Many patients at insane asylums had physical, as well as mental, health problems. Epilepsy was a particular problem for doctors, who could not even control the condition until bromides were introduced to calm symptoms. Aside from the usual causes of death like heart failure or exhaustion, patients sometimes died from suicide, or after a violent episode with attendants or fellow patients in which rough treatment could have been a contributing factor. One patient at Southwestern Lunatic Asylum in Virginia died from “swallowing pins, needles, and buttons, to which she was much addicted.” Another unusual cause of death, at Western North Carolina Insane Asylum, was from “gangrene of external genitals.”
The minutes of an 1892 meeting of Southwestern Asylum’s executive committee discussed the death of an inmate who had simply walked off the grounds one day in the middle of December. Staff searched for him unsuccessfully, and his body was discovered two weeks later, some distance from the asylum. He had doubtless died of exposure. Though they deplored the man’s death, the committee decided that they would rather allow patients a degree of freedom and risk such an incident, as deprive all of freedom on the off chance that someone else might escape in the future.