Category Archives: Medical Staff

Dangers for Patients

Columbus Asylum for the Insane

Asylum superintendents could be focal points of animosity from both patients and the public (see last two posts), but patients were really the ones who suffered most from violence. They were at the mercy of staff, and if their attendants were cruel or took a dislike to them, they were almost helpless.

A Boston Post article from November 12, 1878 entitled “FIENDISH CRUELTY” described a situation of systematic cruelty at the Columbus (Ohio) Asylum for the Insane that is hard to imagine. An investigation had discovered that for the past thirteen months, female patients had been victimized by a type of discipline called “ducking.”

When a patient wouldn’t immediately obey an order from her, an experienced attendant in the chronic insane ward named only as Mrs. Brown, would “rush the offending victim to the bath room, where she was stripped of her clothing and thrown into the water. The unfortunate patient’s head was forced under the water until the poor creature was nearly strangled, and then her head was raised for a moment that she might recover,” the paper reported.

Hydrotherapy Was a Well Established Method of Treatment for the Insane

The process was repeated until the victim was so exhausted and terrorized that she would promise to obey the attendant at all times. Mrs. Brown enlisted her fellow attendants to do likewise, and they ran the ward with an iron hand. The Boston Post reported that the patients were so afraid that “the slightest motion of the finger by an attendant met with abject obedience.” But the matter didn’t end there, the paper continued. “A compact was made with the attendants from other wards and a secret alliance formed . . . . The physicians were hoodwinked.”

Finally, one of the female attendants involved was discharged, and she suspected that Mrs. Brown was involved in the dismissal. The attendant brought all the abuse forward as charges against Mrs. Brown, and spurred an investigation. Evidence/testimony proved that at least ten female attendants had “ducked” patients this way.

Nurses From Northern Hospital for the Insane, 1890s, courtesy Oshkosh Public Museum

Though they were immediately discharged, who knows how many patients suffered at their hands before their actions were discovered? At the time of the article’s appearance, the investigation had just started.

Welcome to America

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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

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,1902 – 1913, New York Public Library

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

Believing Their Own Hype

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Compilation Portrait of Members of the Association of Medical Superintendents of American Institutions for the Insane, courtesy National Library of Medicine

Practitioners in the new field of psychiatry made some expert moves early on that both enhanced their reputations and brought them better incomes than the average physician. In 1844, a gathering of asylum superintendents met to form an exclusive group: the Association of Medical Superintendents of American Institutions for the Insane. They quickly set themselves up as the only doctors–in the only proper setting–who had the knowledge to diagnose and treat mental problems. These asylum superintendents quickly convinced the public that they and their institutions were the real solution to the problem of treating insanity.

The association’s stated objectives were “to communicate their experiences to each other, cooperate in collecting statistical information relating to insanity, and assist each other in improving the treatment of the insane.”

The New York State Lunatic Asylum at Utica Was One of Only 25 Public and Private Mental Hospitals in America in 1844

It was an appropriate goal, because most of these “experts” had little true expertise in running asylums. Many years later, in 1885, Dr. Pliny Earle brought up the question of allowing assistant physicians at insane asylums to join the Association. In his discussion, Earle reminded the organization’s members that in the Association’s early years, only one physician had even ten years’ experience in healing the insane in a public institution. Only five others had five years or more experience as heads of institutions. The reality was, most men running asylums at that early time only had two to four years of experience doing so.

Dr. Pliny Earle, courtesy National Library of Medicine

Dr. Earle suggested that assistant physicians who had worked continuously five years or more in institutions for the insane be admitted to the Association. This proposal was voted on and adopted.

Plight of the Attendant

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Stephen Smith, State Commissioner of Lunacy in New York, courtesy Appletons Encyclopedia

Most asylum accounts deal with the hardships patients faced, but the employee side had difficulties as well. Dr. Stephen Smith, the State Commissioner of Lunacy in New York, wrote about a particularly difficult type of patient for a paper submitted to the National Conference of Charities and Corrections in 1885. In his “Care of the Filthy Cases of Insanity,” Smith explained the problems caused by this particular “class” of patients.

Filthy patients were those who constantly soiled themselves (whether by accident or design) and required a great deal of any conscientious attendant’s time. In his paper, Smith wrote: “I have seen patients in the asylums of this State who were thoroughly bathed, and had a complete change of under-clothing, and two or three times of their external clothing, eighteen times in a single day. And this occurred in spite of constant watchfulness to anticipate their wants.”

Male patients being washed by hospital orderlies. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Male patients being washed by hospital orderlies, Long Grove Asylum, Epsom. In the Royal College of Psychiatrists. circa 1930? Published: - Copyrighted work available under Creative Commons by-nc 2.0 UK, see http://wellcomeimages.org/indexplus/page/Prices.html

Male patients Being Washed by Hospital Orderlies, courtesy Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk

Smith encouraged asylums to place filthy patients on a toilet training and personal care program. He also recommended that sufficient staff for a “night service” be employed, their duties being to help with this training program and to ensure messes were promptly cleaned so as not to disturb other patients in the room. When these measures were adopted, Smith had seen wonderful improvements in ward cleanliness, neat and tidy patients, and a much more pleasant atmosphere. Though constant vigilance would have been burdensome, it is still easy to believe attendants would rather have watched these patients closely than clean them up after an accident.

Executive Committee of the National Conference of Charities and Correction, courtesy of the social welfare library, vcu.edu

Because many asylums cut their night staffs to provide simple monitoring rather than active care, the financial burden to provide more attendants was likely rejected by most asylums. Day attendants were also stretched thin to save money, but without these measures in place, the stress of time-consuming and unpleasant clean-ups very likely caused more than a few attendants to snap–either at the offender or a handy target.

Asylum Superintendent’s Job Included Danger

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American Journal of Insanity

Dr. John Gray (see last post) was an influential, well-known alienist, long-time editor of the American Journal of Insanity, and superintendent of the State Lunatic Asylum at Utica, NY. He was also the chief medical expert who had testified for the prosecution at the trial of Charles J. Guiteau, the assassin of President James Garfield in 1882. While sitting in his office one evening of that same year, Gray was shot through the upper jaw by Henry Remshaw in the presence of three other people (including his son, John Gray, Jr.).

Assassination of James Garfield, courtesy Smithsonian Magazine

Remshaw’s deed was thought to have been provoked by some aspect of the Guiteau’s trial, and he had apparently made several threats against Dr. Gray previous to the actual shooting. Remshaw ran outside the asylum to avoid capture, fired at his pursuers, and finally reached his home. There, he told a woman living on the lower floor that he had killed Gray, then “danced about, showed her four revolvers, a dirk, and piles of cartridges” and then told her he would give himself up.*

Inmates in Lockstep at Auburn Prison

When Remshaw did give himself up at the Mohawk Street jail, he turned over his four loaded weapons and cartridges, plus a bottle of acetic acid and opium. Remshaw raved that he was an ambassador sent from heaven to kill Gray, but observers seemed to consider him a “crank and a fraud” more than someone who was insane. A court commission did find him insane, though, and recommended he be sent to an asylum. Remshaw was sent to the Insane Department of the State Prison at Auburn.

Gray died November 29, 1886 from causes attributed to his decline in health following the shooting.

*Quoted from an article from the Journal of Psychological Medicine and Mental Pathology.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Medical Staff

Dangers for Patients

Welcome to America

Believing Their Own Hype

Plight of the Attendant

Asylum Superintendent’s Job Included Danger