University of North Carolina at Asheville

 

 

 

 

 

 

 

A Community, A Permanent Asylum, A Refuge, and A Home –

 

Broughton Hospital; Morganton, North Carolina

 

1883-1891

 

 

 

 

 

 

 

 

A Senior Thesis Submitted

To the Department of History

In Candidacy for the Degree of

Bachelors of Arts in History

 

 

 

 

 

 

 

By

Megan Norman

 

 

 

 

 

 

 

 

Asheville, North Carolina

November 22, 2005

 

            It was not until 1848, when Dorothea Lynde Dix came to North Carolina, that interest in institutionalizing the mentally ill developed.[1]  North Carolina was the only one of the original thirteen colonies without state care for the mentally ill, and Miss Dix would set about to correct this situation.[2]  North Carolina’s first mental institution at Raleigh opened in 1856.[3]  It was known as the North Carolina Insane Asylum and it served the white population of the entire state for well over twenty years.[4]  When the first state hospital became overcrowded, it became necessary to establish another.  The establishment of a second hospital, Broughton Hospital, first known as the Western North Carolina Insane Asylum, admitted its first patient, who, incidentally, was a medical doctor, on March 29, 1883.[5]  The first female patient, the wife of a school teacher, was admitted two months later.[6]  Although Broughton Hospital was the second mental hospital provided for by the General Assembly, another hospital had actually opened prior to 1883.[7]  This hospital, located in Goldsboro and called the Eastern North Carolina Insane Asylum, was for colored patients.[8]  Broughton Hospital, the first mental institution in Western North Carolina, was founded in 1883 due to an urgent demand to house the insane of the Western District who before then had lived in jails and poor houses.  Although modern studies suggest that “overall rates of psychiatric disorder are almost identical for men and women,” from the beginning Broughton Hospital residents were disproportionally female.[9]  These women, who did not conform to the middle class standards of female respectability in society, were defined as helpless victims or as troubled women who could not handle the pressures of life, and required strict supervision and control by the state.[10] 

            From the beginning, the hospital treated gender as a significant factor – from the spatial layout of the grounds to the kind of supervision and activities provided for male and female patients.  These differences tended to reinforce the cultural assumption that women in particular needed to be taken care of.  This notion was also evident in the fact that women generally remained hospitalized for longer periods than men, and that they were more likely to be admitted after shorter illnesses, for less serious causes, and during their childbearing years.  In addition, the reasons given at the time for admission often seemed to reflect an inability to handle ordinary pressures of life. 

 

I. Background.

            Samuel Sloan of Philadelphia was hired as the architect.[11]  The hospital was built of brick using the Kirkbride plan; this plan was used in constructing many of the mental hospitals throughout the United States.[12]  The linear arrangement consisted of a center section for administrative and other activities, with wings for patients extending on each side.[13]  Broughton Hospital’s original building in 1883 consisted of the administrative building with three wings.  The South wing contained ten wards for female patients while the North wing contained ten wards for male patients.[14]  Apparently Sloan and the builders expected the hospital to treat equal numbers of men and women.  The third wing in the rear of the main building housed the boiler room and the kitchen.[15]  The wards themselves were fairly self-contained.  Most patients would have single rooms.[16]  Broughton Hospital has around 100 acres of land that allowed space for farming and gardening.  Thirty to fifty acres around the main buildings were used as pleasure grounds with a separate area for men and women.[17]  Separation of genders could have meant that the women needed protection from the men.  The size of the patient population was an important factor in developing the Kirkbride buildings.  In the 1880s and 1890s, when several new hospitals were opened, they were built on the cottage plan of detached quarters for patients and centralized dining areas.[18] 

