Category Archives: Medical Treatments

A Crazy Cure

Medicine for Asthma Went Straight to the Lungs Via Cigarettes

Many nineteenth-century theories about disease and mental illness were based on assumptions that made sense within the limited knowledge of the time. Unfortunately, quacks could pick up on ill-founded theories and make a fortune if they were good salespeople–and of course, most were excellent. Dr. Edwin Hartley Pratt’s theory about chronic disease resulting from irritation of bodily orifices (see last post) is a case in point.

Dr. Frank E. Young took on the orifice problem and created rectal dilators with exaggerated claims: they were good for anemia, constipation, sallow skin, acne, insomnia, anorexia, headaches, and on and on. These rubber plugs–shaped somewhat like a torpedo–also cured insanity. In promoting his cure, Young asserted, “three-fourths of all the howling maniacs of the world” were curable “in a few weeks’ time by the application of orificial methods.”*

Dr. Young’s Rectal Dilators

Though the medical world scoffed, Young’s devices were popular (primarily for constipation) until the FDA began to regulate and oversee medical devices in 1938. In 1940 the agency seized a shipment of Young’s dilators as misbranded (because of their claims to cure so many conditions) and Young’s company fell out of favor.

Arsenic for Beauty Typified the Errors in 1800s Medical Knowledge

*Reported in The Medical News, April 29, 1893, p. 471.

The American Disease

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Chart From American Nervousness, Its Causes and Consequences, 1881

“Nervous” diseases became prevalent toward the end of the 1800s; most manifestations were lumped under the term neurasthenia. Some public commentators believed the condition was entirely manufactured, since it seemed to affect only the wealthier people in the country. Others were convinced it was a real condition brought on by the stresses of modern life and the burdens of business. Almost all agreed that it was a peculiarly American disease.

Writers tended to mock “nervous” women who went to rest homes, sanitariums, or cruises to recover from neurasthenia, but seemed to find the condition more credible in men. “Americans who make money or achieve marked success generally have neurasthenia at some time in their lives,” said the Fort Wayne Sentinel in 1890. Nervous strain was a natural part of these successful lives, and eventually, the body succumbed to “nervous exhaustion.” Doctors often compared neurasthenia in men to the mental aberration called hysteria in women.

Nerve Medicine Aimed at Men

Symptoms of neurasthenia included fatigue, anxiety, headache, heart palpitations, and depression. Treatment in general terms emphasized rest, a change of scenery, and freedom from responsibility and care. Specifically, treatments could include massage, ocean bathing, electrical stimulation, and hypnosis. Of course, nerve tonics became popular as well. These “secret” formulas often included strychnine, morphine, cocaine, and opium among other questionable ingredients.

This Elixer Said It All

The term neurasthenia has faded, but its symptoms live on as chronic fatigue syndrome, “burn-out”, and similar terms that denote high stress and its effects.

Mothers and Madness

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Puerperal Mania in Four Stages, 1858

Alienists in the 1800s believed that most madness stemmed from a physical cause that then created mental symptoms. Women, because they were physically weaker, were more prone to madness and had to be sheltered or restricted from many stressful situations. Unfortunately, motherhood–woman’s highest calling in the minds of many and almost unavoidable for married women–could be an “exciting cause” of insanity because of its physical strain on the body.

Madness associated with pregnancy fell under the general term “puerperal insanity” and was further divided into three categories: gestation, lactation, or parturition (childbirth). The insanity of gestation tended to be rare and usually manifested during first pregnancies; its symptoms included melancholia, suicidal thoughts, and apathy. It was generally cured upon the birth of the child. The insanity of lactation had similar symptoms but tended to occur during subsequent pregnancies. This type could be more serious and end with complete dementia, though it typically resolved within a few months. The insanity of parturition was quite different–women manifested manic symptoms rather than melancholy. These mothers talked incessantly, couldn’t sleep, rejected their children or husbands, cursed, and otherwise dismayed and dumbfounded the males in their lives.

Admission Statistics, Including Puerperal Insanity, courtesy Missouri State Archive

Women were often committed to asylums during these problematic episodes. Fortunately, physicians generally treated puerperal insanity with–for the time period–restraint and common sense: rest, food, purging, and sedation. Depending upon the symptoms, patients might also be closely watched or confined to prevent them harming themselves.

