Tag Archives: alienist

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.

 

Asylum Superintendent’s Job Included Danger

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American Journal of Insanity

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

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

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.

What Can We Do?

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1800s Plasters to Induce Blisters, courtesy Library of Virginia

1800s Plasters to Induce Blisters, courtesy Library of Virginia

For much of psychiatry’s history, experts were only able to treat symptoms, rather than the causes of mental illness. When insane asylums first came into public use, most alienists had largely abandoned Dr. Benjamin Rush’s (considered the Father of American Psychiatry) depleting treatments, but they still had to find ways to deal with their patients’ moods and behaviors.

One treatment popular in this beginning era of psychiatry was to use a counter-irritant on patients. Doctors would blister someone who was manic in order to divert his/her attention; they would also blister someone who was melancholic in order to “divert the mind from its morbid train of thought.”

Tartar Emetic Was Definitely Potent

Tartar Emetic Was Definitely Potent

For recent cases of insanity–also called acute cases and the most hopeful of recovery–alienists applied tartar emetic ointment to the back of the neck. This ointment consisted of potassio-tartrate of antimony added to one ounce of lard or other carrier; the compound “will produce an eruption on the skin very similar to small-pox in appearance.” Presumably the pain of the treatment would keep a patient’s mind off his original problem. Cold compresses to the head, cold baths or showers, and warm baths with vigorous rubbing of the extremities were also useful treatments for insanity.

Water Therapy Could be as Confining as Restraints

Water Therapy Could be as Confining as Restraints

Readers will note that all these treatments were uncomfortable if not actually painful for the patients. However, inflicting pain seldom deterred alienists intent on “helping” their patients with mental issues.

(These treatments are discussed by Dr. Edward Cowles in the July, 1894 issue of the American Journal of Insanity in his review of psychiatry’s progress over the past few decades.)

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.

Schools for Insanity

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Alienist Dr. Isaac Ray

Alienist Dr. Isaac Ray

People today wonder how physicians and other educated people could have believed excessive smoking, masturbation, or reading novels might lead to insanity. Though anything in excess is probably not as healthy for a person as that same thing in moderation, how could something like “excessive study” cause insanity? An extremely prominent alienist, Dr. Isaac Ray, explained:

“Though hard study at school is rarely the immediate cause of insanity, it is the most frequent of its ulterior causes, except hereditary tendencies.” Ray further declared that the chances of recovery [from insanity] were far fewer in the “studious, intellectual child” than in the opposite type. The reason for this, Ray explained, was that “though the immediate mischief may have seemed slight, but the brain is left in a condition of peculiar impressibility, which renders it morbidly sensitive to every adverse influence.”

irls From Glen Eden Boarding School for Girls, circa 1911

Students From Glen Eden Boarding School for Girls, circa 1911

Ray’s remarks appeared in a September, 1859 issue of the The Atlantic Monthly, within an article strongly admonishing the then-present system of excessive schoolwork for children. A typical schedule in a well-run girls’ boarding school could be something like this: Rise at 5:00 a.m., study for two hours, eat breakfast, spend six more hours in the schoolroom, eat lunch, then spend two hours sewing, writing letters, completing other small tasks, and perhaps walking if weather permitted. Afterward there would be another hour of study, supper, and then two more hours of study–eleven in all. The author later mentioned popular Sunday School contests throughout the country, in which winners memorized up to 5,000 Bible verses.

An 1854 Math Book by Joseph Ray

An 1854 Math Book by Joseph Ray

It’s no wonder that many children fell into ill health, whether or not the excessive study actually led to insanity. However, with this kind of tasking in mind, it’s a bit easier to believe the (unnamed) author’s statement that he had recently heard of “a child’s dying insane, from sheer overwork, and raving of algebra.”

 

Confusion About Insanity

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This Delusional Woman Believed Her Friends Wanted to Hurt Her

This Delusional Woman Believed Her Friends Wanted to Hurt Her

Though many alienists (a term for early psychiatrists) felt perfectly competent to treat insanity, few felt that they could actually define it. In his book, A Treatise on Insanity in its Medical Relations (1883), Dr. William Hammond demonstrated the difficult of defining insanity by citing various experts:

“According to Hoffbauer, an individual is insane when the understanding is diverted . . . when he is powerless to avail himself of  his intellectual facilities, or to make known his wishes in a suitable manner.” However, Hammond pointed out, this definition would include conditions like “apoplexy and concussion and compression of the brain.”

“The late Professor Gilman . . . declared that ‘insanity is a disease of the brain by which the freedom of the will is impaired.'” As with the previous definition, however, Hammond declared that “this definition neither covers the subject nor excludes other diseases.”

Insanity Could Lead to Unthinkable Crimes

Insanity Could Lead to Unthinkable Crimes

Several alienists Hammond quoted declined to define insanity at all, saying that no definition in any kind of general terms would be useful. Even common manifestations of insanity such as illusions, hallucinations, and delusions could not definitively diagnose it, since there were reasons why these conditions might occur whether a person was insane or not.

Alienists Did Not Necessarily Believe Insanity Caused All or Most Crime

Alienists Did Not Necessarily Believe Insanity Caused All or Most Crime (January 19, 1919 Issue of the Chicago Tribune)

One of the issues surrounding the diagnosis of insanity through the ages is that the condition can’t really be defined the way a case of measles or a broken leg can be. Culture, custom, expectations, and so on constantly refine what is acceptable behavior or what will be tolerated through the ages and across cultures.

That leaves the question: What is insanity?