            On December 7, 1882 Doctor Patrick Livingston Murphy was selected as the first superintendent of The Western North Carolina Insane Asylum.[19]  Murphy was chosen by the Board of Directors to continue to build there, organize a staff – medical and lay – and direct the work of caring for the mentally ill.[20]  Murphy advocated freeing the ill from shackles and like Kirkbride, whose plan was used to build the hospital, he advocated activity, fresh air, and recreation.[21]  He fought against overcrowding and pushed for the cottage plan to provide extra space for the ill.  Murphy also advocated the colony system which was already being practiced in many states at the time he took office.[22]  The original colony plan required the acquisition of a large tract of land in a farming community near the main institution, the erection of suitable cottages, each not exceeding a capacity of thirty patients, a residence for the physician, a chapel, an amusement hall, and all the other small farm out-buildings.[23]  The main purpose of the colony system was to have a place where all the healthy, able-bodied chronic cases might be trained in pursuits that were healthy, educative to the patient and remunerative to the institution.  Henry Hurd and his co-authors of The Institutional Care of the Insane in the United States and Canada, spoke highly of Doctor Murphy, saying, “He had great success in the management of this institution, and developed it into a hospital in name as well as in fact, when through his influence the name of state institutions for the insane was changed from asylum to hospital.”[24]

            Doctor Murphy married Bettie Waddell Bumgardner in 1878.  Bettie Murphy was loved by all of the patients and was constantly doing acts of kindness for them; for this they adored her.[25]  The Murphys had four children whom they raised while living at Broughton Hospital.[26]  Young people from here and there were often guests of the Murphys.  The medical staff also thought highly of the Murphys.  In appreciation of Mrs. P.L. Murphy, J.K. Hall said, “No other State Hospital, I can easily believe, was ever so blessed with so little of the institutional and by so much that was a reminder of home.  We were a big family; some of us, perhaps not altogether mentally well, but all of us in one big home, and all of us loved and tenderly cared for and ministered to by Dr. Murphy and Mrs. Murphy.”[27]  The Murphys treated the sick, the well, the black, and the white all the same. 

            Broughton Hospital began using the colony treatment in 1903 to employ the insane and other defectives on a farm as a way to treat and care for their needs.[28]  The colony treatment meant “the erection of buildings some distance from the central hospital plant and placing farm working patients there, to be under the control and management of the hospital officers.”[29]  The first building was built for thirty men with enough room to house their families.  The man would supervise the place while the wife would cook and do other household work.[30]  In some cases, if one parent was insane the whole family would move to the colony and assume duties alongside the insane member to keep the family unit together.[31]  The colony buildings, outhouses, and surroundings were built as closely together as possible to give the Morganton colony patients a home-like experience.[32]  Doctor Frederick Peterson, of New York, in an address before the Medico-Psychological Association said, “We do not have an institution after all, not a corridored agglomeration of huge pavilions, not a palatial barrack for hundreds of patients of all classes, but a farming hamlet, a village community, if you please.”[33]

            During early experiments, the first patients sent to the colony were fifteen men who were expected to be the nucleus of the organization.[34]  When the first fifteen became accustomed to the colony and the hospital saw that this type of treatment was successful, they would bring in fifteen more patients.  Doctor Peterson said, “Healthful outdoor exercise on the farm has been found to be the best treatment as well as the most remunerative.”[35]  These men gained in health and self-confidence, and became happier because they felt like there was still something left for them in life.[36]  The male patients were employed for work in whitewashing, painting, hauling wood to the kitchen, working in the fields, or tending to the farm animals.[37] 

            The women patients were employed to work in housekeeping and in caring for the flower beds and lawns.  They also did all the laundry work for the colony along with their personal laundry, made most of their clothing, and in certain seasons picked fruits and vegetables.[38]  Doctor Murphy once said, “I have kept all who were able to work steadily employed…Anything that takes and keeps the mind from self goes a long way towards restoration certainly towards amelioration of their suffering.”[39]  One female patient, who recovered, wrote Doctor Murphy after going home and suggested that there was not enough work for women; they often got together to gossip due to the lack of work.[40]  Doctor Murphy replied to her and said:

            We have never had any outdoor work for our women for fear of elopement and the dangers pertaining to the sex when not under observation; but it would be           

            desirable to have light work, such as gardening, gather vegetables and such other employment as suits their sex and former condition to life.[41]

The female patient further suggested that there should be some sort of work supplied to them, such as sewing, spinning, making mats, gardening or raising poultry.  This principle was the same as the men’s: if the hospital kept the women busy it was easy for them to forget about their ailments and to renew their interest in life.[42] 

            Recreation was also a part of the colony treatment.  During their free time men were allowed to smoke, play games, read or do what pleased them.[43]  The male patients would often play baseball.[44]  The women patients might choose to take a class in basketry, sewing, or embroidery under the instruction of a teacher.[45]  In addition, the women were allowed amusements that suited their individual tastes; reading, music, in fact, anything that was agreeable and pleasant was allowed.[46]  Most of the time the male patients participated in outdoor recreational activities, while the female patients participated in classes held indoors.  It seems like the hospital supervised the women’s activities more closely than the men’s. 

