INDIANA MEDICAL HISTORY QUARTERLY

INDIANA HISTORICAL SOCIETY

Volume IX, Number 1 March, 1983

R131 A1 15 V9 NOI 001 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indianapolis Indiana 46202.

EDITORIAL STAFF CHARLES A. BONSETT, M.D., Editor 6133 East 54th Place Indianapolis, Indiana 46226

ANN G. CARMICHAEL, M.D., Ph.D., Asst. Editor 130 Goodbody Hall Indiana University Bloomington, Indiana 47401

KATHERINE MANDUSIC MCDONELL, M.A., Managing Editor Indiana Historical Society 315 West Ohio Street Indianapolis, Indiana 46202

MEDICAL HISTORY SECTION COMMITTEE

CHARLES A. BONSETT, M.D., Chairman

JOHN U. KEATING, M.D. KENNETH G. KOHLSTAEDT, M.D.

BERNARD ROSENAK, M.D. DWIGHT SCHUSTER, M.D.

WILLIAM M. SHOLTY, M.D. W. D. SNIVELY, JR., M.D.

MRS. DONALD J. WHITE

Manuscripts for publication in the Quarterly should be submitted to Katherine McDonell, Indiana Medical History Section, Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. All manuscripts (including footnotes) should be typewritten, double-spaced, with wide margins and footnotes at the end. Physicians’ diaries, casebooks and letters, along with nineteenth century medical books and photographs relating to the practice of medicine in Indiana, are sought for the Indiana Historical Society Library. Please contact Robert K. O’Neill, Director, In­ diana Historical Society Library, 315 West Ohio Street, Indianapolis, Indiana 46202. The Indiana Medical History Museum is interested in nineteenth century medical ar­ tifacts for its collection. If you would like to donate any of these objects to the Museum, please write to Dr. Charles A. Bonsett, Indiana Medical History Museum, Old Pathology Building, 3000 West Washington Street, Indianapolis, Indiana 46222. Copyright 1983 by the Indiana Historical Society

Pictured on the cover is an interior scene of the Women’s Department (Seven Steeples) at Central State Hospital during the 1920’s. (Photograph in the collection of the Indiana Historical Society Library.)

R131 A1 15 V9 NOI 002 IN THIS ISSUE

This issue of the Quarterly deals with the age-old problem of mental illness. In spite of ever-progressive knowledge and change, the problem of caring for the mentally ill will always be with us. The articles which follow represent three different, and yet equally provocative, approaches to the history of mental health care in Indiana during the late nineteenth and twentieth centuries. The first article, by Dr. Hugh C. Hendrie, describes Central State Hospital from the perspective of local twentieth century newspapers (with primary emphasis on the year 1973). Newspaper articles, particularly during this period, tend to be highly critical of the hospital. The reader of these periodic expose's is left with an indelible impression that something is grossly amiss with the system, the hospital, or its management. Dr. Hendrie’s unique and enlightening topic, if expanded to cover the hospital’s 135-year history, would make a most interesting book since controversial events, attracting the attention of the press, also have occurred from time to time during the nineteenth century. Dr. James Athon of Central State, for example, in response to the state legislature’s failure to make the necessary appropriation in 1857, returned his patients to the communities from which they were committed. This action prompted an immediate response from the press, and from the legislature. Dr. William B. Fletcher, the Hoosier Pinel who became superintendent in 1883, initiated his term by making a public bonfire using all the hospital’s mechanical restraints. Although the medical reform implicit in this act was long overdue, he was promptly rebuked on the editorial page of the local press. Later, when he exposed the graft, political corruption, and abuse taking place in the state hospital system, he was fired. In the second article, the late Carrie (White) Lively (1871-1957) reminisces about her experiences as a ward attendant, first at Central State Hospital (or more correctly, at the Indiana Hospital for the Insane as it was designated at that time), and later at East Haven in Richmond, Indiana. Mrs. Lively’s experiences within the state hospital system occupy about two years, most of which was at the Richmond hospital at the turn of the century. It is important to bear in mind that she began her work at Central Hospital with no preparation or training. She was a young widow (about twenty-nine years old with four children to support) who was suddenly confronted with the task of attending to society’s most severe examples of mental illness. However unpleasant the task, her family responsibilities made her persevere. Further, she was a sympathetic person, identifying with her patients, which made her sensitive to what she considered their abusive treatment. The following information may be useful to fully appreciate Mrs. Lively’s article. The state hospital system, then as now, was underfunded. Dr. George Edenharter, superintendent at the time that Carrie Lively worked at Central State, strove for eco­ nomic efficiency through a very tightly structured organization. His period of super­ intendency (1893-1923) was characterized by progress and growth, and the news­ paper coverage of his period is generally of a laudatory nature. Actually Central State’s high water mark in public esteem was achieved during the Edenharter years, and since his superintendency the hospital course has been slowly but progressively downhill. Mrs. Lively’s observations, which are critical of Edenharter, then are especially noteworthy as they describe problems existing during a more salutary

3

R131 A1 15 V9 NOI 003 4 INDIANA MEDICAL HISTORY QUARTERLY

period of the hospital’s history. Dr. Ellen Dwyer provides the final article for this issue. She tells of the medical and budgetary limitations of the system which permitted the development of the symptomatology described by Hendrie and Lively. Dr. Dwyer provides a brief outline of the history and development of the mental health institutions in Indiana and why they have functioned in a less than perfect manner. Her scholarly article provides the perspective necessary to visualize the overall problem, an essential first step in comprehending this most complex subject.

Charles A. Bonsett, M.D. Editor and Chairman

George P. Edenharter served as superintendent of Central State from 1893 to 1923. (Photograph in the collection of the Indiana Historical Society Library.)

R131 A1 15 V9 NOI 004 PRESS COVERAGE OF CENTRAL STATE HOSPITAL: ALARMS AND EXCURSIONS

Hugh C. Hendrie*

There is a perception held by observers and critics of the health professions that physicians are inadequately trained to practice medicine in this modern complex society. Doctors are too often puzzled and irritated by the patient’s response (or lack of it) to their well-meaning advice and bewildered and often angered by their inter­ actions with governments, hospitals, or insurance companies. The fault, say critics, lies not in the medical student’s mastery of medical science and technology, but in his or her ability to place the practice of medicine within its societal context. This problem, however, has not passed unnoticed among medical educators. To quote Henry Sigerist:

Medical education can never reach definite forms, but is obliged to adapt itself to ever-changing conditions. Every society required of its physicians certain quali­ ties such as knowledge, skill, devotion to patients, conscientiousness. But the position of the physician in society and the tasks assigned to him changed and were determined primarily by the social and economic structure of a given society and by the scientific and technical means available to medicine at that time.1 The educator’s dilemma then is determining an appropriate vehicle to teach this health-societal interaction. Concentration on present-day issues is fraught with problems because educators are also integral members of their culture. It is difficult to distance oneself from society to observe objectively its effect on medicine. Sometimes it is much easier to perceive, for example, the effects of the political process on the practice of medicine in foreign cultures like the Soviet Union than it is to observe a similar process in one’s own country. There is one possible method of conveying the relationship between medicine and society in an unbiased manner. Again, to quote Sigerist discussing the teaching of medical history:

It should give us a more complete picture of this development of civilization and ... should make us aware [of] where we come from in medicine, at what point we are standing today, and in what direction we are marching.2

It was with this aim in mind that I considered incorporating histories of the treatment of the mentally ill in teaching clinical psychiatry to medical students. How­ ever, upon inspecting these documents, one is reminded of the Japanese film Rashomon, which was devoted to the exploration of a single event as remembered in different ways by the participants. So in the history of psychiatry, one has the “insider’s” view of it being a triumphal procession to the present state of enlighten­ ment, contrasted with that of the social critic who perceives it as an increasingly sophisticated medium for social repression.

‘Hugh C. Hendrie is Albert E. Sterne professor and chairman of the Department of Psychiatry at Indiana University School of Medicine. This paper, originally entitled “Institutionalizing the Insane,” was delivered at the Indiana Historical Society’s annual meeting on November 7, 1981. The author wishes to thank Michele Rudnick for her research assistance during the summer of 1981.

5

R131 A1 15 V9 NOI 005 6 INDIANA MEDICAL HISTORY QUARTERLY

The present study arose from the hypothesis that perhaps one could examine best the interrelationships between society and psychiatry by utilizing the Rashomon-like qualities of the various reminiscences to construct parallel views of a representative institution. As Central State was a convenient, and in many ways, archetypical institution, I undertook to explore the history of the hospital from the viewpoint of 1) the involved professionals — primarily drawn from the superintendent’s reports; 2) the public — mostly from newspaper accounts; 3) the patients — using oral history techniques; and 4) the legislators — from the governors’ papers and other sources. This, as I am now aware, is a monumental task which may well take the rest of my professional life to accomplish properly. The following paper therefore represents only a preliminary analysis of a small part of the press coverage of the hospital. Thanks to the good graces of newspaper reporter Fremont Power, my research assistant and I were able to gain access to the archives of the Indianapolis News and the Indianapolis Star and its predecessor, the Indianapolis Journal. We supplemented this with material from the Indianapolis Times (in the Indiana State Library). While there were a number of smaller newspapers which probably ran stories on Central State, we felt these major papers would represent a fair sample of the press coverage during the period. We attempted to record all stories pertaining to Central State Hospital from 1900 through 1975. We are reasonably certain we ob­ tained almost all the articles for the post-1940 period. However, for the pre-1940s we uncovered fewer accounts, making us suspect that a considerable number were missed. We next counted the number of stories each year and in each decade sepa­ rately. Table I shows this count for the decades from 1940 onward. As one can see, a distinct pattern emerges. A flurry of stories usually occurs in aone-or-twoyear period and is followed by a much longer, relatively quiescent period with the appearance of only a few articles. We then scrutinized the contents of these stories, paying particular attention to those years when the most articles were written. For the purposes of this paper, I will follow the press coverage of Central State during 1973, when no fewer then twenty-eight articles about the hospital were published. Coverage of the hospital began in the May 22,1973, issue of the Indianapolis News with an article entitled “Central State Patient Abuse Revealed.” This story was under the byline of Skip Hess and Reginald Bishop. The reporters apparently had carried out a random investigation of patients at the hospital. The reasons for the News’s inves­ tigation are unclear. As a result of this probe, however, Hess and Bishop wrote the

TABLE I Number of Newspaper Articles Relating to Central State Hospital Per Year of Study

1 9 4 0 -1 1 9 5 0 - 5 1960 — 11 1 9 7 0 - 6 1941— 0 1951 — 10 1961 — 6 1 9 7 1 - 7 1 9 4 2 - 0 1 9 5 2 -1 5 1962 — 0 1972 — 6 1 9 4 3 - 2 1 9 5 3 -1 6 1 9 6 3 - 1 1973 — 28

1 9 4 4 - 3 1954 — 3 1 9 6 4 - 4 1974 — 5 1 9 4 5 - 0 1 9 5 5 - 6 1 9 6 5 - 3 1 9 7 5 - 6

1946 — 3 1 9 5 6 - 4 1 9 6 6 - 6

1947 — 3 1 9 5 7 - 5 1967 — 2 1 9 4 8 - 7 1 9 5 8 - 9 1 9 6 8 -1 2 1 9 4 9 - 7 1 9 5 9 -1 2 1969 — 5

R131 A1 15 V9 NOI 006 PRESS COVERAGE OF CENTRAL STATE HOSPITAL 7

article alleging a number of abuses. These included: 1) forcing men and women to use the same toilet facilities; 2) subjecting patients to physical and verbal abuse (e.g. an elderly woman patient claimed she was forced to beg forgiveness on her knees to an attendant); 3) failing to properly clean patients’ rooms (e.g. some rooms were filled with cockroaches); and 4) using seclusion rooms solely for patient control. When the newspaper reporters approached the superintendent and the chief nurse about the findings, they were promised a full investigation. The allegations quickly escalated. The May 24, 1973, edition of the Indianapolis News had as its headline “State Mental Health Group Asks Patient Abuse Probe.” In this story, again written by Skip Hess and Reginald Bishop, the president of the Mental Health Association demanded a full-scale probe into the reports of patient abuse and stated that he was going to “insist upon charges being filed against any person implicated.” At the same time, the president took the opportunity to reproach the legislators, who in the last session had reduced the budgeted hospital personnel funds. He stated that “this may well have forced state hospitals to violate patient rights to adequate medical treatment and housing.” He went on to invite legislators to visit Central State “to observe the effects of their action on mental patients.” The patients apparently now began to notify the reporters of their willingness to testify for the investigators. One ex-patient said she “was treated like an animal.” She added: “The help I got was the most degrading and most depressing three years of my life.” She blamed the public for these conditions: “Do you really think the public gives a damn about mentally ill pepole?” The legislators answered the call. The headline of the News on June 1,1973, was “Bowen Deplores Facilities in Visit to Central State Hospital.” This report was about Governor Bowen’s unannounced hospital visit in which he found the facility “deplora­ ble and shameful.” He discovered, for instance, there were only seven registered nurses at the hospital. Bowen was equally disturbed by the approximately one-to-one- hundred ratio of nurses to patients. He stated, however, that the new facilities (which were ordered in September, 1971) were finally being built. Rather slyly, the News added that the new buildings were ordered only after their reporters had conducted a similar investigation in 1971. The article ended with a quotation from Bowen: “We are going to make up for past deficiencies, but it cannot be done at once.” Revelation now followed revelation. The headline of the June 4, 1973 News was “Mental Patients Forced to Work Without Pay.” This article explained that mental patients at Central State Hospital were working close to forty hours a week without pay, an obvious violation of federal law. A spokesman for the State Department of Mental Health agreed that they should have been paid, but that the General Assembly had only budgeted $50,000 for patient pay when they needed $2,000,000. One depart­ ment supervisor stated that with the shortage of hospital employees, it would be im­ possible to run his department without patient workers. The following day the News carried an article entitled “Two Team Probe of Hospital Set” which stated that the Mental Health Commission had now set up an impartial task force and inspection team to carry out the audit of Central State Hospital. The task force was expected to complete its evaluation within a week. In the meantime, the sister newspaper, the Indianapolis Star, remained strangely aloof from the scandals, a posture they maintained for the entire year. The newspaper’s first report on Central State Hospital was on June 7, 1973. There, in a story entitled “Central State Construction Work Pushed,” reporters described the new facilities to be opened at least four months ahead of schedule. Skip Hess, from the News, however, was unrelenting in his coverage. The June 11, 1973, story was headlined “Central State Probe Begins.” There, Hess described the seven-man investigation team which included two Indiana State Police detectives.

R131 A1 15 V9 NOI 007 8 INDIANA MEDICAL HISTORY QUARTERLY

The executive assistant governor said that employees should not fear the investiga­ tors. He also encouraged former patients and employees to come forward with information on patient abuse. On June 12,1973, the Star once again remained benign. It ran a short article entitled “Special Bus Assists Wheelchair Patients,” describing the Marion County Mental Health Association’s present of a bus, allowing wheelchair patients to be taken to their various activities. The Indianapolis News, however, increased their barrage. Headlines on June 21, 1973, read “Hospital Patient Denied Treatment.” There, again, Skip Hess described his own independent investigation of psychiatric care at the hospital. Hess discovered 160 mentally ill patients had not been seen or treated by a psychiatrist for more than five months, and in general, found psychiatric care at the hospital inadequate. The assistant superintendent, in response, complained about the inability to hire psychia­ trists. In fact, “last week,” he said, “the hospital was just notified to cut $516,000 from their personnel budget,” in marked contrast to what Governor Bowen had stated on the first of June. The executive assistant to the governor, however, disagreed saying management, rather than money, was the problem. Another story on the subject appeared in the June 26, 1973, News and was head­ lined “Conditions Filthy at Central State, Probers Tell Board.” This article described the findings of the ten-member board (apparently they had gained three members within a week). They found the conditions at Central State “deplorable and dehuman­ izing,” and, if the situation was not changed dramatically, the board warned that the two new units “again, will very quickly become an old, new Central State Hospital.” They then cataloged the deplorable conditions, the poor and inhumane care, and the hundreds of code violations they had found in their probe. The Central State officials fought back. In a June 27,1973, News article, entitled “Central State Officials Blame Public Legislature” and again written by Skip Hess, the officials of Central State said “ the present situation is a result of a lack of public support, unsympathetic legislators, and inadequate funds.” The News was accepting no excuses, however. In their parallel editorial, “Get on With It,” they stated: “The history of Central State Hospital is laced with alibis, excuses, and buck-passing. Point out a problem, you’ll get a reason why it can’t be eliminated.” They made the point that it is not only additional dollars that were necessary, but also a strong hospital admin­ istration that was not content to let deplorable conditions exist. The editorial added that they needed additional financial assistance from the legislature, but said “until that help comes, it is high time that the administration and the staff get on with the job.” The next article in this series by Skip Hess, “Clean up Ordered at Central State,” appeared in the July 5, 1973, edition of the Indianapolis News. Hess reported that Governor Bowen’s office had announced a program to eliminate all unsanitary con­ ditions at Central State Hospital. To keep the new facilities at Central State in good condition, a project engineer was to be hired. Moreover, seventeen workers from the State Farm Prison in Putnamville were to be brought in to help employees clean up the hospital grounds. Bowen’s investigators also said that they disagreed with the Central State officials’ assertion that doctors on leave could not be replaced. “There is no reason in the world their doctors can’t be replaced,” said the executive assistant to the governor. In the next article by Skip Hess, headlined “Treatment Quality at Central State Blamed on ‘Politics’” (appearing in the News, July 9, 1973), Central State officials struck back. The assistant superintendent of medical service and clinical director of Central State Hospital said politics was the reason physicians could not achieve their goals in patient care at the hospital. One bone of contention was that the new facilities at Central State were designed to work under the unit clerk plan. According to this

R131 A1 15 V9 NOI 008 PRESS COVERAGE OF CENTRAL STATE HOSPITAL 9

idea, the clerks were to relieve doctors and nurses from paperwork, leaving the pro­ fessional staff more time for patient care. The 1973 General Assembly, however, did not provide enough funding for the eight clerks needed. “I can’t really put the blame on the legislators, budget, or personnel,” the assistant superintendent said, “it’s just politics.” The article reported that Governor Bowen’s cleanup project was under way. It also stated that the two police detectives in the investigation expected arrests for criminal activity at the hospital. The following day in an article by Skip Hess, headlined “Central State Blame Accepted,” a rather unique event occurred. Central State’s chief engineer said he would accept full responsibility for the conditions at Central State Hospital. “I’ll take my lumps but I’m going to get this place straightened out come hell or high water,” he declared. He also said that the expose by the News “laid us wide open.” That same week on July 12,1973, Skip Hess reported an “allegation” made by two state hospital employees that “a maintenance worker hit a mentally ill patient with his fist__ ” The employee continued: “All the patient did was ask for a drink of water. We heard a lot of yelling at the south door of the maintenance shack. We personally saw the man hit the patient.” The next week on July 17,1973, Skip Hess wrote about investigations into another misconduct charge — i.e. a patient dying “45 minutes after allegedly being beaten by an attendant.” A former Central State patient said “he and other patients saw an attendant take another patient into a clothing room at the old Central State Farm Colony at 2400 North Tibbs, heard the patient being struck numerous times, and that the patient was injured severely and taken to a hospital after the alleged beating.” The former patient said the incident, which occurred in 1966, was reported to farm colony officials, but they refused to believe it. The next article to appear was on July 23, 1973, when police detective Leon Griffith called for a grand jury investigation of “thefts and patient abuse at Central State Hospital.” According to Skip Hess: “Griffith said he and Sgt. Chet Enlow have gathered information on theft of both hospital and patient’s property, and that a grand jury investigation could lead to indictments.” In a front page story of the July 24,1973, issue of the Aretcs, a former Central State doctor claimed “two of his patients died because hospital officials ignored his recommendations that the patients not be allowed ground privileges.” One patient left the ward and “died of exposure,” and the other was killed by a vehicle on Indiana U.S. 40. In the same story, a security guard reported that “many patients frequent nearby taverns at night.” The guard said the 160-acre hospital complex and grounds were too large to prevent patients from leaving. Two weeks later, on August 8, 1973, William C. Lloyd, Executive Assistant to Governor Bowen, declared the Marion County Grand Jury would deal with those “isolated incidents” at the hospital not related to management problems. Five days later, on August 13, 1973, “a mountain of material” had been submitted to the grand jury, including “information on hospital-wide thievery.” The August 15, 1973, edition of the News printed photographs of the new patient units. The structures, worth $8.2 million, were to open within a month, “replacing 100- year-old buildings” previously housing the patients. The old buildings were to be razed. The next week in the August 21, 1973, News, Hess reported that “a thirteen- member sanitation task force today began a three-day inspection of Central State Hospital to learn if the facility it found to be ‘deplorable, dehumanizing, and filthy’ five weeks ago had been improved to its satisfaction.” Task force head, Dr. Curt Dol- lins, delayed the inspection because hospital sanitation violations “could not be cor­

R131 A1 15 V9 NOI 009 10 INDIANA MEDICAL HISTORY QUARTERLY

rected in a few days,” and gave hospital employees two months to complete this work. According to Joanne Lintzenich, consulting dietician, the task force “would continue to inspect Central State,” to “insure that all unsanitary conditions are eliminated, and are not allowed to exist again.” On August 27,1973, seven witnesses were subpoenaed to testify before the grand jury. Under investigation were employees accused of stealing from patients and the hospital. There were also charges of physical abuse and sexual exploitation. Two Central State attendants were convicted, the News reported, of “beating two mentally retarded children.” John U. Keating, M.D., Central State Superintendent, on September 4,1973, said Governor Bowen had approved plans to improve hospital security. Also, according to the News, Central State patients were to be moved into the newly-built patient units within a week. In the September 8, 1973, edition of the News, Skip Hess called the move “a matter of going from the unbelievable to the unbelievable: from a terrible nightmare to a beautiful dream.” The Star on September 9, 1973, described the new unit openings as “a chain reaction,” having a beneficial impact on patient morale and employee morale, and attracting better employees and more volunteers. “A five-step plan for management of mental health programs and a firm warning that poor man­ agement will not be tolerated were issued yesterday by Governor Otis R. Bowen,” the Star reported on September 11,1973. The plan’s five steps were: “Accreditation of all mental health institutions; regular plant management and maintenance; a coordi­ nated program of growth between state institutions and community mental health centers; an integrated management and personnel system for operation of state facili­ ties; [and] effective medical and psychological rehabilitation programs.” The press coverage for the year, however, ended on a rather sour note. In the Sep­ tember 29, 1973, News, Skip Hess reported the arrest of a tinsmith on theft charges involving hospital property. Hess added: “Police expect to make additional arrests in connection with criminal activity at Central State, which has been under heavy inves­ tigation by state officials since May.” Ten months later, on Tuesday, July 23, 1974, perhaps the inevitable story ap­ peared. The News reported that a new superintendent had been named at Central State Hospital. Dr. John U. Keating was replaced by Dr. George T. Teaboldt. Contrasting the 1973 press coverage with that of the previous year, one finds in 1972 all positive articles focusing on rehabilitation and improvement. Indeed Skip Hess, the same man who was the scourge of Central State Hospital in 1973, described all the hospital improvements since Dr. John U. Keating had become superintendent in 1968. Hess wrote in the October 7,1972 edition of the News: “Four years ago, Central State Hospital was one of the worst mental hospitals in the nation___Now it is only months away from being one of the best.” An examination of the contents of the pre-1970 articles reveals a similar pattern. Scattered stories, relatively benign, were written for a period of years and then several articles focusing on a “scandal” appeared over a relatively brief period of time. In early 1968, for example, a year in which there were twelve feature articles on Central State, the reporters concentrated on the hospital’s unsanitary conditions. On February 15, 1968, for example the Indianapolis News reported: “990 rats killed at the hospital in 6y2 months.” In 1953, a year in which sixteen articles appeared, the News of May 12, 1953, carried the headlines “Conditions at Seven Steeples Angers Craig. Central State Called a Disgrace to Indiana.” In 1949, which along with 1948 had the most stories during the 1940s devoted to Central State, there appeared in the March 6 issue of the Times a dramatic article, “Legislators Walk Among the Living Dead,” written by

R131 A1 15 V9 NOI 010 PRESS COVERAGE OF CENTRAL STATE HOSPITAL 11

Richard Lewis. In it Lewis states:

I took a walk through Central State Hospital the other day with a couple of state representatives, and in the catacomb-like recesses of that institution we saw the living dead---- Some on the tour suggested the infirmaries smelled worse than the Dauchau Concentration Camp near Munich, Germany, but having smelled Dauchau, too, I can point out one principal difference. The inmates of Dauchau were liberated. There appears to be no rescue for those in the infirmaries of Cen­ tral State Hospital. None of them will leave those places alive, unless relatives take one of them before he dies.

This piece appeared only one year after the hospital’s 100-year anniversary in 1948. In that year in an article in the November 14 issue of the Star, reviewers praised Central State’s “century of progress.” Alarming articles, however, were not just a feature of the post-1940 era. In 1908 the superintendent, in a newspaper interview appearing in the October 18 edition of the Star, described the conditions at the asylum as “serious.” Newspaper coverage of Central State Hospital, then, is characterized by long periods of neglect with a scattering of relatively positive stories. Then suddenly, for reasons which are not always entirely clear but often precipitated by a mishap or a revelation by a patient, a series of articles focusing on the scandalous and inhumane treatment of patients appears. As in the 1970’s, this is often associated with a series of charges and counter-charges by the interested parties, the mental health authorities, the governor and the legislators, and the mental health association. Then a number of apparently dramatic steps are disclosed — e.g. commissions of inquiry, the appoint­ ment of a new superintendent, or the announcement of a new building program. Great claims are made for these improvements. The excitement wanes and the articles diminishin number and fervor until the “new” scandal with the same charges begins a decade later. This pattern of newspaper coverage of psychiatric institutions has been com­ mented upon previously. Why does it occur? One explanation clearly relates to the general nature of much newspaper reporting which has been characterized as super­ ficial in nature, scandal-oriented, and brief in duration. Moreover, the public’s perception of mental illness and psychiatric treatment makes it particularly prone to this type of coverage. Mental illness arouses severe conflicting emotions, both in the sufferers and in their families. In addition to enduring the disorder, the patient frequently experiences intense feelings of guilt and shame. More precisely, the sufferer often believes that this illness reflects a weakness in character which in turn renders him or her unworthy of appropriate respect and care. At the same time, by its nature, it makes the patient intensely dependent on the involved professionals. For the families, the emotional conflicts are, if anything, even more accentuated. In addition to the shame of having a member of the family labeled as mentally ill, there are often the guilt feelings of being responsible for the disorder’s occurrence. Patients with psychiatric problems are also frequently not the easiest individuals with whom to relate. They often generate anger in those closest to them, and this in turn heightens the guilt feelings of the family member. There is, then a psy­ chological framework set up for a system of care which isolates the sufferer from the scrutiny of society, thus assuaging the shame but also rendering likely periodic out­ bursts of remorse about inadequacy of care (which can take the form of the newspaper scandal). This psychological state probably reflects, in turn, the lack of societal con­ census on the whole concept of the nature and boundaries of mental disorders. Is it an illness which deserves compassion and treatment, or is it a form of moral weakness

R131 A1 15 V9 NOI Oil 12 INDIANA MEDICAL HISTORY QUARTERLY

which deserves societal censure and character reform? This cultural ambivalence is also evident in the general lack of high regard for the professionals who care for the mentally ill, and a widely held pessimism regarding their ability to treat successfully their patients. Physically separating the mental health system, or at least the psychiatric institu­ tions, from society, only aggravates the problem of the lack of scrutiny. As John E. Talbot points out, the system is not one with which members of the public-spirited, upper-middle class come in daily contact.3 Thus, the general inadequacy of care is not something which is commented upon routinely. And unlike those afflicted with ill­ nesses such as cancer and heart disease, the psychiatric patients do not have the powerful political lobbies at their disposal. The mentally ill are politically powerless.4 There are many characteristics of our present mental health institutional system which unfortunately make horror stories all too easy to write. It is chronically under­ funded and burdened with an inflexible bureaucratic superstructure. Chronic men­ tally ill patients are difficult to treat, and understanding of the causes, and thus, of appropriate treatment measures is in its infancy. The changes which have occurred have largely been cosmetic in nature. No fundamental alteration has occurred within the system. Thus, it is likely that the pattern of alarms and scandals appearing in the newspapers will continue in the future.

NOTES

'Henry E. Sigerist, “Remarks on Social Medicine in Education," in M. I. Roemer, ed., Henry Sigeriston the Sociology of Medicine (New York: M. D. Publications, Inc., 1960) pp. 360-61. 2Ibid. 3John E. Talbot, The Death of the Asylum: A Critical Study of State Hospital Management Service (New York: Grune and Stratton, 1978), pp. 47-65. 4Norman Dain, “From Colonial American to Bicentennial American: Two Centuries of Vicissitudes in the Institutional Care of Mental Patients,” Bulletin of the New York Academy of Medicine, LII (1976), pp. 1179-96.

R131 A1 15 V9 NOI 012 REMINISCENCES OF A STATE MENTAL HOSPITAL ATTENDANT

Carrie E. Lively*

As I walked up that long flower bordered walk toward the Woman’s Building and the main office, I felt more confident, more sure of myself than I had for years. It seemed I had been born anew to do and be competent. I always had a desire to do things well. Mother had tried to instill that into all of us. When I entered the building, I was taken to the office of Dr. George F. Eden- harter. There he talked to me about the duties of an attendant and gave me a book of rules to read. Those rules were many, and it seemed to me that if one were broken that was the end of it. The one who broke a rule walked out as a discharged employee. It was easy to forget some of those rules because they seemed trivial, but I was sure I would do nothing wrong. How often in the days to come was I to see most of those rules broken by attendants! I was to know in a few weeks that all attendants were not so strictly conscientious about rules. They thought they could break any rule so long as Dr. Edenharter did not hear of it or the supervisor did not learn of it. The ward doctors and the supervisors were the reporting ones. They carried to the superintendent either good or bad reports. I watched some of the most deceiving attendants meet a ward doctor or supervisor with the sweetest smile at the entrance pass door and walk through the two long halls, talk of their work as if they were greatly concerned about it and laugh with some other attendant as soon as the last pass door locked. “I got her through this time without being eaten up,” they would say. I was placed on a back ward where the patients were very insane. I did not suspect the variety of insanity until then. There were all kinds of it, from plain nervous worry to raving behavior. I think we on 21st ward had a sample of each kind. There were epileptics, raving maniacs, cleptomaniacs and melancholia. There were those tending to suicide, religious fanatics, sex crazy, and dangerous ones that were cruel and cunning. The latter had to be watched most closely to protect other patients. I asked an attendant why a new girl should be placed on such a difficult ward and she laughed and said, “If the newcomer can stand the worst wards and be competent, she will be promoted to better wards in time.” It was much worse than I expected. One old lady, real old, moaned day and night. I was so concerned about her that I asked Dr. [Sarah E.] Stocton if something could not be done for the patient. I told her the patient seemed to be in pain. The doctor laughed at me and said, “You let Miss Hart attend to that patient and don’t let your sympathies spoil your work here.” She told me most of the old lady’s pain was imaginary, but later, by watching her closely at night, I came to believe her ailment was one common to women. The uterus

•The editors of the Quarterly are grateful to Florence Yeager of Muncie, Indiana, for submitting this remi­ niscence of her grandmother, Carrie E. Lively (1871-1957). Mrs. Lively, formerly Carrie E. White, was an attendant at Central State around 1899. Prior to working in the state mental hospital system, she taught school and worked as a maid in Bloomington. Mrs. Lively wrote this reminiscence when she was about sixty years old. Except for deleting several names, Mrs. White’s reminiscence has not been altered. Footnotes are the editors’ and not the author’s.