1890 Death Record from Michigan

Though the diagnosis of puerperal insanity probably stemmed largely from the male gender-bias that expected women to be gentle, subdued, and “ladylike” at all times, male physicians did recognize that in most cases, the condition would be short-lived. Rather than being confined in an asylum for years, most women recovered in six months or so and resumed a normal life.

Debating Restraints

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Illustration Showing a Black Man Sitting in a Chair Wearing a Straitjacket, courtesy National Library of Medicine

When British physician Dr. John Bucknill visited U.S. insane asylums and wrote an article about his observations for the October, 1876 edition of the American Journal of Insanity (see last post), he discussed the issue of restraining patients. British asylums had done away with restraints almost entirely, and Bucknill did not like to see them used as freely in the U.S. as he saw during his visits. In his discussion about their use in America, he made the following observations:

Dr. Green of the Georgia State Asylum said that he did not like to use restraints, but did with four classes of patients. These were: suicidal patients, persons who will not remain in bed, persons who persistently denude themselves of all clothing, and inveterate masturbators.

Bucknill also mentioned that Dr. Ranney, who prided McLean Asylum with bringing its use of restraints down to a very low level, still used mechanical restraints on the following types of patients: those exhibiting acute mania; patients who wound themselves, creating ulcers that would never heal themselves unless their hands were confined; epileptic patients who so often became violent; persons whose feelings are greatly perverted and prone to see insults or evidence of conspiracy, who were sometimes little less ferocious than wild beasts; and persons in the throes of acute delirious mania.

McLean Asylum, courtesy Boston Public Library, Digital Commonwealth

“It will be observed,” said Dr. Bucknill, “that . . . we already have nine classes of lunatics who need mechanical restraint, in America.” He added that Dr. Slusser of the Ohio Hospital for the Insane added another class: “. . . those who persistently walk or stand, until their extremities become swollen, and they give evident signs of physical prostration. I have no way of controlling such, but by tying them down on a seat.”

This addition made ten classes of patients needing restraint, but Dr. Bucknill continued with a list of other reasons doctors restrained their patients until he named “fourteen classes of the insane altogether who absolutely need mechanical restraint in the State Asylums of America.” Bucknill noted some ways that British asylums found to avoid restraints, but realized that the American mindset was simply different on this issue.

Mock-up of a Patient in a Restraining Device Called a Utica Crib

Bucknill did say, “Is it surprising that, at the present time, the management of asylums for the insane in America is the subject of mistrust with the people?”

Operating on Insanity

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Phrenology Chart, 1883

Phrenology was a so-called “science” which believed that bumps and other physical characteristics of a person’s head (skull) could reveal personality, mental faculties, and character. Though it fell out of favor in Europe by 1840 or so, two American brothers–Lorenzo and Orson Fowler–began “reading heads” about that time and kept this field of study popular in the U.S. until the late 1800s.

In 1896, a seaman named J. S. Doherty became “dangerously and hopelessly insane” after studying spiritualism. A family friend who was also a phrenologist believed that Doherty, who had been interested in spiritualism for ten years, had studied “on this one question of spiritualism until that part of his brain was abnormally developed.”

A Trepanning Operation and Tools For It, circa 1655

By 1899 Doherty had been insane three years, and his family was clutching at straws. They suggested an operation and signed an agreement that they would not hold their phrenologist friend responsible if it was not successful.

Their friend “located the parts of the head which he argued were afflicted by the pressure of the brain against the skull.” The phrenologist then performed a trepanning operation, in which he removed (and replaced) part of the patient’s skull in order to access the brain.

American Phrenological Journal

“When Doherty recovered he was perfectly sane, and his first words were to inquire about a piece of work on which he was engaged three years ago,” wrote a reporter in the September 9, 1899 issue of The Dayton Herald.*

*Other newspapers reported on the Doherty operation as well.

Early Care at St. Elizabeths

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A Four-Horse Carriage Used to Take Male Patients to Town at St. Elizabeths

A Four-Horse Carriage Used at St. Elizabeths to Take Male Patients to Town

The Government Hospital for the Insane–better known as St. Elizabeths–accepted the insane of the District of Columbia but had a special patient population of veterans from the nation’s army and navy. Like most institutions of its kind, the asylum was beautifully landscaped and had pleasing views for the patients.

