Category Archives: Patients

Notes on the Past

Friends’ Asylum for the Insane

Though it is impossible to fully understand a patient’s real state of mental health from a hundred years’ distance, old doctors’ notes and similar memorandums offer tantalizing clues to researchers today. The case of Caroline Stille is such a case.

A long note concerning the history of her insanity includes the fact that Mrs. S. “has been insane, at short intervals, ever since the age of puberty, at which time she was in the Friends’ Asylum near Philadelphia.” (This note was written in 1878, and put the patient’s age at 50, so the patient was probably born in 1828.) Mrs. S. transferred to another hospital and then into Massachusetts General Hospital in 1841, which put her at about 13 years old.

Oddly, the sentence immediately after the statement that she was in Massachusetts General in 1841 continues: “After her marriage in the same year she exhibited evidence of mental obliquity and moral perversions which rendered her domestic relations extremely unhappy.” Did this mean she married at 13, or merely that her mental symptoms occurred the same year she married?

Addiction Was a Huge Problem in America During the 1800s

And the note then continues, “At this time it was (?) that she was and had long been in the habit of using large quantities of opium and perhaps of alcohol.” Could this woman have become addicted to opium while a patient at one of the various hospitals she stayed in during her puberty? Did she take it routinely for some reason as a young married woman? Whether her marriage was actually in 1841, or later, she never left an asylum after 1857 when she would have been 29.

Opium Was Used Routinely for Women’s Complaints

Did doctors not recognize the symptoms of opium addiction? Or, did they believe Mrs. S.’s symptoms stemmed from some other cause? Whatever happened, by the time this unfortunate woman was 50 years old in 1878, the writer of her mental history could only say: “I earnestly desire that, for the sake of her children, the grievous scandal of their mother’s conduct may be prevented by her permanent restraint in an Institution for the Insane.”

The writer merely signed with the initials “A. S.” and was probably her husband.

The Worst Danger

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Patients at the Chicago State Hospital walking outdoors on a snow-covered path, Chicago, Illinois, December 10, 1910. The Chicago State Hospital (also called the Dunning Mental Institute) was located at West Irving Park Road and North Narragansett Avenue in the Dunning neighborhood

Insane asylums were dangerous places (see last two posts), since both staff and patients could be the victims of attacks. The balance of power, of course, was always in the staff’s favor, and patients were far more often victims of violence than attendants. Tragically, patients sometimes turned violent against themselves despite all efforts to prevent it:

— Martha Grote suffered from melancholia after the death of a child. She evaded the notice of attendants and took some laudanum from the asylum’s drug closet. No one noticed anything wrong at 9:00 p.m. during the last doctor’s round, but attendants found her almost dead the next morning. They could not revive her. (Cook County Hospital for the Insane, 1897)

— Edward E. McClintock committed suicide by tying one end of the cord of his bathrobe around his neck and fastening the other to a bar on a window in his room. He had suffered from several strokes the last three years “and his brain was affected,” wrote the Asbury Park Press in New Jersey. (Essex County Hospital, 1910)

— James Toovillon had been in the Oregon State Insane Asylum for eighteen years and was considered completely trustworthy . . . but he managed to get hold of strychnine and took his life at the age of 55. (April 7, 1909)

Oregon State Hospital, circa 1900

Asylum superintendents despaired over these suicides, and not only because of the negative publicity surrounding them. “It is noteworthy that suicides in asylums occur in streaks,” said Dr. Asa Clark in a newspaper interview in 1905. (Clark was superintendent of the Stockton State Hospital in California.) “One will be followed by two or three others, almost invariably, as these things work upon the minds of other patients.”

That Clark’s belief may have been somewhat true is borne out by a short note in The Tennessean (Nashville) which wrote in 1901 that there was “an epidemic of suicide in [the] asylum for the insane in Shelby County.”

Stockton State Hospital, courtesy California State Library

Clark took what steps he could to keep patients safe and to guard against them learning of other suicides, but he noted that there were “a thousand male patients with but fifty-three attendants.” According to Clark, until the number of attendants increased, it would be impossible to prevent suicides.

Dangers for Patients

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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.

No One Safe

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Dr. John P. Gray

Patients could bear animosity toward asylum staff (see last post), but no one in the public eye was immune from random attack–including Dr. John P. Gray, superintendent of the State Lunatic Asylum in Utica, New York. He had been an expert witness regarding the sanity of Charles J. Guiteau when he stood trial for the assassination of President James Garfield. “I see nothing but a life of moral degradation, moral obliquity, profound selfishness, and disregard for the rights of others,” Gray said [of Guiteau] at trial. “I see no evidence of insanity but simply a life swayed by his own passions.”