13

R131 A1 15 V9 NOI 013 14 INDIANA MEDICAL HISTORY QUARTERLY

would not stay in place. I was certain it was not all imaginary pain and perhaps pain could cause insanity. I did not interfere again, however. I thought, “I’ll relieve all I can and that which cannot do, I’ll let alone.” Once, when a person was placed in the hospital for the insane, they received very little relief from pain. It was all called mental ailment and considered incurable. It was pretty much just that way when I was an attendant, but I’ve heard from responsible sources that now mental ailments are largely first physical disorders and that many cures are successfully made and patients are allowed to go home. The first two weeks were a horror to me. I lay awake at night and thought, “Oh, I’ll have to become hardened to suffering or leave here.” I often contemplated leaving. I told our ward girls how I felt and two of them sympathized with me and told me to just make up my mind to stay until I received one pay and they were sure I would stay longer. That is just what I did. At first I could not sleep well because of some maniac yelling or someone moaning and suffering. Once an old Negro woman sang camp meeting songs in a room not far from ours. The attendant I liked best said, “I’ll stop that!” She got up and got a cup of water and suddenly dashed it in old Clarissa’s face. The singing was suddenly drowned. When Clarissa was asked next day what Marie had done to her, she would say with a grin, “She cooled me off!” I never went to them at night without their asking for water as I passed their rooms. I believed we had one cruel attendant on our ward, and I talked with Marie Hart about it. Miss B was breaking rules every day and laughing about it. I would have reported her if Marie had not advised me not to do so. She said attendants were loyal to each other and if I did report M iss B the attendant who worked with her would say my report was not true. This and the fact that the ward physician had cautioned me about letting my sympathy spoil my work kept me from acting. So I never reported any attendant, much as I would have liked to report some things that I regarded as cruelty. We had an hour out on the grounds every evening we were off duty which was every other night. On this back ward two attendants were left on duty and two were off for the evening. I enjoyed those evenings out. The grounds were beautiful and we could go anywhere on the hospital grounds we wished and we could sit on a swing with a friend and just rest and talk. We always wore our blue and white striped uniforms when on the hospital grounds. When we could get a pass and left the grounds, we could wear any clothes we wished to wear. I soon learned there was quite a hospital society there. Many of the attendants had as nice evening clothes as Mrs. Nat U. Hill.1 Of course, those girls spent their entire incomes on dresses. I knew I could never do that, but I longed for some pretty dresses — not evening or party dresses, but good, pretty street wear. I had written mother, I did not tell her it was so hard at first for I thought if the rest could get so they could stand it and go out on passes and have a good time, I, possi­ bly, could, too. Well, it was just as Marie had predicted. If I would stay one month, I would stay longer. I had good friends. I met a very nice young man by the name of Jack R. I became re-acquainted with a girl I had gone to common school with. We had fine times to­ gether. We planned passes together. Sometimes, we could not all get passes at the same time, but often we could. Jack and I and ZellaGilstrap and her friend would goto

R131 A1 15 V9 NOI 014 REMINISCENCES 15 Society Library.)Society The Women’s Department,The Women’s orSteeples, Seven atCentral Statethe(Photograph Indiana Hospital of during the Historicalcollection in the 1920’s.

R131 A1 15 V9 NOI 015 16 INDIANA MEDICAL HISTORY QUARTERLY

one of the parks near Indianapolis and get a boat and ride for an hour. We often sang songs on these boat rides. The music sounds sweeter on the water, or so it seemed to me. It didn’t seem but a short while until I realized Jack thought much of me and I of him. Each evening I was off duty, I spent walking on the grounds with Jack or sitting in a swing with him. It was bringing life back to me again. Life was good. Sometimes things in the ward were far from pleasant, however. To this day, I believe Miss B was the cause of a girl’s death. Of course, I did not know enough to make me sure, but this is the way it was. There were four attendants on those bad wards. Never was one left alone very long with the patients. I had charge of the long hall that week since we took time about. The patients that were well enough always helped with the work. Mary was crazy as crazy could be but good help in the bathroom and she liked me. I tried to be as kind to her as I could. That morning Marie and I took all the patients to the dining room that were able to go. Counting them, I knew Mary had not come. I called and Miss B answered, “We can’t get the stubborn thing to move. Go on and we will attend to her.” I knew Miss B. I knew also her methods with a stubborn patient, and I knew Mary would be punished. Miss B would soak a towel full of water, suddenly slap it over the patient’s face and draw it tight from behind. She could easily have smothered a patient if she had not removed the towel in time. Now that is what I felt she had done when Marie and I returned with our patients. I went to work as usual in the bathroom. There were vessels to wash, and I looked around for Mary. She had always willingly washed those vessels. No Mary came so alone I went about the work. All at once Miss B came in and said, “Mrs. White, will you come and look at Mary?” “Sure,” I said. I knew Mary had been as full of life as ever when we went to breakfast. Now I found her gasping for breath. I said, “Miss B, she is dying. Get a doctor at once!” She died before a doctor could get there. I always believed Miss B killed Mary by going too far with her wet towel punish­ ment, but how could I prove it. All I could do was keep still until I knew more. The doctor said Mary’s heart had failed. Agnes Stritt had been left on the ward to care for patients who were not well enough to go to the dining room. One look at Agnes confirmed my suspicions. Then, there was a remark Agnes made after Mary died. She said to me, “I can’t work in that bathroom. It always seems I can hear Mary say in her old way, ‘Say, fellows, come on bring your vessels.’” Mary had always addressed everyone as “fellows.” I had always disliked Miss B, but now I shunned her as I would a snake. She noticed it and tried to find out why. “Oh,” I said, “I know a few things about Mary, I guess, and when I get it cleared up, I’m reporting it.” Miss B’s face turned a grayish color. For a minute, I thought she was going to faint. Then, she revived and we quarreled. In that quarrel, she reminded me of a cornered tiger. Anyway, she proved to me she was capable of fighting back. I did not let her know it, but I could see I would have to have clear proof of the crime of which I thought her guilty. That evening she had a nervous chill and we sent for the ward physician. He said she was on the verge of nervous prostration and advised her to go home for a rest. It was a rest for me not to have to stay on the same ward with her. Miss B’s departure brought some changes. I was sent to 9th ward. This ward was not quite so wild and unmanageable. Yet it was bad enough. Marie Hart was also sent

R131 A1 15 V9 NOI 016 REMINISCENCES 17

to 9th ward. Agnes Stritt, who was working partners with Miss B, was left behind on 21st ward. The new ward was difficult at first because I had to learn the ways of my new patients and their hobbies. An unbalanced mind always has a certain thing to worry and fret about. I had to get acquainted and it took almost all of a week. We made some mistakes that were overlooked until we knew our patients’ habits. I remember our first night on the ward. Those who were mentally right enough to undress always went to bed when told at the customary place. I heard a commotion in a bedroom and rushed to see what was wrong. There in a corner lay an old lady whim­ pering like a puppy. In the bed a husky patient was muttering, “I’ll teach her whose bed she can get in. I threw her out and there she is. Take her out of my room.” The poor old lady was almost totally blind and got into the wrong room which was easily done because there were so many alike. In fact, all of them were alike. They were numbered as in a hotel. I helped the old woman to her bed and remembered from then on that that particular woman needed help to get to the right room and bed. Once every month we were given what was called an afternoon and evening. That meant we left after noon and could stay until midnight. Zella and I and our gentlemen tried to get our passes for the same day. We did not succeed in getting our wish. Zella’s pass and her friend’s were allowed and also mine. But for some reason, they refused Jack’s pass. As I left the grounds, I met him as he went to the office for something. He was disappointed and had a plan he wanted me to try. He asked me to call the office after I reached the city and ask them to tell Jack that a friend was at the Union Depot and ask if he could get off. I told Zella what Jack had asked me to do, and she said, “I don’t believe I would do that if I were you. You might lose your job for a little thing like that.” And so I did. It seems that Myers, Dr. Edenharter’s secretary, knew my voice. She at once recognized it as a set up plan for Jack to meet me. Jack got the pass, but got it too late to meet me. I was coming back in as he went out. I came in early for I did fear I had made a mistake. And so just that little mistake cost me my job. Also his. We both went the same day, but we spent a few hours together in Indianapolis before our trains came. Mine was for Bloomington. His was for Madison, Ind. He was so sorry because it was his fault, but I did not blame him. I had dared to do it so I was just as much to blame. Mother was not expecting me and was both surprised and glad, but sorry when I told her I was out of a job. I told her I would go back to the city and get a place as maid again until I could get another hospital position, but I needed a rest, a time with the children. It seems they had grown so much in that short while, and they had also grown away from me. After awhile I laid my plans to go back to Indianapolis. There I would get housework again and try from my place of work to get institution employment again. I told my sister, Amelia, about my plans, and the amount of money I had. She tried to discourage me. “Suppose you fail to get work?” she asked. “Then,” I said, “I’ll have just about enough to return home.” But I did get work. I remember the feeling of confidence that came to me as soon as I got off the train and started down Illinois St. in Indianapolis. I thought of mother, her prayers and her faith and a new determination was in my heart. I did not feel alone in a big city. I felt good and happy. I went to an employment agent and sat there about half an hour and then he sent me to a place on North Penn­

R131 A1 15 V9 NOI 017 18 INDIANA MEDICAL HISTORY QUARTERLY

sylvania to a family named Metzger. After working at Nat U. Hill’s in Bloomington, I thought I was capable of any place and truly think I was. I should to this day be thankful to Mrs. Hill for the domestic lessons she taught me. I took the job, but that night I sent for three application blanks from Evansville, Logansport and Richmond hospitals. I filled those out and signed the same names as references that were on my first successful one. As soon as I had filled them all out and returned them, I felt better, more hopeful. If I ever got another place like that, I knew no man would cause me to lose it. Well, it was only about two weeks until I heard from Richmond, Ind. I had put Metzger’s phone number on each application. I think I was really lucky to be the one to answer this phone call. Dr. [Sam] Smith2 asked me if I was ready to take the place at once. I told him, “Yes, I’ll be there the next day.” As I entered that hospital, I did so with a very thankful heart. I had left Metzgers not feeling very good about me, but that I had to pass by as another unpleasant experience. The hospital at Richmond was called East Haven and unlike Central, it was built on the cottage plan. Each ward was a cottage just a little home for the big family consisting of about 30 patients in a ward and not more than four attendants. As with Central, new attendants were sent first to the worst wards and gradually were promoted to the wards where no violent patients were placed. I’ve known many perfectly good, quiet patients to be placed on back wards, however. No one but the patients’ relatives are allowed to visit those wards. I was assigned to 8th ward which had three attendants. Mrs. Hays was head atten­ dant and had been on that ward for years. She had been there so long that it was like home to her and she didn’t ask for change. Soon, I liked it, too, and did not care for anything better than I had, except possibly one. There was a ward, 4th ward, I remember. It was a ward of just old and mentally weak people. One young woman patient was there, but she was of the gentle or mild type of insanity. Only one attendant was ever on that ward. When she took her passes, some other attendant was detailed to relieve her. When on duty there, I sat quietly in front of the fireplace heated with gas and talked to those really nice elderly ladies. Some of them made me wonder why they were there. No insanity was discernible. Perhaps it would come on periodically, I don’t know. I did love that ward. It was so like a real home. The work at East Haven was similar to that at Central but much nicer and I liked the doctors and supervisors much better. Dr. Smith was a fine man and a good doctor. You could see he was trying to do all he could for the welfare of his patients. “Why wouldn’t I be satisfied,” I wrote to Jack. We kept up our correspondence. He, like me, had gotten into a hospital. He was at Logansport. He begged me to put in an application and go there. I did apply and would have accepted had not Dr. Smith talked me into changing my mind. My mind wasn’t hard to change for I loved East Haven and didn’t know what I would run into at Logansport. Dr. Smith met me in the hall of the administration building where I had gone to give a daily report to the ward doctor. I was frightened. I wondered what I had done and wondered if I was going to be discharged. He advised me as one good friend to another. He said he knew why I wanted to go to Logansport and that Jack had tried to transfer to East Haven. He advised me not to place too much faith in hospital men. He said some of them were no more than hospital bums going from one hospital to another.

R131 A1 15 V9 NOI 018 REMINISCENCES 19

I didn’t think Jack was a bum because I knew he was a gentleman, but I had said I would never let a man interfere with my job again and so I told Dr. Smith I would prefer to stay at East Haven. “I’m glad,” he said. “I don’t think you will regret your choice.” Then he told me the superintendent at Logansport was his brother-in-law. Jack and I kept on writing for a long time. He sent me a little gold ring that I’ve worn until it is thin. It was not meant for Jack and me to ever come together again. I was having a very good time socially at East Haven. I got passes and everything was going smoothly. Soon I was due for a vacation to go home again and be paid for the time! It seemed too good to be true. My vacation was not coming at a good time. It was now December and getting cold. I wanted to be home with mother and the children, but knew it would not be so pleasant in the winter time. I knew I would have to be driven by someone from the station to the house. My niece, Mary Etta “Mettie” Smith, had married Cameron Todd and lived at Saunders. That was as near home as any station so there I went and Cameron took me to mother’s with his team and farm wagon. I was so bitterly cold before I got home that I almost wished I was back on the good, warm, comfortable wards at East Haven. I found them all happy and well. Mother’s hair had started to turn grey. That was all the difference I could see in her. She was the same enduring, patient mother serving everybody when they should have been serving her. It was just as pleasant a vacation as I had expected. When it was over, Cameron drove me to the station. It was a very cold morning, and I remember my feet being almost frozen and ice was frozen on his mustache. I was truly glad to get seated on a comfortable warm train and be going back to East Haven which had become a real haven of comfort to me. When I returned, Dr. Smith told me I need not go on duty until morning so I had a real rest after my trip. I thought of mother’s life and compared it with mine. She was in her own home surrounded with her loved ones. Sometimes she endured the cold. She would have to go out and milk. That was a hardship in winter. She went out in the cold again to care for her chickens. Was I just getting soft? I didn’t count those things hard while Tom lived. I rather liked it. Home contentment. I once had it, but would I ever again? Here everything was convenient. No going out in the cold if you didn’t wish to go, but who is it that doesn’t love to get out in the crispy cold air once in awhile. In a way I was having the easiest time, but mother had the blessed contentment of home. Now comes January in East Haven and the doctor has assigned me to night duty. It was quite a change. I was the youngest on the force of night watches. I’ve often won­ dered why he picked me for night duty. I was happy as I was, but when it was given me, I could not refuse. The ward physician came through the ward and said, “Mrs. White, you are to go up to the night watch’s quarters and go to bed and then go on duty tonight here on 7th ward.” It was not a violent ward. The patients were pretty good. Some few had suicide tendencies and dying was all they could think of or talk about. There were some epi­ lepsy patients and some with just problems with their nerves. Some of the patients were rational enough at times and one would think they were well enough to go home then suddenly they would lose their balance. About one of these, I once asked the head attendant, “Why don’t they send Mrs. Y home? I’ve never yet, and I’ve been here 18 months, seen her disturbed or even excited. Mrs. Hays said she was once sent home and was there only three weeks. She returned

R131 A1 15 V9 NOI 019 20 INDIANA MEDICAL HISTORY QUARTERLY

Carrie E. Lively (Photograph courtesy Mrs. Florence Yeager, Muncie, Indiana)

Attendants at Central State during the 1920’s. (Photograph in the collection of the Indiana Historical Society Library.)

R131 A1 15 V9 NOI 020 REMINISCENCES 21

so bad and violent that it took all the ward doctors and the superintendent to carry her in the ward again. The only thing Dr. Smith said about it was, “If I ever send her home again, it won’t be to her husband!” He did not say why. Anyway, I can still say Mrs. Y was always rational while I was at East Haven. She was a help to the ward and one I very much appreciated after going on night duty. There was one patient, Alice, who was a very quiet person at times, but if I awakened and heard a storm of wind blowing, I knew I would have trouble with her. So it was. One night I saw her rise and stand up in her bed and begin tearing her sheets to strings. She always tore her clothes or her bedding when she was disturbed. I called to her, “Alice, don’t tear your sheets.” She paid no attention. It was the middle of the night, and all the rest were sleeping quietly. I had a bunch of keys on a ring and a whistle attached to them. I should never have gone to Alice without that whistle. I just thought I could get her to lie down and quiet her as soon as I could, but when I stood by her bed and touched her, she sprang onto me like a young tiger. Her arms clasped around my neck, her weight was more than I could stand so I went down under her like a feeble plant being crushed. I could have gotten help from the day attendants if I had had my whistle. But there I’d left it lying on my table. I thought of Mrs. Y always being so good to help so I called her and asked her to get my whistle and blow it hard until the girls woke up and came in. I think Mrs. Y must have saved my life. She saw my helplessness. I was under Alice and she was trying her best to choke me. Mrs. Y blew and kept it up until the girls came in. They soon helped me restrain Alice with a restraining sheet, one that has straps with which to fasten the patient down in a reclining position in her bed. Alice raved then all night disturbing the other patients and making it a very bad night for me. Sometimes all would be quiet all night and all I had to do was watch them and read. Other nights I would have trouble with some, but I never had to call the day girls up again. When off duty in the morning, we could take a walk, which we nearly always did for the fresh air, or we could read or write in our rooms. In the winter, there wasn’t much amusement for those on night watch. But there was one thing we love, ice skating. There was a pond or small lake on the grounds. We all procured skates, those of us who didn’t have them. Some of us had to learn to skate and oh, what fun we had in our tumbles until we did learn. I remember the glad feeling I had when I could go out on the ice and really skate alone — independent of any help or guidance. Sometimes we would all join hands and skate to the end of the lake together. Once I remember a big tall fellow who joined us and was willing to try but said he had never skated. He was so tall I remember thinking he would have a long way to fall. It was very foolish of him to try with so many. When he went down, he not only took himself, but all those near him. There wasn’t anything anyone could do to help him much because he was so tall and heavy. I was skating near the outside of the row of skaters and a Mr. Cole was next to me. He said, “Let loose. Come on!” We did not stop until we reached the end. Then, he went into convulsions of laughter. He said that was the most elegant fall he had ever seen. It seems cruel to laugh at Mr. Hamilton, but that is just what we did. We laughed until our sides were sore. The one who feared he would fall always fell. I noticed that. Those who went on the ice with self confidence scarcely ever fell. While we were learning, however, we took

R131 A1 15 V9 NOI 021 22 INDIANA MEDICAL HISTORY QUARTERLY

many an “elegant” fall as Mr. Cole called them. East Haven looked like a small village with its wards and shops and hospital. I don’t know how many acres of ground belonged to it, but I do know the inmates helped to farm and garden. It was Dr. Smith’s idea that this would create some interest in life for them and most certainly it did for some of them. I saw no cruelty among the attendants there as I had at Central. Dr. Smith was kind and considerate to his employees and some of them had been there until they were growing old. When spring came, we night watchers were all over the grounds. I don’t know why we felt so free, but we even went into the strawberry patch and picked berries. That is four of us did, Harry Hults and myself, Albert Bovard, and Iola Ferncine (spelling?). We four could be seen foraging most anywhere good things grew. The doctor liked for us to get out of mornings before we retired for the rest of the day and sometimes we almost forgot to retire. Spring was lovely. It was hard to return to our sleeping rooms to shut out the sweet sunshine and sleep the rest of the day. When we awakened, we felt as if we had lost a day, and we missed it. When I went on night duty, I hoped it wouldn’t be for long, but it seemed it was going to be permanent. Well, anyway, we were having a pretty good time. I didn’t know how to play cards until I got to East Haven. There everyone played cards as a pastime so I just had to learn. We would go out, the four of us, get under some tree in a shady spot and play when we should have been in our rooms getting our sleep. Spring came and went. About the time spring was turning into summer, I received a letter from an old sweetheart of mine, Tolbert Lively. He, too, had married, but had divorced. He met my niece, Georgia, at an ice cream festival at a church in Heltonville and asked for my address. I was astonished and pleased to receive the letter. It seems he was working in Indianapolis. We became friendly again. One day when I had an afternoon and evening, I went over to Indianapolis and he met me. We spent quite a pleasant day together. He could not visit me at East Haven for that was against the rules. We wrote constantly and soon it seemed I was going to get a chance at rebuilding a home. It was not long until he asked me to be his wife. I promised and in June, 1902,1 resigned my place at the hospital and married.

NOTES

'Nat U. Hill was a banker and prominent citizen of Bloomington, Indiana. 2Dr. Sam Smith was a nationally recognized leader in psychiatry at this time, and later became Chan­ cellor of the Indiana University Medical Center during the developing years of the schools of medicine and dentistry. Dr. Smith made enduring contributions to the mental health movement in Indiana.

R131 A1 15 V9 NOI 022 MENTAL HEALTH CARE IN EARLY TWENTIETH CENTURY INDIANA AND THE LIMITS OF REFORM

Ellen Dwyer*

Several years ago, the historian Gerald Grob sharply criticized “the unhistorical history of the asylum,” that is, the tendency of scholars to write about the history of mental hospitals as an unchanging chronicle of graft, patient abuse, and therapeutic failure.1 Yet, as HughC. Hendrie suggests in his analysis of the newspaper coverage of Central State Hospital in Indianapolis between 1900 and 1975, there is a sameness about the periodic exposes of such institutions which helps to explain the popularity of an ahistorical pessimism about their potential for change. In a similar fashion, although Carrie Lively’s account of her experiences as an attendant first at Central State and then at East Haven reveal her to be a hard-working and compassionate care­ taker of the insane, her anecdotes about the frequency with which other attendants abused the most helpless of the patients have a familiar ring. Almost identical stories can be found in other sources, based on experiences in a range of states and taking place over a period from the mid-nineteenth century to the present day. Nonetheless, despite the undeniable persistence of certain structural problems within American mental hospitals, Grob’s admonition is still an important one. In this essay, I will try to sketch the specific medical and institutional context in which the problems detailed by Lively and Hendrie arose. By the early twentieth century, the innovation of the “lunatic asylum,” which had spread so rapidly and been the focus of such high hopes in the mid-nineteenth century, was being sharply criticized. While Progressive reformers did not advocate the abo­ lition of asylums (newly renamed “hospitals” in most states), they felt that psychia­ trists should emulate their medical colleagues by using the techniques of laboratory science to uncover the causes of insanity. They also supported the development of alter­ natives to large lunatic asylums, such as “detached cottages” for harmless incurables and psychopathic hospitals for recent cases of acute insanity.2 Indiana adopted several of these Progressive reforms, including the advocacy of pathological research, the expanded concern for community education in mental hygiene, and the development of a “cottage” system of care for some of the mentally ill. But, at the same time, it was still fighting battles which had been won decades earlier in more populous states, such as the removal of the insane from county poorhouses and jails, the building of a separate institution for epileptics, and the provision of specialized care for the crimi­ nal insane. At the start of the twentieth century, Indiana had four mental hospitals — Central State (1848), Logansport (1888), Richmond (1890), and Evansville (1890) — scattered geographically so as to meet the needs of the various regions of the state. Central State, with an average patient population of 1800, was by far the largest; the others held from 400 to 800. The testimony of the hospital superintendents at the annual meetings of the Board of State Charities and Corrections suggested that, to varying degrees, their hospitals were being asked to perform an ever-increasing number of functions. For example, the superintendent of Central State, George Edenharter, responded to the

♦Ellen Dwyer is assistant professor in the Department of Forensic Studies at Indiana University, Bloom­ ington. Her major research interest is the nineteenth century care of the mentally ill.

23

R131 A1 15 V9 NOI 023 24 INDIANA MEDICAL HISTORY QUARTERLY

Progressive call for a more scientific study of insanity, by adding research and edu­ cation to the institution’s therapeutic and custodial goals. To do this he built a large pathological laboratory, whose facilities attracted visitors from all over the world.3 Edenharter justified the expense as an essential component of adequate patient care. He also argued that the laboratory permitted Central State to offer a four-year course of pathological lectures for local medical students, who would then be qualified to recognize and treat insanity in its early stages, before it required institutional treat­ ment.4 Edenharter clearly saw himself as the leader of a state movement to “Agitate, Educate, Organize” until all of the mentally ill of Indiana received appropriate care.5 Despite its sophisticated facilities, Central State’s pathological research suffered from the same flaws which plagued such efforts across the country. Although the pathologists firmly believed in “a multi-dimensional psychobiological conception of mental illness that rejected a purely somatic or physical approach to psychiatric phe­ nomenon,”6 the research reports of Central State’s pathologist, Charles Neu, differed little from those published some thirty to forty years earlier in The American Journal of Insanity. The titles of his medical papers indicate both their strengths and weak­ nesses, e.g., “The Relation of the Peripheral Nerves to the Central Nervous System” and “Acute Haemorrhagic Pancreatitis.”7 Although Neu provided much detail about the condition and size of bodily organs and examined tissue samples under the micro­ scope, neither he nor his colleagues were able to link physiological data with the be­ havioral indices of mental illness available in patient case histories and clinical reports. Whatever its limitations, the busy, well-organized world of psychiatric research described by Neu and Edenharter differed dramatically from the picture of back wards, abusive attendants, and depressed patients which appeared in Indianapolis newspaper exposes almost from the opening of Central State.8 The explanation of such a discrepancy, as well as of the almost ritualistic, repetitive nature of asylum exposes, whether published in 1851, 1902 or 1975, is a challenge for the historian. Not sur­ prisingly, superintendents such as Edenharter were unwilling to draw attention to the bleaker side of asylum life. Yet, as a young attendant at Central State, Carrie Lively encountered none of the spirit of rational scientific inquiry that pervades Eden- harter’s reports. Instead she commented that, as the superintendent seldom appeared on the wards, he tended to be unaware of the worst abuses. While she did not excuse the brutalities she witnessed, she made clear the heavy work load on the more difficult wards, and graphically described the process whereby she decided, “I’ll have to be­ come hardened to suffering or leave here.” Furthermore, attendants received no formal training except for the rattling off of a long list of rules on their first day of employment (despite the national effort of the American Medico-Psychological Asso­ ciation to encourage the establishment of specialized training programs for atten­ dants and nurses). Yet, despite these negative notes, the picture drawn by Lively of early twentieth-century Indiana asylum attendants has many positive elements. Although attendants refused to report on each other, only a small number were cruel to patients and many put up with long hours and poor pay with relative good cheer. Her experience also points out the diversity of institutional arrangements in Indiana for, when she took a second job at East Haven, she found no cruelty to patients at this much smaller institution, built on the so-called “cottage plan,” and she described it as “a real haven of comfort to me.” Lively’s account tends to support the observations of her contemporary, Clifford Beers, a former mental hospital patient. Beers observed that those patients most need­ ing care and treatment — the infirm and the senile, and the violent, noisy, or trouble­ some — suffered the most.9 Central State’s grouping of patients by their institutional

R131 A1 15 V9 NOI 024 MENTAL HEALTH CARE 25

behavior, rather than by psychiatric syndromes or therapeutic treatments, was a characteristic strategy in most early twentieth-century mental hospitals. In the insti­ tution’s defense, it should be noted that its staff had to deal with large numbers of difficult-to-manage patients, as well as of the chronic mentally ill, even though recent research suggests that the relative numbers of mildly disturbed in state mental insti­ tutions were increasing.10 For example, of the patients studied by Neu at Central State between 1903 and 1906, 23 percent were suicidal and 10 percent homicidal.11 Almost all were delusional, with psychoses and neuroses aggravated by a wide range of phy­ sical disturbances.12 Not atypical was the twenty-eight-year-old man who had locked himself in his room for five months before admission, refusing to associate with his family out of fear of being drugged. He ate only raw food prepared by himself and carried guns and other weapons. He also claimed that his family did not appreciate him and that he was engaged in a physical culture experiment, although he could not say what he wished to discover.13 A forty-five-year-old woman was reported to be “restless, destructive, violent, homicidal, epileptic,” on admission. She too felt she was being mistreated by friends and claimed to be seeking the help of secret societies.14 Even more difficult to deal with were those patients in the last stages of paresis, advanced alcoholism or senility.15 Whatever the management problems posed by such patients, Hendrie’s account of the frequency with which Indianapolis newspapers have documented patient mis­ treatment since the early twentieth century raises the question of why the state of Indiana (along with almost every other state) has consistently failed to eliminate abuse. An examination of the earliest attempts to respond to abuse charges suggests some of the limitations of the typical state response to asylum exposes. During the late nineteenth and early twentieth centuries, in Indiana as elsewhere, the investigation of institutional malfeasance was made the responsibility of a six-person bipartisan Board of State Charities.16 The Board had grown directly out of an 1889 investigation of Central State which, according to Governor James Mount, “revealed enough of iniquity and incompetency to humiliate the pride and bring the blush of shame to the cheeks of all the people of Indiana.”17 Although the Indiana asylum superintendents initially opposed the imposition of an external regulatory commission, they quickly discovered (as did their colleagues across the country) that the Board almost always sided with the institutions (in part because of the difficulty of proving charges made by patients and ex-patients). The Board itself felt confident that its investigatory visits, when combined with the assiduous collection of institutional statistics, would prevent the recurrence of abuses, save money, and improve care.18 Only rarely did Board members suggest specific reforms to the leaders of Indiana’s early twentieth- century mental hospitals and, when they did, their suggestions showed little under­ standing of the realities of life in institutions with one to two thousand mentally- disturbed patients. For example, in 1900, the President of the Board praised the “kindly treatment and beautiful surroundings” which he felt characterized Indiana’s state mental hospitals and urged the provision of “more flowers, clean table cloths, napkins, sweet music, and individual care and concern.”19 Although in 1901, a Board member commented proudly that “no hospitals for the insane are conducted in a better way than are those of Indiana,”20 seemingly not everyone in Indiana was equally con­ vinced of the hospitals’ good will for, that same year, a state legislative investigative committee was established to supplement Board visits to state institutions. More stringent commitment laws also were enacted and state auditor’s control over hospital purchases increased.21 However, even if the Indiana Board of State Charities failed to live up to its promise to eliminate all mismanagement from the state’s mental hospitals, in this

R131 A1 15 V9 NOI 025 26 INDIANA MEDICAL HISTORY QUARTERLY

respect it was no different from similar boards across the country. More atypical was its seeming lack of concern about the renewed use of “mechanical restraints” at In­ diana mental hospitals, a therapeutic technique generally out-of-favor by this time because of the ease with which it could be abused. The Board accepted without chal­ lenge Edenharter’s justification of the continued use of mechanical restraints at Central State on the grounds that the bruises they sometimes caused lasted only several days while the potential harm from drugs used to quiet patients was incalcu­ lable. At the same time, Edenharter himself admitted that straitjackets were used more often when the institution was short on attendants and that they often were left on for longer periods of time than required.22 A final constraint on reform in early twentieth-century Indiana (as today) was the inadequate funding of mental health programs. In Indiana, as in other states, taxpayers and legislators wanted high-quality therapeutic and custodial care for the insane, but, as the Superintendent of the School for the Deaf noted in 1901, even the reformers wanted “the most possible good for the money.”23 Although advocates of the “new science of philanthropy” argued that monetary and humanitarian social concerns were not incompatible,24 at Central State in particular, Indiana’s fiscal con­ servatism undercut the institution’s humanitarian goals by creating a situation of constant overcrowding. Again and again at state meetings, reformers and politicians equated therapeutic advances and improvements in care with lowered per capita costs at mental hospitals.26 In large part, they felt justified in so doing because state level hospitalization, whatever its imperfections, was clearly better than the horrors of county poorhouses. No matter what the overcrowding at Central State, it offered better care than that available in the 1905 county poorhouse in which an insane inmate was found to have been locked in a steel cage for thirteen years.26 After visiting the Tippecanoe County Infirmary, where the insane were confined in small cells without windows or lights, one Board of Charities member observed that he would rather die than go to such an institution.27 In conclusion, in Indiana, as across the United States, early twentieth-century state mental hospital superintendents were asked to carry out a wide range of func­ tions, with relatively small staffs, limited therapeutic tools, and little understanding of the dynamics of mental illness. Given these limitations, as well as vacillating levels of state funding and a lack of control over the types of patients admitted to and dis­ charged from hospitals, those who administered and worked in “the enduring asy­ lum”28 deserve praise as well as criticism for their efforts to reconcile the therapeutic ideals of the early nineteenth century with the custodial realities of the twentieth. For, even while some Indiana reformers were asking of charitable work, “Does It Pay?”29 many agreed with the South Bend Board of Charities member who said: “In this fierce fight [for success] there are many who fall by the wayside__ There is a compact exist­ ing among us that we, not being brutes but human beings, all made in the image of the Common Maker, shall take care of those who break down.”30

NOTES

'Gerald Grob, “Reflections on the History of Social Policy in America," Reviews in American History, VII (September, 1979), 293-306. 2David J. Rothman, Conscience and Convenience: The Asylum and Its Alternatives in Progressive Amer­ ica (Boston: Little, Brown and Co., 1980), pp. 293-98. Names A. Mount, “Nonpartisan Management of State Institutions,” The Indiana Bulletin of Charities and Corrections (June 1901), p. 17; “Central Hospital Pathological Laboratory,” ibid. (December, 1901), pp. 3-4; “The Insane,” ibid. (June, 1902), pp. 64-66.

