Tag Archives: St. Elizabeths

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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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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No Job Too Small

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Oscar S. Gifford

Superintendents felt strongly that only one person could be in charge of an asylum. They wanted no interference from boards of directors or trustees, or from the public, since they felt that no one but themselves really knew their business. Superintendents also disliked sharing power–patients and staff should have no doubt as to who was in charge. Superintendents often fought a running battle with outside forces who wanted to provide oversight or help them. Superintendents frequently got their way, but that meant they were also inundated with administrative tasks that ate up their time.

Oscar S. Gifford, the first superintendent of the Canton Asylum for Insane Indians, had to personally accept and receipt for $14 and $2, the property of patients Miguel Maxcy and Arch Wolf, respectively, when they were transferred from St. Elizabeths in January, 1903. He personally took patients to church at times, escorted new patients from their reservations to the asylum, and picked up escaped patients after they were caught and detained. He wrote annual reports, corresponded with the Indian Office, and reviewed employment applications among other duties. Despite his extremely small institution, small staff, and few patients, Gifford eventually ran into trouble because he could not manage to supervise any of them effectively.

Sample Asylum Report, courtesy University of North Carolina

Patients in St. Elizabeths

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Meals at Asylums

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Dr. Harvey Black

The quality of food at asylums ranged from the piece of bread and five prunes Nelly Bly received on Blackwell’s Island to the abundance of milk and eggs sickly patients received at St. Elizabeths. Many institutions made a point of offering enticing food to patients who had problems eating; one woman at Hilltop recounted the generous breakfast of oatmeal, bacon, scrambled eggs, toast, milk and juice, and the evening pot of chocolate brought to her by staff.

Physicians generally considered it positive when patients put on weight. Notes on a woman named Katie at the Southwestern Lunatic Asylum in Virginia said that she had “fattened up some.” Of another woman there, the physician wrote that she had “gained flesh and strength.” Of others, doctors noted that patients had “improved in flesh” or had “grown stout.” There never seemed to be any attempts to help patients lose weight, even if they were described as “quite stout.”

The superintendent at Southwestern Lunatic Asylum, Harvey Black, wrote in his first report that three things were necessary to help patients recover and go home: a sufficient quantity and variety of good food, neat, comfortable clothing, and a sufficient number of efficient ward attendants. He spoke of a planned orchard of 400 apple trees, peach and pear trees, grapes, and berries, and stated that even more than that was needed. If nourishing food did have curative powers, Black seemed to want to provide it.

Southwestern Lunatic Asylum

St. Elizabeths, N-building, courtesy Library of Congress

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Insane Asylum Graveyards

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Poughkeepsie, NY Lunatic Asylum

Large public insane asylums were built primarily for people who could not afford private care. Many families, relieved at finding a place for a difficult member, left him or her at an asylum for life. And death. Asylums had to set up cemeteries for patients whose bodies weren’t claimed by families, or who had entered as paupers.

St. Elizabeths in Washington, DC was unusual in that its patients were also military veterans. The institution served as a military hospital during the Civil War, and the grounds contain a separate Civil War cemetery for military patients who died while they were hospitalized. (This time period is when St. Elizabeths got its current name. Civil War soldiers were embarrassed to write home that they were staying at the Government Hospital for the Insane, so they referred to it as St. Elizabeths, the colonial name of the land on which the hospital was located.)

Philadelphia Insane Asylum, circa 1861, where "eighteen raving maniacs were burned to death" in February, 1885

St. Elizabeths Hospital Military Cemeteries

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