 

II. Treating and Caring for the Female and Male Patients.

            According to the bylaws, the Superintendent had to visit all patients daily, learn their condition, and direct such medical, moral and physical treatment as he saw fit, so that the patients might be comfortable.[47]  There was one Assistant Physician in charge of the male departments and another Assistant Physician in charge of the female departments.[48]  The Superintendent and the Assistant Physicians had access to all the wards and departments of the Asylum.  No other male officer was allowed to enter any of the female wards or departments without the permission of the Superintendent or the Assistant Physician in charge of the ward; if allowed entrance he had to be accompanied by the Matron or the female assistant.[49]  Likewise, no female officer was allowed to enter any of the male wards or departments without the permission of the Superintendent or the Assistant Physician in charge of the ward, and if allowed to enter had to be accompanied by the Steward or the male assistant.[50]  The Steward had to assist the Superintendent as the Secretary; his duties included keeping an account of all purchases and keeping up the books, maintaining the police of the establishment, and he was in charge of the grounds.[51]  On the other hand, the Matron had the duty of looking after the female patients, had to be with them as much as possible, saw that they were being treated kindly, that their food was being properly distributed, and that the female attendants were doing their duties.[52]  The board of directors state that:

            She must supervise the kitchen, the cooking, the washing and ironing, the dairy and soap-house, and take care of the clothes and bedding of both sexes, and see that they

            are always clean and in order, keep a record of the clothing of patients when they enter and during their continuance in the Asylum, and watchfully superintend the bathing

            of the female patients.[53] 

The Watchman had to go on duty at sundown.  He had to pass around all of the buildings at least every hour in the night, and take particular care over the female apartments occupied by the female patients.[54]  Women were not only closely supervised while participating in leisure activities, but also at night.  The bylaws show that there was only one prominent female position that women were allowed to hold in the hospital – the matron; all of the other important jobs such as the superintendent and physician went to males.  The matron was a vital position that the hospital needed for every day routines to take place. 

 

III. Key Differences between Female and Male Treatment.

            At first, from 1883 to 1891, there were slightly more females (1,764) undergoing treatment than males (1,693) undergoing treatment.  This began a small trend of more females than males being treated at Broughton Hospital because they could not handle the ordinary pressures of life.[55]  This trend may have been small because the hospital had not been open long enough to have time to bring in female patients who needed to stay for extended periods of time to recover, unlike males who were treated and released fairly rapidly.  In 1896, twelve years after the hospital opened, it became necessary to refuse admission to fifty-four women, all of whom needed the care of the hospital.[56]  An effort was made to learn how many women in the Western District needed hospital care.  Out of fifty-two counties, seventy-five cases existed for whom application had not yet been made.[57]   The Superintendent stated, “The names of not less than two hundred persons can be called, most of whom should have the benefit of hospital care and treatment.  Of this number, about two-thirds are women.”[58]  Even after a cottage for women was built in 1897, which accommodated seventy-five, the hospital still had to turn patients away for lack of space.  Then in 1899, the hospital reported to the Board of Charities that 332 males and 451 females had been admitted and were currently being treated.[59]  The board of public charities said in their quarterly report:

             The department for women is full, and all cases of whatever nature are refused admission for this reason.  The ward set apart for the acute and disturbed class of

             women has such a large number of the noisy chronic cases with the acute that the efficiency of this most important department is ruined, and the patients who have

             a fair chance for recovery under favorable circumstances have their chances greatly impaired, if not destroyed, by the presence of the chronics.[60] 