R131 A1 15 V9 NOI 026 MENTAL HEALTH CARE 27

'Report from the Pathological Department, Central State Hospital for the Insane, 1903-1906 (Indianapo­ lis: Wm. B. Burford, 1908), pp. 9,17; George Edenharter, An Extract from a Statement by the Superintendent of the Central Indiana Hospital for the Insane to the Board of Trustees, September 30, 1915 (n.p., 1915), pp 8 15. "“Insane,” The Indiana Bulletin (June, 1902), pp. 64-66. 6Joseph P. Morrissey and Howard H. Goldman, “The Ambiguous Legacy: 1856-1868,” in TheEnduring Asylum: Cycles of Institutional Reform at Worcester State Hospital, ed. by Joseph P. Morrissey, Howard H. Goldman, and Lorraine V. Klerman (New York: Grune and Stratton, 1980), pp. 64-65. ''Report from the Pathological Department, p. 331. 8Report of the Joint Committee, Appointed by the Senate and House of Representatives to Investigate Cer­ tain Charges Against the Commissioners and Other Officers of the Indiana Hospital for the Insane (Indi­ anapolis: J. P. Chapman, 1851); Alexander Johnson, “A State Aged 100: Glimpses of Social Progress in Indiana During One Hundred Years,” The Survey, XXXVI (April 29, 1916), 119-20. Clifford Beers, A Mind That Found Itself (New York: Longmans, Green and Company, 1917), pp. 68, 169. '"Ellen Dwyer, “The Asylum and the Community: Commitment Patterns to Two Nineteenth-Century Lunatic Asylums (Unpublished paper, 1981), p. 5; Myra Himmelhoch, “Elizabeth Packard: Nineteenth Century Crusader for the Rights of Mental Patients," American Studies, XIII (Number 3, 1979), 344. "Report from the Pathological Department, p. 328. '2IbicL, pp. 326, 328. '3Ibid., p. 238. 14Ibid., p. 130. m id ,, pp. 237, 239, 249. '"Alexander Johnson, “President’s Address — The Results of an Ideal in Politics,” The Indiana Bulletin of Charities and Corrections (June, 1904), pp. 2-12; Amos W. Butler, “The Board of State Charities and the People,” ibid. (September, 1908), pp. 1-5. "Mount, “Nonpartisan Management,” The Indiana Bulletin (June, 1901), p. 13. '"Thomas E. Ellison, “President’s Address,” The Indiana Bidletin of Charities and Corrections (June, 1902), pp. 12-13. '"Ibid., p. 14. 20“The Insane,” The Indiana Bulletin (June, 1902), p. 63. "'“New Laws,” The Indiana Bulletin of Charities and Corrections (March, 1901), pp. 17-24. ""“Insane,” The Indiana Bulletin (June, 1902), pp. 65-66. ""Richard O. Johnson, “State Charities,” The Indiana Bulletin of Charities and Corrections (June, 1902), p. 18. "4Francis H. Gavisk, “The New Science of Philanthrophy,” The Indiana Bulletin of Charities and Cor­ rections (June, 1908), pp. 4-7. ""Mount, “Nonpartisan Management,” The Indiana Bulletin (June, 1901), p. 16. ""“County Charities,” The Indiana Bulletin of Charities and Corrections (June, 1905), p. 98. ""“Discussion,” The Indiana Bulletin of Charities and Corrections (June, 1900), p. 98. ""Rothman, Conscience and Convenience, p. 348. 29T. F. Rose, “Does It Pay?” The Indiana Bulletin of Charities and Corrections (June, 1904), pp. 33-36. ""“Response to Welcome,” The Indiana Bulletin of Charities and Corrections (June, 1902), p. 10.

R131 A1 15 V9 NOI 027 28 INDIANA MEDICAL HISTORY QUARTERLY

NEWS AND NOTES

George S. Porter, M.D., of Richmond, Indiana, recently donated the manuscript minute book of the Boone County Medical Society (1873-1901) to the Indiana Historical Society Library. Dr. Porter’s great grandfather, A. G. Porter, was the first secretary of the society. The medical society was founded on March 25, 1873 as the Drake Medical Society (named after the famous Cincinnati physician, Daniel Drake). Its name was changed in 1878. As with other medical societies at the time, the Boone County Medical Society offered its members an opportunity to listen to formal papers and share interesting or unusual cases of disease and surgery.

Helen L. Davidson, retired archivist from the Eli Lilly and Company and curatorial assistant at the Indiana Medical History Museum, will present a lecture and slide show entitled “Botanicals: The Lilly Connection” on April 29 at the Indiana Historical Society Spring Workshop at Springmill State Park. For details about the Spring Workshop, see the Society’s Newsletter which members will receive in March.

Beginning with this issue, all articles published in the Quarterly will be indexed and/or annotated in Historical Abstracts; America: History and Life-, Bibliography of the History of Medicine (and its corresponding database HISTLINE); Recently Published Articles-, Writings on American History, and The Journal of American History. ninpls I 46202 0 2 6 4 IN Indianapolis, Quarterly istory H edical M ciety o S Indiana istorical H Indiana s i treet S hio O est W 5 1 3

emi No 3 4 6 38 o. N it Perm ninpls IN Indianapolis, nprft Org. rofit p on N . . Postage S. U. PAID

R131 A1 15 V9 NOI 028 INDIANA MEDICAL HISTORY QUARTERLY

INDIANA HISTORICAL SOCIETY Volume IX, Number 2 June, 1983

R131_A1 _I5_V9_N02_001 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202.

EDITORIAL STAFF

CHARLES A. BONSETT, M.D., Editor 6133 East 54th Place Indianapolis, Indiana 46226

ANN G. CARMICHAEL, M.D., Ph.D., Asst. Editor 130 Goodbody Hall Indiana University Bloomington, Indiana 47401

KATHERINE MANDUSIC MCDONELL, M.A., Managing Editor Indiana Historical Society 315 West Ohio Street Indianapolis, Indiana 46202

MEDICAL HISTORY SECTION COMMITTEE

CHARLES A. BONSETT, M.D., Chairman

JOHN U. KEATING, M.D. KENNETH G. KOHLSTAEDT, M.D.

BERNARD ROSENAK, M.D. DWIGHT SCHUSTER, M.D.

WILLIAM M. SHOLTY, M.D. W. D. SNIVELY, JR., M.D.

MRS. DONALD J. WHITE

Manuscripts for publication in the Quarterly should be submitted to Katherine McDonell, Indiana Medical History Section, Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. All manuscripts (including footnotes) should be typewritten, double-spaced, with wide margins and footnotes at the end. Physicians' diaries, casebooks and letters, along with nineteenth century medical books and photographs relating to the practice of medicine in Indiana, are sought for the Indiana Historical Society Library. Please contact Robert K. O'Neill, Director, In­ diana Historical Society Library, 315 West Ohio Street, Indianapolis, Indiana 46202. The Indiana Medical History Museum is interested in nineteenth century medical ar­ tifacts for its collection. If you would like to donate any of these objects to the Museum, please write to Dr. Charles A. Bonsett, Indiana Medical History Museum, Old Pathology Building, 3000 West Washington Street, Indianapolis, Indiana 46222.

Copyright 1983 by the Indiana Historical Society

Pictured on the cover is Dr. Livingston Dunlap (1799-1862). Dr. Dunlap was the major proponent of establishing a hospital in Indianapolis during the antebellum period. (Photograph in the collection of Wishard Memorial Hospital and reproduced with the permission of Margaret Wicks, Wishard Memorial Hospital.)

R131 A1 15 V9 N02 002 THE INDIANAPOLIS CITY HOSPITAL, 1833-1866

Katherine Mandusic McDonell*

Although a few leading citizens attempted to establish a hospital in Indianapolis during the 1830s, the city lacked the benefit of such an institution until after the Civil War. Thus, the early history of the Indianapolis City Hospital (now Wishard Memorial Hospital) is a story of ideas and attitudes rather than an account of a functioning institution. Over the course of three decades, the hospital idea evolved from one of a pesthouse to an almshouse and finally, to a modern hospital. It was the modern hospital idea (i.e., an institution accepting only the acutely ill and not limited to charity cases) that came to fruition after the Civil War. The purpose of this paper is to trace the development of the hospital idea in Indianapolis and to analyze the problems resulting from this effort to obtain municipal funds to care for the city’s sick. I: PESTHOUSE

In the 1830s Livingston Dunlap, a prominent local physician, pointed out the need for a permanent place to care for the sick, particularly the city’s smallpox and cholera victims. Probably upon Dunlap’s request, on July 20, 1833, Indianapolis’ first board of health recommended that a hospital be erected within the city. The local residents, however, viewed such a facility as an expensive luxury.1 Not until the 1840s, when another smallpox epidemic broke out in the city, did the citizens of Indianapolis realize the possible benefits of a hospital. On June 12,1847, Dr. John L. Mothershead of Indianapolis confirmed the arrival of smallpox in the city. In response to Mothershead’s report, the Common Council of Indianapolis authorized the city marshal to remove any smallpox sufferer “to some suitable and safe place to prevent the further spread of said disease in the city, and to procure attendance upon said persons during their sickness of said disease....”2 As the number of smallpox cases increased, the city employed more drastic measures to stop its spread. On July 10, the Council appointed Drs. Mothershead, Dunlap and John S. Bobbs to serve on a board of health and report the existence of infectious or contagious diseases within the city. At the same meeting, the Council appointed a committee to procure “a suitable piece of Ground, within the limits of the City not less than one acre on which to erect a building of sufficient dimensions to accommodate not less than six persons [,] which building shall be, and is hereby set apart exclusively for the use of persons laboring under the Smallpox or varioloid or other contagious or infectious diseases....” More precisely, the hospital was to function as a pesthouse. The Council gave the committee the small sum of one thousand dollars to purchase not only the grounds but also to build an appropriate structure and supply all the necessary furniture, medicines, and provisions.3 By July 27, 1847, the committee reported the purchase of four acres of land in outblock 159.4 Probably because of monetary restraints, along with a brief remission in the epidemic, the plan to construct a hospital never materialized. With the recurrence of smallpox in the winter of 1847-1848, Indianapolis citizens recognized the need for immediate action to prevent the disease’s spread. In 1848, a group of city

* Katherine Mandusic McDonell is Medical Research Historian at the Indiana Historical Society and Curator of the Indiana Medical History Museum. The author wishes to thank Ann G. Carmichael, M.D., Ph.D., for her editorial comments and Charles A. Bonsett, M.D., John Selch of the Newspaper Division of the Indiana State Library, and Willard Heiss of the Indianapolis City-County Archives for their assistance in locating documents pertaining to City Hospital.

3

R131 A1 15 V9 N02 003 4 INDIANA MEDICAL HISTORY QUARTERLY

residents met publicly and elected spokesmen who, in turn, asked the Council at their meeting on February 7, to establish a committee to study the city’s sanitation system. This citizens’ group also urged the passage of a resolution allowing the Council to carry out, by whatever means necessary, steps to prevent the spread of smallpox. The public committee, obviously aware of the expense of such a project, also suggested a resolution be passed giving the Council permission to raise funds by taxation to enact these health measures.5 Drs. Mothershead, Bobbs, Dunlap, and four other area physicians comprised the committee to study an appropriate sanitation system for Indianapolis. As part of their public health measures, this committee proposed a city-wide vaccination program and the construction of a municipal hospital. To oversee the hospital construction, another committee was formed and this group was to “issue notice for the reception of sealed proposals for the construction of said House at the earliest practicable period....”6 To pay for these measures, the Council ordered on February 17,1848, that a special tax of fifteen cents be levied on each one hundred dollars of real and personal property and a one dollar tax on each poll “for the purpose of defraying the expenses necessary to prevent the spread of Small pox within the limits of the city, and for the purpose of erecting a suitable building to be used as a City Hospital.”7 By March 6, the Hospital Committee had made the necessary contracts for the construction of a smallpox hospital.8 The plans for the extension of hospital services met resistance as smallpox subsided. Opponents of the hospital condemned the Council’s actions and accused that body of violating its charter.9 Many citizens, too, refused to pay the smallpox tax. By May, 1849, the Council had collected only $766.51 in smallpox taxes, leaving $705.63 in debts for the hospital land and the vaccination program.10 Proponents of the hospital, however, remained firm. The editors of the Locomotive, for example, harshly criticized the hospital’s adversaries:

Why did not these gentlemen attend the first meeting, and then put in their objections if they had any? Why wait until all the necessary steps had been taken before their objections could be made known? Why wait ‘till the horse was gone’ before you found it necessary ‘to lock the stable?’ Is the course you have adopted right? Is it manly? Is it honorable? [sic] thus to refrain from acting with your fellow-citizens, in order that you may come out afterwards and denounce their conduct? These things may all be right, proper and legal, but our dull cranium cannot perceive how.11 The editors concluded with praise for the Council’s plan to preserve the health of Indianapolis. The Locomotive’s efforts failed to save the city hospital. On May 18, 1849, the Council admitted that any further attempt to collect the hospital tax would be “fruitless.” For those who had paid the tax, the Council provided a refund via a credit on their general taxes. To cover the debts incurred by maintaining a vaccination program, the Council sold its hospital lot and raised general taxes. Still recognizing the need for a public health program, the city government decided to support “means for such improvements as will have a tendency to remove the cause of disease.... 12 Thus, the idea of a hospital was dead for the immediate future. It is not surprising, however, that these early attempts to establish a hospital in Indianapolis failed. Even in the first decades of the nineteenth century, hospitals were relatively new institutions. Care of the sick occurred in the home, whether a doctor treated the patients or the individuals dosed themselves. The patients in most hospitals were often the poor and those “without roots in the community.”13 Larger cities had pesthouses, or lazarettos, to isolate those suffering from contagious diseases, but many hospitals functioned as almshouses. These institutions housed not only the

R131 A1 15 V9 N02 004 INDIANAPOLIS CITY HOSPITAL 5

sick poor (including contagious patients), but also the aged, disabled, insane, and sometimes even the petty criminal. There were “modern hospitals” during this period, but most of these had evolved from almshouses. The Philadelphia General Hospital, for example, started as an almshouse in the 1730s. It was not until 1835 that adminis­ trators placed the hospital portion of the almshouse in a separate building (although the almshouse and hospital structures were on the same grounds). The hospital continued to care for the insane until 1859.14 The other “modern hospitals” during this period were the private, or voluntary hospitals, but these institutions required a large monetary commitment from the private sector.16 Indianapolis’population was too small to support even an almshouse. In 1830, the population was approximately 1,600 and by 1849 it had increased to only 6,504.16 When Philadelphia opened its first almshouse in the 1730s, the population of that city was 11,500.17 In 1835, when administrators separated the hospital portion of the institution from the almshouse, Philadelphia’s population was well over 80,000.18 Moreover, eastern cities with almshouses and hospitals had large numbers of poor people and immigrants crowding their streets. Indianapolis, by contrast, did not have a significant poor or immigrant population in the 1830s and 1840s.19 Furthermore, because of the hospital’s connection with the almshouse, the public viewed hospitals with suspicion. The often deplorable conditions within these institu­ tions further tainted their reputation. According to experts of the day, most hospitals were unsanitary and disease-producing because of their poor design and inadequate internal management. Many hospitals admitted contagious patients and housed them with the regular ones.20 Some hospital experts of the nineteenth century, such as W. Gill Wylie, even went so far as to say that until hospitals were better organized, "on sanitary grounds alone," it would be better to treat patients in their homes “even though they may be very bad and unhealthy places to live.”21 Wylie also contended that hospitals had a bad influence on the patients since a large number of those admitted to hospitals were from the lower classes: “Like all public and general charities without the safeguard that personal knowledge affords, hospitals tend to foster idleness, helplessness, and their natural results, pauperism and crime.”22 In short, as historian Morris J. Vogel concluded, “history stigmatized the hospital.”23

II: ALMSHOUSE

With these factors working against a hospital, the idea of establishing such an institution in Indianapolis understandably lay dormant for six years. But in 1854, when smallpox once again threatened the city, Livingston Dunlap offered a resolution to the Common Council stating that “a hospital should as soon as practicable, be erected, to receive the stranger, the unfortunate, and the destitute, to be under the control and management of the City authorities....” Dunlap hoped such an institution would meet the city’s growing needs. To carry out this resolution, Dunlap suggested the Council appoint a committee of three to investigate the “price and condition by which the premises can be obtained.” The Council adopted this resolution on February 7, 1854, and appointed three of its members, including Dunlap, to a committee for overseeing this resolution’s implementation.24 Procuring an ideal location for the hospital became the first obstacle for the committee. The site originally chosen lay in the southern part of the city and was described as a “healthy location” on “the most elevated land in the city.” But the owner of the property, James Turner, reneged on his contract with the city to sell the land. In response to Turner’s action, the Council appointed another committee of three to choose a location for the hospital. In December, 1854, the second committee purchased

R131 A1 15 V9 N02 005 6 INDIANA MEDICAL HISTORY QUARTERLY

an eight-and-one-half acre parcel of ground in the northwestern portion of the city. Instead of the elevated and relatively inexpensive land originally offered by James Turner, this piece cost $500 an acre, or a total of $4,305, and bordered on the low-lying regions around Fall Creek.26 On March 10,1855, the Council appointed yet another three-member committee (again including Dunlap) to “procure plans and specifications” for a city hospital.26 This committee hired Isaac Hodgson, an Indianapolis architect, to draw the plans. Hodgson’s design received public praise:

The appearance of the building is much admired by all that have seen it, and we are satisfied no better or more economical arrangements could be made for the convenience and comfort of the patients, affording heat, air, ventillation [sic] and water, all within the main building, and on each floor.27 The three-story brick hospital building had two wings and a basement which contained the fixtures for cooking, washing, and heating. Hodgson’s design was such that the center section and wings could be built at separate times. The estimated cost of the entire structure was $26,000, whereas the proposed cost of building only one wing was $6,250. Given the economic situation of the city, the Council decided to capitalize on Hodgson’s adaptable plan and opted initially to construct the hospital’s south wing.28 On June 25, 1855, the Council approved Hodgson’s “drawings and plans,” and appointed a three-member committee, again with Dunlap serving on it, to oversee the construction of the hospital.29 Over the next several years, work on the south wing of the hospital continued, but construction costs far exceeded the original estimate. By September, 1857, the Council had appropriated $17,995 for the hospital project. Yet, the hospital building remained unfinished, and it was evident that even more money would be needed to complete the structure.30 During the next few years, the Hospital Committee faced several problems involving the incomplete hospital project. On September 1,1858, James S. Athon, the individual who sold the hospital lot to the city, notified the Council that they owed him $671.26. The Council had paid him in banknotes, but had failed to reimburse him with hard currency when the notes had matured two years earlier. Athon asked for either payment of the notes or an assurance from the Council that 12 percent interest per year on the debt would be paid (from January 1,1856 to September 1,1858), making the total $843.50. The Council referred the matter to the Finance Committee. The Finance Committee’s procrastination caused Athon to sue the Council in March, 1859. The city finally settled the suit in May of that year.31 Even more trouble for the hospital ensued when the state and county sold the hospital and grounds for delinquent taxes in January, 1859. The sale eventually was declared void because of City Hospital’s tax- exempt status.32 The Hospital Committee’s problems increased in 1859 when the project lost its major proponent — Livingston Dunlap. Dunlap was no longer on the Common Council of Indianapolis.33 Without Dunlap, the new Hospital Committee limped along. On April 23, 1859, the Council agreed to fence the hospital lot and sink a well on the property.34 By the fourteenth of the following month, the Hospital Committee received bids for this work.35 At the Council meeting of May 28, Herman Tilly, the head of the Hospital Committee, reported the need for an additional fifteen hundred to two thousand dollars to complete and furnish the hospital.36 Yet, by late 1859, the hospital building still remained unopened and unfinished. Vagabonds and prostitutes reportedly were inhabiting the vacant structure.37 Meanwhile, public opinion toward the project was souring rapidly. The Common

R131 A1 15 V9 N02 006 INDIANAPOLIS CITY HOSPITAL 7

Council on June 25,1859, adopted a motion “that the Committee on [the] Hospital be directed to advertise for bids for renting the Hospital buildings and grounds, and report at the next meeting of Council.”38 No action was taken on this proposal, but the criticism over the hospital project intensified. Part of this criticism was spurred by the Hospital Committee’s request in October, 1859, to place a new roof on the empty City Hospital building. Herman Tilly, the head of the Hospital Committee, asserted that the old roof was “not sufficient to keep out the rain.”39 Alarmed by the Hospital Committee’s latest demands, the editors of the Locomotive questioned the committee’s management of funds. In an editorial entitled “WHO DID IT?”, the editors asked the Council to explain the need for a new roof:

Who put the present roof on City Hospital? Unless there is some very good reasons for its giving away so soon, the Tax-payers who paid for that improvement, will have cause to think it was a miserable botched job. The people look at these things closely; and it would, perhaps, be but justice to all concerned, if any extenuating circumstances can be presented, that they be given, with the reasons why a new roof is needed on a new building.40

Probably as a result of all the public’s criticism of the hospital project, the idea of renting or selling the empty hospital building arose again in 1860. In February of that year, the Hospital Committee admitted that City Hospital had been “a dead expense to the city” costing some $27,000 and urged the Council to rent the structure “until the same may be otherwise disposed off [sic].”41 In May, 1860, the Council president recommended conversion of the building into a home for the destitute and friendless. In response to the president’s remarks, the Hospital Committee expounded upon their own plans for the building. Although in basic agreement with the president of the Council, the committee proposed the “grounds be fitted up for the purposes originally intended.” Realizing, however, that the public saw little benefit in a hospital, the committee made specific suggestions on alternative uses for the building. In addition to housing the friendless and poor, the Hospital Committee suggested part of the structure be used for the reformation of prostitutes. If the Council rejected this idea, the committee believed it could be used as a “House of Correction and Work House for vagrants in general.” But until the Council made a decision on the use of the building, the committee urged the city to fence the grounds around the structure.42 While the Common Council contemplated these proposals, the Sisters of Providence approached the legislative body with a plan for utilizing the vacant building as a charity hospital. Another suggestion also reached the Council chamber. On July 16,1860, a group of Indianapolis women petitioned the Council for permission to convert the hospital into a home for “friendless females,” or those women who had no means of support and no family. After examining both of these proposals, the Hospital Committee opted to create a home for friendless women and asked the Council to formulate an ordinance regarding this m atter.43 The Council drafted this ordinance on October 27, I860.44 Between July and October, however, opposition toward the plan for establishing a home for friendless women developed in several sectors of the community. The editors of the Journal believed this idea was an “impracticable measure” that would “load the city with a heavy and continual expense, and be a never ending bother and perplexity.”45 An interested citizen identified as “J.M.K.” (possibly Dr. John M. Kitchen of Indianapolis), in a letter to the editor of the Journal, recommended the hospital be used as a state-owned “Asylum for Idiotic and Imbecile Youth.” J.M.K.

A1 15 V9 N02 007 8 INDIANA MEDICAL HISTORY QUARTERLY

even took the liberty of bringing the superintendent of Ohio’s “asylum for the education of idiotic youth” to City Hospital. After seeing the grounds, the Ohio superintendent concluded that the hospital and surrounding area was “extremely desirous for an institution of this kind.”46 On November 10,1860, the city attorney invalidated the ordinance for creating “a home and work house for homeless and abandoned females” at City Hospital. According to the city attorney, the ordinance was too ambiguous regarding the management of the hospital. Although control of the workhouse originally was intended to be in the hands of the Indianapolis women, the ordinance failed to clarify this point.47 Once again, the future of the idle hospital building was undetermined. In midst of the debate over the fate of the hospital, several cases of smallpox broke out in Indianapolis. In March, 1861, the city’s Board of Health recommended the Council seriously consider preparing “one or more rooms of the City Hospital building, for the reception of new cases of disease, in order to more effectually prevent its spread....” According to the Board of Health, readying rooms in the hospital would save the city the “expense of seclusion, nursing, cleaning houses & c.” Furthermore, because patients would be attended by their own doctors, the city would save medical expenses.48 Yet, as the number of new cases of smallpox dwindled by the end of March, 1861, the idea of using City Hospital as a pesthouse lost momentum.49 The building remained abandoned until the outbreak of the Civil War. Although it is relatively easy to understand the Council’s failure to build a hospital in Indianapolis during the 1830s and 1840s, it is more difficult to explain the hospital’s shortcomings in the 1850s. One possible reason for the failure of City Hospital during this latter period was the community’s prejudice against the chronically ill. It would appear that residents of Indianapolis did not want to support an institution which housed incurable patients such as the aged, the disabled, and the poor. They were willing, however, to open the hospital’s doors to those suffering exclusively from short­ term or acute illnesses. More precisely, the people of Indianapolis wanted a modern hospital. This attitude worked against the hospital project since the idea of a municipally-supported hospital exclusively for acute cases still was relatively new in the first half of the nineteenth century.60 As originally designed, the Indianapolis City Hospital was to admit foreigners, the homeless, and the poor, in addition to the sick. In the resolution creating the hospital, Dunlap also mentioned the admission of railroad accident victims to the institution.51 Thus, Dunlap allowed for the admission of another type of chronic patient — the disabled. In short, City Hospital was to function as an almshouse to care for both acute and chronic cases. Evidence would suggest that few individuals in the community favored the expenditure of city funds for the care of the chronically ill.52 Those who proposed that the hospital assume additional almshouse functions received no support. In a letter to the editor of the Locomotive, one anonymous individual, for example, recommended the City Hospital take over the duties of the poorhouse.63 In 1860, an individual indentified only as “a SPECTATOR” advocated the use of City Hospital as an almshouse to care for both the sick and the poor. If the number of paupers grew disproportionate to the numbers of sick, then this interested citizen suggested the city construct a separate building for the acutely ill.54 Neither one of these proposals met with public acceptance. Instead, the support which arose for the Indianapolis City Hospital centered around the use of the building as a pesthouse. The patients who entered such an institution stayed for a relatively short period of time. Thus, they represented the acute cases and were more desirable than the chronic patients. In 1856, the editors of the Locomotive noted its value to the city as a pesthouse:

R131 A1 15 V9 N02 008 INDIANAPOLIS CITY HOSPITAL 9

. . . since the Engine House on the Circle was destroyed, the city has no place to put any one suffering from them [epidemic diseases]. We have been fortunate in not having use for a hospital for this purpose, but we are liable to have such diseases among us at any time, and unless proper provision is made, the business and prosperity of this city would suffer more in one week than the entire building would cost.65

The editors of the Locomotive continued their support of the institution long after the city had decided to sell the empty building, but again they stressed its usefulness as a pesthouse rather than an almshouse or hospital:

. .. the city had better keep her Hospital buildings. We have so far been exempt from contagous [sic] disease, but we may not always be so, and our city is now growing to such dimensions that a hospital will soon be a necessity.56

Even when alternative plans for the hospital were proposed, the public countenanced those institutions designed to cure patients and return them to society. Among the alternative plans for the empty hospital building was an “Asylum for Idiotic and Imbecile Youth,” which was favored over a home for friendless women. Advocates of the asylum for retarded children believed it would produce more "benevolent results” than a home for friendless females. “J.M.K.,” the asylum’s major proponent, pointed out that in similar institutions across the country, “ ‘children’ utterly helpless and painfully disgusting in their habits have been transformed into neat, orderly and happy beings, and their powers of mind so developed as to enable them to enjoy life and earn their own support.”57 More precisely, these children would be returned to society rather than burdening the city for years. Thus, it would appear that Indianapolis residents were opposed to opening a hospital for the care of both the acute and the chronically ill. Whereas, it is true that the city had institutions to care for the poor and insane, Indianapolis still lacked proper facilities for chronic cases such as the aged and disabled. By 1860, the city’s population had reached 18,611 and an almshouse would have fulfilled a necessary service for a city of this size. Few residents, however, wanted an almshouse.58 The city’s unsuccessful attempt to open a hospital during this period also can be attributed to the fact that the project was always a low priority of the Common Council. During the 1850s, Indianapolis experienced an unprecedented increase in population.59 As with any other growing city, it demanded such necessities as street lights, fire-fighting equipment, and a police force.60 Because other organizations in the city performed many of the traditional hospital functions, such as caring for the poor and insane, the City Hospital still was viewed as superfluous.61 Thus, the money available for the hospital project was limited. The Hospital Committee, for example, was to oversee the construction of City Hospital “in the cheapest and best manner, as laid down in the specification, and report at least quarterly to the Council, the action setting forth in detail, the expenditure and progress.”62 At the September 3, 1855, meeting of the Council, Dr. Livingston Dunlap “reported that the south wing of the building had been put under contract, so that it would be enclosed this Fall, at the lowest rates....”63 As the expenditures for other municipal improvements steadily mounted and the city coffers dwindled, the hospital became an easy target for budget cuts. The first hint of financial trouble came on August 6,1855, when the Council reported that it had no money in the treasury to pay for the hospital lot and had to borrow the “balance due on the first payment of the Hospital grounds” from the school fund.64 By the following May, the city clerk estimated the city debt to be as high as $15,295.78.65 In comparison,

R131 A1 15 V9 N02 009 10 INDIANA MEDICAL HISTORY QUARTERLY

the debt the previous year was only $567.23. Henry F. West, the mayor-elect, in response to the rapidly mounting debt, reported that some activities of the city might have to be curtailed. The mayor asked the Council’s Finance Committee to determine “whether more economy can be introduced.” In his speech to the Council in May, 1856, Mayor West sounded the death knell for the hospital: “If there can be no funds and materials obtained to complete the City Hospital, the building and materials should at once be made as secure as possible, from exposure to the weather, and the depredations of idle and vicious persons.”66 With the city in debt, it is not surprising then that after 1855, the Council only reluctantly expended money for the hospital project. On August 18,1856, the Council appropriated the twenty-five hundred dollars needed to “finish” the hospital. Yet, as is evident in the resolution’s wording, the money was allocated merely because failure to do so would damage the work already done on the hospital:

Whereas, Economy and good policy require the Council to complete with all reasonable dispatch, the City Hospital, which is now being erected for the use of our growing city; and whereas, in delaying its progress will naturally injure the walls of the building now up; and destroy much of the material on hand [,] Therefore, Be it resolved, that Two Thousand five hundred dollars be appropriated from the City Treasury, in warrants, for the special purpose of enclosing the Hospital.

