A Modern Madhouse: An Inspection Report

The Philadelphia Medical Journal, November 12, 1898

About thirty miles from Baltimore a little off from the main line of the Baltimore and Ohio Railroad, on the undulating land bordering the valley of the Patapsco, lies one of the historic demesnes of the State of Maryland. The manor house built in the classic simplicity of the Colonial period, although well in its second century, has fortunately escaped disfigurement by modern additions and improvements.

Here lived the willful Betsy Patterson, who one night after her father had gone to bed, let herself out by a window and mounting a horse, with a negro slave upon another horse carrying her dress, rode to Baltimore to attend the ball where she met the French officers and found her fate among them in the young Jerome Bonaparte; and here, one lovely summer evening after dinner, we sat on the beautiful lawn fronting the house, the road, unlike the approach to most dwellings leading to the rear, listlessly watching the rising full moon, the hum of birds and insects in the surrounding park alone disturbing the blissful calm, until the notes of a distant bugle sounding the tattoo caused the post prandial idlers to stroll out upon the lawn and look whence came the sounds, toward a group of buildings that had been erected within a year upon a hill 400 yards away, and which were then brilliant with electric lights.

Again the bugle sounded “taps,” and with the last notes the lights disappeared simultaneously, save a few dimly marking certain sites. It was not a military post that sent forth these familiar martial strains but a madhouse, wherein 154 madmen had gone to bed as so many soldiers in a barrack to sleep unmanacled and behind no restraining bars or locked doors until the bugle’s reveille should call them to the labors of the day; and the old Colonial homestead is the official residence of the superintendent Dr George H. Rohe, where he rules his domain of 800 acres by the touch of an electric button.

Let us see how the madman of to day lives his disjointed life.

By the time we had had our own breakfast and had crossed the intervening space to the cottages on the hill, we met gangs of apparently well-conditioned laborers or farmhands at work with spade and shovel and pick leveling off hummocks and grading hillsides; others with heavy iron mallets sitting in the road breaking stone for macadamizing; still others, rake and hoe in hand, weeding the vegetable gardens — here a party mending fences and trimming hedges, there a crowd of jolly haymakers, and in the house some with long-handled fretteurs polishing the waxed floors of the corridors, sitting-rooms and dormitories, or with mop and cloth brightening mirrors and window panes and chasing incipient dust heaps from their hiding places in corners and crevices.

Of the 154 inmates, the morning report of the medical officer of the day showed 113 actively at work, minds diverted from dwelling upon their idea by congenial occupations that demanded their attention, the outdoor employments at the same time exposure to sun and air and helpful exercise of muscles — hygeiatherapy — that made them keen for the signal to cease their labor for dinner — how — by depositing their clothes in the basement of their several cottages and washing at the spacious lavatories on that floor.

Then, with clean hands and faces and decent garments, they fall into line at the bugle’s call to dinner and, led by uniformed attendants in squads, two by two, arm in arm, the stronger supporting the weaker, each with his chosen companion, along the covered corridors to the dining room in the service-building where, standing until all are in place, they seat themselves upon a signal at tables with clean white cloths and furnished with and bowls or cups and saucers, glass tumblers,  — what old madhouse doctor would believe it — knives and forks, and, at the time of our visit, spoons for ice cream, which was decently served as a dessert.

There was no stint of food. The plates of the hungry and the ravenous were replenished over and over by watchful attendants; the indifferent or obtuse induced to eat, or whim and fancy catered. When all had finished, the knives and forks were gathered and counted and, this done, the medical officer  of the day, always present, pulled the gong signal, and they rose in order fell in in pairs, and at another stroke of the gong, marched back to their respective cottages to smoke, to loll, to gossip until their afternoon duties should again call them to work, or to bathe or to stroll or to whatever else might be the day’s routine.

The distinguishing features of this new establishment for ministering to men with minds diseased may be briefly stated to be: (1) Impressing upon the inmates the fact that they are patients under treatment; (2) dispensing with every form of visible restraint or irritating means of compulsion; (3) finding appropriate occupation, especially outdoor work for everyone utilizing the skilled labor of mechanics, or giving the Polish Jew, who never knew other instrument than the needle, the task of mending clothing bedding; (4) encouraging and exacting habits of personal cleanliness, water closets, urinals, lavatory basins or rain baths, soap and towels being provided on every floor in apparent superfiuity; (5) instituting a quasi-military precision and regularity in the associated operations, in dressing and undressing, in beginning and quitting work, in going to bed and rising, bugle calls, so far as possible supplementing personal orders and uniformed attendants acting rather as captains and guides rather than as keepers or guards.

The hospital idea in its full development comprehends numerous elevations embraced within the extensive limits of the estate with independent groups of buildings. One for male patients is completed and in successful operation; ground has been broken for a second for females, which is to have only female nurses, attendants, cooks, and assistants, and female medical officers; a third for epileptic insane will follow; and so, until the capacity of the grounds shall have been exhausted and the inmates number thousands.

The group completed consists of four detached buildings, each occupying the side of an open space or court 200 feet square connected by covered but unenclosed corridors. One of the four is the service building of the group, in which the medical officers and attendants live and have their offices, and wherein are the visitors’ reception room, the store rooms and dispensary, this being the least frequented in the building, and in the basement, the kitchen, pantries, refrigerators, and patients dining room, as only the bedridden and the helpless are fed elsewhere.

The other three buildings are practically two storied and basement cottages, of which the ground floor is chiefly devoted to sitting room purposes, with large, open porches, whose attractive outlooks make them the preferred resorts, while on the upper floor are the dormitories, solely used as such. In the basements are hooks and boxes for working suits and shoes. On all the floors are lavatories.

