Category Archives: Buildings

Preparing for Idiots, Lunatics, and Insane Persons

Leave a reply
Commericial Hospital Began Ambulance Service in 1865, courtesy National Library of Medicine

Commercial Hospital Began Ambulance Service in 1865, courtesy National Library of Medicine

Ohio became a state in 1803 and quickly realized the need for an insane asylum; its initial institution was established as The Commercial Hospital and Lunatic Asylum of Ohio in Cincinnati. Built without delay, in January, 1824, the hospital’s trustees were able to put a notice in the Liberty Hall and Cincinnati Gazette: “. . . the undersigned trustees hereby give notice . . . that they are prepared to receive idiots, lunatics and insane persons.”

Though it was a gentle enough invitation, these unprotected guests of the state may not have enjoyed their stay. Built before reformer Dorothea Dix’s campaign to treat the mentally ill with kindness and understanding, the asylum was as much a prison as a place of healing.  In 1831, the state legislature even asked the question as to “whether the cells and apartments of the lunatic asylum are sufficiently separated from each other by thick walls to prevent the inmates from communicating with each other.” Was solitary confinement their goal?

Longview Asylum, 1860

Longview Asylum, 1860

Though stumbling a bit at inception, the hospital was the starting point for an orphan asylum, the city infirmary, the Cincinnati Hospital, and Longview Asylum. A description (from 1916) of patients’ rooms at Longview shows a dramatic upswing in comfort from what must have been dismal quarters at the original Commercial Hospital:

1910 Article Shows That Asylum Was Fallible

1910 Article Shows That Asylum Was Fallible

“The walls are covered with photographs of the best pictures of the world . . . . Everywhere throughout the house are inlaid tables and unusual pieces of fancy furniture, fancy needlework, flowers, singing birds, bric-a-brac, etc. which is seldom roughly handled or destroyed by patients. In each ward is a tastily furnished cozy corner, fitted up with book shelves, easy chairs, etc., where patients who will not abuse the privilege are allowed.”

 

 

 

A Room of One’s Own

Leave a reply
Blockley Alsmhouse

Blockley Alsmhouse

Few patients in mental institutions were so out of touch with reality that their surroundings made no difference to them. One of the pillars of early psychiatric theory was that a patient’s environment did, indeed, made a great deal of difference. This is a particular reason alienists recommended bringing patients out of their old home environments and into the insane asylum’s new one. The implication, of course, was that the asylum’s was better. Most planners did strive to provide stately, serene buildings within a pastoral country setting. The reality did not always match their hopes.

The October, 1876 issue of the American Journal of Insanity included an article by Dr. John Bucknill, “Notes on Asylums for the Insane in America.” In it, Dr. Bucknill pointed out some glaring deficiencies within Philadelphia and New York asylums.

Dr. John Bucknill

Dr. John Bucknill

In Philadelphia, a collection of buildings called the Blockley Almshouses, included an insane asylum. The place was constructed to hold 500 patients, and instead held 1,130. Beds were strewn on any available floor space at night to accommodate the extra people, and consequently the air become humid and smelly. Dr. Bucknill noted that there was nowhere for patients to exercise.

The female ward was particularly shameful. In a space designed to accommodate 19 “excited patients” in single rooms, instead held 65 women. The rooms were only six feet by 10 feet to begin with, which was justified by their use to for manic or disturbed patients. Unfortunately, Dr. Bucknill wrote, “. . . these lodging rooms are occupied at night generally by two, and frequently by three persons, and all of them, as I was informed, were regularly put into strait-jackets to prevent mischief during the night.”

Woman Wearing a Strait Jacket in Bed, 1889

Woman Wearing a Strait Jacket in Bed, 1889

How anyone–staff, trustees, inspectors–could have seen this situation and expected patients to recover their sanity says a great deal about the people running it. Dr. Isaac Ray, in an 1873 paper read before the Social Science Association of Philadelphia, said of the conditions: “If homicide is not committed every night of the year, it is certainly not for lack of fitting occasion and opportunity.”

A Special Veterans Hospital

Leave a reply
An Early View of the Government Hospital for the Insane

An Early View of the Government Hospital for the Insane

Though Armistice Day (November 11) was renamed Veterans Day only in 1954, veterans with mental health issues did have a special facility to meet their needs quite early on. Though crusader Dorothea Dix had pushed unsuccessfully for federal funding to help pay for America’s (civilian) mentally ill, she and other supporters did manage to get approval for a hospital for the insane of the army, navy, and District of Columbia. On January 15, 1855, the Government Hospital for the Insane received its first patient, Thomas Sessford.