The Council appointed a building committee to carry out this resolution.67 In light of the city’s increasing indebtedness, the press attacked the Hospital

The above map shows the location of the Indianapolis City Hospital in relationship to the present Indiana University School of Medicine campus. (Taken from Thurman Rice, “History of the Medical Campus: The Capital in the Wilderness,” Monthly Bulletin of the Indiana State Board of Health 50 (February, 1947), 39.

R131 A1 15 V9 N02 010 INDIANAPOLIS CITY HOSPITAL 11

Committee’s expenditures. While praising its “fine architectural appearance,” the editors of the Journal suggested people visit the structure, not to observe the hospital, but to see a view of bustling Indianapolis from atop it! As the editors wrote: “A view of the city from the hospital is well worth the labor of a visit to that locality. Indianapolis can be seen as good an advantage from that point as from any other, and perhaps better.”68 The editors doubted the wisdom of building such a hospital during unstable economic times and questioned the composition of the Hospital Committee:

We have never been able to learn who the hospital committee is composed of. There has been none appointed to our knowledge since the present Council came into power, and for all the people know, the committee of the old Council, with Dr. Dunlap of the present Council as chairman, are still acting. The wisdom of building the hospital in the present condition of the city finances has been questioned. It was a matter that originated with those who controlled the city a year or so since, and much light in regard to their actions has never struck the public eye or reached the public understanding.69 The editors of the Journal, however, were not the only ones concerned about the steep expenditures for the hospital. At the Common Council meeting of September 26, 1857, “Mssrs. Locke, Porter and Geisendorff desired some light in reference to the expenditures on the Hospital.”70 Already a low priority in the eyes of the Council, the hospital was in a vulnerable position by the late 1850s. The building was still unfinished, and construction costs had far exceeded the original estimate for the structure’s completion. Almost inevitably, the hospital fell prey to politics. Since City Hospital was the project of a Democratic city government, the Republicans took the opportunity to attack their “wasteful” spending. They claimed City Hospital had cost the city thirty thousand dollars and still two thousand dollars was needed for its completion. The editors of the Journal continued: “The building is a continual expense to the city, and is of no more use than a lighthouse on White River to protect the commerce of that stream.”71 The Democrats responded in the State Sentinel by accusing the Republicans of spending their money, not on improvements and buildings such as a hospital, but “recklessly in electioneering schemes for the purpose of perpetuating their power.”72 When the editors of the Journal learned that vagabonds and prostitutes were occupying the vacant hospital building, they again attacked the Democratic Council. They claimed that the hospital had been a drain on city funds and “the money expended on it has taken from the treasury which could but poorly afford to spare it.” The editors of the Journal went on to accuse the Democrats of creating a public nuisance:

. . . the vagabonds of the city... have taken possession of the building and appropriated it to the most vile purposes. They have made it a den of prostitution of the filthiest character, and the city authorities not only have a building on their hands which is useless, but one which is a possible nuisance.73 The expenditures for the building, as they rightfully held, could have been used “to pay every dollar of municipal indebtedness and put a handsome surplus in the treasury.” According to the Journal, the money spent on the hospital would “as well been sunk in White River for the amount of public good it has done, and considering the positive evil from its outlay in [the] hospital, it had better by far been placed where it could not be recovered.” Claiming the structure was “utterly useless for any purpose whatever,” the editors continued their diatribe against the institution by advocating the sale, rather than the rental of the building.74 In response to the Council’s decision in 1859 to put a new roof on the unopened City

R131 A1 15 V9 N02 Oil 12 INDIANA MEDICAL HISTORY QUARTERLY

Hospital, the editors of the Journal called the hospital “a monument of Democratic folly originating in the brain of Dr. Dunlap, who aside from his connection with this project has made a very fair councilman.” Furthermore, they compared the Council to a man winning an elephant in a raffle: “They have it, but don’t know what to do with it.” The editors suggested the Council dispose of the hospital immediately, even if its sale resulted in a financial loss. They suggested that it be used as a medical school or a house of refuge, but pleaded for its disposal, calling it a “continual expense” and “a piece of property entirely useless and uncalled for.”76 The question as to the hospital’s fate developed into a vituperous debate between the editors of the Journal and the Sentinel, both sides taking full advantage of the opportunity to place blame on the other for the failure of City Hospital. In reply to the Journal’s comments about the hospital, the editors of the Sentinel remarked:

Its [the Journal’s] tender heart dissolves through its eyes once a week, in barrels of salt drops, because we have no squalid disease to fill its wards. We most sincerely hope that the fountain of its tears may never be dried up, but that fevers may keep aloof so as not to disturb the lamentations of this interesting ‘Niobe.’76

The Sentinel editors said they, too, believed the Council should sell the hospital (preferably to establish a workhouse for women and children), but expressed serious reservations about the realization of this plan. The Journal editors, they asserted, would rather “leave the Hospital Building a waste, and point to its delapidating walls and cry over Democratic extravagances” believing such action would “bring votes to its party, and consequently it will oppose every move to use the building for any other purpose.” The Sentinel called the hospital issue the Journal’s “local ‘Bleeding Kansas.’”77 The editors of the Journal responded to these remarks by saying the Sentinel has made a “big fool of itself.” They continued:

It don’t [am] know what to say about the hospital, has no suggestions to make, and contents itself at its old practice of falsifying. Perhaps such a position may satisfy the indigo dyed-in-the-wool Democratic readers, but it will not satisfy the public.78

The Journal inaccurately claimed the Democrats spent forty thousand dollars on the hospital project and added that to make such a large expenditure merely “to gratify the whim of a single Democrat is not a matter to be spoken of lightly....”79 From the remarks of both the Republicans and the Democrats, it is obvious that by the late 1850s, City Hospital had become a political football. This situation undoubtedly injured the already troubled City Hospital project. There are other reasons, too, for the failure of City Hospital. Indianapolis lacked a medical school in the 1850s. In both the Midwest and the East, medical schools figured prominently in the founding of hospitals. Schools in Cincinnati, for example, used hospitals within the city to enhance their clinical instruction. Medical schools in Chicago, too, utilized hospital facilities for teaching purposes.80 From the 1830s until 1866, Indianapolis had only one medical school — the Indiana Central Medical College. This short-lived school was founded in 1848, but permanently closed its doors in 1852.81 A medical school in Indianapolis during the time of City Hospital’s construc­ tion could have provided a major incentive for its completion and opening. Nor can one ignore Livingston Dunlap and the Hospital Committee’s part in the organization’s early difficulties. First, there is no evidence to suggest that either Dunlap or the members of the Hospital committee solicited the support of their colleagues in the medical community. In other cities such as New York, the physicians were often the major proponents of hospitals.82 Secondly, Dunlap and the Committee’s

R131 A1 15 V9 N02 012 INDIANAPOLIS CITY HOSPITAL 13

persistence in asking the Council for money when the city was heavily in debt, prejudiced the public against the project. While the Council undoubtedly needed prodding to complete the hospital building, Dunlap’s aggressiveness was excessive and ill-timed. Dunlap and the committee damaged the project’s image even more when the final cost of one wing far exceeded the original estimate. The Council was willing to pay for a six thousand dollar hospital, not a twenty-seven thousand dollar one. Dunlap and the committee could not adequately explain these expenditures.

Ill: HOSPITAL

By 1861, the use of the empty hospital building as a healthcare facility seemed a dead issue. But with the outbreak of the Civil War, the City Hospital building faced a brighter future. As early as May 1 of that year, the City Hospital building as well as the hospital at Camp Morton and various boarding establishments within the city, began housing the sick and the wounded.83 At their May 18,1861, meeting, the Council approved a resolution allowing the state “free use of the hospital” for lodging sick troops within the city.84 The state in turn transferred the hospital to the federal government. The state appointed Drs. Patrick Henry Jameson and John M. Kitchen as hospital surgeons, and these two physicians continued in that capacity after the federal government took over the building. Additional paid staff included a steward and three women to do the washing, ironing, and cooking. The Sisters of Providence provided the nursing care for the hospital.86 Although the hospital at Camp Morton and other hospitals set up throughout the city during the war continued in operation, the worst cases of disease were sent to City Hospital.86 To care for those suffering from contagious diseases, the United States government erected a separate pesthouse on the east bank of White River.87 In 1861, the total operating costs for the hospital were less than fifteen dollars per day. The average number of patients in the facility was above fifty and less than two percent of the patient population died.88 But as the number of sick and wounded soldiers steadily increased, the government opened several other temporary hospitals, some of which were located in the center of the city. The citizenry expressed their opposition to the location of these hospitals.89 One angry resident wrote: “I regret to notice a disposition on your part [the editors of the Journal] to ignore the fact that the centre and main thoroughfares of the city are not exactly the proper localities for hospital purposes....”90 This criticism led to the physical expansion of City Hospital in 1862. The addition to the hospital was “a frame building, 100 feet long by 42 feet wide, 3 stories in hight [sic], with halls dividing each floor into two long wards.”91 The new wing was completed in May, 1862.92 Besides adding on to the hospital building, the federal government planned to erect “a bake house large enough to bake bread for 5,000 men, with two large ovens of the most approved kind.”93 Because City Hospital accepted only acute cases during the Civil War, the institu­ tion resembled a modern hospital, rather than an almshouse. The sick and wounded soldiers and prisoners of war were assigned to wards based upon their type of disease and condition. Each patient reportedly had a “suitable number of attendants” who “all were under the immediate supervision of skilled surgeons,” and the patients’ rooms were “clean swept” and “well ventilated.” The hospital faithfully kept detailed records of all its patients, including name, regiment, company, ward number and bed number, facts about the case, date of death or discharge, and grave number, if applicable. Strict regulations governed the conduct of patients and employees of the hospital. Only after receiving permission of the surgeon in charge, could any nurse,

R131 A1 15 V9 N02 013 14 INDIANA MEDICAL HISTORY QUARTERLY

patient, or attendant leave the hospital. Smoking, loud talking, and swearing were prohibited in the institution. Furthermore, visitors had to obtain permission to enter a ward and to give alcohol and other provisions to the patients.94 In the summer of 1864, the government made several improvements at the hospital. The bathrooms were “thoroughly renovated and supplied with apparatus for hot, cold and shower baths.” The hospital also added storerooms and baggage rooms as well as an “excellent library.” The outside of the hospital was landscaped with heart- shaped and star-shaped flower beds.95 By May, 1865, the hospital celebrated its fourth year as a successful military hospital. During this four-year period, 11,470 soldiers had been treated there. Of that number, 10,620 were Union soldiers and 850 were prisoners of war.96 Throughout the Civil War, the public and the press supported the Indianapolis City Hospital. Citizens of the community donated food for special occasions such as the Fourth of July, and periodically provided other services for the institition.97 In June, 1863, for example, the young women from Miss Merrill’s school in Indianapolis visited City Hospital to serenade the sick soldiers and present each with a bouquet of flowers.98 And in 1864, when the hospital administrators decided to plant shade trees and erect arbors on the grounds, one Indianapolis citizen, W. H. Loomis, generously donated to the cause.99 The press extolled the efficiency and economy with which City Hospital was managed. Shortly after the hospital opened in 1861, the editors of the Indianapolis Daily Journal, who previously had called the City Hospital project worthless, wrote: “We doubt there is another hospital anywhere in the country where the inmates are cared for better or at so little expense to the Government.” The editors of the Journal claimed the operating costs of the hospital were less than twenty cents per day per patient.100 On October 15, 1861, the Journal lauded the patient care at City Hospital and the overall management of the institution. The patients, the Journal editors ascertained, had “skillful physicians to prescribe for them, and careful and tireless nurses to watch over and provide for them.”101 In March, 1862, the editors of the Journal wrote:

The City Hospital was opened as a military hospital about the 1st of May, 1861. Since that time, over 1800 patients have been treated, of which number but 50 have died. This speaks well for the management of the hospital under the control of Drs. Jameson and Kitchen.102

Again in April, 1862, the Journal praised Kitchen as “an excellent physician” who “is possessed of much business tact, and that industry so essential in all hospital service.”103 During its second year of operation (May, 1862, through April, 1863), the favorable reports from the hospital continued. The editors of the Journal wrote:

... we are assured by those who have been patients, that Dr. J. M. Kitchen, the Surgeon in charge, has spared no pains to administer to the comfort of the sick and wounded soldiers who have found an asylum there in consequence of camp diseases and the accidents of war.104

The editors even endorsed Kitchen’s attempts in 1862 to get the grounds enclosed and erect a substantial fence: “This ought to be done at once. No hospital has cost the Government so little, and it can well afford to make these improvements.”105 The newspaper editors even claimed that the Indianapolis City Hospital was governed much better than the military hospitals at Louisville and Jeffersonville. Writing about the patient conditions at City Hospital, the editors stated:

R131 A1 15 V9 N02 014 INDIANAPOLIS CITY HOSPITAL 15

One of them [patients] said to us that next to home, it was the sweetest quietest spot ge [sic] had ever found. All of them with whom we conversed said there was no comparison whatever between this and the hospitals at Louisville and Jeffersonville. There they were fed on bread and coffee twice a day, and the wounded only dressed about once in three days. Here they have regular meals, of everything suited to their condition, receive a constant and tender care from their nurses, and medical attention from the physicians every day.106

The editors of the Journal also portrayed the staff of the hospital as industrious and hard-working. The Sisters of Providence, they noted, washed and ironed approxi­ mately one thousand pieces of clothing and washed five hundred sheets a week.107 Yet, not all the reports from the hospital were so positive, suggesting perhaps a one-sided view of the hospital by the press. H. W. McCune, an employee of the Indianapolis City Hospital and a member of the Veteran Reserve Corps, wrote the following to Maggie Wright, of Economy, Indiana, in 1864:

I presume you have never or seldom visited an Army hospital, and that your ideas of the manner in which they are conducted and the sick are taken care of, are very much like the ideas of people generally. If so I could tell you much about them which would not agree with your ideas.108

Although McCune noted that “with one or two exceptions,” the sick were doing well, he failed to expound upon the specific details of City Hospital’s administration.109 The press, however, continued to bombard the public with positive reports about the hospital’s management. After the Civil War,the federal government returned the hospital buildings to the city. By 1865, however, Indianapolis’ finances were so “deplorable,” the city could not afford to maintain a hospital.110 As a temporary solution to the problem, the Council on

Indianapolis City Hospital, ca. 1862. The original City Hospital Building was brick. The two-story frame additions were constructed during the Civil War. (Photograph in the collection of the Indiana Medical History Museum.)

R131 A1 15 V9 N02 015 16 INDIANA MEDICAL HISTORY QUARTERLY

July 31, 1865, allowed the Soldier’s and Seamen’s Home Association to occupy, rent- free, the hospital building until a permanent home for the organization could be found. This action by the Council represented a brief return to the almshouse idea. The Association was in the process of soliciting funds to purchase grounds and erect their own building.111 The Association hoped to build a spacious establishment to house a large number of the 828 disabled; 2,760 partially disabled; and the 9,086 orphans living in Indiana. They also hoped to include a school and workshops in this complex so the disabled veterans could become productive members of society.112 A need for such an institution rapidly was becoming evident. Although the home at City Hospital originally was to accommodate only fifty veterans, fifty-five disabled soldiers had been admitted to the home by November 17,1865. Most of these patients had lost limbs or were suffering general "debility” or old age. Two of the patients had tuberculosis (known then as consumption) and one suffered from dropsy.113 By February, 1866, the editors of the Journal reported the temporary soldier’s home at City Hospital “was so full yesterday as to necessitate the purchase of additional bedding, so as to accomodate [sic] the needy applicants.”114 In an effort to solve this problem of over-crowding, the Soldier’s and Seaman’s Home Association continued its appeal to the state legislature for additonal funds.115 The campaign for a new location proved successful. By April, 1866, the Association chose Knightstown Springs (presently Knightstown in Henry County) as the permanent site for a home for disabled veterans.116 The Association vacated the hospital by the end of April, 1866. Once again City Hospital was placed in the hands of the Committee on Public Buildings of the Common Council to “be properly taken care of.” This committee, in conjunction with the Board of Health, was to make recommendations on the future of the hospital.117 The Board of Health naturally was concerned about the reports of cholera in other cities, and as early as November 23, 1865, it had recommended various sanitary measures necessary to reduce the chances of a cholera epidemic within the city. As one of these measures, the Board strongly urged City Hospital be readied to receive patients:

Strangers, being attacked with disease of any kind popularly believed contagious or infectious, never willingly kept, and sometimes ejected from hotels and boarding houses, should have a place of refuge prepared for them, especially in times of pestilence.118

Despite all the talk about the hospital, the city showed little interest in the building when the Soldier’s and Sailor’s Home moved to Knightstown. In a letter to the editor, Dr. John M. Kitchen, chief surgeon at the City Hospital during the Civil War, criticized the city’s attitude toward the hospital:

I wish some one could be found to take immediate charge of the City Hospital and the surrounding grounds. The only tenants found there last evening were fifteen hogs and six cows.... For God’s sake and for the sake of humanity, let us take an interest in some other charity than the Marion County jail. This city needs a hospital badly, and every resident physician knows it. Seldom a day passes but what there is a demand for such accomodations [sic], and it is a shame and an outrage to kick the poor suffering creatures from our doors.119

Dr. Kitchen reported that the physicians and the Board of Health constantly faced obstacles in opening City Hospital. Thus, he asked the churches, an obviously more powerful and respected sector of the city, to “take hold of the City Hospital, furnish it, and make a comfortable place for the sick and afflicted who know not where else to go.”120 The religious groups in town took Dr. Kitchen’s plea seriously. On April 29, they

R131 A1 15 V9 N02 016 INDIANAPOLIS CITY HOSPITAL 17

posted announcements at various churches of a meeting to be held at Christ Church on the following day. The purpose of this meeting was “to canvas the propriety of the churches taking hold of City Hospital, and placing and keeping it in proper condition to answer whatever demands may be made upon it during the coming summer.” These interested church members confidently added:

Our church people are the ones who should take hold of the hospital without reference to class, and if a proper association is formed this morning, the Council will give the building and its custody over to them at once.121 At the Council meeting on April 30, 1866, a citizens group (probably the church members who met on the same day) expressed their opinions on City Hospital. Speaking for the group, a Mr. Howland stated that “the citizens were anxious, in view of the approach of an epidemic, to have such an institution ready.”122 Residents of the community assured the Council that enough money could be raised to furnish the hospital. In response to this support from the community, and the obvious need for a hospital if cholera struck Indianapolis, the Council appointed a three-member committee (with Dr. Patrick Henry Jameson as chairman) to meet with the Board of Health, develop a plan for furnishing and managing City Hospital, and report these results to the Council at their May 2, 1866, meeting.123 The special committee chaired by Dr. Jameson reported at the Council meeting on May 2 that twelve hundred dollars was necessary “for the fitting up and furnishing the Hospital.” The committee decided to send a “well-qualified person” to Jeffersonville to buy enough hospital supplies from the military hospital there to ready the City Hospital for seventy-five patients. Suggested purchases included bedsteads, blankets, beds (mattresses), bedspreads, three sheets and two pillows for each bed, bedside tables, wardrobes, chamber pots, towels, wash basins, dinnerware, feeding cups and spit boxes. If the price were low enough, then the committee recommended purchasing more chairs, a small stove and additional towels. The committee advised that the agent also procure medicines and other items necessary to outfit the hospital. The Common Council drafted and passed a special ordinance for this purpose.124 On May 31,1866, the Council passed the ordinance for establishing and governing City Hospital. This ordinance provided for a nine-member board of directors for the hospital. All members were to be chosen by the Council and were to serve without compensation. Within ten days of their appointment, the board was to organize and elect a president. They were required to meet at least once a month. It was the board’s duty to control the hospital, employ a medical staff to serve with compensation, hire an auxiliary staff and purchase necessary equipment and medicine for hospital use. The board was also responsible for keeping the patient, employee, and financial records. Additionally, the board was to make weekly, monthly, and annual reports to the Common Council of Indianapolis.126 The board also was empowered to formulate all the rules and by-laws for governance of the hospital. According to the ordinance, all patients who “have the ability to pay for medical treatment, boarding, or lodging in said Hospital” were not to be charged over five dollars per week. However, indigent patients were to be cared for at city expense.126 By June 4, 1866, the Council selected the hospital’s board. As specified in the ordinance governing the hospital, the board met within ten days of its formation to elect officers. At this meeting, the board chose John M. Kitchen as president and L.B. Wilson as secretary.127 They appointed Kitchen, Wilson, and F. B. Newcomer to an executive committee. This committee was to meet directly with the Council.128 The board hired Greenly V. Woollen as superintendent, and also employed a general laborer, a washer woman, two cooks, and a nurse.129.

R131 A1 15 V9 N02 017 18 INDIANA MEDICAL HISTORY QUARTERLY

At the July 2, 1866, Council meeting, the executive committee of the hospital board presented the municipal legislators with a list of those items and repairs still needed at the hospital. The items required by the hospital included a cookstove, pillows, bedspreads, bedclothes, flatware, basins, brooms, buckets, stands, pitchers, coffeepots, teapots, saltcellars, ice chests, laundry and ironing equipment, lamps, dining room tables, tablecloths, soap dishes, and a clock. The board also reported that a carpenter and painter would be needed to make the hospital ready for admissions. Without delay, the Council approved all the board’s requests.130 In August of the same year, the board disclosed its first patient reports. During that month, fourteen patients were in the hospital. All but one of the fourteen were male, and the female was pregnant. Most of the males suffered from fevers (congestive, bilious, remittent and intermittent). Additionally, there were two patients with fractures, one with syphilis, and one suffering from dysentery. The duration of these patients’ hospital stays ranged from four days to well over a month. Expenses for City Hospital during August, 1866, were $557.14, with total expenditures for the patients being $371.53 or an average expenditure of $1.73 per patient per day.131 During the week ending October 13,1866, nine patients were in the hospital. Their illnesses ranged from fractures to syphilis and cancer.132 By October, the average expense per capita, per diem, dropped to eighty-six cents.133 Thereafter, the board submitted weekly reports to the Council and the Council included these reports, in tabular form, in their minutes. The detailed reports of the board have not survived to the present. However, the records available for the hospital indicate that

In 1906, plans were made to raze the original portion of the City Hospital building shown above. (Taken from the Indianapolis Star, May 20, 1906).

R131 A1 15 V9 N02 018 INDIANAPOLIS CITY HOSPITAL 19

during its first year of operation, City Hospital treated seventy-four patients and registered one birth.134 After thirty years, the modern hospital idea had materialized — City Hospital was operating as a hospital for the acutely ill. Why were Indianapolis residents receptive to the establishment of a hospital after the Civil War when they had opposed the opening of one during the antebellum years? Unlike before, the Indianapolis City Hospital received the support of physicians in the city. During this period, doctors were recognizing the importance of hospitals, medical schools, and medical journals. Hospitals, in particular, were valuable for teaching and research purposes.135 Moreover, an appointment as hospital surgeon offered prestige to the physician.136 Dr. John Kitchen reminded physicians, “The city needs a hospital badly, and every resident physician knows it.” To insure his success, he enlisted the support of area churches and local physicians.137 Livingston Dunlap’s campaign, in contrast, was a one-man effort. Likewise, part of the hospital’s success can be attributed to the change in the general nature of hospitals. Hospitals were no longer synonymous with almshouses. By the 1860s, the United States could boast several municipally-supported hospitals which cared exclusively for the acutely ill.138 During the Civil War, the Indianapolis City Hospital provided residents with a model of a modern hospital rather than an almshouse. Since these modern hospitals excluded the more undesirable patients (i.e. those suffering from chronic diseases), the public and press were more than happy to support it. Indianapolis’ population, too, had grown during the Civil War. By 1870, for example, the population was 48,244.139 Thus, by 1866, Indianapolis had a sufficient population to fill the wards of a hospital with the acutely ill. Furthermore, since the hospital accepted paying patients, as well as the charity ones, it had another means of support and was not forced to rely exclusively on city funds. Thus, the conditions in the city were favorable to the establishment of a hospital. This combined with the fact that the nature of medicine and hospitals were changing facilitated the opening of a hospital. By 1866, the Indianapolis City Hospital, once a dream of Livingston Dunlap, finally had become a reality.

NOTES

'Thurman Rice, “History of the Medical Campus: The Origin and Development of the City Hospital,” Monthly Bulletin of the Indiana State Board of Health 50 (April, 1947): 92; L.G.Zerfas, “Indiana Medicine in Retrospect: Dr. Livingston Dunlap,” Journal of the Indiana State Medical Association, 20 (January, 1936), 40-41. The earliest indication of Indianapolis’ interest in a hospital came shortly after the mile-square area downtown was laid out in the 1820s. Square number 22 was designated as Hospital Square. A log structure was built there and according to local historians, it was used as a state hospital and asylum for the insane. No further information about this building exists. Thurman Rice, M.D., one of the local medical historians, claims that the first governor’s mansion (located on the Circle), was used “as sort of a pest house." (Rice, “Origins and Development of City Hospital,” 91). Unfortunately no other mention of this institution can be found. The records referring to the Board of Health’s request for a hospital in 1833 are also lost. The only surviving record of the Board of Health at this time was a circular they issued warning citizens of the advent of cholera. In this broadside, the Board of Health advocated that residents form together in associations to nurse each other. [Gayle Thornbrough, ed., The Diary of Calvin Fletcher, Vol. I: 1817-1838 (Indianapolis: Indiana Historical Society, 1972), 213]. Information about population in 1833 can be obtained from The Indiana Gazetteer, or Topographical Dictionary of the State of Indiana, 3rd ed. (Indianapolis: E. Chamberlain, 1849), 262. 2Records of Proceedings of Common Council, City of Indianapolis, Book 2 (June 12, 1947): 17. These manuscript records are located in the City-County Archives, City-County Building in Indianapolis and will hereafter be referred to as “Records of Proceedings.” 3Records of Proceedings, Book 2 (July 10, 1847), 25 'Ibid., Book 2 (July 27, 1847), 28

R131 A1 15 V9 N02 019 20 INDIANA MEDICAL HISTORY QUARTERLY

&Ibid., Book 2 (February 7, 1848), 57; The Locomotive (Indianapolis) March 11, 1848. 6Records of Proceedings, Book 2 (February 10, 1848), 58. ''Ibid., Book 2 (February 17, 1848), 60. aIbid„ Book 2 (March 6, 1848), 61 9Locomotive, March 11, 1848. ‘“Records of Proceedings, Book 2 (March 18, 1849), 149; Locomotive, May 26, 1849. 11Locomotive, March 11, 1848. “Records of Proceedings, Book 2 (May 18, 1849), 141; Locomotive, May 26, 1849 and April 27, 1850. “ Morris J. Vogel, “The Transformation of the American Hospital, 1850-1920,” in Health Care in America: Essays in Social History, edited by Susan Reverby and David Rosner (Philadelphia: Temple University Press, 1979), 105. ‘■'Harry F. Dowling, City Hospitals: The Undercare of the Underprivileged (Cambridge, Massachusetts: Harvard University Press, 1982), 9-12. "•Ibid., 8-9 16The Indiana Gazeteer 3rd ed. (1849), 262. ‘’Stuart Bruchey, The Roots of American Economic Growth, 1607-1861 (New York: Harper and Row, 1968), 20. 18In 1830, Philadelphia’s population was 80,458 and by 1840, it had reached 93,665. [Fifth Census of Enumeration of the Inhabitants of the United States, 1830 (Washington: Duff Green, 1832), 65; Sixth Census Enumeration of the Inhabitants of the United States... 181,0 (Washington: Blair & Rives, 1841), 150]. ‘“Emma Lou Thornbrough, The History of Indiana, Vol. 3: Indiana in the Civil War Era, 1850-1880 (Indianapolis: Indiana Historical Bureau & Indiana Historical Society, 1965), 540-555, 557. ““John Green, City Hospitals (Boston: Little, Brown and Company, 1861) 12-14. 21W. Gill Wylie, Hospitals: Their History, Organization, and Construction (New York: D. Appleton and Company, 1877), 64. ™Ibi(L, 65-66 ““Vogel, “The Transformation of the American Hospital,” 105. 24Locomotive, February 11, 1854; Records of Proceedings, Book 3 (February 7, 1854), 187-188. 26Locomotive, September 2,1854 and December 23,1854; Records of Proceedings, Book 3 (August 25, 1854), 343,345; Ibid., Book 3 (September 4,1854), 355; The Indiana Daily State Sentinel, December 20,1854. Despite local historians’ assertions that City Hospital was located in the unhealthiest and swampiest regions of the city, contemporaries failed to comment on the hospital’s location. Instead, the project initially received public praise [Rice, “History of the Medical Campus: The Origin and Development of City Hospital,” 92; “The Indianapolis City Hospital: History and Present Condition,” Indiana Medical Journal, 17 (October, 1898), 123; Sentinel, December 21,1854], Next to the hospital building was a drainage area for the facility, and this might have been the “swamp” to which local historians referred (Locomotive, October 15, 1859). When the building was used temporarily as a Soldier’s and Seaman’s Home after the Civil War, the press criticized the institution for not cleaning up the “nasty pool of water standing immediately opposite the Home, over which the green scum thickens, and from which malaria arises so heavy as to be almost a fog in the morning.” (The Indianapolis Daily Journal, September 9,1865). This also could be the swamp which local historians mention in their accounts of the hospital. 26Locomotive, March 17, 1855. 27Ibid., April 28, 1855. ““Records of Proceedings, Book 4 (July 21,1856), 170; Locomotive, June 30,1855; Journal, September 22, 1857. ““Records of Proceedings, Book 4 (June 27, 1855), 548; Sentinel, June 27, 1855. ““Records of Proceedings, Book 4 (September 12,1857), 503-504; Ibid, Book 4 (September 29,1857), 524. The actual amount expended on City Hospital up to this time is questionable. According to a report submitted by the Hospital committee to the Council on August 14,1858, $17,995 had been appropriated for the hospital project from its beginnings inl854 to September, 1857. In the same report, however, the balance sheets showed $3,000 as the amount “of appropriation reconsidered subject to the order of the committee.” On August 16,1858, the editor of the Journal indicated that $17,361 has been appropriated for the hospital project, and of this amount, $15,604.51 had been expended [Records of Proceedings, Book 5 (August 14, 1858), 206-207; Journal, August 16, 1858]. “‘Records of Proceedings, Book 5 (September 1, 1858), 242; Locomotive, March 19. 1859; Records of Proceedings, Book 5 (April 9, 1859), 552; Locomotive, May 21, 1859. ““Records of Proceedings, Book 5 (March 26,1859), 521-522; Journal, March 28,1859; Ibid, March 29, 1859. ““Thurman Rice, One Hundred Years of Medicine: Indianapolis, 1820-1920 (Reprints from the Monthly Bulletin of the State Board of Health), 52 (September, 1949), 203. On May 14,1859, the mayor announced the

