Many Physicians Believed Insanity Stemmed from Physical Causes

Some of the new ideas about insanity and ways to prevent it helped doctors believe in cures after a long period in which they had resigned themselves to believing that most insanity was chronic. An article from the November 12, 1922 edition of The Washington Post quoted Dr. Toulouse, a renowned French alienist, who had founded the League for Mental Hygiene and Prophylaxis. He believed that “half the occupants of the world’s insane asylums are not mad, but diseased.” Like most other alienists, Toulouse also believed that early intervention was critical; he set up a clinic where people could go when they felt their “nerves giving way.”

Toulouse believed the three great causes of insanity were sorrow, thyroid deficiency, and vice. Patients at his clinic would be questioned at length so that Toulouse could arrive at a life history for the individual. A physical exam would then determine whether they “were born with an excess of thyroid matter” or whether they had become addicts to vice–including drugs. Though all three (main) causes of insanity could be cured, Toulouse felt that madness caused by sorrow was the most difficult to resolve successfully.

Sorrow caused by bereavement or crosses in love could be healed after time, but sorrow caused by loss of money was the hardest to cure. “Practically the only sedative for a person who has once been wealthy and who finds himself suddenly poverty-stricken is to provide him again with wealth,” said Toulouse. This was obviously an impractical course of treatment.

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Dr. Isaac Ray, courtesy National Institutes of Health

The nineteenth century saw many medical breakthroughs (see last post), and the public and doctors alike began to think that science could solve all human ailments. Doctors saw that better sanitation and hygiene during the Civil War helped prevent disease,and alienists began to hope that the same strides could be achieved through mental hygiene. Dr. Isaac Ray, a very powerful and prominent insane asylum superintendent, defined mental hygiene (in part) as “preserving the mind against all incidents and influences calculated to deteriorate its qualities.”

Isaac and others involved in the mental hygiene movement believed that if people could live in a situation and atmosphere that promoted mental health, they would either not fall ill in the first place, or the symptoms might not be as severe. Stress, urbanization, poverty, and industrialization were considered major players in undermining mental health, and these mental health hygienists emphasized the importance of proper rest, diet, exercise, education, self-discipline, and proper surroundings to promote mental health. (The latter is one reason that asylums were built to be magnificent and beautiful.) Though almost everyone could see benefits to these important elements of living, not all alienists agreed that they would prevent or resolve mental problems. Some thought that all mental illness sprang from biological, rather than social, causes. Early hygienists did not institute scientific studies or use methodologies that could support their beliefs, so mental hygiene remained only on the fringes of medicine for decades.

The Principles of Mental Hygiene Had Wide Acceptance, courtesy Johns Hopkins Public Health Magazine

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Lister's New Disinfectant Method in Use

Important medical breakthroughs occurred during the 1800s. Especially important was the idea that disinfectants could help prevent the spread of disease in hospitals. Joseph Lister used carbolic acid to clean wounds and surgical instruments in hospitals, which brought deaths from infection down from 60% to about 4%. Many doctors scoffed at his ideas, but his success forced them to adopt his methods. Just a few years later, Louis Pasteur and Robert Koch developed the germ theory of disease. This was also revolutionary, since many doctors until then had no idea whatsoever about the mechanism of disease. Some thought illness generated spontaneously, while others thought the atmosphere could contain the elements of ill health or that certain personalities and physical attributes predisposed people to certain diseases.

In 1879, researchers developed a vaccine for cholera. Before the turn of the century, vaccines were developed for anthrax, rabies, tetanus, diphtheria, typhoid, and plague. It must have seemed that science had conquered–or would soon conquer–all the ills of mankind. It was a hopeful time, which led both medical doctors and alienists (specialists in treating diseases of the mind) to believe that few conditions were beyond treatment and cure.

Joseph Lister

Robert Koch, courtesy National Library of Medicine

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Cato Sells, Commissioner of Indian Affairs in 1921

Admissions to the Canton Asylum for Insane Indians were routed through reservation Indian agents (later superintendents), who performed much of the administrative and supervisory functions concerned with running these population centers. The asylum usually had several dozen applications on file, and tried to fill vacancies with patients who had been waiting the longest. Sometimes urgent or acute cases took precedence, but there were always more applications than room at the asylum. Dr. Harry Hummer was often accused of poor record-keeping, but he was apparently required to take a “census” of patients at the end of each fiscal year (June 30). Not all of these survive, but those that do at least give a snapshot of the asylum population. In 1921:

There were 45 male and 45 female patients. Since opening, there had been 146 male and 114 female patients, so the patient population tended to skew male.

