Iowa History Project
Medicine in Iowa
by D.S. Fairchild, M.D., F.A.C.S.
reprinted from The Journal of the Iowa State Medical Society, 1927
transcribed from the original book for the Iowa History Project by S. Ferrall
page 265 - 285
A history of medicine in Iowa would not be complete without a reference to our public institutions for the care of the mentally afflicted. While mental disease constitutes a specialty of itself, it has so wide a relation to the general practice of medicine that it cannot be omitted from general consideration.
The practice of medicine as we have thus far considered it has been as a private business, developing in a new country in a way and under circumstances so different from our present conception of medicine, that we are liable to think of the days before the developement of the "Germ Theory of Disease", as belonging to a past age and to disassociate it with the present. Fortunately such views are held largely by those who make the practice of medicine a trade. The men whom we delight to look upon as men of broad and liberal views, clearly understand that so difficult and complex a subject as medicine requires a long period of evolution and could only develp with the advancement of science. The private or general practitioner utilized so far as possible the revelations of science in his daily work, but the fullest realization of the discoveries of science needed the cooperation of institutions of learning and the institutional care of patients where scientific methods of treatment could be employed in a manner not possible for the private physician. We have endeavored to point out the contributions of men obliged to depend largely on their own resources.
The physicians connected with the hospitals for the insane, were in a position to utilize the resources placed in their hands by the state and could remain stationary or extend their opportunities according to the industry, skill and ability of the responsible medical officers.
The early history of insane hospitals and the treatment accorded their inmates was tragic indeed, but fortunately for us, this period had passed before our institutions were organized, but we were not free from the tradition that insane hospitals were for the care of the insane and only incidentally for treatment.
Dr. Gershom H. Hill has kindly agreed to write of the evolution of psychiatry in the United States, with biographical sketches of the superintendents of Iowa insane hospitals and their work.
Psychiatrists of Iowa
Beginning with Dr. Patterson, the first superintendent of the State Hospital at Mount Pleasant, and ending with Dr. Lowrey, assistant director of the new psychopathic hospital at Iowa City, Iowa, a biographical sketch will be furnished to the readers of the Journal of twenty men, who in the past were known as alienists.
The task of preparing the histories of these fellow practitioners is undertaken because the writer has had the proivilege of a personal accquaintance with each and every one of them, also has a distinct knowledge of the services rendered by them to the state of Iowa.
"The Association of Medical Superintendents of American Institutions for the Insane" began with thirteen members, in 1844, in Philadelphia. It met annually in different states where there were institutions for the insane. In 1893 the name was changed to "The American Psychological Association" and in 1920 to "The American Psychiatric Association." The first meeting was held at Jones Hotel in Philadelphia. On this occasion there were present: Dr. Samuel B. Woodward of Worchester State Hospital, Massachusetts; Dr. Isaac Ray of the Maine State Hospital for the Insane, Augusta, Maine; Dr. Luther V. Bell of the McLean Asylum at Somerville, Massachusetts; Dr. Charles H. Stedman of the Boston Lunatic Asylum; Dr. John B. Butler of the Harford Retreat, Connecticut; Dr. Amariah Brigham of the State Lunatic Asylum at Utica, New York.
With these charter members this organization has grown, by having in it not only the heads of the state and private institutions for the insane, but also many of their experienced assistants, besides psychiatrists and neurologists engaged in private practice, so that the total membership at present is nearly one thousand.
A knowledge of mental diseases, especially the causes of them, has, like civilization itself, been an evolutionary process. Thousands of years ago the heathen believed that diseases came from an unknown world, often directly from God. The Christianity of the New Testament does not materially modify the belief in demonology.