R131 A1 15 V9 N02 020 INDIANAPOLIS CITY HOSPITAL 21

members of the Hospital Committee. The Committee consisted of H. Tilly, J. S. Pratt, and E. Kuhlman. Livingston Dunlap was no longer a member of the committee. (Records of Proceedings, Book 5 (May 14, 1859), 620). 34Locomotive, April 23, 1859. 35Records of Proceedings, Book 5 (May 14, 1859), 627. 36Locomotive, June 4, 1859. 37Journal, August 16, 1859. “ Records of Proceedings, Book 6 (June 25, 1859), 80-81. 33Ibid., Book 6 (October 8, 1859), 211. '"Locomotive, October 15, 1859. ‘‘Records of Proceedings, Book 6 (March 10, 1860), 398-399. “ Records of Proceedings, Book 6 (May 26, 1860), 529; Journal, May 30, 1860. i3Locomotive, June 23,1860 and July 21, 1860; Records of Proceedings, Book 6 (June 20,1860; July 16, 1860; and July 21, 1860), 572, 591, 614. ‘‘Records of Proceedings, Book 6 (December 27, 1860), 730; Locomotive, November 3, 1860. '"Journal, October 30, 1860. '"Locomotive, October 27, 1860. ‘’Records of Proceedings, Book 7, (November 10, 1860), 9-10. ‘"Ibid., Book 7 (March 9, 1861), 87-88. 49Journal, March 28, 1861. “ Dowling, City Hospitals, 10-14, 28-29, 30-31. 51 Locomotive, February 11, 1854; Records of Proceedings, Book 3 (February 7, 1854), 187-188. 62Locomotive, February 11, 1854; Records of Proceedings, Book 3 (February 7, 1854), 187-188. The prejudice toward chronic patients was not unusual. As Charles E. Rosenberg points out, the almshouse- hospital “never occupied a morally neutral niche in the public mind." Because almshouses admitted the chronic patients, they were stigmatized as places of “last resort” and often were viewed as institutions promoting poverty and idleness. The doctors at these almshouses often disliked the policy of admitting chronic patients. Caring for such individuals offered little prestige for the hospital physician (Charles E. Rosenberg, “From Almshouse to Hospital: The Shaping of the Philadelphia General Hospital,” Milbank Memorial Fund Quarterly///ea/

R131 A1 15 V9 N02 021 22 INDIANA MEDICAL HISTORY QUARTERLY

"Journal, December 20, 1859 "Ibid. “ Madge E. Pickard and R. Caryle Buley, The Midwest Pioneer: His Ills, Cures and Doctors (New York: Henry Schuman, 1946), 144-148. “ George B. Manhart, “The Indiana Central Medical College,” Indiana Magazine of History, 56 (June, 1960), 105-122. 82The medical community in New York, for example, strongly supported the establishment of a hospital there. Drs. Samuel and John Bard were instrumental in convincing local physicians of the value of a hospital [Eric Larrabee, The Benevolent and Necessary Institution: The New York Hospital, 1771-1971 (New York, Doubleday and Company, 1971), 6, 39], "Ibid., May 1, 1861. “ Records of Proceedings, Book 7 (May 18, 1861), 157. 86Journal, October 15, 1861. "Ibid., February 28, 1862 and May 2, 1863. 87Journal, June 13, 1864; Records of Proceedings, Book 9 (July 31, 1865), 209. 88Journal, October 15,1861. The Journal editors claimed the hospital had from thirty to forty patients and operating costs totaled fifty-five dollars per day. Drs. Jameson and Kitchen were quick to correct the Journal’s inaccuracies. The figures provided in the text are those of Jameson and Kitchen. 89Journal, March 6, 1862, March 13, 1862, and March 14, 1862. "Ibid., March 15, 1862. "'Ibid., March 22, 1862 and March 25, 1862. "Ibid., April 29, 1862 and May 9, 1862. ""Ibid., March 22, 1862. 94I b i d March 8, 1864. ""Ibid., June 11, 1864. "Ibid., May 2, 1865. "Ibid., July 9, 1861, October 15, 1861 and July 7, 1863. "Ibid., June 2, 1863. "Ibid., March 8, 1864 and April 21, 1864. 100Ibid., July 1,1861. By October 15,1861, operating expenses of the hospital were less than eleven cents per day per patient (Ibid., October 15, 1861). ""Ibid., October 15, 1861. '"Ibid., March 5, 1862. '"Ibid., April 29, 1862. '"Ibid., May 2, 1863. '"Ibid. '"Ibid., June 11, 1864. '"Ibid. l08H. W. McCune, Indianapolis, to Maggie Wright, Economy, Indiana, November 22, 1864, Thomas Marshall Collection (Group II), Indiana Historical Society, Indianapolis. '"Ibid. 110Journal, June 6, 1865. “ ‘Records of Proceedings, Book 9 (July 31, 1865), 226; Journal, August 1, 1865. 112Memorial of Officers and Directors of Indiana Soldier’s Home Association (Indianapolis, 1865), 3-6. Booklet in the Governor Oliver P. Morton papers, Indiana State Archives, Indianapolis. 113Journal, September 20, 1865; Memorial of Officers and Directors of Indiana Soldier’s Home Association, 6 114Journal, February 17, 1866. “6M. M. Wishard to Oliver P. Morton, October 31, 1865, Governor Oliver P. Morton papers, Indiana State Archives, Indianapolis. 116Journal, April 17, 1866 and April 25, 1866. "’’Ibid., April 24, 1866. ""Ibid., November 16, 1865. ""Ibid., April 27, 1866. '"Ibid. '"'Ibid., April 30, 1866. '"Ibid. '"Ibid. ‘“ Records of Proceedings, Book 10 (May 2, 1866); 156-158. ‘"For two months, the detailed records of the Indianapolis City Hospital were included in the Common Council’s minutes. These records listed the patient’s name, age, sex, nativity, disease, date of admission, and date of dismissal. After October 17,1866, however, only the statistical summaries of the hospital’s records

R131 A1 15 V9 N02 022 NEWS AND NOTES 23

were included in the Council’s minutes. Unfortunately, the hospital’s own records during this period have not survived to the present. mIbid„ Book 10 (May 31, 1866), 233-235. '^Journal, June 5, 1866; Records of Proceedings, Book 10 (June 4, 1866), 256-257. mJoumal, June 13, 1866. ‘“ Records of Proceedings, Book 10 (September 10, 1866), 533. l30Ibid„ Book 10 (July 2, 1866), 345. mIbid„ Book 10 (September 17, 1866), 533. mbid.. Book 10 (October 15, 1866), 579-581. mIbid„ Book 10 (November 12, 1866), 653-654. ‘“Index to Patient Records at City Hospital, 1866, Indiana Medical History Museum, Indianapolis; Riee, “History of the Medical Campus; The Origin and Development of the City Hospital,” 93. ‘“ Richard Harrison Shryock, Medicine and Society in America: 1660-1860 (New York, 1960; reprint ed., Ithaca, New York: Cornell University Press, 1975), 153-160; Larrabee, The Benevolent and Necessary Institution, 6, 109-110. ‘“ Shryock, Medicine and Society, 42; Rosenberg, “From Almshouse to Hospital,” 117. Serving in a modern hospital was more prestigious than being on the staff of an almshouse. 137Journal, April 27. 1866. ‘“ Both Chicago and Boston opened hospitals for the acutely ill after the Civil War. Chicago erected its city hospital in 1854, but the building remained idle until 1859 because of a dispute over staffing. It was finally leased to doctors from Rush Medical College and opened as a city hospital after the Civil War. In 1858, Boston decided to build a city hospital for the acutely ill, but the structure was not completed until 1864 (Dowling, City Hospitals, 28-29, 30-31). By this time, many of the major city hospitals no longer provided almshouse services (Ibid., 10-14). ‘“ Francis A. Walker, The Statistics of the Population of the United States... From the Original Returns of the Ninth Census (Washington: Government Printing Office, 1872), 127.

NEWS AND NOTES

The Medical History Committee of the Indiana Historical Society will sponsor a session on Saturday morning at the Fall History Conference in Evansville, September 9-11. Wayne Sanford of Indianapolis will talk about the effects of the influenza epidemic of 1918 on the military, and Philip C. Ensley, Professor of History at the University of Evansville, will lecture on the effects of this same epidemic on the citizens of Indiana. Details of the conference will appear in the July issue of the Indiana Historical Society’s Newsletter.

On May 18,1983, the Indiana University School of Medicine class of 1933 held its fiftieth reunion in the amphitheater of the Old Pathology Building (which currently houses the Indiana Medical History Museum). Of the forty-two surviving class members, twenty-eight attended the reunion. Myron Maxwell Hipskind, M.D., F.A.C.S., former clinical professor and chairman of the Department of Ear, Nose and Throat at the Stritch School of Medicine, Loyola Medical Center, Chicago, addressed the class with his reminiscenses about his early days as a student and practitioner. As a result of the class reunion held in the Old Pathology Building, Drs. Hispkind, Dennis Megenhardt, and Edmund L. Van Buskirk have organized a committee to investigate various sources of funding for the Indiana Medical History Museum.

The Indiana Historical Society Library recently received several donations to enhance its medical history collection. William M. Sholty, M.D. of Lafayette, Indiana

R131 A1 15 V9 N02 023 24 INDIANA MEDICAL HISTORY QUARTERLY

donated the casebook of Dr. W. R. McMahan of Huntingburg, Indiana, to the library. Dr. McMahan’s records contain detailed accounts of various cases he treated from 1868 to 1905. George S. Porter, M.D. of Richmond, Indiana, gave the library a collection of nineteenth century medical works. Included in this donation were such classics of American medical literature as an obstetrical text by the famous Philadelphia physician, Charles D. Meigs; the first surgical work by an American author, Caspar Wistar’s Systems of Anatomy (1830); and one of the most popular medical texts during the 1830s, John Eberle’s Notes on the Theory and Practice of Medicine (1834). Paul D. Williams, M.D. of Indianapolis, donated a collection of over forty-five medical books to both the Indiana Historical Society Library and the Indiana Medical History Museum. Most of these works belonged to Dr. Salem A. Tilford (1827-1893) of Martinsville, Indiana. Dr. Tilford was the father of Dr. Williams’ great uncle, Dr. Benjamin W. Tilford. Dr. Salem Tilford attended the University of Kentucky from 1847-1848, and in 1849, began his practice of medicine in Martinsville. In 1879, he received his medical degree from the Medical College of Indiana in Indianapolis. He also served two terms as president of the Morgan County Medical Society. Tilford’s library included such classics as William Gibson’s The Institutes and Practice of Surgery (1835); Samuel D. Gross’s A System of Surgery: Pathological, Diagnostic, Therapeutic and Operative (1864); and Robert Druitt’s The Principles and Practice of Modem Surgery (1851). Rachel Lehman of Indianapolis, also donated medical books to the Society. Included in her gift were two domestic medical books, Dr. Chases’ Recipes: or Information for Everybody... (1880) and R. V. Pierce’s The People’s Common Sense Medical Adviser In Plain English; or Medicine Simplified (77th edition, 1909). nin Hitrcl ociety S istorical H Indiana ninpls I 46202 0 2 6 4 IN Street Indianapolis, hio O Quarterly est W 315 istory H edical M Indiana

emi No 3864 o. N it Perm ninpls IN Indianapolis, nprft Org. rofit p on N . . Postage S. U. PAID

R131 A1 15 V9 N02 024 INDIANA MEDICAL HISTORY QUARTERLY

INDIANA HISTORICAL SOCIETY Volume IX, Number 3 September, 1983

R131 A1 15 V9 N 0 3 001 The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. EDITORIAL STAFF CHARLES A. BONSETT, M.D., Editor 6133 East 54th Place Indianapolis, Indiana 46226

ANN G. CARMICHAEL, M.D., Ph.D., Asst. Editor 130 Goodbody Hall Indiana University Bloomington, Indiana 47401

KATHERINE MANDUSIC MCDONELL, M.A., Managing Editor Indiana Historical Society 315 West Ohio Street Indianapolis, Indiana 46202

MEDICAL HISTORY SECTION COMMITTEE

CHARLES A. BONSETT, M.D., Chairman

JOHN U. KEATING, M.D. KENNETH G. KOHLSTAEDT, M.D.

BERNARD ROSENAK, M.D. DWIGHT SCHUSTER, M.D.

WILLIAM M. SHOLTY, M.D. W. D. SNIVELY, JR., M.D.

MRS. DONALD J. WHITE

Manuscripts for publication in the Quarterly should be submitted to Katherine McDonell, Indiana Medical History Section, Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. All manuscripts (including footnotes) should be typewritten, double-spaced, with wide margins and footnotes at the end. Physicians’ diaries, casebooks and letters, along with nineteenth century medical books and photographs relating to the practice of medicine in Indiana, are sought for the Indiana Historical Society Library. Please contact Robert K. O'Neill, Director, In­ diana Historical Society Library, 315 West Ohio Street, Indianapolis, Indiana 46202. The Indiana Medical History Museum is interested in nineteenth century medical ar­ tifacts for its collection. If you would like to donate any of these objects to the Museum, please write to Dr. Charles A. Bonsett, Indiana Medical History Museum, Old Pathology Building, 3000 West Washington Street, Indianapolis, Indiana 46222.

Copyright 1983 by the Indiana Historical Society

Cover: The members of the 1933 class of Indiana University School of Medicine pose for a photograph at their fiftieth class reunion. Dr. Hipskind, the author of the article in this issue of the Quarterly, is shown in the front row (the third from the left, holdingthe left side of the sign). ROW 1: Edmund L. Van Buskirk, M.D., Charles L. Wise, M.D. (now deceased), Myron Maxwell Hipskind, M.D., Herbert F. Sudranski, M.D., Wellington W. Reynolds, M.D., Milton John Miller, M.D. ROW 2: Guy E. Ross, M.D., DennisS. Megenhardt, M.D.. Bernard D. Rosenak, M.D., Robert R. Blondis, M.D., Everett Winton Thomas, M.D. ROW 3: J. H. Oyer, M.D., William H. Norman, M.D., Paul L. Stier, M.D., Harold F. Bonifield, M.D. ROW 4: Jonathan G. Yoder, M.D., C. L. Herrick, M.D., Bryce P. Weldy, M.D., Wallace David Buchanan, M.D., John L. Hillery, M.D. ROW 5: Hugh Ramsey, M.D. (class of 1934), J. R. Mathew, M.D.

R131 A1 15 V9 N03 002 IN THIS ISSUE

This issue of the Quarterly presents “A Doctor’s Fifty Year Perspective” by Myron Maxwell Hipskind, M.D., F.A.C.S., former clinical professor and chairman of the Department of Otorhinolaryngology at Loyola University School of Medicine in Chicago. Dr. Hipskind, a 1933 graduate of Indiana University School of Medicine, completed his internship and residency in otorhinolaryngology at the University of Chicago Clinic at Billings Hospital. In 1938, he was appointed Clinical Instructor at Loyola University School of Medicine and in 1962, became head of the Department of Otorhinolaryngology. During this time, he has published more than thirty scientific papers. He is a member and has held office in a number of organizations. Among others, he is a Fellow in the American College of Surgery and a Fellow of the American Academy of Otolaryngology. He is certified by the American Board of Otolaryngology. He was a Lieutenant Colonel during World War II with the 108th General Hospital, serving as Chief of the Eye-Ear-Nose-and-Throat Department. For his work during the war, he was awarded the Bronze Star. Dr. Hipskind began his premedical studies in the year that Charles Lindberg flew the Atlantic Ocean (1927). He graduated from Indiana University School of Medicine just a few months after Franklin D. Roosevelt was sworn into his first term as President. The country was in the midst of the Great Depression, Congress had passed the National Recovery Act, and the National Recovery Administration was established to affect its policies. The year 1933 saw the Blue Eagle and the slogan “We do our part” emblazened on the letterheads, envelopes, and windows of businesses all over the country. It was into this scene that Dr. Hipskind and his fellow 1933 University School of Medicine graduates emerged and commenced their professional careers. The year 1983 marks the fiftieth anniversary of Dr. Hipskind’s graduating class. For the occasion, Dr. Hipskind presented aversion of the following paper to his fellow graduates at their reunion held on May 18, 1983, in the Old Pathology Building (presently housing the Indiana Medical History Museum). Dr. Hipskind’s reminiscences provide not only a personal glimpse of the years since his graduation, but demonstrate the vast number of changes which have occurred in medicine during this period.

Charles A. Bonsett, M.D. Editor

3

R131 A1 15 V9 N03 003 A DOCTOR’S FIFTY YEAR PERSPECTIVE

Myron Maxwell Hipskind, M.D., F.A.C.S.

Today we celebrate the golden anniversary of our graduation from the Indiana University School of Medicine. Certainly it may be said that a review of the past fifty years confirms the adage that “the old order changeth, giving rise to the new.”

I

In 1927, we began our premedical studies. As a freshman in college, the first few days seemed like buzzing confusion. We were herded into the huge gymnasium for our “physical examination,” a procedure which amounted to no more than a parade of undressed males past a table of seated examiners. A few questions were asked, but no medical instrument was used or even in evidence. Next, we were ushered into multiple classrooms for “I.Q.” tests. Scholastic tests always terrified me and luckily, I was never told how well or how poorly I did on them. I recall with profound anxiety our first meeting with the chemistry professor. We were seated in an amphitheatre. The professor’s thick and abundant eyebrows in no way masked the threatening look from his eyes as he said:

This is the toughest course in premedicine. More students will fail this course than any other. I see by the roll call sheet there are one hundred eighty of you in this room. Only eighty of you will enter medical school and that means one hundred of you will flunk out.’

I could swear he was looking right at me, and I did not sleep that night. Looking back on that fearsome experience, I realize now that he captivated us by his dedication to providing a solid basis in chemistry.

There was fierce competition for good grades. We frequently heard how “an anxious student would cut his mother’s throat for a high grade.” The pressure of studies, however, did not preempt all our effort and time. Indeed, the premedical era has many happy memories. One of the fondest was our association with Dean Burton Dorr Meyers. A graduate of the University of Leipzig, he possessed the charm of the old world. A handsome man with wavy white hair who elicited the envy of any grande dame, he had a warm and engaging personality and was always a gentleman. I recall the gentle encouraging pat on the shoulder by Professor “Jakie” Baderscher, as he leaned over my microscope. Dr. Baderscher taught histology. I liked the “hospital smell” of the anatomy dissecting laboratory. To this day, I brag that Branch McCraken, a physical education major, dissected on the same cadaver assigned to me. Branch was an achiever. At a height of six feet, three inches, he was considered a tall man for those times. He played center on the basketball team. I remember that when we played Purdue, he was jumping against a six feet, eleven inch center called “Stretch” Murphy. Every time the ball was “centered,” Branch crouched to the floor to get a greater spring, although he never once mastered the taller Murphy. Later, McCraken affectionately was referred to as “The Sheriff” because of his premature graying hair. He became one of the most winning basketball coaches in the country before his untimely death. The dissection of the dogfish in zoology led me to Darwin’s “theory of evolution” and a reexamination of my teachings of childhood. Science gave me a newly-found freedom. I no longer felt like getting up on Sunday to attend Mass. I quit “wasting

4

R131 A1 15 V9 N03 004 FIFTY YEAR PERSPECTIVE 5

time” in prayers, and I saved the dime I formerly dropped into the collection box. This heady strength in science sustained me through a period of six weeks until we had our first final examinations. Without thinking, I found myself on my knees asking for God’s assistance. I returned to Sunday Mass and raised my offering to twenty cents. As a bewildered student, I continued to pray and study and passed my final examinations! From that time to this, I have kept a safe distance between religion and science.

II

At the time we began our medical studies, the country was enjoying uninhibited prosperity. It was the era of the “talking pictures” featuring A1 Jolson in the “Jazz Singer;” it was the decade of Hoagy Carmichael’s “Georgia on My Mind,” “Rocking Chair” and the immortal “Stardust;” it was the time of the Stutz Bearcat and the raccoon coat, the “cord” trousers, the baggy pants and the garterless socks. Lavish fraternity and sorority parties were in vogue and bathtub gin in the “flask” on the hip was an integral part of the well-dressed “collegian.” On October 29, 1929, one month after our admission to medical school, the Stock Market crashed and ushered in the worst depression in American history. The cars and the raccoon coats were sold to pay for tuition. The fraternity and sorority houses were half-empty. The parties were nonexistent, and the predominant extracurricular activity was the search for jobs. We paid for our room and board by firing coal furnaces, waiting on tables, peeling potatoes for restaurants and hotels at four o’clock in the morning, covering the funeral telephone at night, and chauffeuring wealthy women to Brown County in the fall and to the grocery store on the weekends. The latter activity was particularly rewarding since these women were compassionate and understanding. Many of them loaned us money to pay our tuition. If I were asked to give a single indication or mark of a college student in our time, I would suggest “the laundry box.” Rich or poor, freshman or senior, all used the weekly “laundry box.” This was a sturdy container made of heavy, reinforced paper and fabric. It was secured by straps and contained an area for an address. In the period of the late 1920s, there were no laundromats. Indeed, no facilities existed for washing clothes in the fraternity or sorority house, and there were no cars to drive home on weekends. Thus, the laundry was mailed home. As important as clean clothes may have been, the laundry box had an even greater function—our families sent back food carefully packed between the layers of the fresh laundry. My roommate, whose family lived on a farm, always received vegetables, bread, cookies, and jars filled with meat in his “laundry box.” Although only a nickel, a White Castle hamburger was no substitute for the canned pork and beef we received from home. We could not have survived had it not been for the “laundry box.” During our senior year in medical school, President Franklin D. Roosevelt ordered the banks closed on March 6,1933. A month later, the gold standard dropped and in the same year, prohibition ended. The Depression had a profound effect on our medical education. Although it was a hard struggle, the price for survival in those premedical years was a bargain. I expressed exhilaration only on my arrival at the medical school campus in Indianapolis. It is refreshing to look back and gratefully recall the individuals whose labors made the present possible. It was our inestimable good fortune to fall under the influence of Charles P. Emerson, M.D., Dean of the Indiana University Medical School. He possessed all the characteristics of a teacher, author, doctor, and friend. He was one of the last Americans to study with “the beloved physician,” Sir William Osier. His eastern education was reflected by his “British accent.” I recall when Dr. Emerson would get angry at us for our shortcomings. He calmly

R131 A1 15 V9 N03 005 6 INDIANA MEDICAL HISTORY QUARTERLY

detailed the infraction and concluded with a quiet “clahs:” “You ‘cawn t do this. Then in almost a shout, he repeated in a Hoosier twang: “Class, I tell you, you simply CAN T do this.” Dr. Emerson served as dean for twenty-one years. Under his guidance, Indiana University Medical School became one of the leading institutions in the country. He was a man of great dignity and poise. His lectures in internal medicine were articulate and impeccable. He had an influence on my life for which I will ever be grateful. He remained on the faculty of the medical school as Research Professor of Medicine, a position he held until his death from bronchial pneumonia at the age of sixty-six. Had we known then what we know now and had we the technical tools and the medicines then that we have now, Dr. Emerson could have been saved. Willis D. Gatch, M.D. succeeded Dr. Emerson. He served as Dean of Indiana University Medical School from 1931 to 1946, the difficult years which encompassed both the Depression and the Second World War. Dr. Gatch was born and educated in Indiana. He graduated from Indiana University in 1901 and from Johns Hopkins Medical School in 1907. A modest human being, he was a prolific writer. He refused to compile a complete text on surgery, averring that no one person could be fully qualified to cover all the phases of such a vast and complex science. He was also a compassionate human being. It is known that he spent his own funds to help deserving students remain in school. I can recall another faculty member, William N. Wishard, M.D. who was held in esteem and affection. He stood tall and straight-backed. A nationally recognized urologist, his textbook on the subject was used in every medical school. I recall several stories he told. In one of his accounts, he reported his dilemma with an aged farmer. It seems Dr. Wishard was having difficulty passing a catheter. As the perspiration broke out on Dr. Wishard’s forehead, the farmer asked, “Doc—you trying to draw my water?” When Dr. Wishard nodded assent, the farmer replied: “Why didn’t you tell me!” The patient got up from the table, picked his old, weather-beaten hat from the

Indiana University Medical School classes (including the class of 1933) attended courses in Emerson Hall. The south wing of the building (pictured above) was completed in 1928. The original building was constructed in 1918.

R131 A1 15 V9 N03 006 FIFTY YEAR PERSPECTIVE 7

nearby halltree, lifted the stained sweatband from the inner part of the hat, and withdrew an old and worse-for-wear catheter. He spat upon it and with a deft and sure touch, introduced the catheter into his bladder without difficulty. I also like another story Dr. Wishard told us. He described his anxiety when a rectal examination of a patient revealed a nodular hard prostate. He sent the patient to a Chicago colleague for consultation. The physician called and asked: “Dr. Wishard, why did you send this patient to me? You know as well as I do that he has cancer of the prostate!” Unlike now, cancer of the prostate was a rare illness at that time. It was the custom of the senior class to invite the teacher held in greatest esteem and respect to address the class. Our class voted for Dr. Wishard. In his speech he urged us not to publish before the age of forty. On the business side of medical practice, he warned us against the purchase of farmlands. He noted that many of his colleagues who did so “went broke.” Now, as I look back over the past fifty years, the doctors who are financially secure are those who purchased land. He told us to avoid business endeavors outside the field of medicine. This is not in keeping with the present-day activity. Many of our colleagues successfully engage in the new technologies in industry and business. For example, consider Ted Dietrich, M.D. who at the age of forty-seven, is engaged in a successful pursuit of two careers. This internationally renowned cardiovascular surgeon recently became the majority owner of the Chicago Blitz professional football team, a multimillion dollar enterprise. Time does not permit recognition of all the individuals who influenced our lives. However, it is necessary to include Karl Ruddell, M.D. Probably no physician held more student promissory notes than this highly skilled surgeon. It is said he never turned away a deserving student. His eye was as keen in appraising a student’s intention as it was in suggesting a surgical diagnosis. During my junior and senior years, I had the good fortune to be an extern at St. Vincent’s Hospital and work with Dr. Ruddell. One of my duties was giving nighttime anesthesia and doing laboratory work. I received room, board, and uniforms for these efforts. In those days the acute condition of the abdomen was the most common emergency. Appendicitis led the list, followed closely by acute suppurative abdominal disease caused by gonoccal salpingitis [inflammation of the fallopian tubes]. To allay this condition, Dr. Ruddell used a small McBurney incision [an incision over the surface area of the appendix]. Many times, upon opening the peritoneal cavity, the pus would be exuded forcibly. Indeed, a skilled Chicago surgeon, in such an incident, lost the sight of one eye from a patient’s gonoccal infection of the abdomen. Rarely did women venture into the practice of medicine during the time of my education. They were affectionately called, “Hen-Medics.” One such faculty member was Jane Ketcham, M.D. She was a learned and accomplished clinician. I remember an experience as a student in her medical clinic. It was the custom for the student to independently meet the patient, take the history, and execute the examination leading to diagnosis. These procedures were then taken to the physician in charge for verification and/or correction. During one such encounter, I learned a lesson from Dr. Ketcham that has remained with me all my professional life. My patient complained of recurrent headaches, fatigability, insomnia, and nervousness. At that time, psychosomatic medicine was coming into vogue. On completion of my examination, I reported to Dr. Ketcham that the patient “had nothing wrong,” and was “probably neurotic,” with a functional illness. Dr. Ketcham was so upset with my errors and omissions that she forgot Osier’s dictum of “imperturbability” and “equanimity.” Her usual expressionless face became livid and furrowed with anger. In an uncontrollably loud voice (so that all my fellow students would hear) she asked me: “Did you do a blood count?” “No, ma’am.” “Did you get sinus x-rays?” “No, ma’am.” “What was her metabolic rate?”

R131 A1 15 V9 N03 007 8 INDIANA MEDICAL HISTORY QUARTERLY

Pictured above is the 1933 class of the I

R131 A1 15 V9 N03 008 FIFTY YEAR PERSPECTIVE 9

ndiana University School of Medicine.

R131 A1 15 V9 N03 009 10 INDIANA MEDICAL HISTORY QUARTERLY

“I don’t know, ma’am.” “Are the headaches related to her period?” “I don’t know, ma’am.” “Well, you go back and find out! And don’t you ever make a diagnosis of neurosis until you have ruled out all evidence of organic disease.” I never have. On June 12, 1933, a childhood ambition was fulfilled. I had become a doctor. Elmer Burritt Bryan, M.D. brother of the president of Indiana University gave our commencement address. The theme of his presentation was an appeal to trust our fellow man, a lesson we could use today.