            There were even several cases documented where men and women would write to the hospital and ask, almost beg, for their wife or daughter to be admitted into the hospital.  One man wrote the superintendent saying, “My wife is insane, and has been in a worse condition than ever before for the last ten days.  It is impossible for me to keep her at home, as I did three years ago.  I can’t get any rest, day nor night.  No one will stay with her.  I am up whole nights without a minute’s rest.  Please let me know if there is room for her.”[61]  Another woman wrote and said, “My daughter is badly insane.  I have to keep her confined, and I am a widow and have not the means to take care of her as she could be cared for.  I would be glad if you would take her in the Asylum if you possibly can.  Please write and let me know at once.”[62]  But what could the Superintendent do?  He knew that admitting more people would cause crowded wards that would only mean more injury for the patients already entrusted to his guardianship and probably not be a benefit to the new patients either.[63]  David Mechanic spoke about environmental factors that promote effective hospitalization recommending, “No state hospitals of more than 1,000 beds…should be increased beyond that size because large and impersonal institutional environments cannot provide the individualized attention and environmental atmosphere necessary to overcome institutionalism and to promote the ordinary patient’s competence and initiative.”[64]

            The ledger books that I obtained this information came from the Broughton Hospital Archives collection.  The ledger books do not include an author’s name, but they were written by someone who worked in the Administration of the hospital.   The reason I am concentrating on the data for the years 1883-1891 is that for those eight years the staff at the hospital created tables specifically in the back of the first eight ledger books that consolidated the facts for each year into six or seven tables per book.  The categories include tables that showed 1) the movement of patients for the year, 2) the ages of those admitted and of those discharged for the year, 3) the duration of insanity before admission of those admitted and discharged for the year, 4) the alleged cause of disease of those admitted for the year, 5) the cause of deaths for the year, 6) the social relation of those admitted for the year, and sometimes the residence of those admitted for the year.  These tables have allowed me to establish major trends at Broughton and have helped me to show the reader why women particularly demanded admission and treatment during certain years. 

            During the first year that Broughton Hospital was open, from November 30th 1883 to November 30th of the following year, the movement of patients was charted.  Each ledger book lists the number admitted, the discharged removed, the discharged improved, the discharged not improved, the total dead, and the total removed.  The movement for females and males may give us a better understanding of why women especially and also men required custodial care at the time.  In 1883-1884, there were thirty-nine females admitted and thirty-two males.[65]  Although the gap between admitted female patients to admitted male patients started off significantly low, the numbers would increase in the years to come.  The following year 1884 to 1885, there were a total of 182 patients under treatment.[66]  The total number of patients undergoing treatment increased significantly from the first year.  The number of males undergoing treatment from 1884-1886 remained the same.[67]  The number of patients admitted during the year 1885-1886, doubled for females from forty-nine to eighty-nine and almost tripled for males from thirty-seven to eighty-five males.[68]  From the year 1886-1887, the number of patients admitted decreased from eighty-nine to sixty-one females and eighty-five to sixty-five males.[69]  The hospital admitted four more males than females from November 30, 1886 to November 30, 1887, but the hospital still had more females currently undergoing treatment than males.[70] 

            The number of patients admitted during the year 1887-1888 increased from sixty-one to seventy-five females and sixty-five to eighty males.[71]  While the number of admitted females and males both increased, more males were admitted for the year, but females still led the way for the number already undergoing treatment in the asylum.  During the year 1888-1889, the number of patients admitted decreased again from seventy-five to seventy-three females and eighty to sixty-six males.[72]  The number of patients admitted during the year 1889-1890 decreased for females from seventy-three to sixty-nine, but increased for males from sixty-six to eighty males.[73]  More males than females were discharged from Broughton the same year.  Finally from 1890-1891, the number of patients admitted during the year decreased for females from sixty-nine to sixty-seven, but again increased for males from eighty to eighty-six males.[74]  Females still led the number of patients remaining by a narrow margin with 256 by the end of November 1891 to 249 males remaining in the asylum.[75]  Out of the eight years examined, during five of those years the hospital discharged more males than females, which might explain why more females were always being treated – more of the women never recovered or improved. 