In the reign of Edward II it was enacted that "the King shall have the custody of the lands of natural fools, taking the property of them without waste or destruction, and shall find them their necessaries, of whosoever the lands are holden' and after the death of such idiots, he shall render the same to the right heirs, so that such idiots shall not be alien, nor their heirs be disinherited." The Vagrant Act, however, passed in the year 1744, may be regarded as containing the earliest provision made in England for the safe custody of lunatics. Two justices were by it authored to secure any furious or dangerous lunatic, and to order that such be locked up, and if necessary, be chained. Whatever property he possessed was employed in his maintenance, and his place of settlement determined.
So far back as the year 1763, a committee of the House of Commons investigated the condition of houses in which the insane were confined, and discovered, as might be expected, their fearfully neglected condition. In the following year a bill was introduced for the regulation of private asylums and "mad houses."
In the early history of this country demented persons who could not care for themselves, nor be controlled by relatives, were restrained at first in improvised places in company with paupers and criminals.
The earliest legal recognition of the insane is the adoption of an act in 1751, in South Carolina, which provides for the subsistence of slaves who may become lunatics, while belonging to owners to poor to care for them.
The Eastern Lunatic Asylum at Williamsburg, Virginia, is the oldest state hospital in the United States. It was established in 1774.
The history of insanity has its pioneers in this country and elsewhere, its heroes and heroines; but from the standpoint of personal labors to promote practical reforms in public provision for the insane, the work of Dorothea Dix stands preeminent. In the forty years of her public work she was instrumental in founding and enlarging more than thirty state institutions for the custody and right treatment of the insane, becoming an acknowledged power in this respect, not only throughout the United States, but in European countries as well. Miss Dix was born in Maine in 1802, gained an enviable reputation in charge of "Dix Mansion and Boarding School" in Boston. When thirty-nine years of age she became interested in prisons andprison reform, and entered upon her career as a world wide practical philanthropist. In 1854, Miss Dix spent seven months visiting in Great Britain, Paris, Rome, Constantinople, Hungary, Austria, Russia, Sweden, Denmark, Holland and Belgium. She was cordially received and questioned everywhere. Although her strength had been severely taxed, she lived to be eighty-five years old. During the declining years of her life she was physically incapacitated, but her mind wa sunimpaired. During the last five years, from choice, she made her permanent home in the state hospital at Trenton, New Jersey, where she was wll cared for, and frequently visited by notable friends from far and near.
Florence Nightingale was born in Italy in 1823, had wealthy English parents, and early devoted herself to nursing the sick, and was permitted to enter the Crimean War and first distinguished herself in the relief of suffering among the soldiers in Constantinople. She is the patron saint of all educated nurses, and died a few years after the hospital at Mount Pleasant was opened. Thus the way was paved to establish training schools for nurses in the state hospitals and other establishments where insane persons are cared for.
After the Civil War came a period of prosperity in Iowa, also in the states and territiories west of the Mississippi River. Railroads were extended and new ones constructed; the population of the west rapidly increased. It is observed, however, that most of the pioneers were young, single or married, and in making homes for themselves in Iowa, left their demented relatives to be cared for in eastern institutions, so that the proportion of insane in Iowa was less than in the older states, and in states containing large cities. But now the population of Iowa is not increasing very much, and the statistics show that a large proportion of the patients in the four state hospitals are natives of Iowa.
Hospital for the Insane at Mount Pleasant
The Hospital for the Insane at Mount Pleasant, Iowa, was finished and ready for occupancy the first of March, 1861. In the organization of the hospital the trustees felt that there was not a more responsible duty devolving upon them than the selection of the resident officers, especially of the superintendent, for upon the capacity of this officer must chiefly depend the success of the institution in accomplishing the design of its creation and its claim to the public confidence. Happily Iowa from its wealth and resources, from its increasing population, and from its high prospects of future prosperity, enjoys so high a reputation abroadf, that many of the most distinguished and experienced physicians of the country were ready to accept this most difficult post. The trustees believed that the field of choice shoud not be circumscribed.