Ill

After graduation in June, 1933, hard-earned diploma in hand, I headed for Billings Hospital at the University of Chicago. The streetcar from the train station to the University of Chicago cost five cents. In those days the fee for a clinic visit averaged one dollar. As an intern, I did not receive a salary. My income at the assistant level was twenty-five dollars and I thought I had attained financial security when I received one hundred dollars a month during my first year as Chief Resident! For entertainment, my wife and I had the choice of either going out to dinner or eating a twenty-cent hamburger at White Castle and going to the “movies” before six o’clock for the price of fifteen cents. After six o’clock the price of the movies went up to a quarter. When I started practice, I paid six hundred thirty dollars for a new 1937 Oldsmobile business coupe. Those were the days when one could drive into a gasoline station and order “fill-er-up.” Gasoline was ten cents a gallon. We had special pride in our first apartment—the rent was thirty-five dollars a month. We outfitted our home with items from a used furniture store. In fact, some of the pieces we acquired in 1933 are still visible in our home. Now we call them “antiques.” The University of Chicago School of Medicine was the first in the United States with a full-time teaching and clinical staff. It was at Billings Hospital that I came under the influence of Dallas B. Phemister, M.D., Chief of the Department of Surgery. He had a special talent for showing personal interest in the interns, residents, and surgical staff. It is ironic that, at the prime of his life, this great surgeon died of complications following an appendectomy. George F. Dick, M.D. was Chief of the Department of Medicine. His interest in scarlet fever led to the development of the “Dick test”, a test for determining one’s susceptibility to scarlet fever. Walter L. Palmer, M.D. headed the Section of Gastroenterology. Under his leadership, Billings Hospital was the first hospital in the country to use the gastroscope. The Chairman of the Department of Obstetrics and Gynecology was Joseph B. DeLee, M.D. He had a passion for saving the lives of the unborn. His technique of natural childbirth is underscored by the statement: “The woman is lucky who delivers her baby before the doctor arrives.” As ear-nose-and-throat consultant to the Mother’s Aid Pavillion, in my second year of residency, I came in close contact with the discipline of the Chicago Lying-In Hospital. It was my good fortune to work with Percival Bailey, M.D., Professor and Chief of the Section of Neurosurgery. He had studied under Harvey Cushing, M.D. Dr. Bailey believed in teaching by example rather than by the didactic method. The pathologist, Paul R. Cannon, M.D. had an orderly mind that proceeded in a logical fashion to illicit the cause of death. No minor detail skipped his attention. I remember the day the hospital communication system carried the message: “All medical students, house staff, and faculty members are to assemble in P-115 at 1:00 p.m.” When I arrived, the huge amphitheatre was filled to capacity. Center stage was

R131 A1 15 V9 N03 010 FIFTY YEAR PERSPECTIVE 11

occupied by Dr. Cannon and his assistant engaged in an autopsy. The importance of the autopsy was underscored by the presence of carcinoma of the lung. The disease was so uncommon at that time that Dr. Phemister wanted all medical personnel to witness the autopsy findings. I had the good fortune to be the first resident graduated from the Otolaryngology Residency Program at the University of Chicago Clinics. John Ralston Lindsay, M.D. was Chief of the Section. A young man at the time, he was to become one of the world’s foremost otolaryngologists. His father died in 1939, of meningitis following acute suppurative otitis media [acute middle ear infection], I suspect this inspired Dr. Lindsay to devote his life to a better understanding of diseases associated with the human ear. He was a leading force in breaking down the barrier to silence of the deaf, whom he described as living in “an awful world of separateness where life chaotically moves before them.” I had a profound respect for this unusual man. I followed his every word and move. I emulated his patient-doctor relationship. I know in my heart that whatever success I have had in my professional life could be credited to his teachings and example. IV

Seven years after graduating from medical school, I was out of debt. In fact for the first time in my life, I had some money in a savings account. I was blessed with a loving wife and two wonderful children. But about the time I could look back upon my years since graduation with satisfaction, the terrifying clouds of war became evident. On December 7, 1941, Japan attacked Pearl Harbor. The United States declared war on Japan on December 8, 1941, and on Germany and Italy on December 11, 1941. It was my moral judgement that I could contribute to my country best by offering my medical and surgical abilities to save the lives of the wounded and offer encouragement and understanding to the dying. Thus, I signed up for the Army Medical Corps. I closed my office and transferred my patients and related medical duties to other physicians. Loyola University granted me a “leave” of teaching assignments. After four months of basic training, I was chosen to be Chief of the Eye, Ear, Nose and Throat Department of the 108th General Hospital, an affiliate of the Loyola University School of Medicine. We were sent to the Midlands of England. I had no idea how “black” a “blackout” could be. The slightest beam of light could direct a bombing of that area from the constantly present Nazi Luftwaffe. The British knew how to affect a blackout. Convoys were driven through the night without lights and without trouble. Smoking outside was forbidden. The first night at our new clinic I worked late to be ready for the next day’s patients. Finally, I turned out the lights of the clinic and stepped outside. There was no moon and no stars. After the first few steps I was lost! It was as though I had fallen into one of my mother’s blackberry jelly jars. Dropping to my knees, I felt the edge of the sidewalk. Crawling slowly with my hand on the edge of the sidewalk, I found my way to the clinic door. The distance could not have been more than ten feet. After entering the clinic I stayed the night. Six weeks after D-Day, we were ordered to France. We had lived in a tent for five weeks. Washing and shaving were done with water contained in a helmet and dipped out of a large container of boiling water. We ate our meals standing up and fought for the food before the bees took over. “Slit-trenches” sufficed for sanitary facilities and our “bedrolls” provided us with sleeping accommodations. In mid-August, orders came that we were to be moved to Paris. We arrived with the liberating United States Army Troops. The noise and destruction of war was everywhere. I knew then what Franklin D. Roosevelt meant when he said: “I hate war.” Our advance guard had made a reconnaissance of the Paris area, and we won the most modern hospital in Europe. Built by the free French, it was enlarged by the Germans and designated the main Luftwaffe Hospital. The Nazi flag with the swastika still was flying from the flagpole at the main entrance. Twelve stories high, it

R131 A1 15 V9 N03 Oil 12 INDIANA MEDICAL HISTORY QUARTERLY

had a bed capacity of 1,000. The hospital had a strategical and tactical advantage. In the heart of the combat zone, between the United Kingdom and the European theatre, the wounded were received by air, ambulance convoy, and train. Every foot of available space was utilized; beds even were placed in hallways and lobby areas. By excellent use of this space, we changed this 1,000 bed hospital into one with 3,000 beds. And it was not uncommon to admit 3,000 patients a day to this facility. Those patients who could be moved safely after receiving emergency care were sent to the communication zone; those requiring a longer term of attention or those not expected to be returned to battle were sent by air or boat to the United Kingdom. Ours was an efficient triage system and a competent group of physicians, nurses, and technicians. The hospital unit received the Presidential Citation for their action during the war. When we arrived on the hospital grounds, we were shocked to observe that the large front yard of the hospital contained row after row of German wounded lying on stretchers. It reminded me of the scene in Gone with the Wind which showed the hundreds of wounded soldiers of the South on stretchers in the streets of Atlanta. It was believed that the wounded had been evacuated from the hospital in preparation for pick-up by an ambulance convoy. It would seem that, in the sudden fall of Paris, the Americans had intercepted the convoy. The only occupants inside this 1,000 bed hospital were six wounded British airmen. I moved between the rows of the wounded “enemy.” By definition, an enemy is “a person who hates another and wishes to injure him.” I had no hate in my heart when I looked at these suffering human beings. As a doctor, I knew some of them were facing death. I had only compassion for them and had a sincere desire to help them. I stopped at the stretcher of a handsome young man. His large eyes stopped me. He was looking skyward as if to beg God’s help. I knelt down beside him and said: “It’s O.K., everything will be all right.” His eyes did not move—he was not breathing and had no pulse. He was dead. As my eyes filled with tears, I asked myself: “Why must this be?” Other prisoners of war had swollen legs twice normal size by gas gangrene. (The Germans had run out of antibiotics.) Multiple lacerations of the face and body were covered by paper dressings. (We learned later the Germans had depleted their supply of cloth dressings.) These wounded soldiers were moved with care and efficiency into the almost empty hospital. The destruction of the communication system made it necessary to hand-carry all messages, thus delaying necessary medical and surgical treatment for the wounded. Every physician, surgeon or specialist, was engaged in the effort to save life and save function. We worked around the clock with no concern for food or sleep. The war finally ended in 1945, with the surrender of Germany on May 7, and Japan on August 14.

V

From the time of our entrance into medical school until now, we have witnessed a number of changes in both science and the practice of medicine. To attempt to summarize this progress here is unreasonable. However, the following illustrates a few of the almost countless breakthroughs medicine has made during the past fifty years. Outstanding accomplishments are indicated by the disappearance of rheumatic fever, the treatment of tuberculosis, the cure of many types of congenital heart disease, the improved treatment of diarrheal infections, the restoration of hearing to the deafened otosclerotic ear, and the treatment of retinal diseases with the laser. Sulfonilamide was discovered in 1932, the year before our graduation from medical school. Penicillin became available in 1944 and cortisone came onto the scene in 1949; the Salk vaccine was approved for general use in 1955; the first kidney transplant was performed at Chicago’s Little Company of Mary Hospital in 1950; and

R131 A1 15 V9 N03 012 FIFTY YEAR PERSPECTIVE 13

the heart-lung machine was first used by John H. Gibbon, M.D. in 1953. Five years later, the first pacemaker was installed. Christian Barnard, M.D. performed the first human heart transplant in 1967; and this year, a human life was sustained for a period of time by a mechanical heart. In 1980, the first test-tube baby was born in the United States. We have truly witnessed and have been part of medicine’s golden age. A review of surgery in the 1930s and 1940s indicates that tonsillectomy- adenoidectomy was the most frequently performed operation. Today, it rarely appears on the surgical schedule. Instead, heart surgery is ranked at the head of the list. In our early days, cardiac surgery was unknown. Moreover, our generation has seen the life expectancy reach a record 73.7years; in 1900 it was 47.3. Infant mortality has dropped to a new low of 13.1 deaths per 1,000 live births in this country. Other changes, too, have occurred in medicine. In our lifetime, both the cost of medical care and medical education has risen dramatically. The cost of medical care in the United States rose more than twice as fast as all other prices in 1982. Richard Schweiker, outgoing Secretary of Health and Human Services, states; “At current rates of inflation, health care cost threaten to become so high they could prove insupportable.” The price tag of $280 billion a year for medical care is reported in the New England Medical Journal. A number of doctors charged that medical care is rampant with waste, abuse, and profiteering. The cost of medical education is frightening. George T. Lukemeyer, M.D., Executive Associate Dean, Indiana University School of Medicine, states in the American Medical News: “The financial indebtedness a potential medical student is facing today (using money borrowed from the Health Education Assistance Loan Program) has been calculated to be the staggering sum of $230,000.” And I was worried that I had an indebtedness of $900 when I graduated in 1933! An additional roadblock to the medical student of today is the alleged future oversupply of physicians. John Cooper, M.D. speaking at the American Society of Internal Medicine, stated: “The excess number of physicians that the medical schools are turning out may threaten the perception that medicine is a scholarly profession.” Dr. Cooper warned that the overabundance of physicians could turn medicine into a competitive “business,” which he called an “industry.” Robert Maynard Hutchins, a famous educator and once president of the University of Chicago, said:

We have witnessed a shift of emphasis throughout education from thought to information, from idea to fact. More and more facts come to light each year, so that there is more each year to know. There is now so much to know that it is almost impossible to know much. The education of the physician is an ongoing process which continues throughout his career, as new developments and discoveries in medicine prove useful, the practicing physician must be aware of them. [Robert Maynard Hutchins, No Friendly Voice (Chicago: University of Chicago Press), 55]

I am sure the great majority of medical students today have altruistic goals. They hope to make important contributions to their community and they have expectations of what their medical degree will provide. Unfortunately, the changes caused by the availability of medicine through large clinics for profit, the impersonal patient-doctor relationship caused by “laboratory medicine,” and third party payment can bring horrible disappointment to the contemporary graduating doctor. The introduction of the computer and the advances of technologies, in many instances, have threatened to replace the personal relationship between patient and doctor. The computer has provided advances in obtaining images of the body without the use of potentially harmful x-ray. Moreover it is used in drug and diet administration and has provided medical equipment, such as dialyzers for the treatment of kidney disease. It is being used to develop new drugs for diseases, such as infectious arthritis and cardiovascular problems. All this is wonderful, but the computer cannot hold the hand of the

R131 A1 15 V9 N03 013 14 INDIANA MEDICAL HISTORY QUARTERLY

frightened patient; it cannot console the patient with softly spoken words of compassion, empathy, and reassurance. The computer cannot provide the comfort of an understanding and sympathetic physician. All Americans are accustomed to coming to the doctor, or the doctor coming to them, whenever they experience physical or emotional problems. One of the most significant changes in the delivery of health care is the demise of the“house call.” Asa young physician, I could not go to the “movies” in comfort. I was always fearful that one of my patients might need me. We had a “baby-sitter” for the telephone and I would call home several times during the movie to “see if there were any calls.” I used a “house call bag” containing a veritable hospital of instruments, dressings, sutures, and medicines. I was prepared to give general anesthesia (ethyl chloride) and open the bulging, painful eardrum to bring comfort to a patient suffering middle ear infection. I fully expected to have my sleep interrupted each night; indeed, when I did not get a call for help in the night, I would say to my wife, “lucky night—no calls!” Each day the “house call bag” was resupplied and all its instruments sterilized. The emergency room has replaced the house call. The patient rarely knows the doctor and support personnel. There is something impersonal about this situation to me, and I hope I never have to go to such a place for medical or surgical care. Fifty years ago, the doctor’s office was generally in the friendly confines of his home. Today the office usually is located in a large clinic, hospital, or office building. The rush of the crowds and the long periods of waiting do not produce the feeling of security, particularly when one is fatigued and pained by illness. Thus, as one can see, the practice of medicine has changed dramatically since our graduation from medical school. On the whole, medical knowledge has increased tremendously during that period but perhaps regrettably at the expense of a close doctor-patient relationship.

VI

In conclusion, it is my opinion that one cannot be a physician out of simple election. One must have a vocation to become a doctor. I was aware of this calling in my early childhood. I recall seeing my tender and loving mother’s recurrent illness dim her eyes and pale her cheeks. The pain and fever provoked barely audible sounds of her suffering. I lived in terror that she would die. I comforted myself with the thought that someday I would become a doctor and make her well. The frequent visits to our home by our family doctor intensified my desire to follow in his footsteps. To me, our doctor seemed tall and his gait and his bearing made me liken him to a general in the army. His voice was not loud like other adults. His pat on my head was gentle and his smile reassuring. When he departed our home, we felt comfort in the peace and hope he had imparted. Robert Louis Stevenson must have had our family doctor in mind when he wrote:

There are men and classes of men that stand above the common herd: the soldier, the sailor, and the shepherd not infrequently; the artist rarely; rarer still, the clergyman; the physician almost as a rule. He is the flower (such as it is)of our civilization; and when that stage of man is done with, and only to be marvelled at his history, he will bethought to have shared as little as any in the defects of the period, and most notably exhibited the virtues of the race. Generosity he has, such as is possible to those who practice an art, never to those who drive a trade; discretion, tested by a hundred secrets, tact, tried in a thousand embarrassments; and what are more important, Herculean cheerfulness and courage. So that he brings air and cheer into the sick room, and often enough, though not so often as he wishes, brings healing,

We should take comfort in the choice of our calling for, as Sir William Osier writes: “Medicine offers a combination of intellectual and moral interests found in no

R131 A1 15 V9 N03 014 FIFTY YEAR PERSPECTIVE 15

other profession, and not met with at all in the common pursuits of life.” Sir James Paget spoke of our professional pursuits when he observed that “it offers the most complete and constant union of those three qualities which have the greatest charm for pure and active minds—novelty, utility and charity.” Voltaire in the 18th century, in his Philosophical Dictionary, said: “Men who are engaged in the restoration of health to other men, through the joint exertion of skill and humanity, are above all the great of the earth. They even partake of divinity, since to preserve and renew is almost as noble as to create.” With the attrition of time, there begins to creep over us a change: the silvering of the hair, the change in elasticity, and the slowing in our mental receptivity. We have given a lot of precious time to education, patients, and worry. It is a bleak moment to reflect on all our opportunities—the privilege of being a doctor. If, through these fifty years we have had a readiness to do battle and we have met the occasional and necessary defeat, we can take relief in the words of Rabbi Ben Ezra: “What I aspired to be and was not, comforts me.”

Dr. Hipskind is shown above delivering his speech, “A Doctor’s Fifty Year Perspective.” to the Indiana University Medical School class of 1933.

R131 A1 15 V9 N03 015 16 INDIANA MEDICAL HISTORY QUARTERLY

NEWS AND NOTES

The Indiana Historical Society continues to enhance its collection of rare medical books and manuscripts. Recently, Miss Dorothy Garr Helmer, of Indianapolis, donated the medical school dissertation of her great grandfather, John Wesley Garr (1817-1866), to the library. Entitled “An Inaugural Dissertation on Intermittent Fever,” this twenty-five page document details the supposed causes and the various treatments for malaria (known in the nineteenth century as intermittent fever or ague). The dissertation was written in 1849 and submitted as part of the prerequisites for a medical degree to the president, board, and faculty of the University of Louisville. Dr. Garr practiced medicine in Kokomo, Indiana. nin itrcl Society Historical Indiana nin eia Hsoy Quarterly History Medical Indiana ninpls I 46202 IN Indianapolis, 315 West Ohio Street Ohio West 315

emt o 3864 No. Permit ninpls IN Indianapolis, opoi Org. Nonprofit . . Postage S. U. PAID

R131 A1 15 V9 N03 015 ?72Z me.

INDIANA MEDICAL HISTORY QUARTERLY

INDIANA HISTORICAL SOCIETY

Volume IX , Number 4

December, 1983

R131 A1 15 V9 N04 001 ISSN 0740-8218

The Indiana Medical History Quarterly is published by the Medical History Section of the Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. EDITORIAL STAFF

CHARLES A. BONSETT, M.D.. Editor 6133 East 54th Place Indianapolis, Indiana 46226

ANN G. CARMICHAEL, M.D., Ph.D., Asst. Editor 130 Goodbody Hall Indiana University Bloomington, Indiana 47401

KATHERINE MANDUSIC MCDONELL, M.A., Managing Editor Indiana Historical Society 315 West Ohio Street Indianapolis, Indiana 46202

MEDICAL HISTORY SECTION COMMITTEE

CHARLES A. BONSETT. M.D., Chairman

JOHN U. KEATING, M I). KENNETH G. KOHLSTAEDT, M.I).

BERNARD ROSENAK. M.D. DWIGHT SCHUSTER, M.D.

WILLIAM M. SHOLTY, M.D. W. D. SNIVELY, JR., M.I).

MRS. DONALD J. WHITE

Manuscripts for publication in the Quarterly should be submitted to Katherine McDonell, Indiana Medical History Section, Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. All manuscripts (including footnotes) should be typewritten, double-spaced, with wide margins and footnotes at the end. Physicians' diaries, casebooks and letters, along with nineteenth century medical books and photographs relating to the practice of medicine in Indiana, are sought for the Indiana Historical Society Library. Please contact Robert K. O'Neill, Director, In­ diana Historical Society Library, 315 West Ohio Street, Indianapolis, Indiana 46202. The Indiana Medical History Museum is interested in nineteenth century medical ar­ tifacts for its collection. If you would like to donate any of these objects to the Museum, please write to Dr. Charles A. Bonsett, Indiana Medical History Museum, Old Pathology Building, 3000 West Washington Street, Indianapolis, Indiana 46222.

Copyright 1983 by the Indiana Historical Society

Pictured on the cover is a temporary hospital established in Terre Haute to care for the victims of the 1918 flu epidemic. (Photograph in the Martin Collection, Indiana Historical Society Library.)

R131 A1 15 V9 N04 002 INDIANA AND THE INFLUENZA PANDEMIC OF 1918

Philip C. Ensley*

During the last few months of World War I, the world faced a silent peril, which killed more people in a few months than had been killed in over four years of war. Ten times as many Americans died of it as died at the hand of the Germans.1 This peril, variously referred to as “blitz katarrh,” “wrestler’s fever,” “Bombay fever,” and “the Bolshevik Disease,” was known to most of the world as “the Spanish Lady” or Spanish influenza.2 This pandemic, which killed 21 million people, has been surpassed in its devastation by only two other epidemics — the Plague of Justinian of 542 A .D ., which slew an estimated 100 million people, and the Black Death of 1347-1350, which killed approximately 62 million.3 But no epidemic in world history killed so many people so quickly: “ . . . it killed more humans than any other disease in a period of similar duration in the history of the world.”4 Nor had any other pandemic come at such an inauspicious moment. The attention of the world was directed to war, and because of this, the influenza pandemic of 1918 has been all but forgotten. This paper is an analysis of the Spanish flu epidemic in the state of Indiana, whose experience in relation to the causes, spread, public and private reactions, and effects is typical of most areas of the world affected by it. Influenza is an acute viral infection of the “respiratory epithelium”5 and, though often considered to be little more than a severe cold, is in reality a serious contagious disease, which ranks “among the great plagues of mankind.”6 Influenza viruses comprise three subgroups — A, B, and C. These subgroups are alike in that they possess a “soluble” nucleoprotein antigen, but their antigens are so different that they induce little cross­ immunity. Physicians associate influenza B and C with sporadic epidemics in children and young adults. Since most adults carry antibodies to these viruses, there is no evidence of pandemics of influenza B or C.7 Influenza A, however, because its virus is, “perhaps unique among infectious agents of man in its capacity to mutate sufficiently under natural condi­ tions to circumvent host immunity,”8 causes epidemics every two to four years and pan­ demics every decade or so, including that of 1918-1919.9 When a mutation occurs, acquired immunity is inadequate since the new virus replaces the older virus completely. “Under these conditions, people of all ages and in all places are susceptible to influenza and a worldwide epidemic or pandemic may ensue.”10 Influenza is produced by the introduction of virus from respiratory secretions of infected persons.11 Each cough and sneeze from an infected person blows thousands of droplets into the air. Some will be inhaled immediately by those nearby, while most of the droplets dry out to become “droplet nuclei.” The influenza virus can live in these nuclei and can float in the air for hours provided they are not exposed to sunlight. I f inhaled, some droplet nuclei remain in the nose and pass into the lungs. Influenza spreads rapidly because of the short incubation period of one to three days and because of its ability to multiply in the surface membranes of the respiratory tract.12 Antibiotics, sulfa drugs, and aspirin have no effect whatever on the virus. Moreover, the changeability of the influenza virus (antigenic drift or “genetic” shift) into many variant strains or subtypes makes it difficult to isolate a specific virus in order to create an influenza vaccine.13 Prevention by vaccine is transient, lasting no more than one year. For these reasons, “immunization of the general population is not feasible.”14

*Philip C. Ensley is Professor of History at the University of Evansville. Dr. Ensley is author of The World of Karl Kae Knecht through his Cartoons (Evansville, 1979), an edited collection of the cartoons of the long-time editorial cartoonist of the Evansville Courier.

3

R131 A1 15 V9 N04 003 4 INDIANA MEDICAL HISTORY QUARTERLY

The incubation period of the disease is usually two days. In about two-thirds of the cases, the onset is sudden, beginning with a headache, a general feeling of illness, and either a chill or fever. Within a few hours, the body temperature rises to about 101 degrees and is accompanied by a short, dry cough. Muscle aches in the back and legs are common, but the sneezing, nasal blockage and discharge, and sore throat are present in about half of the cases. Influenza differs from the common cold in the existence of fever, aches and pains, and a general feeling of illness and depression. The fever lasts from one to six days, with an average duration of three days. It is best treated by confinement to bed for the period of the fever and rest during convalescence. In a small proportion of the cases, pneumonia devel­ ops, commonly due to a secondary bacterial infection. In fact, most of the deaths from influenza result from the onset of pneumonia. During the 1918-1919 pandemic, only 20 percent of the influenza cases developed pneumonia, but almost half of those ended fatally.15 Thus, the common belief that influenza was a “delightful disease — ‘Everybody ill, nobody dying’ ’n6 — was untrue of influenza in general and was particularly inapplicable to the pandemic of 1918-1919. Although the evidence is inconclusive, it is generally assumed that the first cases of influenza were observed at Fort Riley, Kansas, in March, 1918. From there, it was carried to Europe by American soldiers, reintroduced into the United States by late summer, and spread throughout the country.17 Influenza started along the east coast, leaped across the Appalachians into the Midwest, jumped across the plains and Rockies to the Pacific coast, and then began “to seep into every niche and corner of America. ”18 The disease first was recognized in Indiana by September 20, 1918, and swept across the state from north to south in two separate waves. From October 8 until February 1,1919, a total of 154,600 cases were officially reported to the Indiana State Board of Health (see Table I). The Board estimated that less than 50 percent of the total number of cases were actually reported.19 Thus, “there were not less than 350,000 cases of influenza throughout the course of the epidemic,” or at least 12 percent of the state’s total population was stricken with influenza. The total number of influenza-related deaths from September 1 to February 1, 1919, was 10,243 (see Table I).

TABLE I

INFLUENZA CASES IN INDIANA20

Official Estimated No. of Deaths Death Rate September 1, 1918- February 1, 1919 154,600 350,000 10,243 3.52/1,000

The epidemic was somewhat less severe in Indiana than it was in the United States as a whole. It was estimated that one-fourth of the total population of the United States had overt cases of flu in 1918-1919,21 while in Indiana the figure was estimated to be about half of that or 12 percent.22 The death rate for influenza-pneumonia was 5.9 per 1,000 nationwide while it was 3.52 in Indiana (see Table Ila). Indiana deaths from influenza-pneumonia comprised 24 percent of deaths from all causes, while nationwide the disease was responsi­ ble for 29 percent of all deaths during 1918. The difference between Indiana’s death rate and the rate nationwide was greater in 1918 than in other years, further indicating that Indiana fared better than most areas during the 1918 epidemic (see Table lib). Why the Indiana

R131 A1 15 V9 N04 004 INDIANA AND THE INFLUENZA PANDEMIC 5

epidemic was less severe is not known, but the fact that Indiana was less urban than the nation as a whole and also the foresight of the State Board of Health in applying a statewide ban may have been factors responsible for the state’s lower death rate.

TABLE Ila COMPARISON OF INDIANA WITH THE U.S.23

Death Rate Percentage of All Deaths Due to Influenza IN D IA N A 3.52/1,000 24% U N ITE D STATES 5.91/1,000 29%

TABLE lib COMPARISON OF INDIANA WITH THE U.S.23

§ fa W fa m fa w P O p p <5 fa O fa H fa SC % W Q

AT 15 V9 N04 005 6 INDIANA MEDICAL HISTORY QUARTERLY

Within Indiana, the effects of the epidemic exhibited interesting regional variations (see Thble III). As might be expected, urban areas, because of higher population density, were more seriously affected by the highly contagious influenza virus. In 1918, Indiana’s population of 2,911,665 was 58.4 percent rural and 41.6 percent urban, but 51.8 percent of all of the deaths from influenza-pneumonia occurred in urban areas. The death rate from the

TABLE III INFLUENZA DEATH RATE IN INDIANA24 SEPTEM BER 1,1918 — FE B R U A R Y 1, 1919

1 2 3 4 5 6

DEATH RATE PER 1,000 PEOPLE

R131 A1 15 V9 N04 005 INDIANA AND THE INFLUENZA PANDEMIC 7

epidemic was 4.38 per 1,000 in urban areas, or 0.86 above the average for the state as a whole, whereas the rural death rate was 2.90, or 0.62 below the mortality rate for the state. It might be expected that there would be a direct correlation between the size of a city and its mortality rate. This, however, was not the case. Indianapolis, the state’s largest city, had a mortality rate of 4.00, which was equal to or lower than the rate of three of the other four largest cities in the state. Only Fort Wayne’s rate of 2.09 was significantly lower than that of Indianapolis. Another curious fact is that the five largest cities in the state — Indianapolis, Fort Wayne, Evansville, South Bend, and Terre Haute (first and second class cities) had a lower rate (3.86) than the combined rate (4.88) of the other forty-four cities in the state with populations between 5,000 and 45,000. Third class cities (20,000-45,000) had a considerably higher rate (5.42) than any other class of cities in the state. These results may be attributed to the fact that the largest cities in that class — Gary, East Chicago, and Hammond — were part of the metropolitan area of Chicago where the epidemic was more serious than it was in Indiana. These statistics suggest that location rather than size may be more important in explaining the severity of the epidemic. Yet, with the exception of the areas near Chicago, there is no discernible regional pattern in the severity of the epidemic. Even in the southern Indiana areas near Louisville (Clark and Floyd counties and the cities of New Albany and Jeffersonville) the epidemic was not significantly different than it was in the state as a whole. The Indiana State Board of Health divided the state into three regions — the Northern, Central, and Southern Sanitary Sections. The Northern and Central Sections had very similar rates (3.70 in the north to 3.59 in the central) while it was considerably lower in the south (3.11). In addition there were considerable differences within each region. The Northern area had the county with the highest mortality rate (Lake, 8.31), as well as the county with one of the lowest rates (Adams, 1.60). In the Central region, Fayette County in the east central part of the state had one of the highest rates in the state (6.59) while Hancock County, two counties away and adjacent to Marion County, had the lowest rate of any Indiana county in the state (1.05). In the south, the neighboring counties of Floyd and Harrison had considerably different rates (4.01 to 1.19). The various health officials’ defini­ tions of influenza and the accuracy of record-keeping by local boards of health are possible explanations for these county discrepancies. Indeed, these regional variations are another curious aspect of the “Spanish Flu.” Unlike previous epidemics which travelled on a slow east-west axis, the Spanish Lady struck in a sudden, random fashion almost “as a prowler in the night.”25 In addition, there is no significant difference between male and females in the incidence of the epidemic, contrary to the official report of the Indiana State Board of Health. In the 1919 Board of Health Year Book, the “Brief Report Concerning the Epidemic of Influenza in Indiana” concluded that “the male deaths exceeded the deaths of females by approximately ten percent.”26 The actual monthly reports indicated that there were slightly more female deaths than male deaths from influenza— 4,731 to 4,709 from September to December, 1918. Because there were more males than females in the total population of Indiana, the female death rate was 3.58, while the male death rate was 3.45. A typical but curious pattern also occurred in the age groups most seriously affected. From September to December, 1918, 52 percent of the deaths were in the twenty to forty age group, the group usually least susceptible to such epidemics, while only 9 percent were in the age group over fifty-five, the group usually most susceptible. In Indiana, if children under five are excepted, “the highest rates from influenza and pneumonia (all forms) as primary causes, in five year groups” for both males and females was in the age group thirty to thirty-four.27 This was typical of the epidemic worldwide as Richard Collier, author of The Plague of the Spanish Lady, notes:

. . . whether Bombay coolie or Wall Street broker, Italian sharecropper or Russian com- missar, it was always the same age group — from 15 to 40 — that knew the greatest

R131 A1 15 V9 N04 007 8 INDIANA MEDICAL HISTORY QUARTERLY

fatalities . . . Now, for the first time, it was striking against the world’s most vital and productive population group.28

Epidemiologists are still uncertain why this group was so severely affected by the pan­ demic. Some explanations include the increased exposure of this age group to infection, their lack of immunity from previous influenza epidemics, their ethnic background and geographical location, and the nature of the virus itself.29 The first official governmental action in response to the epidemic was a telegram sent by Surgeon-General Rupert Blue on September 18,1918, to the health officers of the forty- eight states: “ Request all information regarding the prevalence of influenza in your state.”30 On September 27, the Indiana State Board of Health issued an order to county and city health officers warning of the possibility of an epidemic and suggesting certain preventive action: . . tell the people when compelled to cough or sneeze to hold cloth or paper handkerchiefs over their nose. Persons with colds must be excluded from public gather­ ings.”31 On October 6, the Board of Health, complying with the United States Public Health Service, issued an order banning all public gatherings. The ban was temporarily lifted, however, because it had been imposed while Dr. John N. Hurty, Secretary of the Board of Health and a nationally recognized pioneer in preventive medicine, was out of town. He repealed the order because he believed: “ . . . the government cannot prescribe what a state board of health can do. It may suggest certain action, and this is possibly what it did.”32 This federal-state jurisdictional dispute and the resulting lack of centralized authority and direction would severely hamper effective governmental action against the epidemic. Such conflict was equally pronounced between the State Board of Health and local health authorities. On October 9, the Board of Health officially imposed a statewide ban. The Board declared that epidemic influenza, “a dangerous communicable disease is now epidemic in Indiana, causing deaths daily,” and ordered:

(a) That all public gatherings are prohibited, (b) That spitting on sidewalks, on walls and floors of public buildings and public conveyances is prohibited, (c) That all persons shall hold a cloth or paper handkerchief over their faces when coughing or sneezing, (d) That all street cars, ipterurban cars and public conveyances shall have all ventilators open regardless of outside temperature. . . . Railway passenger cars shall have all ventilators open regardless of outside temperature. All street cars, interurban cars and railway passenger cars shall be thoroughly cleaned after each service trip and before being put in service again. (e) That physicians shall promptly report all cases of Epidemic Influenza coming under their care to the health officer having jurisdiction. (f) City and health officers shall report to their County Health Commissioner, who shall make a daily report to the State Board of Health. (g) This order supersedes all previous orders and instructions and shall be in force and effect until 12 o’clock midnight of October 20th.

