Tag Archives: acute mania

Asylum Patients Under a Doctor’s Care

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Indiana Hospital for the Insane

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

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

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

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.

 

Sherlock Again

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Image from Doyle's Story, The Creeping Man

Image from Doyle’s Story, The Creeping Man

Sir Arthur Conan Doyle’s Sherlock Holmes stories illustrate several Victorian ideas about insanity and its causes (see last post). In “The Adventure of the Naval Treaty,” Doyle described a case of acute mania which was resolved with prompt and proper care–an entirely understandable outcome. However, with “The Creeping Man,” Doyle’s understanding of the external causes of human behavior seems to be completely awry.

In this mystery from 1923, Professor Presbury’s personal secretary tells Holmes and Watson about his employer’s peculiar changes in behavior. Holmes eventually discovers the bizarre reason for the professor’s changed behavior: Presbury started to behave like a monkey because in a quest for youth, he began using a serum obtained from monkey blood/glands. This serum has given him the animal’s traits.

Insane Asylum at Kankakee

Insane Asylum at Kankakee

The idea behind this story sounds ridiculous, but Doyle may have been taking a cue from real events. In 1899, the New York Times had reported on Irwin Fuller Bush, a young man considered hopelessly insane and admitted to the Insane Asylum at Kankakee (Illinois). He had been almost miraculously restored to health by Dr. B. P. Roberts, a physician in Greene City, Missouri who treated Bush with animal glands. Roberts said, “Today, through the treatment with lymph from glands of goats, Bush is at home and declared to be completely restored in mind.”

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

Meeting of the Medical Staff, Kankakee Mental Hospital, circa 1910

The glands were also said to “arrest senility.” Roberts was enthusiastic enough about his treatment to go to Europe and try to convince alienists there to adopt the treatment in their own insane asylums. This real-life event and others using animal glands to cure various ailments, simply reflected the medical community’s imperfect understanding of what caused physical and mental changes in people.

Writing Madness

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Sir Arthur Conan Doyle

Sir Arthur Conan Doyle

Though modern readers can find old treatments for mental health laughable, they made sense to a generation just beginning to move away from even more archaic thought on the topic. Victorian-era conceptions about “madness” are wonderfully illustrated in Sir Arthur Conan Doyle’s Sherlock Holmes stories. Doyle had a medical degree (University of Edinburgh, 1881) and had practiced medicine before writing these mysteries, so his presentation of mental illness and its causes likely reflected his own, educated views on it.

Rather than look at madness as a permanent state deriving from physical roots, newer thought allowed for events like shock, overwork, and stress to precipitate bouts of insanity that could hopefully prove temporary if given correct–and timely–care. This idea played out well in “The Adventure of the Naval Treaty.” In the narrative, a young man in a trusted position lost valuable papers and felt himself ruined over it. He tells Holmes and Watson that upon trying to go home after his discovery: “I had a fit in the [train] station, and before we reached home I was practically a raving maniac.”

Illustration from Doyle's Story Concerning Temporary Madness

Illustration from Doyle’s Story Concerning Temporary Madness

Woman Admitted to Bedlam Hospital for Acute Mania, courtesy The Sun

Woman Admitted to Bedlam Hospital for Acute Mania, courtesy The Sun

He went on to tell the two that he had been “raving with brain fever” for nine weeks, but that with the tender care of his fiance and doctor, he had just recovered his reason. This episode clearly fit the modern idea that shocks and emotional turmoil could cause insanity–and that so-called acute (recent/short) episodes of insanity, if acted upon quickly, could be cured.