Dr. Charles Nichols was the facility’s first superintendent, and he helped design one of the campus’s earliest buildings, the Center Building. One interesting feature was that the wards used different species of wood for their interiors: the Beech Ward installed woodwork from beeches, and the Cherry and Poplar Wards installed their interior woodwork from like-named trees. The patients had lovely views of the Anacostia River and farmland, and the grounds had extensive trees, shrubs, and flowers to give it a rural feeling of peace.

St. Elizabeths, 1917, courtesy Library of Congress

St. Elizabeths, 1917, courtesy Library of Congress

Allison Building's Sleeping Porches, 1910, courtesy National Archives and Records Administration

Allison Building’s Sleeping Porches, 1910, courtesy National Archives and Records Administration

The Government Hospital for the Insane became known during the Civil War as St. Elizabeths. Sick soldiers quartered in the hospital were embarrassed to write home from an insane asylum and simply substituted the historic name of the land patent on which the hospital stood. The name was made official in 1916.

My next two posts will discuss early care at St. Elizabeths, and its Civil War operation.

 

 

 

Another Kind of Hell

Leave a reply
This Undated Postcard Shows the County Poorhouse Which Later Became the Strafford County Asylum

This Undated Postcard Shows the County Poorhouse Which Later Became the Strafford County Asylum

Most people would consider living in an insane asylum to be a sort of hell in and of itself, but when conditions in these institutions were unsanitary, unkind, or unsafe, life took on an especially hellish aspect. Though most asylums were–at least originally–built to be safe, they did not always stay that way and staff were not always as protective as they might have been. Disaster could result.

The Strafford County Asylum in New Hampshire came into being when the county decided to move its pauper insane from its poorhouse into a separate asylum where patients could be better accommodated. All went well for twenty years, until a personality clash of some kind occurred between superintendent Charles E. Demeritt and his assistant manager, William P. Driscoll. Demeritt gave up control of the asylum to Driscoll.

Though the building was not that old, almost all repairs and renovations had been made using pine. This wood had dried over the years and shrunk to the point that patients could see each other between the floors and cells. The windows had bars in them and the patients’ rooms were locked up at night.

Account of Asylum Fire

Account of Asylum Fire

On February 9, 1893 the night watchman saw a fire in the room of a patient named Mary La Fontaine.  Wilbur Chesley, the watchman, immediately ran into the building and awakened Driscoll, who began to unlock the patients’ doors. The building material was so combustible that Driscoll could only get to some of the first floor rooms before the building was engulfed in flames. He, his family, and only three patients escaped.The rest , some forty or forty-one, were burned alive.

Investigation showed inexcusable ineptness: dangerous conditions had been allowed to exist for years, and the watchman had not even known that a fire hose and fire buckets were available in the building. Even worse, the fire was so small–no bigger than a bushel basket–when Chesley and Driscoll had rushed to the patient’s room, that they could easily have extinguished it. Instead, Chesley ran for help and Driscoll began unlocking rooms. And finally, the matches which probably started the fire, had been given to the patient (who smoked) by Driscoll himself.

Another Dreadful Fire Had Previously Occurred January 7, 1881 at the Strafford County Almshouse

Another Dreadful Fire Had Previously Occurred January 7, 1881 at the Strafford County Almshouse

As a result of this disaster the state’s legislature abolished county asylums and placed the care of the insane under the state.

Could Anyone Be Cured Here?

Leave a reply
New York City Asylum for the Insane, Men, Ward's Island

New York City Asylum for the Insane, Men, Ward’s Island

Conditions for newly-arrived immigrants judged to be insane (see last post) were dismal. The emigrant hospital on Ward’s Island was completely inadequate, and it was discontinued after only a few years. New York’s insane population (immigrants included) continued to be housed on these islands, however, and even the most oblivious visitor must have seen that it would be nearly impossible to cure any patient under the conditions there.

“The overcrowding on Blackwell’s Island, even after 400 male patients had been transferred to Ward’s Island, was unbelievable,” says one writer (either a Dr. Parson or Dr. Rowe, who both contributed to a history of New York’s insane asylums). “Not less than 400 beds were made up nightly on the floor.”

Women Eating at Bellvue Hospital, Blackwell's Island, circa 1896, courtesy Museum of the City of New York. 93.1.1.4918

Women Eating at Bellevue Hospital, Blackwell’s Island, circa 1896, courtesy Museum of the City of New York. 93.1.1.4918

Ward’s Island sounds even worse. There were too few attendants, too little food and clothing, inadequate seating–and so few common necessities that patients often had to eat with their fingers. “Nights were hideous with noises and profanity,” the doctor continues. “Patients were locked in their rooms . . . straw-filled ticks, reeking and filthy, lay heaped about. Nurses were unknown and the attendants were coarse and inexperienced.”