The closing order affected schools, theaters, and churches, but not essential war activities, industries, commercial activities, the Red Cross and the Liberty Loan drives, nor juvenile baseball, football, or tennis. Violations of the order could be punished by fines of five dollars to fifty dollars per occurrence.33 The assistant secretary of the Board of Health, in cooperation with the United States Public Health Service and the Red Cross, was given administrative charge of influenza control and relief work. The Public Health Service provided $8,269.09 for payment of salaries and travel expenses of physicians engaged in emergency control work, while the

R131 A1 15 V9 N04 008 INDIANA AND THE INFLUENZA PANDEMIC 9

American Red Cross paid for salaries and travel for nurses engaged in emergency hospital and community nursing work.34 On October 13, Dr. Hurty sent a telegram to local health authorities asking them to canvass “for names and addresses [of] physicians who will volunteer for epidemic influenza work in Indiana as needed.” The Red Cross will pay “two hundred dollars [a] month and travel expense four dollars day subsistence if called.”35 More than 200 Indiana physicians volunteered for influenza control service; seventeen went to Massachusetts, five to Pennsylvania, and nine to Kentucky before the Indiana epidemic became severe. In all twenty physicians were employed for “full time service in Indiana” in approximately fifty stricken communities around the state.36 The Board of Health also tried to keep the public informed about the epidemic. It did so indirectly through local health authorities as well as directly to the public. It informed local health authorities that “quarantine was limited. Only the patient is to be kept in.” It suggested that “churches may be open for prayer and meditation but large numbers, as for regular services, must not congregate.” Public funerals were forbidden; family funerals were permitted, but the “house must be well ventilated and only relatives and close friends admitted.” Poolrooms and “dry drink saloons” were to be closed if crowded and used for loafing. “ I f a proprietor won’t stop loafing and will not ventilate thoroughly, close the place.”37 The Board also published notices in the state newspapers entitled “ Influenza — How to Avoid It — How to Care for Those Who Have It,” giving practical advice to the Hoosier public. It recommended that if a person felt a chill, muscular pain, headache, backache, and fever, he or she should, “GO TO BED A T O N C E ,” open all bedroom windows, “take medicine to open the bowels freely,” take nourishing food, such as “milk, egg-and-milk, or broth every four hours,” and stay in bed until told by a physician to get up. Additional instructions were given to householders, to workers, and to nurses. In these ways the Board of Health made invaluable contributions to the people of Indiana during this serious epidemic.38 Some activities were not covered by the statewide ban, thus demanding decisions by local health authorities. One such decision concerned the necessity of finding additional hospital beds. To meet this requirement, twenty-one communities established temporary hospitals.39 In Muncie, the third floor of the Commercial Club became the temporary hospital.40 In Gary, hospitals were set up in the Knights of Columbus and Masonic Halls;41 while in Evansville, the Elks Home was one of the over 500 from that organization donated as temporary hospitals across the United States.42 They were usually run by the Red Cross, supplied by individuals or corporations, and organized as a supplement to the overcrowded regular hospitals. They were not “charity” hospitals but were to help all, from “every class and on almost every street,” to overcome the ravages of the flu.43 A second local decision was whether or not to close the schools. This was a worldwide concern, with schools closing in some areas — Athens, Winnipeg, and Melbourne — while remaining open in others — Stockholm, Paris, and Cairo. The New York City experience of leaving the schools open with daily inspections by physicians was so successful — “cases of influenza among New York’s children . . . were almost non-existent from the first”44 — that it encouraged other cities to attempt it. Evansville school officials kept the schools open during the second wave of the epidemic because they believed that children could be protected better in school than at home or on the streets.45 Gary, although the hardest hit of any city in Indiana, opened its schools before the ban was lifted because of its “splendid system of medical supervision.”46 A t the other extreme was Fort Wayne whose schools had been closed for seven of the first fourteen weeks of the school year.47 A third local decision was whether or not to require the use of gauze masks. Most physicians thought that the mask was a valuable precaution, but there were those in the medical community who opposed its use. Great Britain’s Dr. Leonard Hill, for example, condemned the mask for striking at the respiratory membrane’s natural defenses,48 and

R131 A1 15 V9 N04 009 10 INDIANA MEDICAL HISTORY QUARTERLY

South Bend’s health official Dr. E. G. Freyermuth opposed masks because they prevented “the wearer from breathing pure air.”49 In reality, masks probably had little effect because the influenza virus is so tiny that it can pass through any cloth no matter how tightly woven. To be even slightly effective, masks must be worn at all times, tied firmly, and washed and dried at least once daily. Enforcement of such restrictions was impossible and thus commu­ nities where masking was compulsory “almost always had health records the same as those of adjacent communities without masking.”50 Nonetheless, after the San Francisco experi­ ence with masks had reduced the death rate in half by early November, other cities began to require masking.51 On November 19, Indianapolis required masks to be worn by everyone while “in any store, office, factory, public building, theater, church, street car or any public gathering place.” Dentists, bankers, clerks, waiters, and street car conductors also had to wear them.52 That the order was enforced is indicated by a headline on November 23: “Three ‘Unmasked’ Men Held.”53 Fort Wayne imposed a similar order on December 4 and appointed special officers to enforce it. When the number of cases of flu declined in the city, the Fort Wayne Journal-Gazette headlined, “All hail the mask!”54 Evansville, like South Bend, had no mask ordinance, partly because as one merchant noted, “the sight of a person in a mask would frighten the women and create undue fear.”55 Miscellaneous responses to the flu included a ban on public funerals in both Evansville and Lake County.56 Although no city introduced “spitless Sundays” as did New York,57 Evansville had an anti-spitting ordinance which imposed fines of one to five dollars for expectorating in public.58 Muncie decided there would be “no Halloween celebration of any kind. ” They prevented the sale of Halloween masks in the city, claiming masks could be tried on by “a hundred persons” before they were sold, thus transmitting germs which will “have no chance to escape.”59 These are examples of the numerous expedients attempted by local authorities and the sacrifices expected in order to prevent the further spread of the epidemic.

The use of gauze masks was a common preventative It Is Up to Each One of Us! measure employed during the 1918 flu epidemic. On the right, Evansville C ourier editorial cartoonist Karl Kae Knecht urges citizens to wear masks and take other recommended precautionary measures to prevent the spread of the flu. [Photograph taken from the Evans­ ville Courier, November 21,1918; reprinted in Philip C. Ensley, The World o f K a rl Kae Knecht through his Cartoons (Evansville: University of Evansville, 1979), 63.]

R131 A1 15 V9 N04 010 INDIANA AND THE INFLUENZA PANDEMIC 11

Just as the severity of the epidemic varied around the state so did the response of local health authorities. Although all health authorities agreed with the Fort Wayne Journal- Gazette that “the lives of men are more valuable than profits,”60 there was no agreement about how best to save lives! The cases of South Berfd and Fort Wayne are good examples of these varied responses. Dr. E. G. Freyermuth, secretary of the board of health of South Bend, refused to impose the statewide ban upon South Bend immediately because “we have no epidemic here.”61 He admitted, however, that he did not know how many cases there were; physicians were not reporting cases because “influenza is not a reportable disease according to law.”62 When cases were reported, he denied there were that many, even though almost all health officials assumed the reverse to be true.63 Officially South Bend had a serious epidemic with its fatality rate of 4.55 per 1,000.64 It is possible, although it cannot be proven, that the failure to impose the ban or to take the epidemic seriously increased the number of cases in South Bend. In Fort Wayne, on the other hand, where the fatality rate was lower than that of any major city in Indiana, the city and health authorities as well as the business community vigorously supported the statewide ban. The Merchants and Manufacturers Association of Fort Wayne sponsored a full-page ad entitled “Keep Scourge from Fort Wayne” warning that influenza was not “some strange malady attacking Chinese, or East Indians” but was killing the people of Allen County. The ad then listed symptoms, treatment, and precau­ tions.65 The health authorities reflected this same attitude when they continued the ban locally even after the state lifted it on November 2.66 The lifting of the local ban on November 15 did not end the vigilance, as indicated by the mask ordinance, the appoint­ ment of a special commission to advise the board of health, the appropriation of $9,000 by the common council, and the passage of an influenza ordinance on December 15.67 The contrast between South Bend and Fort Wayne, though not proving a connection between the severity of the epidemic and the local response to it, supports the general observation that “methods of control in cities and localities . . . vary greatly.”68 Such varied responses were caused partly by the lack of consensus among health authorities and physicians about the epidemic’s causes. This was a worldwide phenomenon, but there was an interesting example of the lack of knowledge about influenza in a discussion among three Muncie physicians. In discussing the question of immunity, they concluded that they “don’t know and hardly think anybody else does.” One physician argued that it was contracted by coming into contact with the breath or sputum of one affected, while another claimed it was an “atmospheric disease and perhaps goes in waves.” One asserted that “serum treatment is of doubtful value”; a second stated he gave it to patients but had “doubts about its value”; while a third believed it had proven its great value and “is as helpful as antitoxine used in diphtheria.” One physician believed that “masks are useless” because “influenza germs can penetrate any cloth masks without trouble,” while another asserted that masks were “the best preventive.” It is not surprising then that amidst all the disagreement in the medical community over influenza that the Muncie Press was led to conclude that “laymen and physicians are all at sea both as to preventives and as to treatment.” The best response was one of common sense: “plenty of fresh air” and a “well nourished body.”69 This lack of consensus about the epidemic led to hundreds of theories about possible cures, “almost as many theories as there were doctors.”70 The proliferation of claims for preventives and cures led Surgeon-General Blue to warn that “there is as yet no specific cure for influenza and that many of the alleged cures and remedies now being recommended by neighbors, nostrum vendors and others do more harm than good.”71 That warning did not prevent products from being advertised as cures. The Evansville Courier for two days advertised the following products as cures or preventives for influenza: Hall’s Superlative Compound, Dr. Jones’ Liniment (generally known as Beaver Oil), Horlick’s Malted Milk,

R131 A1 15 V9 N04 Oil 12 INDIANA MEDICAL HISTORY QUARTERLY

Mendenhall’s Chill and Fever Tonic, Dr. Chase’s Blood and Nerve Tablets, Dr. Pierce’s Pleasant Pellets, Father John’s Medicine, Red Devil Grippe Tablets, Hills’ Bromide, and Cascara Quinine.72 A specific example was an ad for Worner’s Cacto as an “absolutely pure herbal medicine” which will positively get every organ in the body working in harmony; one in this condition is not likely to fall heir to the ‘flu’.”73 A milk company suggested that drinking milk would “strengthen your body and enrich your blood to resist the insidious attack of the influenza germ.”74 A chiropractor asserted, “Why be alarmed, when a few chiropractic adjustments will remove all traces.”75 These numerous advertisements in Indiana newspapers reflect the lack of any generally accepted cure or preventive. By late October, the epidemic appeared to have run its course. From a daily average of 2,426.5 new cases in mid-October, the average had declined to approximately 1,500 per day by the end of October and to an average of 743 on the first two days of November.76 On November 2, the Board of Health lifted the ban because of public pressure, the decline in the number of cases, and the belief that “experience had shown that such closing had very little if any effect in controlling the spread of the disease.”77 It was, unfortunately, a most inauspicious moment to remove the ban, for a little more than a week later the state, nation, and world celebrated the end of World War I: “For one brief but foreseeably fatal moment, the people relaxed their vigilance: caveats, all prohibitions concerning public gatherings, the do’s and don’ts of hygiene, were cast aside.”78 Indiana health authorities agreed that the second wave of influenza beginning around November 15 was attributable to the Armistice Day celebrations. Dr. N. D. Berry, city health officer of Muncie, stated that “beyond doubt the jollification here is the cause of the spread of the disease. . . . Everybody was happy that day and completely forgot himself. Many of the celebrators passed such instruments as whistles from mouth to mouth and thus opened the way for diseases.”79 During the last two weeks of November, the number of cases rose to an average of 1,456 daily, increasing to a peak of 2,371 cases per day from December 1 to December 11, almost equal to that of the first wave. The state did not reimpose the ban but recommended vigilance and left the decisions to local health authorities. By late December, the second wave had passed, as the number of new cases declined to a daily average of 400.80 On February 1, 1919, the Board of Health officially declared an end to the most devastating epidemic in the history of the state of Indiana.81 One of the most extraordinary aspects of the entire epidemic, as true of Indiana as elsewhere, was how little newspaper attention it received. In several communities, a newspaper reader would have been unaware that there was an epidemic. The headlines and front-page stories covered the last battles of World War I, the armistice, the preparation for Wilson’s departure for Europe, the upcoming negotiations at Versailles, and a Congres­ sional election. In the midst of these important events, the story of the epidemic was secondary. Although Hoosiers may have been more aware of the epidemic than others because of the relative incoveniences associated with the statewide ban, a casual reader of Indiana newspapers would have had no sense of urgency. It is no wonder then that since 1919, as H. L. Mencken observed, “the epidemic is seldom mentioned” and most Americans have almost completely forgotten it.82 Health authorities, though, were aware of the seriousness of the epidemic and realized the need to “centralize” authority in order to respond more effectively to an epidemic.83 The State Board of Health recommended in its annual report that a “full time health officer service” be established to render the state “the highest possible degree of intelligent leadership and guidance.”84 The Board stated that the part-time health officer system had several “fatal” defects including the lack of complete cooperation from the doctors engaged in public health work and the inability of the health officers (who were full-time practicing physicians) to give adequate time and attention to public health work. The Board also

R131 A1 15 V9 N04 012 INDIANA AND THE INFLUENZA PANDEMIC 13

believed that the public health officers lacked information and training in public health work. Their education, the Board claimed, was “in the line of the pound of cure, and not in the ounce of prevention.” A Modern Health Law “would not be an expense but an invest­ ment, bringing splendid returns in freedom from epidemics, increased health . . . and best of all it would bring greater efficiency and happiness.”85 A bill to establish a full-time health commissioner in each county and a municipal health commissioner in cities o f20,000 or more was introduced in December, 1918, as it had been every year since 1911.86 It would have established full-time doctor health officers but was defeated by health cultists, town health officers, and physicians in the legislature.87 Not until 1935 was such a bill passed. That law gave to county commissioners and common council members “the power and authority to provide for a full-time county or city health officer, and for the expenses of his office.”88 Yet at present only five of the state’s ninety-two counties have full-time health officers, and only seven have free public health clinics. Representative John Day (Democrat, Indianapolis), chairman of a legislative subcommittee studying the system, called the state’s public health system a “national embarrassment.”89 Thus, although public health officials may have learned from the epidemic about the need for centralized and full-time health authorities, they have been unable to persuade the public of that need. What lessons, if any, have Americans learned from the Spanish flu epidemic? In spite of the knowledge accumulated in two generations of intensive worldwide research and enor­ mous advances made in virology, many questions are still unanswered. Because we do not really know what happened in 1918, we cannot justify optimism that such a killing pandemic may not occur again. Physicians still disagree about the seriousness of potential outbreaks and the need for a mass vaccination program. Such continuing disagreements, similar to those among health officials in 1918, confuse the public and reduce the effectiveness of an immunization program, which is the only major preventive against influenza. Such confu­ sion hampered the government’s response to the anticipated swine flu epidemic in 1976. In

YM C A Hostess Houses were established to accommodate wives and mothers visiting stationed serv­ icemen. As with many public gathering places, masking was required at these establishments. Shown above is the telegraph station of the YM C A Hostess House at Camp Zachary Thylor, Kentucky. [Photograph taken from War Work Bulletin, No. 48 (November 15, 1918), 2.]

R131 A1 15 V9 N04 013 14 INDIANA MEDICAL HISTORY QUARTERLY

addition, today, like 1918, the American people do not have a well-developed concept of public health, without which an effective campaign against influenza or any other serious epidemic will be less effective. And our decentralized system of health organization makes more difficult a coordinated centralized response to any epidemic. Thus it is possible that a recurrence of an influenza epidemic “would as likely destroy in the same haste and magni­ tude” today as it did over sixty years ago.90 That can be prevented only if we remember that influenza is not a “delightful disease,” but one that can become a serious epidemic. Knowl­ edge of the 1918 pandemic and the lessons learned from it should help us avoid a return visit from the “Spanish Lady.”

NOTES

lrThe total death toll for the epidemic was 21 million. The country most severely hit during this epidemic was India, whose death toll was estimated at 12.5 million and whose death rate was 40 per 1,000. The country with the second highest death toll was the Netherlands-East Indies (now Indonesia) whose death toll was approximately 800,000. The United States lost 550,000 from the flu (with a death rate of 5.9 per 1,000). In contrast, 43,000 Americans were killed during World War I, which was almost at an end when the epidemic struck [Alfred W. Crosby, Jr., Epidemic and Peace, 1918 (Westport, Connecticut: Greenwood Press, 1976), 206-207; Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919 (New York: Atheneum, 1974), 305-306]. 2Collier, The Plague of the Spanish Lady, 10-11, 82. 3Ibid., 306. 4Crosby, Epidem ic and Peace, 215. 5Vemon Knight, “ Influenza,” in Kurt Isselbacher, et al., Harrison’s Principles of Internal Medicine, 9th Edition (New York: McGraw-Hill, 1980), 787. 6W.E.B. Beveridge, Influenza: The Last Great Plague, An Unfinished Story of Discovery (New York: Prodist, 1977), 11. 7Edwin D. Kilbourne, “Influenza,” in Paul Beeson and Walsh McDermott, Cecil-Loeb Textbook of Medicine, 12th Edition, Volume I (Philadelphia: W.B. Saunders, 1967), 21. 8Ibid. 9Knight, “Influenza,” 785. “ Kilbourne, “Influenza,” 21. nKnight, “ Influenza,” 787. “ Beveridge, Influenza, 47-49. * Ib id .} 68-74. 14Kilbourne, “Influenza,” 25. “ Beveridge, Influenza, 11-12, 15. “ Crosby, Epidem ic and Peace, 20. 17A.A . Hoehling, The Great Epidem ic (Boston: Little, Brown and Co., 1961), 3; Crosby, Epidemic and Peace, 19-32. “ Crosby, Epidem ic and Peace, 63-64. l9Year Book o f the State of Indiana fo r the Year 1919 (Fort Wayne: Fort Wayne Printing Company, 1920), 491. ^United States Department of Commerce, Bureau of the Census, Vital Statistics, 1920 (Washington: United States Government Printing Office, 1920), 84. 21Crosby, Epidem ic and Peace, 205. 22It is estimated that one billion people, or one-half of the world’s population suffered from influenza (Collier, The Plague o f the Spanish Lady, 305). 'a Vital Statistics, 1920, 84. ^Indiana State Board of Health, Monthly Bulletin, X X I (September-December, 1918), 110-111, 122-123, 134-135, 146-147; Indiana State Board of Health, Monthly Bulletin, X X II (January, 1919), 10-11. ^Collier, The Plague of the Spanish Lady, 34. 26Indiana Year Book, 1919, 491. ^United States Department of Commerce, Bureau of the Census, Special Tables o f Mortality from Influenza and Pneumonia. Indiana, Kansas and Philadelphia, September 1 to December 31, 1918 (Washington: United States Government Printing Office, 1920), 7-8. ^Collier, The Plague o f the Spanish Lady, 1,0. 29Crosby, Epidem ic and Peace, 215-308; R oberts. Katz, “Influenza, 1918-1919: A Study in Mortality,” Bulletin o f the History of Medicine, X L V III (Fall, 1974), 416-422. 30Collier, The Plague of the Spanish Lady, 43.

R131 Al 15 V9 N04 014 INDIANA AND THE INFLUENZA PANDEMIC 15

31Indianapolis Star; September 27, 1918. 32Evansville Courier, October 7, 1918. 33“Order of the Indiana State Board of Health to Control Epidemic Influenza,” October 9, 1918, Indiana Pamphlet Collection, Indiana State Library, Indianapolis, Indiana. 34Indiana Year Book, 1919, 492. “ “Telegram from Dr. Hurty to Local Health Authorities,” October 13, 1918, Indiana Pamphlet Collection. 36Indiana Year Book, 1919, 492. 37“Influenza Hygiene Management,” n.d., Indiana Pamphlet Collection. “ “Influenza — How to Avoid It — How to Care for Those Who Have It,” Indiana Pamphlet Collection. "Indiana Year Book, 1919, 492. 4l,Muneie Evening Press, December 10, 1918. 41Lake County Times, November 22, 1918. 42Evansville Courier, October 26, 1918. 43Ibid., October 27, 1918. 44Collier, The Plague of the Spanish Lady, 150-152. 45Evansville Courier, November 20,1918. 46Lake County Times, October, 29, 1918. 47Fort Wayne Journal-Gazette, December 12, 1918. “ Collier, The Plague of the Spanish Lady, 193. 49South Bend Tribune, November 20, 1918. 50Crosby, Epidemic and Peace, 101. 51Collier, The Plague of the Spanish Lady, 194. 52Indianapoiis Star, November 19, 1918. B3Ibid., November 22, 1918. “•Fort Wayne Journal-Gazette, December 7,1918. “ Evansville Courier, November 22, 1918. 56Ibid., October 11, 1918; Lake County Times, October 21,1918. 57Collier, The Plague of the Spanish Lady, 191. “ Evansville Courier, October 11,1918. 59Muneie Evening Press, October 23, 1918. “ T o rt Wayne Journal-Gazette, October 12, 1918. 61South Bend Tribune, October 7,1918. BZIbid., October 8, 1918. 63Ibid., November 22,1918. “ •Indiana State Board of Health, Monthly Bulletin, September 1918Janaury 1919. 65Fort Wayne Journal-Gazette, October 16,1918. mIbid., November 8,1918. B7Ibid., December 4,1918; December 5,1918; December 15,1918. “ •“Spanish Influenza and Its Control,” Survey, X L I (October 12, 1918), 45. 69Muncie Evening Press, December 11, 1918. 70Collier, The Plague of the Spanish Lady, 105. 71Hoehling, The Great Epidemic, 169. 72Evansville Courier, November 4-5, 1918. 73Ibid., September 24, 1918. 74Ibid., October 10, 1918. 75Evansville Journal-News, October 6, 1918. 76Indianapolis Star, October 16, 1918-November 3, 1918. 77Indiana Year Book, 1919, 492. 78Collier, The Plague o f the Spanish Lady, 232. 79Muncie Evening Press, November 16, 1918. “ Indianapolis Star, November 5 ,1918-January 2, 1919. 81Indiana Year Book, 1919, 491. 82Collier, The Plague o f the Spanish Lady, 304. ®/6id., 87. 84Indiana Year Book, 1919, 493. "Ib id ., 486-487. “ Richmond Palladium, December 9, 1918. S7Year Book of the State of Indiana fo r the Year 1920 (Fort Wayne: Fort Wayne Printing Company, 1921), 487. “ Thurman B. Rice, “History of the Indiana State Board of Health,” in Dorothy R. Russo, ed., One Hundred Years of Indiana Medicine, 1849-1949 (Indianapolis: Indiana State Medical Association, 1949), 49. “ Evansville Courier, August 7,1978. “ Hoehling, The Great Epidemic, 4.

R131 A1 15 V9 N04 015 16

THE INFLUENZA EPIDEMIC OF 1918 AND ITS EFFECTS ON THE MILITARY

Wayne L. Sanford*

In September, 1918, Vance Hobart Fox was one of the many young men drafted into military service. He left his home in Avon, Indiana, that same month and reported for duty at Camp Sherman, near Chillicothe, Ohio. But Fox never had a chance to participate in the war. Two weeks after taking the oath of allegiance, Fox was stricken with a malady popularly known as “the grippe.” On October 15,1918, he died.1 As with so many others drafted during the fall of 1918, Fox had an underlying sense of anxiety about the war and an even greater concern about an epidemic of influenza which was raging across the nation. Reports of a virus called “influenza di freddo,” or Spanish influenza filled military cantonments and training camps throughout the United States.2 Although a minor epidemic of influenza broke out at several military camps in March and April, 1918, the first documented cases of Spanish influenza were reported at Camp Devens, an army installation located forty miles northwest of Boston, Massachusetts, on September 8 ,1918.3 (See map for first reported cases of influenza in the military camps.) Before the end of spring, 1919, nearly 791,000 cases of this devastating viral infection were reported in these camps. The outbreak of influenza was so severe that on given days there were more domestic military deaths due to influenza than American fatalities on foreign battlefields.4 From September 18 until November 8, 1918, there were 316,089 reported cases of influenza and 53,449 of pneumonia among troops in this country.5 The sixteen larger training camps in the United States reported an average total of 148,148 military personnel during this same period. Slightly more than 22 percent of these men were confined to hospital facilities.6 In one day, forty-five men died at Camp Sherman, Ohio, “with an additional twenty-five expected to suffer the same fate by midnight” of that same day. The post hospital at Camp Sherman reported that patients were “coming in at a rate of fifty per hour.”7 By the end of October, 1918, medical reports from Camp Funston, a basic training camp connected to Fort Riley, Kansas, reported nearly 11,300 cases of flu, or slightly more than 20 percent of the total troops and personnel garrisoned there.8 (See Table I.) The flu epidemic placed a severe strain on America’s military machine. From July 1 to October 31,1918, nearly 1,200,000 men were drafted. However, because of the serious threat influenza posed, training for 142,000 of the new recruits was postponed indefinitely. More­ over, the shipments of men to France, which totalled approximately 257,000 in September, dropped to 180,000 one month later.9 As a result of the flu epidemic, base hospitals and regimental infirmaries became seriously overcrowded. At Camp Funston, for example, the Army constructed new facilities and converted nonmedical buildings to accommodate the sudden overload of sick.10 Fear heightened among the recruits as the flu spread throughout military camps in the United States. Howard Taylor, a native Hoosier stationed at Camp Travis, a cantonment adjacent to Fort Sam Houston, Texas, recalled how the outbreak of flu made some rather dramatic changes in everyday life:

. . . the flu epidemic hit just ten days before we were ready to go over [to France] . . . we were still in quarantine when the Armistice was signed [November 11, 1918]. These big husky guys were always going around bragging that “A cold doesn’t bother me.” And in a week or so, people started dying. You never knew whether you were going to live or die. But the ones that always died first were those big husky fellows, that wouldn’t take care of themselves. They’d get a little cold and they’d say, “That don’t bother me.” And they

*Wayne L. Sanford is chairman of the Military History Section of the Indiana Historical Society and is author of many articles on Indiana military history.

R131 A1 15 V9 N04 016 INFLUENZA EPIDEMIC OF 1918 17

R131 AT 15 V9 N04 017 18 INDIANA MEDICAL HISTORY QUARTERLY

T AB LE I

ADMISSIONS AND DEATHS DUE TO INFLUENZA

PERCENT CAMP EPIDEMIC PERIOD ADMISSIONS DEATHS OF STRENGTH

Camp Devens, Mass.* 9/8-10/29 17,400 787 33% Camp Funston, Kansas* 9/16-11/7 16,983 841 28% Camp Thylor, Kentucky* 9/22-11/3 14,761 720 20% Camp Meade, Maryland* 9/17-10/20 14,280 763 27% Camp Dix, New Jersey* 9/9-11/1 13,733 808 26% Camp Lee, Virginia* 9/13-11/10 13,597 674 24% Camp Sherman, Ohio* 9/24-11/19 13,161 1,101 33% Camp Pike, Arkansas* 9/23-10/31 13,124 423 23% Camp Grant, Illinois* 9/21-11/3 13,071 1,060 26% Camp Custer, Michigan* 9/23-11/3 12,773 660 26% Camp Travis, Texas* 9/29-11/9 12,120 199 28% Camp Dodge, Iowa* 9/18-10/22 11,931 702 30% Camp Jackson, Miss.* 9/18-10/16 9,427 412 22% Camp Hancock, Georgia + 9/28-11/4 8,984 499 22% Camp Beauregard, La. + 9/18-10/20 8,551 410 53% Camp MacArthur, Texas + 9/30-11/4 8,354 189 35% Camp Upton, New York* 9/13-11/30 7,921 432 22% Camp Gordon, Georgia* 9/19-10/31 6,689 166 17% Camp Greenleaf, Georgia 9/23-11/26 6,159 325 22% Camp Doniphan, Okla. + (Not given) 5,794 77 (?) Camp McClellan, Ala. + 9/20-11/8 5,445 228 14% Camp Humphreys, Va. 9/13-10/18 5,408 413 16% Camp Sevier, S.C. + 9/20-11/13 5,422 340 16% Camp Greene, N.C. + 9/22-11/4 5,221 269 28% Camp Bowie, Texas + 9/26-11/13 5,212 142 43% Camp Kearny, Calif. + 9/24-12/8 5,188 129 25% Camp Sheridan, Ala. + 9/28-11/4 5,155 145 20% Camp Mills, New York (Not given) 4,978 364 (?) Camp Logan, Texas 9/10-10/30 4,947 111 34% Camp Cody, New Mexico + 9/26-12/12 4,040 240 44% Camp Lewis, Washington* 10/9-10/31 3,851 127 8% Camp Johnston, Florida 9/18-11/1 3,360 165 15% Camp Forrest, Georgia 9/29-11/11 3,170 181 30% Camp Wheeler, Georgia + 9/30-11/29 2,876 140 18% Camp Shelby, Miss. + 8/26-11/10 2,803 48 16% Camp Fremont, Calif. + 10/8 -11/7 2,775 149 16% Camp Syracuse, New York 9/12-10/15 2,761 208 18% Camp Las Casas, R R . 10/20-12/15 2,403 69 16% Jefferson Barracks, Mo. 9/28-11/2 2,392 119 29% Camp Eustis, Virginia 9/25-11/19 2,352 118 8% Camp Wadsworth, S.C. 9/24-11/4 1,883 80 10% Ellington Field, Texas 9/30-10/23 1,205 15 23%

* Represents an Arm y camp that trained drafted soldiers. + Represents an Arm y camp that prepared National Guard soldiers for combat. These camps were greatly reduced in numbers at the time of the influenza epidemic because the N ational Guard divisions were generally out of the country by the summer of 1918. NOTE: These statistics were compiled by the author from United States Surgeon General, The Medical Department of the United States A rm y in the War,; Vols. IV, IX, X V (see footnotes for complete citations).