From the many eminent physicians who were recommended to them, they selected Dr. R.J. Patterson of Ohio. Dr. Patterson had had ample experience in the department of medical practice to which he was called. He had been for several years assistant physician in the State Lunatic Hospital of Ohio; afterward, for several years, the superintendent of the Hospital for the Insane of the State of Indiana; and at the time of his appointment to this situation, superintendent of the Asylum for Idiots and Imbecile Youths of the State of Ohio.
In accordance with the provision of law, the trustees fixed the price of board and the care of patients at two dollars and fifty cents per week. They were not able to determine the actual cost of board per week for each patient, but they were confident that it would not exceed the sum established, and they hoped it would be less.
In the first printed report made December 1, 1861, we find the superintendent's opinion concerning the causes of insanity.
Concerning treatment, the doctor explains to the trustees that there are no specifics in the treatment of insanity, but the same general principles must guide us here, that should guide us in the treatment of other diseases. Harsh means, either medical or moral, are in no way suited to the insane, but on the contrary, mild treatment only is allowable.
By the direction of the trustees, the superintendent framed by-laws, setting forth the duties and restrictions for attendants and other employes making a total of eighty-three sections.
In the printed report of December 1, 1865, the trustees have to report a serious cause of regret in the retirement of Dr. Patterson from the office of superintendent.
[transcripton note: immediately following are the biographies of Dr. R.J. Patterson and Dr. Mark Raney. They can be found in the Biographical section on the Table of Contents]
Insane Hospital at Independence
The second hospital for the insane was provided for by the Twelfth General Assembly. Hon. W.G. Donnen, then senator from Buchanan county, was active and succeeded in having it "located on suitable ground within two miles of Independence." Hon. Geo. W. Bemis was a suitable citizen of Independence to become the local member of the building commission. The other two capable men were Marturin L. Fisher and Erastus G. Morgan, president of a bank in Fort Dodge. They met in June, 1868. Colonel S.P. Shipman of Madison, Wisconsin, was employed to prepare plans, which after being examined and modified by Dr. Ranney, were adopted. As appropriations made by the twelfth and following assemblies became available, the institution was erected and occupied piece-meal. The central portion, occupied by the officers, and directly in the rear the kitchen, laundry and heating plant were at the same time as the north wing of the institution finished and occupied as soon as possible. This institution fronting toward the east and the Rock Island railroad track, known as the main building, was not completed and occupied for many years. Afterward collages were added, not only to be occupied by patients, but store houses and shops of various kinds have been built, until the hospital at Independence is quite like the other three hospitals in its ability to classify patients and to treat and cure them in a most up-to-date manner.
The Insane Hospital at Independence was opened in 1873 with Dr. Albert Reynolds superintendent and Dr. Gershom Hill assistant superintendent in 1874. In 1881 Dr. Reynolds resigned and was succeeded by Dr. Hill, who served until 1902. In 1895 a laboratory service was organized under the direction of Dr. Albert M. Barrett. In 1898 the work of the institution was reorganized, with laboratory investigation as an important factor in administration and treatment.
From the period of reorgainization, the Independence Hospital, in common with other institutions of a similar character, assumed the functions of a real hospital for the care and treatment of the mentally afflicted.
[transcripton note: the biographies of Dr. Albert Reynolds and Dr. G.H. Hill are in this section; readers should refer to the Biographical section on the Table of Contents]
Clarinda Hospital for the
The Twentieth General Assembly enacted a law to make further provision for the care of the insane persons. The governor, with the consent of the executive council, to appoint three suitable persons, who shall constitute a board of commissioners for the purpose of selecting the location and site, adopting plans and erecting an additional hospital for the insane of the state. The location shall be in the southwestern portion of the state and shall be selected with reference to its healthfulness and accessibility. The site shall consist of not less than three hundred and twenty acres of land and shall be selected so as to secure an abundant supply of good water and an opportunity for the proper and efficient drainage and no gratuity or donation shall be received as an inducement to such location.
