Tag Archives: Bryce Hospital

Asylums and Public Inspection

Staff at the Illinois Asylum for the Incurable Insane, 1903

Staff at the Illinois Asylum for the Incurable Insane, 1903

Public insane asylums and hospitals were monitored in part by committees whose members inspected the facilities and made recommendations for changes and improvements. These committee members were laypeople who took an interest in a particular institution and volunteered their time to visit and inspect it.

Sometimes outsiders get a different sense of a situation than people who are immersed in the field, and can be useful in pointing out conditions professionals have gotten used to seeing. However, asylum and hospital professionals were wary of these public “visitors” simply because they didn’t understand institutions and their limitations. In 1895, two physicians (Dr. John S. Billings and Dr. Henry M. Hurd) created a short pamphlet with suggestions for hospital visitors. They urged these laypeople to come “in a friendly spirit”–not to find fault or with preconceived notions, but with an open mind that sought to understand what was going on.

John Shaw Billings, circa 1896

John Shaw Billings, circa 1896

The authors explained that any visitor would find shortcomings. “No hospital, however wealthy it may be, has means sufficient to furnish the best known means of treatment and the best care to all who apply to it for relief,” they acknowledged. Few, if any, hospitals (or asylums) had all the medical equipment its doctors wanted, or served the best food, and so on. With these limitations in mind, the authors asked visitors to go through the institution with the idea that they could help its administrators improve its function.

Patients Playing Billiards at Bryce Hospital in Alabama, 1916

Patients Playing Billiards at Bryce Hospital in Alabama, 1916

Though Drs. Billings and Hurd may have begun their pamphlet sounding as though they wanted to protect medical institutions from hard scrutiny, they made it plain that visitors were to examine the place thoroughly. Some of the things visitors were to look out for will be mentioned in my next post.

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The Low Cost of Care

Norwich State Hospital for the Insane

Taxpayers today cry out against waste and unchecked expenses within the public health care system, and demand value for each health care dollar. It was the same a hundred years ago, and state insane asylums felt constant pressure to keep their expenses down. Care at that time was largely custodial, and patients eased their institution’s expenses somewhat by contributing labor in gardens, kitchens, and laundry rooms. Today’s strides in medical care and the curtailment of patient labor make comparisons between the eras difficult, but it is plain that life in an institution was never luxurious.

The average income a hundred years ago was $1,033. A gallon of gas cost seven cents, and a loaf of bread five cents; a medium-priced home was $2,750. The cost of living sounds great, but in 1912, Alabama insane asylums were confined to a per capita expenditure of $3.25 per week, or $169 per year. (In today’s dollars, that would be a little over $77 per week, or $4,004 per year.) That weekly $3.25 had to pay for food, clothing, entertainment, and medical treatment; wages for physicians, nurses, and attendants had to be covered; and utilities, equipment, tools, supplies, and repairs to the buildings also came from that sum.

The more patients in an asylum the lower the per capita costs. The Norwich State Hospital for the Insane in Connecticut began operations in 1905 with an average pf 77 patients and a weekly per capita cost of $6.58. By 1915, it had 1,109 patients and had dropped its weekly costs to $3.51. The Canton Asylum for Insane Indians, which held fewer than 100 patients, could not compete cost-effectively with larger institutions. Its superintendent faced the constant danger that Congress would decide to close the institution for financial reasons and disperse its patients to their respective state insane asylums.

Dairy Herd, State Lunatic Asylum No. 1, circa 1900, courtesy Missouri State Archives

Bryce Hospital for the Insane in Alabama

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