R131 A1 15 V9 N04 018 INFLUENZA EPIDEMIC OF 1918 19

are the ones that you’d see on the cot in front of the tent the next morning with a shroud over them.u

Doctors and medical staff in military camps throughout the United States became frustrated in their efforts to halt the spread of flu in their own installation and to other posts around the country. The primary problem they faced was a lack of adequate knowledge about the mechanisms of this disease. Influenza itself was not fatal, but it increased a patient’s susceptibility to pneumonia. And at that time, physicians lacked cures for both pneumonia and influenza. Indianapolis physician Harry Becker, M.D., recalled studying the complications of influenza while a medical student: “[The flu] paved the way for bacterial invasion which caused pneumonia. . . . I f a patient did not die he developed [an] infection in his chest so that, perhaps, a lung would be entirely surrounded with pus, and if the pus were not drained, the individual would die. . . ,”12 Advance diagnosis of the disease was virtually impossible. X-rays failed to show the accumulation of pus in the patient’s lung in time to save the patient’s life. William J. Ryan, M. D., of Columbus, Indiana, stated: . . you’d get a picture at night — or afternoon — on a guy, and it didn’t show anything. And you’d get it next morning and his whole lung would be done [filled with fluid]. . . ,”13 The second problem the military faced when dealing with influenza was a severe shortage of doctors, nurses, and support staff to care for the growing numbers of patients. Out of 140,000 American doctors, approximately 40,000 had enlisted in the Arm y and most of these were sent to Europe.14 Likewise, there was a shortage of nurses. Ann Cranston, an Indianapolis resident and nurse at a tuberculosis hospital near New Haven, Connecticut, noted that the normally adequate number of nurses was greatly reduced as the military authorities continued to send nurses to hospitals in England and France.15 A t the height of the influenza epidemic in America, only 221 nurse trainees were on duty in seven canton­ ment hospitals. This meant that there was only one nurse trainee to care for about sixty- eight flu patients, certainly not enough to give proper care to each.16 The mounting death toll from the flu epidemic caused many military camps to stress prevention. Detention or quarantine of flu patients, or suspected flu patients, was the most common precautionary measure. Frank K. Levinson, an Indianapolis native and quarter­ master sergeant at Camp Funston, recalled the fear these detention camps inspired among the soldiers:

They took a culture every morning, in every barracks. They took a little paddle with cotton on it and stuck it in your throat. And your name or [service] number was drawn on this little stick of wood. So, when you came home at night, you were scared to death to look at it to see whether you had to go to a detention camp. They had a detention camp with tents, and had haphazard floors in the tents, and if you were a carrier, you had to go. It was awful!17

Yet, statistics would seem to indicate that isolation did little to reduce the number of influenza cases. Of the ninety-nine camps using detention, fifty-three reported a lower than average incidence of cases, while forty-six indicated a higher than normal total. Twenty-one other camps had no quarantine whatsoever. Of this group, eleven indicated a below average number of cases, while the other ten in the same category were above average.18 Vaccination also was employed to help prevent the spread of flu. A t least two varieties of influenza vaccine were developed and distributed across the land. The first and best publicized one was prepared by Timothy Leary, M.D., of Tufts Medical College.19 The second vaccine was developed by William H. Park, M .D ., of the New York City Department of Health.20 Yet, no matter how effective the flu vaccine was claimed to be, its major contribution was nonmedical in nature. According to one source, both serums did more to

R131 A1 15 V9 N04 019 20 INDIANA MEDICAL HISTORY QUARTERLY

YMCA Hostess Houses often lacked adequate space to house all the wives and mothers of stationed servicemen. Tents (as shown on the right) often were used to accommodate the overflow of vis­ itors. [Thken from War Work B ul­ letin, No. 48 (November 15, 1918), 2.]

“calm nerves” than anything else.21 A truly successful flu vaccine was not developed until the 1950s.22 Another precautionary measure employed in many of the camps was the face mask. Forty-one of the camps used the mask, while seventy-one others did not. Sprays and gargles also were common forms of prophylaxis. Forty-six military installations used sprays or gargled with different solutions containing drugs or chemicals such as quinine, silver nucleinate, dichloramine-T, or arygol.23 Arm y physicians at Camp Sheridan, Ohio, had one company gargle with quinine salts in an attempt to kill off pneumococci presumed to cause fatal pneumonia. The experiment failed, as the company’s mortality rate was higher than any other in the same camp.24 Whereas the results of using preventative measures in United States military camps were mixed, precautionary measures employed in transporting troops to France noticeably reduced the severity of the flu epidemic on the United States troops stationed there. In October, 1918, the total number of men in the American Expeditionary Force was 1,843,000. The total number of reported cases of flu was 43,000, or 2 percent of the total force. Ships that had reached the coast of France with flu patients aboard were forced to remain some distance from the main harbor until the cases were cured, and no further outbreak reported.25 Nonetheless, losses on board ships transporting troops to France were high. Eugene Bailey, a native Hoosier and a member of a Black regiment, recalled that his ship the USS General Grant, was obliged to remain at anchor some distance from Saint-Nazaire, France, for ten days while the sick were cured and the dead buried. Mr. Bailey remembered that the trip to France was a complete nightmare. They lost 156 men from the flu, and these men were buried at sea. Almost everyday, Bailey reported, they “buried three in the morning and three in the afternoon.”26 The major crisis created by the flu epidemic had ended by middle or late December, 1918; and by April of the following year, the numbers of new cases reported in military camps from coast to coast dropped below 1,000 for the first time since August, 1917. (See Table II for reported cases of influenza in military camps from 1917 to 1919.) A worldwide pandemic had ended, leaving an enormous toll of dead and disabled. Mortality figures from all nations exceeded 21,600,000. The United States tallied more than 548,000 deaths resulting from Spanish influenza and its deadly partner, pneumonia. Included in this number were about 25,000 American military men and women, serving both in the United States and abroad.27

R131 A1 15 V9 N04 020 INFLUENZA EPIDEMIC OF 1918 21

TAB LE II

CASES OF INFLUENZA IN THE MILITARY, 1917-1919

U.S. EUROPEAN 1917 CASES CASES

April 858 May 963 June 541 11 July 398 38 August 687 81 September 1,310 139 October 3,488 448 November 6,941 1,503 December 11,990 2,302

1918

January 13,515 1,559 February 9,256 1,071 March 21,124 1,571 April 35,714 2,147 May 10,217 3,884 June 4,617 5,557 July 3,848 4,061 August 3,994 5,954 September 95,754 27,360 October 244,175 42,933 November 21,335 20,590 December 12,178 18,051

1919

January 7,822 12,708 February 2,344 14,979 March 1,545 5,417 April 939 2,159 May 409 891 June 262 271 July 131 162 August 112 60 September 108 38 October 118 32 November 57 17 December 57 138

NOTE: These statistics were compiled by the author from United States Surgeon General, The Medical Department of the United States A rm y in the War, Vols. IV, IX, X V (see footnotes for complete citations).

R131 A1 15 V9 N04 021 22 INDIANA MEDICAL HISTORY QUARTERLY

NOTES

Indiana Historical Commission, Gold Star Honor Roll (Indianapolis, 1921), 242; Hendricks County The Republican, October 8, 1918. 2Harry G. Becker, M .D ., “Influenza: Influenza di freddo — influence of the cold,” Oral History Transcript, n.d. Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. 3Alfred W. Crosby, Jr., Epidem ic and Peace, 1918 (Westport, Connecticut: Greenwood Press, 1976), 5. The first case was thought to be cerebrospinal meningitis and later was diagnosed as influenza. In eighteen days, the total number of flu cases at Camp Devens was listed at 1,176. "•United States Surgeon General, The Medical Department of the United States A rm y in the World War, Vol. IX: Communicable and Other Diseases (Washington, D.C.: U.S. Government Printing Office, 1928), 66. On October 5,1918 the New York Times reported that 104 were killed in action, 64 died of wounds, 4 died by accident in a combat zone, and 15 died of diseases other than influenza and in the combat area. Other statistics included the deaths of 40 officers under fire. The total number of deaths from the combat area numbered 227. Deaths reported as a result of influenza in the United States included 331 for October 3 and 390 for October 4. No influenza statistics could be found for October 5 (Surgeon General, The Medical Department o f the United States A rm y in the World War, Vol. IX, 66). 5Colonel Leonard P. Ayres, The War with Germany: A Statistical Summary (Washington, D.C.: U.S. Government Printing Office, 1919), 126. 6This information was calculated using a composite of admission statistics for influenza by camp found in Surgeon General, The Medical Department o f the United States A rm y in the World War, Vol. IX andVol. XV, Part I: Army Anthropology Statistics (Washington, D.C.: U.S. Government Printing Office, 1921) and Part II: Medical and Casualty Statistics (Washington, D.C.: U.S. Government Printing Office, 1925). 7Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919 (New York: Athe- neum, 1974), 200. 8United States Surgeon General, The Medical Department o f the United States A rm y in the World War, Vol. IV : Activities Concerning Mobilization Camps and Ports of Embarkation (Washington, D.C.: U.S. Government Printing Office, 1928), 70. 9Ayres, The War with Germany, 15,19. The total American force at the end of October numbered 3,433,000 soldiers. Of this total, 1,843,000 were serving with the American Expeditionary Force in Europe (Collier, Plague of the Spanish Lady, 72, 74). “ Surgeon General, The Medical Department of the United States A rm y in the World War, Vol. IV, 70. •■Howard Thylor, interview by Wayne L. Sanford, Military History Section, Indiana Historical Society, April 5, 1982, transcript in the Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. “ Harry G. Becker, M.D., interview by William Carnes for the Military History Section, Indiana Historical Society, December, 1979, transcript in the Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. “ William J. Ryan, M.D., interview by Wayne L. Sanford, Military History Section, Indiana Historical Society, August 17, 1982, transcript in the Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. •“•Collier, Plague o f the Spanish Lady, 44. “ Mrs. Ann Cranston, interview by Wayne L. Sanford, Military History Section, Indiana Historical Society, March 12,1982, transcript in the Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. “ Collier, Plague of the Spanish Lady, 44. “ Frank K. Levinson, interview by Wayne L. Sanford, Military History Section, Indiana Historical Society, February 19,1982, transcript in the Manuscript Collection of the Indiana Historical Society, Indianapolis, Indiana. “ Surgeon General, The Medical Department of the United States A rm y in the World War, Vol. IX , 116-117. “ Crosby, Epidem ic and Peace, 100. 20New York Times, October 2,1918. 21Crosby, Epidem ic and Peace, 84. 22June E. Osborn and J. Donald Miller, “Precursors of the Scientific Decision-Making Process Leading to the 1976 National Immunization Campaign,” in History, Science, and Politics: Influenza in America, 1918-1976, edited by June E. Osborn (New York: PRODIST, 1977),'18-19. ^Surgeon General, The Medical Department of the United States A rm y in the World War, Vol. IV, 118-121. ^Collier, Plague of the Spanish Lady, 155. Of all the camps, sixty-six did not use any form of preventive measures (Surgeon General, The Medical Department of the United States A rm y in the World War, Vol. IV, 118-121). ^A yres, The War with Germany, 15; Surgeon General, The Medical Department of the United States Arm y in the World War, Vol. XV, Parts I and II. 26Eugene B. Bailey, interview by Wayne L. Sanford, Military History Section, Indiana Historical Society, May 19,1982, transcript in the Manuscript Collection, Indiana Historical Society, Indianapolis, Indiana. 27Collier, Plague of the Spanish Lady, 305; Surgeon General, The Medical Department o f the United States A rm y in the World War, Vol. IX , 69.

R131 A1 15 V9 N04 022 23

“I DON’T KNOW ONLY WHAT WE HEAR”:1 THE SOLDIERS’ VIEW OF THE 1918 INFLUENZA EPIDEMIC

Marybelle Burch*

“Where do we go from here, boys?” ran a popular World War I song, “Where do we go from here?” To servicemen quarantined in military camps in the United States during the Spanish influenza epidemic, the answer was “nowhere.” They had expected to fight a war in Europe but instead were fighting influenza in Ohio or Illinois. The disease killed thousands of the men and left others in a weakened condition unsuited for military service. Even those who escaped influenza could not escape its disruptive effects on military life. “ It begins with a high fever,” wrote Harney Stover, a sailor at the Great Lakes Naval Training Station in Illinois,2 “It affects most men pretty hard for the first few hours. They turn ashen gray and usually faint.”3 The symptoms of Spanish influenza were to become dreadfully commonplace in the next few months, but when Stover wrote on September 16, 1918, the disease had just struck the huge Great Lakes station. Stover observed that the disease itself was not serious, but “it leaves everyone in a condition to take pneumonia. ” Ray C. Morrison, also at Great Lakes, was of the same opinion: “The disease is nothing more than the Spanish Gripp [sic] or a bad cold unless it runs into pneumonia but most of the fellows it does not effect [sic] bad at all.”4 Stover, afraid that his family would worry, gave the reassurance that, “At the rate it is spreading, everyone will have had it and be well in a week.”5 Everyone was not well in a week, but it did seem that everyone would catch influenza. The disease spread so incredibly fast that soon barracks were being converted into hospitals for the less serious cases. H. L. Morris at Great Lakes estimated that half of the barracks in his camp had been converted into temporary hospitals. The men were not taken to the main hospital until they became seriously ill.6 Treatment at the Great Lakes station was described by Harney Stover: “They take the sick ones put them in hospital cots and put all wool bed clothing on, even helmets,7 and let them sweat.”8 H. L. Morris estimated that, “At one time we had 10,000 cases here in the whole [Great Lakes] station.”9 Hospital duty was assigned to the men much as K .R duty. Hazardous work, it would seem; but, according to Norris McHenry, the orderlies never caught influenza. A t Inter­ laken, near Rolling Prairie, Indiana: “They used the masks when waiting on the patients. Looks strange that the mask would do it but it surely did. Of course they watched themselves, too.”10 Whether they caught the flu or not, the orderlies were still in an uncomfortable situation. Harry Carman caught influenza within a few days of entering the Franklin College Student Arm y Training Corps and then took pneumonia. Through it all, a man named Nelson was his orderly. When Harry Carman died on October 17, Nelson, at the request of Carman’s parents, became one of the pall bearers.11 Another Nelson, this one stationed at Winona Lake, was sorry to hear of Harry Carman’s death, and commented: “When you get in the army, life doesn’t amount to very much.”12 The numbers of dead, like the numbers of cases, were so large as to be mean­ ingless. Influenza “sure picked lots of the boys off here, from 150 to 200 every day for two weeks,”13 wrote Walter Lemmon on October 8th. When he wrote again on October 11, the situation had improved; there had been only thirty deaths the day before.14 By contrast, the spinal meningitis epidemic at Great Lakes in the winter of 1917 had killed fifteen men in one day.15 Before the Spanish influenza epidemic, that number had seemed incredible.

*Marybelle Burch is Manuscripts Librarian, Indiana Division, Indiana State Library.

R131 A1 15 V9 N04 023 24 INDIANA MEDICAL HISTORY QUARTERLY

On October 3, Harney Stover walked past the morgue at Great Lakes: “One whole side of the yard was piled 6 ft. high with caskets. We looked at the names on the end but didn’t recognize any. There were several Indiana men.”16 It was easier to understand the situation if one counted the deaths of friends or acquaintances. One of the men in Stover’s company returned from the hospital after having pneumonia. While there he had seen two other men from their company die.17 Influenza victims like Dave Boyer took a special view of death: “I sure was lucky to get off as easy as I did . . . 95 bodies at one time was in an undertaking place at Rockford.”18 Boyer faced a long convalescence. He had been out of the hospital for six days and was still very weak. He had heard a rumor that the convalescents might be sent home as soon as the quarantine was lifted: “I certainly do hope it’s true . . . for the way I feel now I can’t get home any too soon.”19 Another Indiana soldier felt the same way. Walter Lemmon thought he could get well much faster if he were back home in Harrison County. Confined to barracks, too weak to stand more than ten minutes on the drill field, hardly able to hold a pen in his hand (“This writing looks like the deavil [sic]”),20 he wanted to be back home or back on the job. He hoped to be made a corporal, “after I get able to go out and make a full hand for Uncle Sam.”21 About a month after falling ill, Lemmon announced that he was feeling “fine and dandy.”22 In November, he was sent to Camp MacArthur, Texas. It wasn’t home, but at least it was warm. “The flu is quite a nice thing not to have in my estimation,”23 wrote Chester Spurling, who had just recovered from it and was thus in a good position to judge. Trying “not to have” influenza was a complicated matter, unpleasant, even dangerous, in itself. The military employed a wide variety of preventative measures. One form of prevention was vaccination. Vaccinations were advocated and sometimes compulsory, but they caused two kinds of side effects. The first was pain and swelling in the vaccinated arm. Norris McHenry of the Valparaiso University S. A.T.C. noted: “Some of the boys have terrible looking arms caused by the vaccination. One fellow said his was 15 inches around once. That is pretty big but his arm looked bad allright.”24 McHenry’s arm had not bothered him, but despite the lack of pain, he believed the vaccination had “taken.”25 The second type of side effect was illness following vaccination. It was so common, in fact, that Francis Derthick at Great Lakes, who did not become ill following vaccination, thought it worth writing home about:

I have had two shots and neither one has put me under. There are three of us who have not been made sick by the shots. The rest of the fellows are hoping that the third shot will get us so we won’t have anything on them.26

Lloyd A. Glick resisted the blandishments of a hospital orderly at the Franklin College S. A.T.C. and refused to take a series of four inoculations. Some of the Franklin doctors had had said the vaccine was worthless and the Franklin Evening Republican had printed an article to the same effect. Glick added: “ I have been afraid of taking it, because our Regimental First Sergeant went under when he took the second shot. He is in the hospital now.”27 Harney Stover put his faith in a nameless nose and throat spray which he called “iodine solution” because: “They miss your mouth sometimes and it stains your face just as iodine.”28 He described it as “awful-tasting stuff,” but returned for a “shot” every three hours.29 Less enthusiastic was Charles Streitelmeier who had “some kind of medicine” put up his nose twice a day; [It] tastes bad and smells worse,” he complained.30 Influenza had arrived at Great Lakes during a cold snap while the men were still in

R131 A1 15 V9 N04 024 I DON’T KNOW ONLY WHAT WE HEAR 25

summer clothing and before the heat had been turned on in the barracks. As quickly as possible, the heat was turned on, and the men were given winter clothing. Immediately, the weather turned warmer. The men were still required to wear their overcoats buttoned up around the neck. “They are too hot,” wrote Harney Stover, “but I guess the doctors know what they are talking about.”31 Sleeveless sweaters knitted by the Red Cross were dis­ tributed, and the doctors recommended that the men wear wool wristlets and helmets as well.32 The doctors wanted the men kept in steam-heated barracks, or “every one would die of pneumonia and this epidemic would never be stopped. ”33 The men and the barracks were insufferably hot and uncomfortable, but since the number of influenza cases went down as the temperature went up, the point seemed inarguable. Another means of preventing influenza was to keep the men from congregating. To this end, Y.M .C.A.s were closed, and canteens were allowed to serve only a few men at a time. When church services were reinstituted at Charleston, South Carolina, the men were required to sit in the open, three feet apart.34 In the barracks, men slept head-to-toe so their heads would not be so close together.35 To keep them from congregating in the barracks during the day, the men were required to perform healthful but pointless outdoor work, such as moving a huge pile of kindling from one end of a field to the other. The men entered into the true spirit and played games instead.36 Of all the means of separating the ill from the well and the well from each other, quarantine was the most unpopular with the men. Even when the camps had been places of intense and purposeful activity, the men had been anxious to get away for a few hours’ leave. Now that the camps had assumed a forbidding hospital atmosphere, the desire to get away was stronger than ever. For the first week or so, the men accepted the quarantine and made plans for enjoying leave when quarantine was lifted. Harney Stover wrote, on September 19:

There is a complaint from Milwaukee and Chicago that influenza is being brought there from here. . . . One of our fellows left on shore leave last Saturday and was not heard of until today. They were getting ready to charge him with desertion. He was located in a Chicago hospital very bad sick with the Influenza.37

By September 30, Stover’s mood had changed. Liberty had been resumed, and he had borrowed enough money to go to Chicago. Then the mayor of Waukegan, the town nearest the base, had requested that quarantine be continued another nine days. Captain Moffett, Great Lakes’ Commander, complied with the request. The railroad station at Waukegan was off-limits, so the men could not go to Chicago. The men were furious: “When we get liberty once more the Mayor of Waukegan is going to have his darn little town run off the map and get tar and fethered [sic] himself.”38 By October 6, Stover was more philosophical: “Perhaps we may get liberty next Sunday. I f we don’t it will be because the people of Chicago don’t want Influenza spread.”39 The disease which had been regarded as “nothing more than a bad cold” was now recognized as a real danger to civilians. Dave Boyer, an influenza victim, warned his mother: “I f any of you take it back there for heaven’s sake take care and don’t take pneumonia.”40 Walter Lemmon knew it was useless to send advice to a relative with influenza, but did send sympathy: “ I know what the flu does for a fellow. Tell him that I can feel for him but I cannot reach him.”41 Because the soldiers were quarantined, and, therefore, unable to care for relatives sick at home, it seemed unnecessary to burden them with yet another worry.42 Although there were at least four cases of influenza in the Daniel Stover’s family, he was not told of them. H e wrote from France: “The flu must have been horrible in some places at home. But you people seldom mention it. I don’t know whether you had it or have it coming or, like me, are going to get by.”43 Daniel Stover was equally unaware of the problems faced by the quarantined serv­

R131 A1 15 V9 N04 025 26 INDIANA MEDICAL HISTORY QUARTERLY

iceman. Writing to Harney Stover’s father, he said: “I am pleased with Harney’s getting in the Navy. I f you could see these fellows here [in France] you would be happy. It seems as though they are all perfectly satisfied . . . .”44 Harney was anything but satisfied. He was bored, scared, disappointed, depressed, and he felt that his training at Great Lakes had been for nothing. He wanted a chance to prove himself, but, as the quarantine dragged on, he realized that he would never be given that chance.45 The Armistice was not far off, and one of the most popular forms of entertainment in camp was to start a rumor that the war was over and then watch the results. Harney Stover describes one of these premature celebrations:

The whole station went wild. In the next regiment, they tore the doors out of 2 barracks trying to get out. Every one collected on the parade field and it was almost an hour before the Provost Guards could make everybody get back in their barracks.48

The men could be forgiven, for they had little else to do. “ It sure looks foolish to see so many of us loafing around here and the people at home working their heads off. When I get to thinking about such things I get mad . . .,”47 wrote Harry Thompson at Camp Sheridan, Alabama. Soldiers at Camp Lewis, Washington, spent some of their abundant spare time sewing gauze masks to the amusement of the female sewing instructors. “A cowboy from Montana,” “a moving picture actor,” and “the son of one of our wealthiest American families,” all plied their needles and were “surprisingly dexterous.”48 When quarantines were eventually lifted, some of the men, Harney Stover among them, finally went to Europe. They saw where the fighting had been, even if they never saw the fighting. They were luckier than a soldier who signed himself only as “Carl H.,” and whose near anonymity makes him an appropriate spokesman for thousands of men who felt they had not done their part, although they had done their best:

It looks like Camp Custer and a buck private will be as near the firing line as C.H. will ever get. Guess I will have a picture taken so the boys from France will know I had on a uniform at least. Things would probably [have] been different if it hadn’t been for the “flu”. . . . Well, as the Arm y teaches — “never worry or complain.”49

NOTES

W alter Lemmon, a soldier at Camp Grant, near Rockford, Illinois, recognized that most of the “information” in his letters was untrustworthy: “ I don’t know only what we hear,” he wrote “and that is sometimes a plenty and nothing to it.” (Walter Lemmon to his mother, October 8,1918, Walter Lemmon Papers, Indiana State Library, Indianapolis, Indiana). Lemmon’s caveat applies to most of the information in this paper. 2The Great Lakes Naval Training Station, thirty-three miles north of Chicago, consisted of eleven camps: Barry, Decatur, Dewey, Farragut, Lawrence, Logan Rifle Range, Luce, Paul Jones, Perry, Ross (which was taken over in September, 1918, to house influenza victims) and Instruction Camp. In addition, several schools were established there. For more information, see The War-Time Organization of Illinois (Illinois State Historical Library, War Records Section, 1923), 138-143. For convenience, all camps and schools are referred to as “Great Lakes,” which was also the custom among the men stationed there. 3Hamey Stover, Great Lakes, Illinois, to his mother, September 17,1918, Urban Stover Papers, Indiana State Library, Indianapolis, Indiana. 4Ray C. Morrison, Great Lakes, Illinois, t o ______, September 20,1918, World War I Letters — Bartholomew County, Indiana State Library, Indianapolis, Indiana. These letters are transcriptions made by the women of Bartholomew County as a memorial to the county’s soliders. Some of the letters lack dates, names, and locations. “Harney Stover, Great Lakes, Illinois, to his mother, September 16,1918, Stover Papers. 6H. L. Morris, Great Lakes, Illinois, to Daniel Griffin, October 16,1918, Porter-Griffin Papers, Indiana State Library, Indianapolis, Indiana. 7These “helmets” were of knitted wool. 8Hamey Stover, Great Lakes, Illinois, to his mother, September 16, 1918, Stover Papers.

R131 A1 15 V9 N04 026 I DON’T KNOW ONLY WHAT WE HEAR’ 27

9H. L. Morris, Great Lakes, Illinois, to Daniel Griffin, October 16, 1918, Porter-Griffin Papers. The official number of cases treated at Great Lakes was 2,484. (The War-Time Organization of Illinois , 139), Harney Stover doubted the honesty of the official statistics being given by Captain Moffett, the Commander of Great Lakes (Harney Stover to Urban Stover, September 29,1918, Stover Papers). 10Norris McHenry, Valparaiso University Students’ Arm y Training Center, t o ______, November 24, 1918, World War I Letters — Bartholomew County. llLloyd A. Glick, Franklin College S.A.T.C. to ______, October 17, 1918, World War I Letters, Bartholomew County. ^ “Nelson,” Winona Lake, Indiana, to Dorothy Cottle, October 19,1918, World War I Letters — Bartholomew County. Nelson was training for hazardous duty— driving a supply truck to the front lines — and set his chances of getting killed at three to one. This accounts for some of his pessimism. 13Walter Lemmon, Camp Grant, Illinois, to his parents, October 18, 1918, Lemmon Papers. The number of influenza cases at Camp Grant in 1918 was 10,369 and the number of deaths was 911 (The War-Time Organization of Illinois, 119). 14Walter Lemmon, Camp Grant, Illinois, to his parents, October 11,1918, Lemmon Papers. 15Harney Stover, Great Lakes, Illinois, to his mother, September 12, 1918. Stover Papers. 16Harney Stover, Great Lakes, Illinois, to Urban Stover, October 3, 1918, Stover Papers. i Vbid. 18Dave Boyer, Camp Grant, Illinois, to his mother, October 3, 1918, World War I Letters — Bartholomew County. 19Ibid. 20Walter Lemmon, Camp Grant, Illinois, to his family, October 8, 1918, Lemmon Papers. 21Ibid. ^W alter Lemmon to his family, October 24,1918. Walter Lemmon Papers. 23Chester Spurling to “Dear Schoolmate,” January 2,1919, World War I Letters — Bartholomew County. ^Norris McHenry, Valparaiso University S.A.T.C. t o ______, October 17, 1918, World War I Letters — Bartholomew County. ■x>Ibid. 26Francis Derthick, Great Lakes, Illinois, to Urban Stover, 1918. Stover Papers. 27Lloyd A. Glick, Franklin College S.A.T.C. t o ______, October 17, 1918, World War I Letters — Bartholomew County. ^H arney Stover, Great Lakes, Illinois, to his mother, September 16,1918, Stover Papers. z>Ibid. 30Charles Streitelmeier (location unknown) t o ______, October 4, 1918, World War I Letters — Bartholomew County. 31Harney Stover, Great Lakes, Illinois, to Urban Stover, September 23, 1918, Stover Papers. 32Harney Stover, Great Lakes, Illinois, to Urban Stover, September 21,1918, Stover Papers. ™lbid. ^ “Jack,” Charleston, South Carolina, to Maude Smith, October 18, 1918, World War I Letters. Bartholomew County. 35Ham ey Stover, Great Lakes, Illinois, to Urban Stover, October 6, 1918, Stover Papers. 36Harney Stover, Great Lakes, Illinois, to Urban Stover, October 24, 1918, Stover Papers. 37Harney Stover, Great Lakes, Illinois to Urban Stover, September 19, 1918, Stover Papers. 38Harney Stover, Great Lakes, Illinois, to Urban Stover, September 30, 1918, Stover Papers. 39Harney Stover, Great Lakes, Illinois, to Urban Stover, October 6, 1918, Stover Papers. 40Dave Boyer, Camp Grant, Illinois, to his mother, October 3, 1918, World War I Letters — Bartholomew County. 41Walter Lemmon, Camp Grant, Illinois, to his mother, October 11, 1918, Lemmon Papers. 42Fanny Stover to Urban Stover, December 7,1918, Stover Papers. •^Daniel Stover, stationed in France (location unknown) to Urban Stover, December 1, 1918, Stover Papers. 44Daniel Stover, “Somewhere in France,” to Urban Stover, September 26, 1918, Stover Papers. 45Harney Stover was observant and candid. His feelings about the long quarantine are recorded in his letters of September 16, 1918 to October 16, 1918, during which period he sometimes wrote two letters per day (Stover Papers). 46Harney Stover, Great Lakes, Illinois, to Urban Stover, October 7, 1918, Stover Papers. 47Harry Thompson, Camp Sheridan, Alabama, to Glenna McHenry, October 18,1918, World War I Letters — Bartholomew County 48War Work Bulletin (November 15, 1918), 2. 49Carl H., Camp Custer, Michigan, to his cousin, no date, World War I Letters — Bartholomew County.

R131 A1 15 V9 N04 027 28 INDIANA MEDICAL HISTORY QUARTERLY

NEWS AND NOTES

This issue marks the last number of the Indiana Medical History Quarterly. In 1984, the Indiana Historical Society’s Medical History Committee will begin an occasional pub­ lications series in Indiana medical history. The first work in the series will be an exhibit catalog to accompany an exhibit on early Indiana medicine. The exhibit, entitled “Medicine in Antebellum Indiana: Conflict, Conservatism, and Change,” will open at the Society on March 12,1984, and run through June 30,1984. The Society also plans to publish the edited journals of Richmond surgeon William A. Lindsay (1795-1876). To keep members informed of events in medical history at both the Indiana Historical Society and the Indiana Medical History Museum, the Society and the Museum will publish a joint newsletter two or three times a year.

A ll those receiving the publications of the Indiana Medical History Committee are invited to attend a special exhibit opening to be held at the Indiana Historical Society on Friday, March 23, 1984, from 4 p.m. until 7 p.m. Those attending the opening will have an opportunity to meet and talk with Madge E. Palmer (formerly Madge E. Pickard), co­ author with the late R. Carlyle Buley of The Midwest Pioneer: His Ills, Cures, and Doctors (New York, 1946). More details about the opening and the exhibit will be forthcoming in the Medical History Committee’s newsletter. IndianaMedical History Quarterly ninpls I 46202 INIndianapolis, WestOhioStreet 315 Indiana Historical Society Permit No. 3864 Indianapolis, IN NonprofitOrg. . . PostageU. S. PAID

R131 A1 15 V9 N04 028