casebook does not note what became of Alice or how long she lived at the asylum. Genealogical records, though, suggest that she married in Michigan in 1879 and died in Los Angeles at the age of eighty in 1943.
The asylum accepted and cared for a diversity of patients. The elderly with dementia, women in need of care after childbirth, persons who had attempted suicide or harmed others, those committing crimes while mentally ill, persons with drug and alcohol addictions, and persons with what would be diagnosed today as schizophrenia, depression, or bipolar disorder are examples of the wide variety of the patients treated for conditions considered to be mental illness in late Victorian America.
Three documents were required to commit a person to an asylum in Ohio: a medical certificate from a physician certifying insanity; a request for commitment from the probate court with the names of witnesses; and a paper prepared by the asylum accepting the patient and noting the date, number assigned, age, and county of residence. Nearly a century’s worth of these documents—many thousands of them—are archived with Ohio University Libraries. Folded, packed in letter-sized folios, layered with a fine sifting of dust accumulated over 135 years, and tied with faded red ribbons, the commitment papers reveal many details about asylum patients: age, health, family situation, symptoms, and the medical witness’s best guess as to the cause of the bout of insanity.7 Each of Ohio’s eighty-eight counties had its own medical certificate and request for commitment; thus, the documents vary according to the originating county. The forms for each county evolved over time as to the kinds of details recorded. Some, filed away and undisturbed since 1874, display elaborate wax seals in still-brilliant golds and cadmium reds, and all bear the individual handwriting of physicians and probate judges with notes sometimes attached or written in the margins in ink or pencil. Officials wrote their notes with fountain pens and ink; one learns, as one reads through hundreds of these papers, to decipher the peculiarities of individual handwriting and the conventions of nineteenth-century penmanship. The documents contain the official legal and medical narratives of each of the 4,511 persons admitted between 1874 and 1893. Behind each official story couched in clinical language lie the struggles, pain, and sometimes the death of patients.8 The narratives presented here are constructed from the stark facts offered in the medical evaluations; from the occasional departures from the measured clinical and judicial language in the commitment papers by officials explaining extraordinary medical events or pleading for swift action; and from notes and letters written by patients that were confiscated and preserved in files by asylum staff.
Two casebooks (one for men and one for women) maintained by asylum medical staff are kept under lock and key at the library of the Ohio Historical Society in Columbus, Ohio. Measuring eighteen inches tall by twelve inches wide, the casebooks, labeled with gold letters, are bound in oxblood leather and tan suede, with endpapers of marbled maroon, cream, teal, burgundy, royal blue, and yellow, and contain entries handwritten in ink on preprinted forms. Because the creamy white forms with light blue lines are printed on thick paper with a high cotton rag content, they are sturdy and beautifully preserved today, nearly 150 years later. The men’s casebook is rich in details about the condition of patients at admission, though records cease in the spring of 1874 with Male Patient 179. Updates in the form of Progress of Case notes for these original 179 male patients were made every few months until mid-1875, at which time the effort was either abandoned or a new method of tracking patient progress (now lost to history) was instituted. One wonders whether by 1875, when the average daily number of patients stood at 597, the asylum’s two assistant physicians were overwhelmed by the volume of work and simply ceased taking notes. The women’s casebook contrasts with the men’s. Details for female patients upon admission contain much less detail, and Progress of Case notes ceased altogether in January 1874, with the admission of the tenth female to the asylum.
Though the asylum was designed for only 572 patients, by 1876 the asylum’s average daily count had reached 646. Superintendent Gundry advised the hospital’s trustees in 1876 of crowded conditions: “One fact which these (statistical) tables will fail to show as vividly as your frequent visits to the Hospital during the past year must have impressed upon your consideration is the crowded condition of the Hospital. It is not yet three years since the first patient was admitted within these walls, and the wards are now over-crowded. There are more than seventy (70) patients in excess of the number this house was designed to accommodate.”9
In 1886, the asylum’s staff was caring for 672 patients each day, exceeding its intended capacity by a hundred patients. Even with the 1887 addition of space for 36 men and as many women, bringing the asylum’s capacity to 644, in 1893 the asylum remained crowded, with an average daily occupancy of 813, or 169 patients over capacity.
When it opened, the asylum at Athens served twenty-eight of Ohio’s eighty-eight counties. (Using today’s mental health care language, the asylum’s catchment area comprised twenty-eight counties in the rural south and southeast quadrant of Ohio.) State asylums in Columbus, Cincinnati, Cleveland, and Dayton served the rest of the state, and patients were sometimes sent from there to the asylum at Athens to relieve crowded wards. Athens received a hundred or more patients during the nineteenth century from sister institutions in Ohio; these patients arrived without case records and came usually in groups of a dozen or more, accompanied only by a list of their names, addresses, and age. Likely the patients transferring from Ohio’s urban centers arrived by train, as transport by road to Athens was difficult in the nineteenth century, with axle-deep mud in the winter and spring making wagon and coach passage travel to the asylum nearly impossible at times.10
FIGURE 2.1 Service area of the Athens Lunatic Asylum in southeastern Ohio, 1874. Originally published in The New People’s Universal Cyclopedia of Universal Knowledge (New York: Phillips and Hunt, 1885).
The asylum’s commitment documents reveal that the admissions process dealt with every possible category of patient. Nineteenth-century mental illness diagnostic systems were based on the work of the French asylum physician Philippe Pinel.11 Ohio asylum physicians practicing during the moral treatment era classified patients into eight categories: mania, mania with epilepsy, monomania (an obsession causing mental disarray), paresis (neurosyphilis eventually ending in dementia and death), melancholia (depression), five subcategories of dementia, imbecility, and finally not insane. These categories and the number of patients fitting each description were listed each year in the asylum’s annual report.
Much more diverse were the causes ascribed to mental illness, their relationships to mental illness sometimes inscrutable.12 Sixty-nine possible “physical” causes were tallied annually, including fevers, head and spinal injuries, sunstroke, apoplectic attack, dysentery, pneumonia and asthma, menstrual derangements, change of life, lactation, pregnancy, syphilis, masturbation,13 intemperance, inhalation of nitrous oxide, lead poisoning, opium eating, bathing while overheated, excessive use of tobacco, exposure, loss of sight, and excessive heat. Twenty-seven possible “moral” causes were thought to underlie mental illness in the taxonomy of causation of nineteenth-century asylum medicine. Chief among them were business and financial troubles, domestic troubles, grief at loss of friends or family, and poverty and loss of money. Other moral causes tallied at Ohio’s asylums each year were disappointment, fright, religious excitement, abuse by relatives, prison life, slander, spiritualism, attempted rape, unmarried life, and repression by parents. Community physicians speculated about an even broader array of causation as they filled out patients’ commitment papers, including reasons such as fording a cold creek while menstruating, uterine troubles, typhoid fever, cannonading, the shock of enduring a great storm at sea while immigrating to America from Germany, physical prostration from overexertion, unwise disposition of property, hard drinking, and disease of the stomach and bowel. The accounts of the lives of the patients in this chapter are based on the observations and descriptions of community physicians and probate judges, surviving case notes from asylum physicians, testimony and descriptions from family and friends, and in some instances the writings of patients themselves.
