convulsions, with another four dying from exhaustion following convulsions.

Chippewa Indians in Ceremonial Dress, courtesy University of Minnesota, Duluth

Calvin Coolidge Meets with Sioux Indians from Rosebud Reservation on Lawn of White House, 1925

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Hiawatha Asylum

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Canton Asylum for Insane Indians

One institution that Canton’s “boosters” hoped would put the town on the map was the Canton Asylum for Insane Indians, which was usually called Hiawatha or Hiawatha Asylum by locals. Large asylums for the mentally ill were still the norm across the country, and Hiawatha’s unique patient population seemed to promise renown. Alienists (mental health experts) tended to be very forceful and positive about their field of study, and were eager to add to their knowledge. Town leaders hoped that specialists would come to Canton to study the Indians there, or even conduct their own research.

The facility was smaller than most asylums, but still impressive. It was shaped like a cross, 184 feet long and 144 feet wide, with jasper granite foundations. The outside was of pressed brick with white stone trim on the windows and doors, and inside, a cement-floored basement ran across the entire floorprint. The building had over 100 light fixtures, as well as radiator heat and a modern sewage system. There were also tiled bathrooms and water closets which used range toilets. (This was a unified system which shared a common pipe–toilets flushed at intervals rather than after each use.) Hundreds of trees and bushes were planted on the facility’s acreage, and except for the seven-foot fence around the grounds, nothing indicated that it was a type of prison. Especially for a rural area, Canton’s asylum was a noteworthy structure.

One of the primary reasons the town fought the asylum’s closing was because of the blow it meant to Canton’s economy. During the Depression, the asylum was a reliable source of jobs, and could pay real money for the goods and services it procured. Except for a few local asylum opponents, no one wanted to see the institution shut down.

Center Building, St. Elizabeths, Another Government Insane Asylum

Colorado Insane Asylum, circa 1890

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Later Incompetence

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Dr. Harry Hummer

Dr. Harry Hummer, the second (and last) superintendent of the Canton Asylum for Insane Indians, created most of his own problems. He was a well-trained psychiatrist who had worked at the large government insane asylum, St. Elizabeths. Hummer took over a fairly new facility, but chose to concentrate his attention on administrative details and running the asylum’s farm rather than on his patients. He sought to keep expenses down by not filling the assistant superintendent’s position, thus making himself the only medical person on staff until nurses were assigned to the facility many years later.

Hummer had no excuse for the way patients were mismanaged. He was thoroughly capable of devising therapeutic plans for his patients, but never did. He kept many of the amusements Gifford had initiated and even built on them to a point, but discontinued other occupational-therapy types of activity, like beadwork.

Laundry Room, Northern Michagan Asylum for the Insane

Hummer was also responsible for his own overcrowding. Though he undoubtedly felt pressure to take in as many patients as possible, no one at the Indian Office was likely to have overruled him if he had put up a fight to keep his patient numbers down. Even though the Commissioner of Indian Affairs technically had the sole power to commit or release patients, commissioners nearly always bowed to Hummer’s recommendations.  Hummer continually complained about overcrowding, but used it as a reason to expand his facility. Hummer always had fewer than 100 patients, far less than the caseloads of other superintendents at other facilities. Yet, he quickly abandoned even the most rudimentary psychiatric examinations and relied on unschooled attendants’ notes to keep him apprised of patients’ mental conditions.

Patients at Worcester State Hospital, courtesy Life Magazine

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