The notoriety from this trial likely focused former shoemaker Henry Remshaw’s attention on Gray. Remshaw apparently had made public threats against Gray well before he entered Gray’s office one March evening in 1882 and shot him with a revolver. Fortunately Gray had looked up just at the right moment, and the bullet went through both cheeks rather than his brain. The journal Transactions of the Medical Society of the State of New York reported, “The hemorrhage was at first quite profuse, but in a short time began to subside, and ceased entirely in about four hours. Swelling and infiltration were immediate and extensive, and within a very few minutes of the reception of the wound it was almost impossible to separate the left eyelids, and before midnight the right eye was closed and the face distorted beyond recognition. There was no shock, the pulse ranged between 80 and 90, and the Doctor exhibited perfect self- possession.”

Charles Julius Guiteau

The Transactions of the Medical Society also reported that Remshaw escaped to his brother’s-in-law in the nearby town of Deerfield, “where he called for two glasses of ale and said he was going to New York.” Remshaw later went to the jail and gave himself up. “When searched there was found upon his person four revolvers, a single-barrelled derringer, a dirk knife, and over two hundred cartridges.” Remshaw was sent to the State Asylum for Insane Criminals.

Physicians at the time did not think Gray’s wound particularly serious, but the superintendent never recovered his health entirely. The wound affected his breathing and left him with almost constant pain. Gray died officially of Bright’s disease (which causes inflammation of the kidneys) on November 29, 1886 at the age of 62.

Male Patients Exercising in the Yard of the Utica Psychiatric Hospital, courtesy New York State Archives

Superintendents in Danger

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Howard Hall, Government Hospital for the Insane

Though attendants usually had the upper hand when it came to violent interactions with patients in asylums, patients could also be violent and harbor great animosity toward those in charge of their treatment. The May 22, 1911 issue of the Washington Post detailed what could have been a blood bath at St. Elizabeths (Government Hospital for the Insane) in Washington, DC if not for the loyalty or conscience of an asylum patient.

“The plot was hatched in Howard Hall, the building in which are imprisoned all of the criminally insane patients of the hospital,” the paper explained. A man named Charles Fletcher and “nine other desperate criminals” planned to kill the attendants in the Hall and escape. Another patient, Arthur D. Barnes, overheard the plot, and saw the conspirators hide files, iron bars, and chair legs in preparation for the break.

Dr. William A. White, Superintendent at St. Elizabeths, courtesy National Library of Medicine

“When he was sure he knew everything about the plot, he told Dr. White [superintendent at St. Elizabeths]. His story was found to be true,” the paper went on. Fletcher was taken to “the United States jail for safekeeping” while the others were confined in separate cells.

President William Howard Taft

Someone on Barnes’ behalf presented a petition for pardon to President Taft, who was to rule on it the day after the story broke. Barnes had originally been sent to the penitentiary at Atlanta, Georgia for life, for killing a man “in a fit of jealous rage. Later, he showed traces of insanity, and was transferred to the government hospital,” the Washington Post explained.

An Unusual Case

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San Antonio City Hall, 1892

Most patients going to asylums fought vigorously against commitment, but occasionally a patient went more than willingly. In 1902 W. J. Hayden was accused of swindling a large sum of money from the Woods bank. According to the San Antonio Gazette, Hayden was indicted for the crime, but shortly afterward exhibited signs of insanity and was committed to the Southwestern Insane Asylum in San Antonio (my last post also mentioned this asylum).

Hayden escaped from the asylum shortly afterward and made it as far as north Texas–where he was apprehended for forgery. In jail he wrote to the superintendent of the asylum and asked to go back. Dr. Graves, the superintendent, allowed Hayden to return, but he was suspicious of his patient’s actual insanity. Graves monitored Hayden closely the day he returned and decided that he was only feigning insanity.

Exterior of the Male Hospital, Southwestern Insane Asylum, circa 1910, courtesy UTSA, Florence Collett Ayres

Southwestern Texas Lunatic Asylum, San Antonio circa 1905, courtesy San Antonio Conservation Society

That very night, Hayden escaped once more from a third story window. Unfortunately, he could only manage to get out with his nightshirt on, and wandered around the brushy countryside that way until he was apprehended once more by a sheriff in Smith county. Sheriff Tobin of Bexar county (where the asylum was located) told his counterpart he wanted Hayden returned. Tobin, as well as Graves, was convinced that Hayden was faking insanity, but when the sheriff went to review the records of the case, they had all disappeared–including Hayden’s indictment. Ultimately, the sheriff in Smith county charged Hayden with stealing mules and the twice-escaped “patient” could no longer escape a trial.

Money and Madness

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Southwestern Insane Asylum in San Antonio

Though many asylum patients did need medical/psychological care, many others were in an institution for the convenience–or by the desire–of their families. One unfortunate individual, William I. Browne, was probably incarcerated for both these reasons.

Browne was a heavy drinker who undoubtedly embarrassed his family or gave them trouble in some way, and they felt he needed to go to an insane asylum. To commit someone to such an institution, Texas law required “an affidavit of the examining physician . . . and a certificate from the county judge of the county where the person resides.” The Palestine Daily Herald (Texas) reported years later that Browne had received a cursory examination by Dr. Miguel Barragon (or Arragon), the Mexican consul at Brownsville, Texas, but had not otherwise been given due process.