That said board of commissioners shall procure and adopt the plan known as the cottage plans, and all buildings so erected shall be substantially fire-proof. The exterior of the buildings shall be plain and of brick. That there is hereby appropriated one hundred and fifty thousand dollars provided that not more than one-half of the amount shall be expended in the year 1884. When such buildings or any of them shall be completed, and ready for use, the commissioners shall notify the governor of the state and he shall at once take steps to organize the same by the appointment of a board of five trustees who shall hold their office until the next session of the legislature and whose qualifications and duties shall be the same as now provided by law for the trustees of the others of the state of Iowa, and the laws of the state governing the other hospitals and thus admission of patients thereto, so far as applicalbe, shall apply to and govern the hospitals herein provided for.
On the sixteenth day of July, 1884, the commissioners met again at Des Moines for the purpose of deciding upon the site of the new hospital. They had already visited and carefully inspected every site that was being offered as a location. After deliberation these gentlemen, by a majority vote, selected Clarinda as the place combining in the fullest degree the requirements of the statute under which they acted. The board also elected P.W. Lewellen, M.D., of Clarinda, as the first superintendent, who selected Dr. J.M. Aiken, assistant physician, M.T. Butterfield, steward, and Mrs. Alice W. Lewellen, matron.
Dr. Lewellen resigned his office and was succeeded by Dr. Hoyt in 1892.
[transcripton note: the biographies of Dr. P.W. Lewellen and Dr. Frank Crampton Hoyt are in this section; readers should refer to the Biographical section on the Table of Contents]
Iowa Institution for Feeble-minded Children at Glenwood, Iowa
Through the courtesy of Dr. George Mogridge, the present superintendent, we have been able to collect data for an outline history of this important institution.
Like so many of our public welfare institutions for the betterment of the unfortunate members of soceity, the inception of this one emanated from the broad and liberal mind of a member of our State Medical Society.
In 1873 Dr. W.S. Robertson of Muscatine became impressed with the number of idiotic and imbecile persons in Iowa, commenced a series of investigations to ascertain their number, condition and needs, which he embodied in his presidential address before the Iowa State Medical Society in 1874. This is probably the first public plea in the interest of feeble-minded in Iowa. It may be noted that Dr. Mark Ranney, while superintendent of the hospital at Mount Pleasant, made an effort before the Eleventh General Assembly in 1866 for the relief and benefit of idiotic and imbecile persons in Iowa.
Without accurate census data Dr. Robertson estimated that in 1873 there were at least 1200 idiots and imbeciles in Iowa. At the close of Dr. Robertson's impressive address, the State Medical Society passed a resolution in favor of the establishment of an institution by the state for the care and training of the feeble-minded in Iowa. Dr. Robertson also made a strong plea before the legislature.
On the first day of February, 1876, Hon. C.C. Horton, member of the House from Muscatine, introduced House File No. 240, which was "A bill for an act to provide for building an asylum at Glenwood, Mills county, for the idiots and feeble-minded of the state." After reference and amendments, it finally passed both the House and Senate, and the act was approved by Governor Kirkwood March 7, 1876.
During this struggle to secure an act to provide an institution for the feeble-minded in Iowa, Dr. Robertson availed himself of the advice and aid particularly of Dr. C.T. Wilbur, superintendent of the Institute for Feeble-minded Children for the State of Illinois.
The above institution was organized July 1, 1876 under an act passed by the Sixteenth General Assembly of Iowa creating the same. This enactment was modified somewhat by the Nineteenth General Assembly, and the information as to eligibles is taken from the laws of that session.
The law of the aforesaid Ninteenth General Assembly recites that 'every child and youth residing within the state within the ages of five and eighteen years who, by reason of defective intellect is rendered unable to acquire an education in the common schools, is entitled to receive the physical and mental training and care of this institution at the expense of the state. The county superintendent in each county, on the first day of October to report to the superintendent of the institution the name, age, and post-office address of every person in his county of such age who, by feeble mental and physical condition is deprived of a reasonable degree of benefit from the common schools. And also to give the name and address of parents, guardian, or nearest friend of such person.