The litany of failures went on and on. Of course, no one who could get a better job wanted to work there, and the city was forced to hire convicts as attendants. One can only imagine how these employees “managed” their patients. Finally, a new superintendent in charge worked energetically on the patients’ behalf, and conditions began to change.

Crowded Dining on Blackwell's Island, circa 1896, courtesy Viewing NYC.com

Crowded Dining on Blackwell’s Island, circa 1896, courtesy Viewing NYC.com

My final post on this topic will detail some of the new superintendent’s work.

Welcome to America

Leave a reply
View of New York's Emigrant Refuge and Hospital, Ward's Island, courtesy Arno Press and the New York Times, 1969 and Original circal early 1880s

View of New York’s Emigrant Refuge and Hospital, Ward’s Island, courtesy Arno Press and the New York Times, 1969. Original circa early 1880s

When immigrants processed through New York, some were inevitably sick–and some were judged to be insane. Both groups were sent to a hospital on Ward’s Island in New York until they either got well or five years went by. If the insane had not recovered by then, they were sent to the New York City Asylum on Blackwell’s Island.

The hospital on Ward’s Island was a nightmare. The ratio of nurses to patients was typically 1:30, and graduate physicians worked there–usually without pay–simply to gain experience. Obviously, they had little to no experience caring for the insane and only stayed for a short time anyway, thereby depriving patients of any continuity in care.

Inebriate Asylum, Ward's Island, 1869

Inebriate Asylum, Ward’s Island, 1869

The hospital was overcrowded despite occasional attempts to transfer insane patients elsewhere, such as to Randall’s Island and Hart’s Island. Randall’s Island first used an old inebriate hospital for the overflow (1875), but two years later had to use an unoccupied building and also lease an old barrack building from the Emigration Department. This latter building was extremely primitive, being without either individual rooms or “conveniences”. In all these places, cheapness reigned.

Pens at Ellis Island Registry Room. These People Have Passed the First Mental Inspection, courtesy Miriam and Ira Wallach Division of Art, Printing, and Photography Collection, New York Public Library

Pens at Ellis Island Registry Room. These People Have Passed the First Mental Inspection, courtesy Miriam and Ira Wallach Division of Art, Printing, and Photography Collection,1902 – 1913, New York Public Library

In my next post, I will discuss some of the conditions there and attempts to change them.

 

 

 

Work and Money

Leave a reply
Clarinda State Hospital Was Impressive

Clarinda State Hospital Was Impressive

Even new insane asylums–presumably built by the demands of a state’s constituents–often had money woes. For many institutions, funds were only provided every two years via legislative appropriations. This meant that they were built piecemeal, seemingly always a step or two behind the real needs of patients and their families. Clarinda State Hospital in Iowa is probably typical.

Iowa’s General Assembly passed an Act to establish the asylum in April, 1884 and the Iowa Grand Lodge of Masons laid the cornerstone in July. A central building and supervisor’s department were nearly finished by December, but it wasn’t until the 1886 session that money was appropriated to go further. The institution opened late that year and accepted its first patients: 222 males received from other asylums. As legislative sessions continued, the asylum received additional funds for building and continued to complete the design which had been planned for it. Finally, in 1897, the asylum stood as a complete entity.

Patients Working in Laundry Room at Fulton State Hospital circa 1910, courtesy Missouri Archives

Patients Working in Laundry Room at Fulton State Hospital circa 1910, courtesy Missouri Archives

As soon as patients arrived, they began working. They graded, sodded, planted, and farmed–hard work rather than the “light” therapeutic work that alienists sincerely believed helped patients occupy their time, divert their minds, and heal both mind and body. Besides the outdoor toil, patients helped a hired tailoress make all the clothing worn by patients (except for white dress shirts, hose, and hats). The asylum’s residents also made their own furniture and shoes, brooms, and mattresses under the supervision of professionals assisted by patients.

Patients Worked at Useful Tasks at Most Asylums, photo courtesy Buffalo Psychiatric Center

Patients Worked at Useful Tasks at Most Asylums, photo courtesy Buffalo Psychiatric Center

Though work did help patients–especially if they wanted to do it–the probability remains high that many patients were subtly coerced into labor they would not have done otherwise. For superintendents charges with controlling costs, the proximity of so much free labor was likely a temptation they didn’t always resist.

Central Lunatic Asylum

Leave a reply
Howard's Grove Hospital

Howard’s Grove Hospital

Virginia’s Central Lunatic Asylum was the country’s first asylum designated exclusively for the “colored insane.” The institution’s first report explained that the state of Virginia had established the asylum for “colored persons of unsound mind” on the grounds of Howard’s Grove near the city of Richmond.