            The ages of the females and males admitted from the years of 1883 to 1891 was recorded.  The ages charted range from ten to twenty years, twenty to thirty years, thirty to forty years, forty to fifty years, fifty to sixty years, and sixty years old and upwards, or unknown.  The top age range for females and males may give us a better understanding of why women especially and also men needed custodial care.  Overall the hospital admitted more females between the ages of thirty to forty and admitted more males between the ages of twenty to thirty from 1883-1891.[76]  Females were generally older than males when first admitted into the hospital.  The only time the majority of females or males were not in the age range of twenty to thirty or thirty to forty was in 1889-1890, when the hospital admitted more males ranging from ages forty to fifty than any other age range.[77] 

            In Gerald Gurin’s book, Americans View Their Mental Health, a nationwide interview survey was performed and selected demographic characteristics showed, for example, how age can affect mental health.  The data in this book comes from about seventy years later, but it may give some clues as to persistent patterns in American mental health in rural areas.  Reports show that older people tend to worry less, have fewer problems in marriage, in their jobs, and have a more positive self-image.[78]  They also suggest that older men are more satisfied with their jobs than younger men.[79]  On the other hand, reports show that younger people who are actively involved in the numerous aspects of their lives – their families, their jobs, their friends – express greater dissatisfactions about their lives.[80]  Gurin and his co-authors concluded that age differences seem to reflect differences in the current level of aspiration in older and younger people.[81] 

            The duration of insanity of the females and males admitted from the years of 1883 to 1891 was also recorded.  The duration of insanity charted ranged from less than one month, 1-3 months, 3-6 months, 6-12 months, 1-2 years, 2-3 years, 3-5 years, 5-10 years, 10-20 years, twenty years and upwards, and unknown.  The top duration of insanity for females and males may give us a better understanding of why women particularly and also men required custodial care at the time.  Overall, the hospital admitted both females and males who endured insanity any where from up to 1-3 months before admission.[82] This shows that men and women were quickly admitted after showing signs of insanity.

            The alleged cause of insanity of females and males admitted from the years of 1883-1891 was recorded.  The most interesting causes of insanity from 1883-1891 include: anxiety, blow on head, business troubles, Civil War, desire to marry, disappointment, excessive use of cigarettes, excessive use of snuff, early marriage and child bearing, exposure, fall on head, fatigue and worry, fever, financial trouble, fright, hard study, heredity, homesickness, injury to head, jealousy, law suit, loss of eye, loss of sight, nursing son, over-work, political excitement, pressure on brain, religious excitement, rheumatism, seduction, solitary life, studying, and weakness.[83]  For the most part, the unusual causes of insanity might only appear once or twice a year.  The three highest causes of insanity for females and males may help us understand why women especially and also men needed treatment at the time.  Overall, the top three causes of insanity for females between the years of 1883-1891 are first, unknown; second, ill health; and third, heredity.[84]  The top three causes of insanity for males between the years of 1883-1891 are first, unknown; second, heredity; and third, masturbation.[85] 

            The cause of death of females and males admitted from the years of 1883 to 1891 was also recorded.  The most interesting causes of death from 1883-1891 include: accident, bronchitis, cerebral softening, diarrhea, exhaustion, exhaustion of mania, gangrene of scrotum, pneumonia, and marasmus (a condition of chronic undernourishment occurring especially in children and usually caused by a diet deficient in calories and proteins).[86]  Most of the causes of death listed as interesting were placed there because one would rarely think of these sicknesses, such as bronchitis, causing a death today.  The three highest causes of death for females and males may help us understand why women particularly and also men needed treatment at the time.  Overall, the top three causes of death for females between the years of 1883-1891 are first, phthisis (pulmonary tuberculosis); second, exhaustion of many different forms (maniacal, melancholic); and third, senility (the physical and mental infirmity of old age).[87]  The top three causes of insanity for males between the years of 1883-1891 are first, epilepsy (any of various disorders marked by disturbed electrical rhythms of the central nervous system and typically manifested by convulsive attacks usually clouding consciousness); second, phthisis; and third, exhaustion of many different forms (chronic mania, maniacal).[88]  The top three causes of death among females and males show that there was no major difference between the causes of female deaths and the causes of male deaths.  Females and males both had high deaths occurring from phthisis (pulmonary tuberculosis), and exhaustion of many different forms (maniacal, melancholic).  The only difference among deaths was that females ranked high in deaths from senility (commonly known as “old age”) and males ranked high in deaths from epilepsy.