There were 28 tribes represented. Since opening, 50 tribes were represented. The greatest numbers of patients came from the Chippewa, Menominee, and Sioux, with the latter being highest. This undoubtedly resulted because the asylum was located near Sioux reservations; studies had always shown that asylums served more people in close geographic range than farther out. States that tried to locate asylums centrally to be fair to an entire region were frustrated in these attempts because of this natural pattern.

Since opening, 62 patients had died of respiratory diseases, mainly tuberculosis (45) and croupous pneumonia (9). From 1903 to 1921, 115 patients had died.

TB Sanitorium Buildings, Phoenix Indian School circa 1890 to 1910, courtesy National Archives

Alaskan TB Patients, courtesy Indian Health Service

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Music Was Popular with Patients

Though Dr. Harry Hummer failed in many important areas when it came to providing care to his patients, he did try to provide occupations for the patients who wanted to be active. Some letters from patients to the Commissioner of Indian Affairs speak of being grateful for chores because being busy helped pass the time. Some also make reference to trips to town in the asylum automobile, going to the movies, and other pleasurable experiences.

In an inspector’s report from 1916, the asylum obviously had outdoor amusements. Other visitors often spoke of seeing patients strolling on the lawns or sitting in chairs when the weather was pleasant. However, the inspector also noted: “Calisthentics,[sic] breathing exercises, and marching are provided for such patients as are able to receive physical training. The play-ground equipment consists of outfits for baseball, basket ball, quoits, tennis, and one giant stride, six swings, one portable see-saw, one teeter tennis and a sixteen pound shot, all of which are popular especially the swings and shot. The play-ground exercises are supervised by the attendants.”

One of the primary pictures of the Canton Asylum for Insane Indians shows some swings in the foreground.

Trolley to an Asylum

Patients Putting on a Play, Long Island State Hospital

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Male Ward at Athens Lunatic Asylum, courtesy Ohio University Libraries University Archives

There are only two or three pictures available of the Canton Asylum; since they are only of the outside, it’s difficult to get a good idea about the physical layout of the rooms or what it might have been like to live there. In 1910, there were eighteen buildings associated with the asylum. These included barns, sheds, granaries, and similar structures. The main building was two stories high, with jasper granite stone foundations. Underneath, a basement ran underneath the entire building. The basement was divided into several compartments by brick partition walls. The first and second stories had eleven foot ceilings, which should have made the inside look spacious.

The main building held four wards. Two were on the first and second floor of the east wing (males) and two on the first and second floor of the west wing (females). Each ward had an attendant’s room, plus three private rooms where patients could be secluded if necessary. The superintendent (Dr. Harry Hummer) and eighteen employees lived in the main building, though Dr. Hummer eventually got a detached cottage for his family. The asylum had electricity which came from a small electric plant about two miles away. The facility was heated via radiators and used hard well water, along with rainwater collected in two cisterns.

Physician's Bedroom at One of Willard Insane Asylum's Buildings (The Branch)

Cisterns Held Precious Rainwater Runoff

A nicely maintained lawn surrounded the building, and patients often sat outside during nice weather. Inside, the building was often stuffy and smelly. The hard water made it difficult to launder clothing and sheets and keep them really clean, and eventually the entire facility began to look shabby and rundown.

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usan La Flesche Picotte, courtesy Smithsonian Institution

Susan La Flesche Picotte was born in 1865 to the last recognized chief of the Omaha Indian tribe, Chief Joseph La Flesche (Iron Eye). She went to the Elizabeth Institute for Young Ladies in New Jersey and then returned to her reservation to teach at a Quaker school. She became interested in medicine and returned east to attend the Hampton Institute, and later, the Women’s Medical College of Pennsylvania. She graduated at the top of her class in 1889 and became the first Native American woman to receive a medical degree.

