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.
Male Patient 1, a merchant from an eastern Ohio county bordering the Ohio River, was admitted to the asylum on Sunday, January 11, 1874. The case notes relate that he was sixty-two years old, married, Methodist, and possessed of a “good education.” His parents had immigrated to America from Ireland and died before his admission. In describing the patient’s disposition and health, the admitting asylum physician noted that he was a quick-tempered, kind, sober, and industrious man with light brown hair. Depressed and in poor health for three months, he feared financial ruin. He had good reason to be worried about his business: at that time, Americans were living through the Long Depression. We learn that the “exciting cause of his mental illness” was judged to be “business perplexity and general ill health” and that he was depressed “respecting his future condition and fear of pecuniary loss.” By the time of admission, he was weak in body with “paroxysmal attacks of jumping and noise,” had made an attempt to hang himself, and was thought to be dangerous and “apt to strike people suddenly.” He had lucid moments in which his mind functioned well, but at other times he was “sometimes excited and tries to fight and bite.” He slept poorly. We learn that his “vegetative functioning” was poor, he possessed a craving appetite, his bowels were constipated, his eyes were blue, his vision was good, and his hearing, smell, and taste were unremarkable. Six entries describing his condition appear in the casebook:
January 11: 98 1/2 temperature, pulse 64, weight 100 pounds. Strength 60 on the Dynamometer.14 Feeling almost normal. Seems to be much better and in good spirits.
January 20: temperature 98 1/4, pulse 64, weight 102 pounds. Seems to be some better. Had a bad day on the 18th, confined mostly to the forenoon and was about as bad as when brought here.
February 7: Pulse 60, strength 70, weight 104 pounds. Improving slowly. Does not have those spells of mania as when he came except some and then not so bad.
May 2: About the same as when first admitted mentally but much stronger physically. Tried to but [sic] his head against the wall about a week ago.
May 8: Has become jaundiced in the conjunctival some and in the skin a little.
May 16: Still continues considerably yellow. Was given a pill containing 1/2 gr. Potassium & 1 gr. Aloes.
May 17: Has taken meat within the last 18 hours. Remains weak and is rather drowsy most of the time.
May 28: Taken away (by his brother who was a physician).15
The last entry notes that Male Patient 1 died at home six weeks later.
The asylum records contain many other instances of men, especially older men, hospitalized for depression and worry surrounding financial circumstances. Male Patient 150, a sixty-year-old farmer, is another example. He entered the asylum for an illness “one year of duration, the exciting cause of which is Financial Embarassment.” Some remained preoccupied with finances while in the asylum, writing for money to purchase clothes or as repayment of debt. Families of men who were depressed, violent, and out of work brought them to the asylum as a last resort. A thirty-year-old man from Chillicothe was hospitalized with “melancholia with incipient dementia (caused by) failure in business.”16 A sixty-year-old man was hospitalized after having been “thrown out of employment” and having attempted “violence upon himself and others.”17 A farmer, age twenty-six and married, fell into a depression after the death of his father, complicated by financial worries and his responsibilities as executor of his father’s estate. The medical witness described the history of his case as “one month, for the first two weeks slight mental disturbance followed by violent fits of insanity. The cause is depression of mind from the recent death of his father, of whom he is Executor and anxiety relative to pecuniary matters.” The physician and the asylum also cited a