Browne constantly fought for his release, but his wife was indifferent to his plight, as were his siblings. Not a wealthy man when he entered the Southwestern Insane Asylum in San Antonio, Browne inherited some valuable property from his father shortly after he was committed. Browne’s siblings subsequently controlled both his inherited property as well as property Browne had owned before his commitment. The value of both grew over the years.

Newspaper Account of Browne’s Lawsuit

After more than a decade in the asylum, Browne successfully brought his cause to court. After Browne answered a number of complicated questions, County Judge Phil Shook released him as a sane man. At this point Browne not only had a chance to enjoy his freedom, but to also learn about the personal wealth he had accumulated. He promptly sued his siblings for $50,000 (worth more than $1.3 million today).

A Relaxed Group of People at the Southwestern Insane Asylum

Newspaper accounts detail the facts above, though articles about the outcome of Browne’s lawsuit against his siblings are absent. The Houston Post reported on June 23, 1916 that Browne’s body had been found floating in the Rio Grande near Brownsville, TX where his brother, Albert, was mayor.

Patients Having Fun

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Central State Hospital, the Former Indiana Hospital for the Insane, courtesy Indianapolis Recorder

Though patients did not enjoy life in an asylum, many did manage to retain a sense of humor and find humor where they could. Attendants often joined in the fun and helped patients pull off a joke–usually on the public.

One practice patients universally detested was that of allowing the public to come into asylums and “view” patients for amusement. Many felt shamed at being stared at like zoo exhibits, or were pained by the mocking comments they overheard. Far too often, visitors didn’t even pretend to feel compassion or mask their visits with a “show” of sympathy or desire for knowledge–they simply laughed and felt superior to the “poor creatures” they had come to see.

Patients sometimes had the last laugh, though. Anna Agnew, a former patient at the Indiana Hospital for the Insane, describes the push-back from the asylum’s inhabitants:

“Our attendants, too, all over the house, frequently play patient, generally hanging lovingly over some dudish sort of a chap, whom they profess to recognize as some former lover, and several times quite touching scenes have been described by imaginative gushing reporters from some of our most reputable papers . . .

Anna Agnew

“Such as,” Agnew continued as she described one of these reports: “When I entered the door [wrote the reporter] I was immediately approached by a lovely young girl, with large mournful, soulful, blue eyes, in which smouldered the gloom of insanity, and with her wreath of golden hair disheveled and flowing . . . she said, oh, so mournfully, sinking on her knees, ‘Please, kind sir, take me home with you?'”

Agnew writes wryly, “Dramatic, wasn’t it?” But in reality, “that lovely creature was one of the attendants, up to that sort of thing, and her patients enjoyed seeing the reporter fooled quite as well as she.”

Dr. Sarah Stockton Was Appointed Physician at the Indiana Hospital For the Insane During Anna Agnew’s Stay, courtesy Indiana Archives and Records Administration

It was a small victory, certainly, but an uplifting one that bonded patients and attendants against a common enemy: an ignorant, sneering public.

Holiday Fun

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Northern Hospital for the Insane

Though patients were not usually happy to be at an insane asylum, many could still enjoy themselves and have fun under the right circumstances. The Daily Northwestern in Oshkosh, Wisconsin wrote that during one Christmas party, patients enjoyed seeing one of the doctors receive a good-natured gag gift. The patients were delighted with their own gifts, which had been distributed amid festive decorations and a beautiful Christmas tree. However . . .

“Another present worthy of mention was an elegant box of cobwebs received by Dr. Pember who was made the victim of a good joke which many of the patients as well as attendants enjoyed. It appears that the doctor has a great habit of going around the building and upsetting chairs, tables, etc., in search of cobwebs for which it is alleged he has a great abhorrence. As a sort of a take off on his pet pleasure the attendants gathered some cobwebs and gave the doctor a carefully packed box of them,” the paper reported in 1885.

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

The Daily Northwestern continued: “Messrs. Brightrall, Roberts and Anderson, the gentlemen supervisors, and Misses Mitchell, Schultz and Casey, the lady supervisors, Harry Baum, the druggist, T.J. Vaughn, the steward, Mr. Neville, the warden, Miss Hale, the matron, Dr. Wiggington and his amiable wife and every officer and attendant connected with the institution deserve a deal of credit for the work which they certainly must have done to make the entertainment a success.” The paper added, “One thing is noticeable at the hospital and that is the kindly feeling which all of the patients have for Dr. and Mrs. Wigginton.”

Christmas Decorations at Taunton State Hospital, circa 1900

Though some of this commentary may or may not have been typical hyperbole, various patient memoirs show that patients and staff could indeed develop respect, love, and camaraderie for each other.

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.

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Patients

Notes on the Past

The Worst Danger

Dangers for Patients

No One Safe

Superintendents in Danger

An Unusual Case

Money and Madness

Patients Having Fun

Holiday Fun

Early Care at St. Elizabeths