Medicine
"The treatment [of insanity] is properly divided into medical and moral; the former, including the use of medicine, baths, regulations of diet, &c., the latter, all those means and influences brought to bear upon the person in his new situation."
-Horace A. Buttolph, 1847
"The treatment [of insanity] is properly divided into medical and moral; the former, including the use of medicine, baths, regulations of diet, &c., the latter, all those means and influences brought to bear upon the person in his new situation."
-Horace A. Buttolph, 1847
The main focus of early psychiatry was on healing the diseased mind. This left the rest of the body vulnerable to physical diseases that often exacerbated the manifestations of insanity. Moral therapists therefore coupled the use of moral methods with medicine to treat their patients. Despite the close relationship between moral methods (exercise and amusements) and medicinal treatments, physicians were adamant that medicine was not a part of the moral treatment of the insane. The utopia created by the contrived asylum environment was supposed to be enough to cure insanity, but the reality of continued illness meant that additional methods were necessary to treat patients. By admitting this, however, physicians would be acknowledging the limitations of moral therapy and this was not something they were willing to do in the early to mid-nineteenth century. Therefore medicine was maintained as a method of treatment but kept separate from all explanations of moral therapy.
Medical treatment of the insane was complex. Broadly, asylum medicine can be separated into five categories: purgatives, emetics, narcotics, antiphlogistics, and water. Purgatives, emetics, and narcotics were all drugs ingested by the patient while antiphlogistics and water were physical treatments.
Purgatives are laxatives that nineteenth century physicians used to rid the body of perceived harmful substances through excretion. Most moral therapists approved of their use in moderation although different laxatives were to be used in different stages of insanity. When a patient was first admitted to an asylum and in the most severe stages of insanity physicians used stronger purgatives like Calomel and Jalap. As insanity progressed toward sanity more mild purgatives like rhubarb and aloetics were employed.
Pharmacy Bottle, Jalap, 1800-1899. Photo courtesy of Mental Health Care Museum at Kingston. |
Emetics, substances that cause vomiting, were used as another method of eliminating harmful substances from the body of an insane patient. Some physicians objected to the use of emetics believing that vomiting increased the flow of blood to the head which could aggravate insanity.
Narcotics were the most objectionable drug used by physicians. Most moral therapists rejected their use all together or only used them when absolutely necessary to deliver “general quietude, indications of drowsiness, nodding and occasional naps.” Antiphlogistics served to reduce fever. The most common method of doing this was localized bleeding or bloodletting. This could be done through cutting open the patients skin with a lancet or by cupping. Cupping was more involved, but arguably more humane. It worked by placing a heated cupping glass on a patient’s skin to create a vacuum which brought blood to the surface. The cup was then removed and a scarificator was placed on the area to cut a series of parallel lines in the skin. Another cup was then placed on the same spot to draw and collect the blood. Like purgatives and emetics, bloodletting served to rid the body of harmful substances and restore balance. Doctor Samuel Woodward summed up the general opinions of moral therapists on the subject of bloodletting in the Twelfth Annual Report of the State Lunatic Hospital at Worcester, Massachusetts: All agree that depletion, by which I would be understood general bleeding and active cathartics, is not favorable in insanity, as it rarely affords more than temporary relief, and frequently produces injurious efforts... But even local bleeding can rarely be relied upon to cure insanity. It is usually prescribed to procure present relief, rather than with the expectation of permanent benefit. Not only does Woodward speak to moderation in bloodletting, but to the general usefulness of medicine in treating insanity. Like other moral therapists, Woodward believed that medicine was only partially helpful in curing the diseased mind. Rather than relying on medical practices, moral means were needed to help asylum patients. |
The use of water as a method of medical treatment was controversial. Physicians in all fields recognized the positive effects of cold water on reducing fevers as well as the effects of hot water to increase circulation and produce the release of toxins through sweating. Rooms entirely devoted to bathing were a requirement of the moral asylum. Not only did water provide medicinal benefits for the patients but it was also hygienic and served to reduce the smelliness of patients and prevent the squalor found in eighteenth century asylums and almshouses.
Mild use of water to treat fevers and clean patients was a general, non-contentious part of moral therapy. Issues arose, however, with the use of the bath of surprise. The bath of surprise involved suddenly, and without warning, immersing patients in cold water and then hot water. Many physicians believed that this would calm down the most excitable and violent patients by shocking them back to reason. Patients did not like this practice and viewed the use of extremely cold and extremely hot water as a form of punishment. In the above picture Ebenezer Haskell, a former asylum patient, depicts a bath of surprise. Haskell explains that pouring buckets of freezing cold water over a person's head does indeed shock them but it often does more harm then good; in fact, the patient feels almost as if they are drowning. Some physicians agreed with Haskell's analysis of the bath of surprise and rejected its use while others saw benefit in the method and used it on the most violent patients to calm them down and restore their senses.
Mild use of water to treat fevers and clean patients was a general, non-contentious part of moral therapy. Issues arose, however, with the use of the bath of surprise. The bath of surprise involved suddenly, and without warning, immersing patients in cold water and then hot water. Many physicians believed that this would calm down the most excitable and violent patients by shocking them back to reason. Patients did not like this practice and viewed the use of extremely cold and extremely hot water as a form of punishment. In the above picture Ebenezer Haskell, a former asylum patient, depicts a bath of surprise. Haskell explains that pouring buckets of freezing cold water over a person's head does indeed shock them but it often does more harm then good; in fact, the patient feels almost as if they are drowning. Some physicians agreed with Haskell's analysis of the bath of surprise and rejected its use while others saw benefit in the method and used it on the most violent patients to calm them down and restore their senses.
Medicine, as a whole, was a side note to the writings of moral therapists. It was used in asylums, physicians made no attempt to hide this fact, but environmental determinism was more important. Medicine was used in conjunction with the effects or a moral, or humane environment. As the century wore on, medicine came to replace moral therapy in importance indicating the decline of the utopian, moral asylum. As early as 1857 a speech read before the American Medical Association of Superintendents of Institutions for Insanity stated:
I advocate entire reliance on medicinal agents in the treatment of insanity. The adoption of proper hygienic rules is essential, as in physical disease generally, Moral treatment, including employment, amusements, the establishment of regular habits, &c., is also a most important auxiliary to recovery. But while admitting the importance of moral treatment, I would avoid an over-estimate of its mechanical part, and carefully investigate not only the laws of physical action, but the influences of medicine on the manifestations of mind, that our noble profession may not become simply an art.
I advocate entire reliance on medicinal agents in the treatment of insanity. The adoption of proper hygienic rules is essential, as in physical disease generally, Moral treatment, including employment, amusements, the establishment of regular habits, &c., is also a most important auxiliary to recovery. But while admitting the importance of moral treatment, I would avoid an over-estimate of its mechanical part, and carefully investigate not only the laws of physical action, but the influences of medicine on the manifestations of mind, that our noble profession may not become simply an art.