We have done what we could to make the Athens Asylum an institution of which you as well as the people of the State of Ohio need not be ashamed, and the mistakes which we have made have been mistakes in judgment alone.56
TWO
PATIENTS
“Each Admission Represented a Poor, Helpless, Hopeless Sufferer”
On a cold day in the middle of winter, a little girl from Athens County became the Athens Lunatic Asylum’s first patient. Her older brother accompanied her as, likely traveling by horse and wagon, they drove down the earthen road from town, across the Hockhocking River, and then up the great hill to the imposing Victorian structure. Eleven-year-old Alice had spent that Friday morning with her brother in commitment proceedings in the office of Athens County probate judge Leonidas Jewitt. Athens physician Dr. H. M. Lash and her brother provided witness and testimony as to her insanity.1 After arriving at the asylum, they climbed its steps and entered the brick building—with its sixteen-foot ceilings, tile and marble floors, and oak woodwork—walked past the carpeted parlors ornamented with potted palms, and entered the west wing. There she was left by her brother with her clothing and little else.
Alice had a seizure disorder. Known at the time simply as epilepsy, seizure disorders were a great puzzle to American asylum physicians. Generally physicians resisted admitting patients with epilepsy, though by 1877 the Athens Asylum was caring, perhaps reluctantly, for patients with this diagnosis.2 Superintendent Rutter in 1877 wrote to the hospital’s trustees, “The hospital at this time contains forty (40) epileptics, all of whom are, by reason of their unfortunate complication, utterly unfit to be associated with any other class of patients.”3
Effective treatment for epilepsy was not developed until the twentieth century, and nineteenth-century asylum physicians were at a loss in their efforts to care for patients with the disorder. Superintendent Holden of the Athens asylum in 1879 recommended to Ohio’s governor a separate institution for Ohio’s “epileptics,” with the idea of isolating them so as not to disturb other patients. Holden noted: “This class of unfortunate beings should claim the attention of the State, and be provided for in a separate institution. The idea of their being associated with the insane is wrong. The fall, with the piercing cry of the epileptic, is shocking even to the sane person, but to those whose nervous constitutions are shattered, or about gone, it is excruciating and greatly detrimental. . . . [T]he epileptics are often dangerous and homicidal.”4
When Alice arrived on January 16, 1874, her pulse and temperature were noted and a case file opened. The asylum physician who examined her described her as intelligent, kind, and cheerful. Her temperament was noted as “excitable” and her health apparently good. The admitting physician wrote that she “has swallowed pins and cut herself with glass as attempts at suicide. The attacks vary in duration and occur from two days or a week, at times more mild than at others. She appears to have warning of an approaching paroxysm.”5
One can only imagine Alice’s life as a young girl with a seizure disorder among three hundred or more women of all ages with a variety of mental illnesses. The medical notes documenting her progress describe the seizures and her recovery from them.
1/21[/74]: Had one paroxysm. Not very severe, stretched and tossed herself about in bed, jaws firmly closed. She did strike and scratch her nurse and remained partly conscious during the whole paroxysm. Was as well as usual the next morning except a slight soreness in muscles of limb and some headache.
1/27/74: Had slight paroxysm last night similar in form to preceding much shorter in duration and less recovery after. Symptoms are much the same as previous.
1/28/74: Had a mild attack at going to bed 8 pm, no symptoms remaining the following morning.
1/29/74: Had one other mild paroxysm last night, no remaining symptoms this morning.
2/15/74: Has had no attacks since the above date and is doing very well at present.6
The 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