St. Elizabeths’ first superintendent, Dr. Charles Nichols, did not run to extreme treatments. If a patient were not overtly disturbed, he prescribed tonics and a nourishing diet, warm baths, and treatments for “regularity of all the alimentary functions.” Provided patients could be induced to eat (the first step on the alimentary journey), alimentary treatment consisted primarily of ensuring the bowel excreted waste properly. Physicians sometimes induced vomiting to “clean out” the system, but it was far more likely that they would administer purgatives (very strong laxatives) to make sure the bowel was completely evacuated.

Dr. Charles Nichols

As in most asylums, patients were offered work to occupy their time and distract their minds from their troubles. Patients were allowed visitors, could walk on the grounds, and enjoyed (especially early on) individual treatment plans. Theories of the time supposed that most insanity was caused by environment and habits, so every effort was made to provide “things rational, agreeable, and foreign to the subject of delusion.”

Nurses on the Lawn Across From Building E, St. Elizabeths, courtesy NARA

Whether a patient’s environment had become contaminated by overwork, marital problems, or the many pressures of life, doctors hoped that taking people away from the environment which had created their mental distress would allow them to recover. For at least the initial period of asylum growth, this belief was an overwhelmingly valid reason for insisting patients be committed to an institution rather than receive treatment at home.

Cures are Insane

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Brattleboro Retreat in Vermont, Which Opened for Occupancy in 1836

To modern sensibilities, much of what has been believed in the past about insanity sounds silly and unbelievable. Though we can often follow the logic behind even outlandish ideas, given the lack of research available at the time, the logic behind certain treatments can be a little more difficult to grasp.

In Vermont somewhere around 1800, a man named Richard Whitney became “mentally deranged” and a council of physicians tried its best to help him. They concluded that a temporary “suspension of consciousness” was just what was needed, the theory being that if the patient could be rendered unconscious in a fairly dramatic way, his mind would be diverted from unhappy associations and so remove the cause of his affliction.

As Late as the 1930s, Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

As Late as the 1930s, Psychiatric Patients Were Induced Into Low Blood Sugar Comas to Rewire the Brain

The physicians first completely submerged him in water until he “became insensible” and then resuscitated him. This experimental treatment failed, but undaunted, the doctors tried again. The second effort involved opium, selected as “the proper agent for the stupefaction of the life forces.” Unfortunately, this trial killed the patient.*

Thought this extreme example is outrageous, alienists (the first mental health specialists) frequently experimented with new treatments on patients–most probably without consent or oversight. Records will never show how many died or suffered catastrophic harm from them, but researchers can rest assured that much suffering was involved.

The Utica Crib Was a Notorious Restraining Device

*Information about this case came from a work called the History of Brattleboro, published in 1806 and retold in a history of asylums in 1916..

Mania and Medicine

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Woman Forced Into Cold Shower, from Elizabeth Packard’s Book Modern Persecution, or Asylums Revealed

Doctors in the asylum era were breaking ground in a new field, and unfortunately, had few scientific studies to reference when it came to treating patients. Most treatments progressed from fairly benign standards like warm or cold baths, enemas, frequent meals, and so on, to more extreme forms of the treatments (baths that lasted hours or days, force feeding, etc.), and then to medicines. Most physicians were quite comfortable–and felt assured of the safety–of medicines that today we know are quite dangerous. Calomel (see last post) is just one example of a favored medicine with dreadful side effects.

Excited patients–particularly epileptics–might be given bromides to calm them. It worked, but at least one doctor (Chicago physician Dr. J. S. Jewell, writing in an 1881 issue of the New York-based journal The Medical Record) noted that the use of bromides in the treatment of epilepsy actually led to “maniacal furor,” a condition that made the person appear insane.

Skin Eruptions Were Another Side Effect of Bromide Use and Resembled Smallpox, from Materia Medica, 1918

Genetian (which could affect blood pressure and ulcers) was used to stimulate patients’ appetites; hyoscyamia (found in plants like henbane and having an action similar to atropine and belladonna) was used to help patients remain calm or sleep; and ergot ( a fungus which includes a chemical that can cause people eating food contaminated with it to go berserk) was used for “persistent congestion of the brain and cord.”

Painting by Matthias Grunewald of Patient Suffering From Advanced Ergot Poisoning, circa 1512

Of course, many medicines used today would be poisonous if they weren’t compounded properly and given in the proper doses. Doctors must also watch for adverse side effects in sensitive individuals and interactions with other drugs patients might be taking. Unfortunately, in the era under discussion, it is unlikely that doctors were skilled at avoiding these potential problems.

