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Medical Conditions and Insanity

John Taylor, Who Was Committed to Lancaster County Asylum (UK) in 1901 for General Paresis of the Insane

John Taylor, Who Was Committed to Lancaster County Asylum (UK) in 1901 for General Paresis of the Insane

Physical conditions like epilepsy sometimes brought their victims a diagnosis of insanity because of the behaviors these conditions manifested. Other diseases and physical problems were likewise misdiagnosed and forced victims into insane asylums rather than more appropriate hospital treatment. A man described in the October 15, 1870 issue of the British Medical Journal was probably typical. He had been admitted after paranoia and hallucinations made it impossible for him to care for himself. He was only 35 at the time of admission, but had “led an irregular life” for many years prior.

“He said he underwent nightly a kind of torture,which he called the “cylinder finish”, and which he described as  an excruciating process, by which his brains were whirled round with extreme velocity, mixed into a pulp, and replaced in his skull just in time for his awaking. This, he believed, was ordered by the doctor, who knew of everything that was done to him, and had the power of regulating the amount of his sufferings,” wrote Dr. H. Grainger Stewart. Commitment to an asylum for a patient like this seemed to make perfect sense.

Al Capone Was Released From Prison in 1939 After a Diagnosis of Syphilis of the Brain

Alienists knew there was little they could do for patients with this form of insanity, called general paralysis of the insane (GPI), beyond giving them sedatives to help them sleep. And sadly, by the time these extreme symptoms manifested, patients often did not have long to live.

Much of Syphilitic Insanity Could Have Been Prevented With Prompt Treatment for the Initiating Disease

Much of Syphilitic Insanity Could Have Been Prevented With Prompt Treatment for the Initiating Disease

Physicians were able to make a tentative link between GPI and previous exposure to syphilis, but weren’t certain because syphilitic insanity did not respond to treatment with mercury the way syphilis did. However, when the bacterium that caused syphilis was discovered in 1905, a test was developed shortly thereafter to detect its presence. Doctors finally realized that untreated syphilis was the cause of the deteriorating mental condition known as general paralysis (or paresis) of the insane.

The Worst Danger

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

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

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

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

Columbus Asylum for the Insane

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

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

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.

 

Superintendents in Danger

Howard Hall, Government Hospital for the Insane

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

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

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.

A Focus On Symptoms

Symptoms Produced a Diagnosis

Symptoms Produced a Diagnosis

The field of psychiatry had little science behind it when insane asylums were first established. Many times, alienists (an early name for psychiatrists) had to base their diagnoses on symptoms alone, simply because they did not understand the root causes of a patient’s behavior. Epilepsy presents a good example: Sufferers often had periods of troubling behavior prior to or after a seizure. When doctors looked at these behaviors, they saw insanity rather than a medical condition.

 

A nutritional deficiency called pellagra also mimicked insanity in some people. This is a disease caused by a niacin (B-vitamin) deficiency, lack of tryptophan (an amino acid) in the diet, or a failure to absorb these nutrients. In the early 1900s many Southern poor ate a diet high in corn, molasses, and fat-back. The corn-heavy diet allowed pellagra to develop because Southern preparation methods did not release corn’s niacin. (In contrast, Mexicans  soaked corn in limewater–which released its niacin–before making tortillas, and didn’t develop the condition.)

Pellagra Was Recognized As a Serious Problem

Pellagra Was Recognized As a Serious Problem

Pellagra’s classic symptoms included dermatitis, diarrhea, and…dementia, which frequently took the form of indifference, stupor and melancholy. Victims were sometimes sent to asylums as a result, where fortunately some actually recovered once their diets became less corn-based.

An Unusual Case

San Antonio City Hall, 1892

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

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

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

Southwestern Insane Asylum in San Antonio

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

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

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

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

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

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

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

Northern Hospital for the Insane

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

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

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.

 

Holidays are Hard

Most asylum superintendents, especially at the beginning of the asylum era, wanted to recreate a home atmosphere for patients. They often arranged outings, dances, and other activities that tried to normalize life for patients. Holidays, of course, can bring sadness to anyone remembering the past and asylum patients undoubtedly had an especially rough time during any festive season.

Photos 1923_0010
Christmas at Morningside Hospital in Portland, Oregon

At Christmas, asylum staff and the surrounding communities tried to remember these forgotten people.  Many civic organizations donated food and clothing to insane asylums, or sought to make the patients more comfortable. Churches, school bands, and choral groups would visit asylums to sing and entertain patients, and money was usually set aside in some way for improved meals. The Milwaukee Sentinel wrote on December 25, 1903 that:

“Inmates of the county insane asylum will enjoy rabbit stew, oysters, and plum pudding for dinner today. The Christmas tree entertainment was held last evening, and the program of music and recitations was followed by dancing and bags of candy and fruit were distributed.

Christmas Decorations in Ward of Bellevue Hospital, 1920
Christmas Decorations in Ward of Bellevue Hospital, 1920

“The usual Christmas festival for the patients of the Milwaukee Hospital for Insane was given on last evening. A Christmas tree, illuminated by colored electric lamps and laden with presents, a concert by the hospital orchestra, and dancing, comprised the entertainment. Every patient received a present and refreshments were served. A special breakfast and dinner will be served today, and skating on the lake will be indulged in.”

Christmas Turkeys Displayed Outside Spencer State Hospital, formerly Second Hospital for the Insane, circa 1924, courtesy WVU Libraries
Christmas Turkeys Displayed Outside Spencer State Hospital, formerly Second Hospital for the Insane, circa 1924, courtesy WVU Libraries

These and similar festivities elsewhere were aimed at patients, but very likely heartened the staff as well.