During the first years of the life of the institution there were received eighty-seven children, at the end of ten years the population was 259, 164 males and 95 females; at the end of twenty years a total of 574, 334 males and 240 females; at the end of thirty years a total of 1038, 565 males and 473 females; at the end of forty years a total of 1409, 733 males and 676 females; at the present time, forty-eight years after its establishment, the inmate population is 1539, 749 males and 790 females. Of this grand total there are enrolled in the school classes about six hundred, the others being enrolled in what is termed the custodial division.
The present school force consists of seventeen teachers, and the branches taught include the usual academic work, vocal and instrumental music, domestic science, physical training, manual work of all kinds, in cluding sewing, fancy needle work, basketry, lace making, etc., for the girls, and for the boys bench work, and making of heavy baskets. Later in their training the children take part time school work, and are also instructed in laundry work, general household duties, cooking, serving, etc., for the girls, and for the boys cobbling, carpentry, painting, printing, gardening, etc. Others who have passed through the entire school period where they have been instructed by ordinary methods, are gradually brought nto fuller activities by being detailed to the various departments of the institution where they assist in the economy of the same.
The bill passed and signed by Governor Kirkwood March 17, 1876, provided: First, for the establishment of an asylum for feeble-minded children to be located at Glenwood on property already owned by the state. Second, the purposes of this institution are for the care, support, training and instruction of feeble-minded children. Third, it provided for the appointment of a board of three trustees, and for the appointment of a superintendent and other resident officers. Fourth, the age of admission to be between seven and eighteen years, and defines the method of obtaining admission. Fifth, it provided a support fund of $10 per capita, per month, and in addition the sum of $2,000 for salaries and wages, also for certain sums for the purpose of securing furniture, repairing buildings and other incidental expenses.
On March 15, 1876, a joint convention of the General Assembly elected the following named gentlemen as trustees: Dr. W.S Robertson of Muscatine, A.J. Russell of Glenwood and Jonathan W. Cattell of Des Moines. These turstees convened at Glenwood April 26, 1876, and effected an organization as follows. Dr. W.S. Robertson, president; A.J. Russell, treasurer, and J.W. Cattell, secretary. the board of trustees then took possession of the property set aside by the state; it being the property heretofore held and occup9ied by the Western branch of the Iowa Soldiers' Orphan Home.
The condition of the property was bad and extensive repairs were necessary for use as an asylum. After the buildings had been repaired, the next step was to secure a superintendent, and the trustees selected Dr. O.W. Archibald of Glenwood, who had formerly been an assistant physician at the Mount Pleasant Hospital for the Insane. He was also made secretary on the resignation of Mr. Cattell. Mrs. S.A. Archibald accepted the position of matron.
Early in 1882 Dr. Archibald resigned as superintendent and Dr. F.M. Powell of Glenwood was elected to fill the vacancy. Previous to the resignation of Dr. Archibald efforts were made to secure the removal of the institution from Glenwood, but failed.
In 1903 Dr. Powell died and Dr. George Mogridge, the present superintendent, was elected.
The history of this institution has been full of interest as showing the difficulties that lie in the way of securing legislative appropriateions for the care of the unfortunate in the earlier days of the state, when economy was necessary and when the representatives of the people were slow in voting money for almost any purpose which would impose taxes upon a people who were impatient of burdens which could be avoided.
It is also of interest to observe the ready response of members of the medical profession in securing beenefits for the unfortunate members of society who were physically and mentally unfit to meet the conditions of our complex civilization.
