Tag Archives: asylum superintendents

Part-Time Physicians

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Doctor with Horse and Buggy, 1894

Doctor with Horse and Buggy, 1894

Early physicians were prepared to handle a variety of medical cases, and rural practitioners often took on mental illness as well, if their territories were too far away from asylums for treatment. They had a difficult and uncertain occupation, however, that didn’t necessarily provide a good living. We may be used to seeing doctors earning comfortable salaries today, but that wasn’t always the case.

 

View of Taunton State Hospital, Interior

View of Taunton State Hospital, Interior

Rural doctors could not set extraordinarily high fees for their work or they wouldn’t have been able to find and keep patients. But, the time-consuming trips they made to see patients (during the age of house calls) prevented them from seeing many patients on any given day. Few patients, of course, meant meager salaries. Earnings were all too often along the lines of the doctor in 1849 who billed a patient $12 for services–but then deducted two dollars in exchange for two bushels of buckwheat.

Because it was so difficult to earn a living as a full-time physician, many doctors took on second jobs. During the early 1800s in Burke County, North Carolina, doctors held second jobs ranging from Superior Court clerk, to school teacher, to hotel operator, to farmer, in order to supplement their wages as physicians.

Doctor's Parlor, Willard Asylum for the Chronic Insane

Doctor’s Parlor, Willard Asylum for the Chronic Insane

It is no wonder that a position as an asylum superintendent would be so attractive to medical men, and so jealously guarded by physicians who were alienists. Because they could squeeze out competition, asylum superintendents enjoyed decent salaries and pleasant places to live. Though they didn’t own the homes or living areas they received on the asylum’s grounds, the buildings were grand and elegant (at least at first), and the grounds beautifully landscaped. Such a situation was much better than the salaries and living arrangements available to many other physicians outside the field.

Medical Attitudes

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Isaac Ray, Asylum Superintendent

Once asylum superintendents gained a measure of respect and prestige (see last post), they used their power to secure their positions within both the medical community and their own specialty. They wanted no meddling or advice from outsiders–especially non-medical outsiders–and fought against any kind of oversight that involved community laypeople. Boards comprised of leading citizens often oversaw the running of asylums, but many times they acted as rubber stamps for whatever the superintendent decided was best. Superintendents could accept a few suggestions, of course, but they particularly resented laypeople making any kind of staff appointments. They did not want to see superintendent or assistant superintendent positions filled through committees of laypeople or appointed by the state governor. Instead, these specialized alienists wanted to establish and maintain a closed circle of “members” who controlled all aspects of asylum management.

This attitude marked their whole approach to management. Besides being very involved with the architectural details and physical construction of the asylum (superintendents were often appointed well before an asylum opened), superintendents imposed their own treatment philosophy on their institutions. “One man, one rule” defined their medical attitude–they wanted all decisions to go through them. They were usually quick to dismiss suggestions from patients’ families, even though these people undoubtedly had valuable insights to offer. This top-down, “I’m the expert” attitude was firmly entrenched by the time the Canton Asylum for Insane Indians opened, and its patients were in a particularly poor position to have their voices accepted.

Asylum Plans

Kirkbride's Plan was Used for Many Asylums

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The Superiority of Superintendents

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Medical School Class Card

In the early 1800s, physicians were not particularly respected by the public. The educational requirements to become a doctor were minimal and no licensing was required; any ambitious young man could apprentice under a doctor for a couple of years or attend three or four semesters of lectures and then launch into his own practice. Few cures for disease existed, and many doctors knew no more about illness, its prevention, or its cure than an observant mother or wise and experienced grandmother. Medicines were another matter–many families relied on herbal and other natural preparations to ease symptoms of illness, but doctors could concoct and dispense stronger remedies full of alcohol or narcotics. Even with this patient incentive to visit a physician (or to request a house call), few doctors made a good living. Competition was fierce because of the lax requirements to enter the field, and many doctors found themselves sharing too few patients with far too many physicians.

When insane asylums were built, however, a few lucky physicians found a wonderful niche for their specialized medical interest. For alienists (doctors who made a special study of mental illness), managing an asylum was a secure, well-paying position with plenty of prestige and power. Rather than competing with any number of other physicians in a family practice, alienists were regarded everywhere as experts in their field and relied upon as such. Asylum superintendents enjoyed their authority and guarded it well. Besides protecting their own turf, they were united in opposing interference in their business from non-medical officials.

Doctor with Horse and Buggy, 1894

Insane Asylum with Some Members of Staff

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Pay Matters

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Clifford Beers

Superintendents considered their authority and standing important, but they also appreciated a well-paid job with a cash salary. In the latter part of the nineteenth century, a superintendent’s salary of (usually) a couple of thousand dollars a year was a tremendous step up from the several hundred that many other doctors made. Outside of cities, doctors often had to accept produce or other goods in lieu of cash, or continually dun patients for payment. As the head of an asylum, superintendents were comparatively well-off and secure.

Good salaries did not apply to attendants. Clifford Beers, who described his own mental illness and stay in an asylum (beginning in 1900) in A Mind That Found Itself, said that his institution employed “the meanest type of attendant–men willing to work for the paltry wage of eighteen dollars a month.”

Beers's Account of His Asylum Experience, courtesy Museum of Disability

Beers spoke of one good attendant who was very kind to him, but of others, said: “[they] did not strike me with their fists, but their unconscious lack of consideration…was torture. Another of the same sort cursed me with a degree of brutality which I prefer not to recall.” Another attendant cursed and spat on Beers when he did not promptly obey an order.

Beers graduated from Yale in 1897; this photo is from 1895 but includes students from 1896 and 1897.

Yale Class Photo, 1895.

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