After an internship in Philadelphia, Picotte returned to her reservation where she provided health care at its boarding school. She was the only doctor on the reservation and served more than 1,000 people; she resigned in 1893 due to her own poor health. She married Henry Picotte in 1894 and moved to Bancroft, Nebraska, where she set up a private practice. Picotte was passionate about improving the health of Native Americans. She taught them ways to improve health, lobbied to prohibit alcohol on reservations, and eventually built a privately-funded hospital on the Omaha Reservation at Walthill, Nebraska. She died two years later at only fifty years of age.

Picotte's Father, Joseph La Flesche (Iron Eye)

Picotte's Hospital

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Boys Working at an Indian Boarding School, location unknown, courtesy Minnesota Historical Society

The Indian Office liked to hire Native Americans who had been educated in its boarding school system, figuring that graduates would be more familiar with white American culture than people who had stayed on reservations. Unfortunately, many boarding school educations prepared students for entry level work rather than supervisory positions. Students frequently spent half their school day in manual labor rather than academics, and then worked as servants in white homes during vacations.

Charles Eastman (1858-1939) was an exception to this typical educational path. He attended mission schools and later Beloit (a private college), before graduating from Dartmouth in 1887. He then attended Boston University, graduated in 1889, and became the first Native American with a certified European-type medical degree. Eastman worked in the Indian Health Service within the Bureau of Indian Affairs (known at that time as the Indian Office) and was able to minister to Native Americans casualties at Wounded Knee.

Charles Eastman, 1897, courtesy Smithsonian Institution

Charles Eastman, 1913, courtesy Smithsonian Institution

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Pueblo Indians Working in the Indian Service School, Taos, New Mexico, courtesy Library of Congress

When Dr. Harry Hummer found himself understaffed as a result of the manpower shortage created by WWI, he asked the Indian Office to approve higher wages to help him fill positions. (See last post.) Otherwise, he would have to look at hiring Indian workers. For him, Indian staff was a last resort; for the Indian Service, hiring Native American workers was becoming much more commonplace. One of the most important reasons for hiring Native Americans was the hope that it would make the process of assimilation (submerging Indians into white culture as a way of “killing the Indian” without actual bloodshed) quicker and easier. Indians’ employment within the Indian Service itself seemed a perfect way to give Native Americans a stake in white culture and for them to serve as role models for others on their reservations.

Before the Civil War, not many positions were filled by Native Americans, but the government pushed employment for them after the war. Employment within the Indian Service’s education department went from 15 percent in 1888 to 45 percent in 1899. By 1912, Native American employees made up nearly 30 percent of all regular employees in the Indian Service, not just in its education department. (There aren’t statistics that break down employment in every job category for this period.) Teachers were still mainly white, but the number of Native American teachers had risen from 0 in 1888 to 50 in 1905.

Yakama Indian Employees and School Children, Fort Simcoe, Washington, circa 1888, courtesy Library of Congress

Hospital Staff, Tulalip Indian School, circa 1910, courtesy University of Washington Libraries, Special Collection Division

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Everyone Helped the War Effort, courtesy baylor.edu

The Bureau of Indian Affair’s efforts to provide health care to Indians was always hit or miss (see last post). One of the obstacles to providing quality–and timely–care resulted from the vast expanses of land out West. Reservation lands could include acreage that rivaled that of some states, but often only one or two doctors were assigned to cover these huge areas. Even if the Indian population had been in comparatively superb health, doctors’ travel time would have prevented them from seeing many patients. Officials knew that many Indians suffered from serious health problems, but didn’t have the personnel to minister to them effectively.

World War I created more problems. Physicians throughout the Indian Service bailed out to work instead for the U.S. Army or to work in the civilian sector; both venues usually meant better pay. The government concentrated most of its construction and supply effort on the army rather than civilian organizations, and there was little done in the way of new construction or even repairs, stateside. Even if the government had wanted to ramp up its efforts to build hospitals and clinics, or provide better health care, it faced the same manpower shortages affecting the rest of the country. Most young, healthy men were overseas or in war-critical positions stateside, and unavailable for more ordinary concerns. Dr. Harry Hummer had such a problem finding and keeping staff at the Canton Asylum for Insane Indians that he implored the Indian Office to raise wages so he could fill positions.

Base Hospital 21, Organized in One Week

Nurse Helen Grace McClelland, Who Served at Base #10 Hospital in France, courtesy University of Pennsylvania

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