At the sound of the tattoo, the inmates of the several cottages ascend to the dormitory floor, strip off their day clothes, each article having its appropriate hook, wash at the lavatory on this floor, which in appointments would not be out of place in a first class club or hotel, and donning their night shirts, go to bed. The long line of day suits exposed to the current of air sweeping through the open windows of the ante room outside the dormitory thus becomes thoroughly ventilated during the night.

At taps lights are extinguished, save at the attendant’s table, where he sits awake with every bed in view until relieved, when he goes to his own room in the service building to sleep, as no one but patients is allowed to sleep in the cottages. Within reach of the attendant are the switches controlling the electric lights and telephone calls communicating with the service building and the superintendent’s quarters. A characteristic feature of the dormitories is the long row of open windows checked only enough to prevent the egress of a body, but with no suggestion of bolt or bar.

On the living floor below, numerous doors without locks open freely outward, a catch on the exterior knob only preventing entrance from the outside. Stone and brick passage ways from the dormitories without bends or angles, locked and unused except in emergencies, provide a rapid means of escape from fire to the outside without the necessity of traversing the buildings. An automatic register in the office in the service building records the progress of the night watchman in his hourly rounds, indicating the time and the place of his several visits.

What can be accomplished toward humanizing these unfortunates who have come here, to be made well if that be possible, or to be cared for if incurable, is most strikingly illustrated at the general weekly inspection by the superintendent on Sunday morning, when every nook and corner are explored with a thoroughness that bespeaks the military antecedents of Major Rohe. Having been more than once invited to act as inspecting oflicer and urged to indicate defects and oversights for which 20 years experience in charge of United States Naval Hospitals perhaps qualified me, I bear witness to the wonderful results that have been here accomplished.

One hundred and fifty cleanly-appareled clean-skinned men, mostly of the humbler class, decorously sitting on comfortable chairs upon the porches in pleasant weather; waxed floors unsoiled by expectoration; spotless window panes and lavatory mirrors; the ridges and hollows of the moldings of steam registers, the angles and bends of stairs, the tops of door jams and window frames, and the narrow spaces behind pipes, which invite dust and neglect, all without evidence of either, even at places only to be reached by chair and ladder; balusters and brasswork, which give no smear to the pocket handkerchief, all these tell their story to the alert inspecting officer. Once only I found a stray dust cloth under a steam-coil, where it had been hastily left by an attendant unexpectedly called away.

In attic and basement, in dormitory and living room, in ante room and dining room, the same incredible order prevailed. Even in the attendants closets the paraphernalia of service were neatly arranged and the folded bedcovers and pillowcases on the long line of beds, all but one unoccupied, would have been the envy of a housewife or the head chambermaid of a hotel, while both these would have appreciated the fact there is no such thing as a chamber pot in the dormitories. Not the least interesting display of the Sunday inspection were the rows of workday clothes and hats and shoes, each in its assigned place in the basement, where their owners had placed them the previous Saturday on ceasing work.

In each cottage on the dormitory floor, there is a single ample-sized porcelain bathtub standing well into the room, so as to be accessible on every side, and used only by the very sick and feeble or others unable to bathe themselves; but an abundance of rain baths (appropriate and desirable for private residences) is provided, where general ablution can be performed decently and thoroughly. When the weather permits, it is the custom to march the several squads for outdoor bathing, for which the numerous watercourses of the domain furnish facility.

Here, then the problem has been solved so far as human intelligence can do it, of the humane treatment of those unfortunates, whose minds have gone adaft. Here, amid the placid surroundings of rural life away, from every exciting cause, with agreeable outdoor occupation, the unbalanced mind may recover its equilibrium, or, if that cannot be if healthy living, wholesome food, and generous indulgence cannot effect a cure, the inveterate sufferer can at least live peacefully, decently, and as far as the fantasies shaped by his seething brain will permit, contentedly.

But these are selected cases an old-time keeper suggests. Is it probable that the almshouse from whose overcrowded insane wards most of them have been received would transfer any but the most unruly and least orderly and least serviceable of its inmates? I saw myself a patient admitted, an acute case, whose wrists still showed the marks of the hand irons he had worn, and put to bed in an open ward and kept there by a watchful attendant, or as many as might be required, and who in three days had become tractable and responded to the usual clinical questions of the physician; while another who, as soon as he landed from the wagon that brought him, made a break to escape and thrice repeated his attempt the same day, before a week had passed was sitting quietly among the others and taking part in their work or play.

Great was the indignation when the people of Carroll County learned that the aristocratic Patterson estate was to become a “lunatic asylum” The village shopkeepers refused their wares to the pestiferous invaders. Immediate neighbors declared their intention of moving away. Those who had to pass along the roads watched askance the groups of laborers who had been put to work utilizing the farm buildings on the grounds. Soon they learned from their own employees that these very laborers were the dreaded crazy men.

Today the brilliantly lighted buildings on the hill, visible for many miles around, are the pride of the county and the envy of adjoining ones, while railroad and express, local dealers and post office rejoice over the thrifty newcomers.

The State of Maryland has great reason to be proud of this unrivaled establishment, and the Board of Managers may congratulate themselves upon the trust they so implicitly placed in the judgment and acquirements of the Superintendent, who himself has the rare satisfaction of having seen his plans and promises fulfilled to the very letter. What has already been accomplished in this superb institution betokens what may be expected in its further development. Simple, chaste, elegant in architecture and appointments, its broad halls, lofty rooms, and admirable proportions and equipment cannot fail to please the critical visitor, while the man whose monument all this is, may justly boast that without stint of what was necessary, with lavishness only in the direction of the sanitary provisions of cleanliness, not one dollar has been expended for which a full equivalent is not in evidence.

Is this a sketch of fancy? Let the doubter defer his verdict until he can come and see.

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