Howard’s Grove Hospital–a former Confederate possession–had been taken over by the Freedman’s Bureau in 1865. The agency used it as a hospital for African-Americans in the area and also for any who wandered in from other places. The Freedman’s Bureau allowed insane patients to stay at the hospital, and in December 1869 the facility was organized as an asylum by order of the military governor of the state, General Canby. At that time, there were 24 males and 45 female patients.

Building for Chronically Ill Females at Central Lunatic Asylum

Building for Chronically Ill Females at Central Lunatic Asylum

Virginia took control of the asylum in 1870 and its governor appointed an 11-person court of directors to oversee it; they supported the superintendent’s request for more money to build additional wards in his first report of November 1870. By then, an additional 110 patients had been admitted (December 1869 – November 1870). Eighteen patients had been discharged, fifteen had died, several “idiots” had been sent to alms-houses while a few remained, and altogether 150 persons were in the asylum for treatment on November 1, 1870.

Shenandoah County Alms House, courtesy Shenandoah County Library Archives

Shenandoah County Alms House, courtesy Shenandoah County Library Archives

Records on many of the patients were incomplete, but besides “unknown” the two primary causes of admission were “religious excitement” and “congenital idiots and imbeciles.” The two primary forms of mental disease were “chronic mania” and “dementia” with “paroxysmal (temporary) insanity” running a close third.

Asylums Were Economical

Leave a reply
Exercise Yard at the Oregon State Insane Asylum, circa 1905, courtesy Mental Health Association of Portland

Exercise Yard at the Oregon State Insane Asylum, circa 1905, courtesy Mental Health Association of Portland

Besides the humanitarian reasons to create asylums–which included more success in curing insanity than any family attempts could hope to achieve–supporters could also point out solid savings for the states which funded them.

By the time asylums became popular for the care and treatment of insanity, states had accepted responsibility for citizens who had no means of support or who caused undesirable disruptions in society. Early on, many of the insane wound up in jails because they had no families or their families simply could not give them proper care. Violent cases, of course, were the most problematic for families to handle.

Willard Asylum Patients Working in the Sewing Room

Willard Asylum Patients Working in the Sewing Room

Asylums were able to hold costs down by using patient labor on a much wider scale than most city or county jails could. Many asylums grew their own food and made or manufactured necessities like clothes and shoes. Charities, clubs, and individuals were far more likely to provide amenities (newspapers and magazines, concerts, clothing, etc.) to asylums than to jails, and states generally could provide the insane better care at less expense in asylums than regional jails.

Central Lunatic Asylum

Central Lunatic Asylum

The Central Lunatic Asylum in Virginia had filled almost as soon as it opened, and after only four months of operation, its first Board of Directors pleaded for money to build additional wards so they could take in patients who had been turned away for lack of space. After making a case for more appropriations based on humanity and the higher quality of care found in asylums versus jails, the Board also said:

“Besides the plea of humanity, economy may be urged as a reason for granting the appropriation. It will cost less to support the colored insane at the Asylum than in the county jails, and the prospect of relieving the State of all expense in each case is increased by promptly affording the Patient the benefits of the Asylum.”

 

And All The Rest

Leave a reply
Female Patients Farming in the early 1900s

Female Patients Farming in the early 1900s

Care in private insane asylums could be quite nice (see last post), but quality care in public institutions usually went downhill once they became popular enough for the public’s demand to lead to overcrowding. Many superintendents held costs at bay by growing their own crops, making patients’ clothing, rearing livestock, and so on, with free patient labor. This labor was at first genuinely believed to be therapeutic, but as work shifted from “light” and enjoyable to strenuous and ongoing, these activities lost much of their therapeutic value. Some patients did note, however, that they appreciated work because it helped pass the time and made them tired enough to sleep.

Overcrowding at Philadelphia State Hospital, courtesy 1946 Department of Welfare Report

Overcrowding at Philadelphia State Hospital, courtesy 1946 Department of Welfare Report

Staff interaction is typically where overcrowding made the biggest impact, particularly with attendants. Staff became overwhelmed with their workloads and simply couldn’t provide the level of care that many patients needed. A paragraph in the March 28, 1900 issue of The Washington Post gives just a glimpse of this issue:

St. Elizabeths' Center Building, circa 1900, courtesy National Archives

St. Elizabeths’ Center Building, circa 1900, courtesy National Archives

“The conditions existing in the disturbed ward of the women’s department are especially deplorable . . . it is necessary to keep the most troublesome under constraint, but, owing to the fact that the accommodations in the sleeping rooms are now entirely inadequate and it is impossible to confine those who are most troublesome, it is necessary to use the straight [sic] jacket or the sleeved vest, binding the arms of the patient while he or she is mixed up with the others in the corridors of the wards. Their cries and piteous struggles make the other disturbed patients more and more uneasy, until all rest is impossible and the chances for cure there made more remote.”