Asylum Patients Under a Doctor’s Care

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Indiana Hospital for the Insane

In 1884 Dr. Joseph G. Rogers, superintendent at the Asylum for the Insane in Indianapolis, wrote in an article (see last post) that nothing remarkable in either the treatment of insanity or recovery of patients had occurred recently. His suggestions for the primary care of acute (recent) mania were rest and nutrition, with the addition of soothing baths and perhaps a dose of medicine to help the patient sleep. These treatments could just as easily be done at home if a family wanted to–so why would they send their loved one to an asylum?

If patients didn’t immediately recover their sanity, of course stronger measures would be necessary. That’s when medical professionals took on more than most families could comfortably embrace.

William Green, a Patient With Acute Mania, Bethlem Hospital

William Green, a Patient With Acute Mania, Bethlem Royal Hospital

Rogers, and most other alienists of the time, believed that patients almost always needed their bowels cleared by a good enema, and he suggested using gallon portions if necessary. The enema should be repeated until deemed successful by seeing proof of the “evacuation of the entire canal.” He called this dramatic enema “hydraulic mining so to speak” and what it would have been like for family members to administer can only be imagined. To aid in the complete cleansing of the patient, Rogers also suggested an active purgative of ten grains of calomel with three of gamboge.

Calomel is a mercury compound which could have devastating side effects and actually kill patients who consumed too much of it over time. Gamboge is a strong laxative (that can also expel worms) with side effects that include vomiting, stomach pain, and loss of potassium–which can damage the heart.

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Effected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Union Soldier Carlton Burgan, Whose Upper Mouth, Palate, Right Cheek, and Right Eye Were Affected by Calomel Poisoning, courtesy National Museum of Medicine and Health

Though laypeople of the time probably wouldn’t have known about these side effects, they might still have felt uneasy giving these stronger kinds of medicines to their relatives. And, if patients needed these stronger interventions, it would be because they were becoming increasing difficult to manage–another reason to send them to an asylum.

Though asylums took much of the care-taking burden off families’ shoulders, they may not have actually given the patient better care. In my next post, I will discuss some of the medicines available to doctors caring for the insane.

Where Are the Breakthroughs?

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The Public Hospital for Persons of Insane and Disordered Minds, Virginia, in the 1800s

In the January, 1884 issue of the American Journal of Insanity, author Joseph G. Rogers, MD, noted: “The past year has not been marked by the discovery of any remarkable special methods in the treatment of insanity, nor any very remarkable advance in results.”

This had to be discouraging for physicians at these facilities, who wanted to help their patients recover as well as make names for themselves and perhaps do a little empire-building. By this time, too, the public had been scandalized by a number of exposés concerning asylum conditions–and this led to its lessened enthusiasm and support for them. Asylum superintendents very much wanted to keep the public’s confidence, and longed for better treatments and cure rates.

This DeKalb Crib, circa 1905, Was the Type of Device That Could Create Scandal Concerning Asylum Care, courtesy Maryland State Archives

Acute mania (mania that had only recently manifested) had the greatest chance of cure, so alienists tended to concentrate on these cases. What could they do? In Dr. Rogers’ words, the tendency for patients with this condition was to “Wear and Waste,” and he suggested “Rest and Food” to help them. Unfortunately this treatment could be done at home, by family, so asylums also needed to look at treatments that most families couldn’t give.

Even though Rogers admitted that rest and food were the primary treatments for acute mania, he also suggested “the speedy committal to a proper hospital”–meaning, of course, an asylum. There patients could receive the “soothing, easeful [sic] influence of the bath at 90° Fahr.” He noted that the patient would probably have an empty stomach, which should be filled with nutrients, followed by a rest. If the patient were delirious, a hypnotic like chloral could be used to bring about the rest.

Though From a Later Date, This Type of Bath Was Considered Therapeutic

So far, most of this treatment could be given at home by the patient’s family. In my next post, I will continue to give Dr. Rogers recommendations for treatment, which were progressively more complicated and medical in nature.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Medical Treatments

A Crazy Cure

The American Disease

Mothers and Madness

Debating Restraints

Operating on Insanity

Early Care at St. Elizabeths

Cures are Insane

Mania and Medicine

Asylum Patients Under a Doctor’s Care

Where Are the Breakthroughs?