Tag Archives: oversight for insane asylums

Useful Visitors

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Photos Showed What Words Could Not

Photos Showed What Words Could Not

Though many patients felt they didn’t get enough visitors, and others didn’t like being treated as entertainment for the thrill-seeking public (see last blog), certain visitors were supposed to help asylum patients. Most states set up a Lunacy Commission whose job it was to visit and inspect the state’s insane asylums. These appointed personnel were supposed to go through the facilities and ensure that patients were being treated humanely. They were also charged with reviewing the superintendent’s management and suggesting changes for the benefit of the institution; this oversight could include reviewing the asylum’s financial records and expenditures. The Government Hospital for the Insane, later St. Elizabeths, was an exception in that it was overseen by a Board of Visitors who performed much the same function.

Most asylums were not at all afraid or ashamed to have their finances reviewed. Many superintendents were proud of their fiscal management and also grateful for numerous charitable contributions such as newspaper subscriptions, special entertainments, gifts of furniture, and the like. They enjoyed showing off the productivity of their patients in terms of food raised, garments sewed, etc. However, superintendents realized that all patients did not present well, and usually took pains to ensure that visiting officials saw their institutions at their best. Most asylums kept the calmer, better-behaved patients in wards closer to the administrative offices. Recovering patients often moved from ward to ward as they got better, and eventually ended up in one of these more public wards. When visitors saw such patients, who were often nearly recovered or had minor illnesses to begin with, they were reassured. Any cruel treatment, confinement, and restraint generally occurred on wards which were not shown to the public. This is one reason that patient abuse could thrive despite the oversight built into the asylum system.

Montevue Asylum, African-American Ward

Montevue Asylum, African-American Ward

Montevue Asylum in Maryland, 1909, Photographed by the State's Lunacy Commission

Montevue Asylum in Maryland, 1909, Photographed by the State’s Lunacy Commission

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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