Cherokee Hospital for the
The Twenty-fifth General Assembly decided to build a hospital for the insane in northwestern Iowa and appointed a commission to visit and report on the sites proposed at Cherokee, Le Mars, Sheldon, Storm Lake and Ft. Dodge. Drs. Gilman, Hoyt, Hill and F. McClelland of Cedar Rapids were named the commission by an agreement, in the finding, in joint session, the report of the commission was heard and by ballot, Cherokee was chosen. At this same session of the legislature the City of Cherokee promised to have a side track made by the Illinois Central R.R. to the farm where the buildings were to be erected, so that brick and stone could be delivered with a locomotive, and coal and fuel in abundance in mid-winter and in rainy weather, and the building committee thought the Burroughs land near town suitable for the patients to cultivate and bought it at $45 per acre. Red or light collored jasper was used for the first buildings erected. They have slate roofs. The Cherokee Hospital as it now stands shows the good materials that have been used, the advantages of the railroad for the transportation first of building materials, then of coal, and of various kinds of supplies.
In August 1902, the board of control elected Dr. Voldeng as the first superintendent. He had served the state at Independence as assistant physician. When Dr. Voldeng left Cherokee, Dr. Donohoe was immediately elected by the board of control to become the second superintendent at Cherokee.
[transcripton note: the biographies of Dr. Matthew N. Voldeng and Dr. George Donohoe are in this section; readers should refer to the Biographical section on the Table of Contents]
Psychopathic Hospital, Iowa
In August, 1921, when Dr. Lowrey was assistant director and associate professor of psychiacrist he gave the following history of this specialty in the United States:
The law establishing a State Psychopathic Hospital was enacted in 1919, Ch 235 of the Thirty-eighth General Assembly. It provides for the establishment of a hospital, especially designed, equipped and administered for the care, observation and treatment of persons who are afflicted with abnormal mental conditions. The hospital is put under the management of the State Board of Education to be located at Iowa City and connected with the College of Medicine of the State University. The board appoints the medical director who shall serve as professor of psychiatry in the College of Medicine. The director in addition to having charge of the hospital shall seek to bring about systematic cooperation between the several State Hospitals for Insane and the State Psychopathic Hospital. Provision is made for him to visit and advise the hospitals, on request. The law carries the first provision made in the state for admission of vountary patients to a state hospital for mental diseases. It provides that they may come voluntarily, either as public or private cases. Patients could also be committed by judges of the district court or superior courts as suffering from an abnormal mental condition which can probably be remedied by observation, treatment and hospital care. The expense to be borne by the family or the county, as the county may decide. It will be noted that this form of commitment does not carry with it the idea of judging the person insane which many people don't like, preferring to think that the patient is sick, as indeed he is. We have then four legal classes of patients, viz: Voluntary, private coming, voluntary public, committed private and committed public. Of these, the second, an order of the judge that support be paid from pubic funds, the third, an order of the commitment by the judge;the fourth, an order of commitment and an order for pubic support. Ample power is given the director to insure that the hospital may select its cases and transfer to the district state hospitals cases not regarded as suitable for the psychopathic, or cases which prove to be chronic or incurable. The original provisions were somewhat modified at the last General Assembly, but the same ends are each preserved and subserved. The total appropriation of $272,000 was granted by the Thirty-eighth and Thirty-ninth General Assemblies for the building and equipment. The plans were drawn by the director, Dr. S.T. Orton. It contains sixty beds with ample day space, so arranged, that a classification of the patients may easily be arranged with respect to their therapeutic needs. There is an ample and well arranged out-patient department, offices and needed rooms for the medical and social service, laboratories for chemistry, serology, pathology, psychology and experimental work; library class room and teaching laboratory. It is in my opinion the best plant in this country for the particular work.
The first psychopathic hospital in this country was established at the University of Michigan in 1906 and the State Psychopathic Hospital in Iowa located at Iowa City is the second one of the kind in the United States, and it is to be observed that the four state hospitals already described are wholly under the management of the State Board of Control while this one according to the law of Iowa is under the care of the State Board of Education. The Board of Education visits the Psychiatric Hospital somewhat as it does the other hospitals under and managed by the state at Iowa City and provides by-laws as it does to the other hospitals at Iowa City and directs Dr. Orton as it does the other doctors working for the state at Iowa City.
[transcripton note: the biography of Dr. Samuel T. Orton followed this section; refer to the Biographical section on the Table of Contents]
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