            The social relation of the females and males admitted from the years of 1883 to 1891 was recorded.  The social relations charted included married, single, widowed, and divorced.  The highest-ranking social relation for females and males may lead us to understand why women especially and also men required admission at the time.  Overall, from 1883-1891 the hospital admitted more females and males with a social status of married than of singled, widowed, or divorced.[89]  There were only two years (1883-1884, 1885-1886) that married females did not have the highest number of hospital admissions; during those two years there were more singles admitted into the hospital.[90]  The first four years were the only years (1883-1884, 1884-1885, 1885-1886) that married males did not have the highest number of hospital admissions.  During those four years the hospital admitted more single males.[91]  From 1884-1885 males tied with the highest number of married and single men admitted.[92]  The social relation shows us that a person was admitted more to Broughton for being married or single than being divorced or widowed.  One would assume that being divorced or widowed would have a greater effect on a person than being married or single, but during these days marriage and single life took a heavier toll on people.  Higher rates of married women requiring hospital admission may also have to do with the fact that there were more married women in the total population at the time Broughton Hospital was first opened. 

            In Gurin’s book, Americans View their Mental Health, another selected demographic characteristic surveyed was marital status.  Married men reported being more distressed about economic and material matters than any of the other unmarried male groups.  This difference probably shows that there is a greater responsibility attached to the married status.[93]  Married men and women more frequently turn to another person for help during unhappy periods (47 percent of the married men and 37 percent of the married women compared to 20 percent and 28 percent of men and women not married).[94] 

            The occupation of the females and males under treatment from the years 1886-1891 was recorded.  The most interesting occupations of those under treatment from 1886-1891 include: brick mason, butcher’s wife, carpenter, carpenter’s wife, civil engineers, commercial traveler, cotton buyer, dentist, druggist, drummer’s wife, editor, gardener, gunsmith, harness maker, hotel keeper, horticulturalist, Indian agent, junk dealer’s wife, lawyer, lawyer’s wife, marble cutter, mechanics, miller, miller’s wife, miner, music dealer’s wife, optician’s wife, orange grower, painter, peddler, physician, physician’s wife, physician’s son, potter, potter’s daughter, preacher, preacher’s wife, prostitute, rail road employee’s wife, school boy, saddlers daughter, seamstress, shoemaker, teacher, teacher’s wife, telegraph operator, trader, tailor’s wife, watchman’s wife, and many more.[95]  The three highest-ranking occupations for females and males will help us understand why women particularly and also men required admission at the time.  Overall, the top three occupations between females and males for the years of 1886-1891 are first, farmers; second, farmer’s wives; and third, laborers, which closely tied with farmers’ daughters.[96]  The top occupation of the females and males under treatment from the years 1886-1891 shows us that if a person did not have the highest paying job such as a lawyer or a doctor then they were more likely to deemed unfit for society and were placed in Broughton. 

            In Americans View their Mental Health, another selected demographic characteristic surveyed was occupation.  The study shows that farmers are one of the least happy groups and one of the groups with a high report of feelings of a nervous breakdown.  They worry about their jobs more than other groups.  Their self-image is the most negative and they are least likely to report past problems in their marriages.[97]  Farmers’ wives may also be thought of as an economically deprived group.  Wives of farmers report unhappy marriages, and like their husbands are least likely to mention having problems in their marriages.  They attribute their marital unhappiness to material sources more than other groups.  They also have a more negative self-image than any other group.[98]  This may show why more farmers and farmers’ wives were admitted at the hospital than any other occupation. 

            More women than men remained in the hospital for long periods because they never recovered or improved.  Females were generally older than males when they were first admitted into the hospital.  More females were admitted between the age range of thirty to forty, while more males were admitted between the age range of twenty to thirty.  Females typically endured shorter illnesses, often just 1-3 months, before being admitted into the hospital.  Females mostly suffered from the same causes of insanity that men faced, which included unknown reasons, ill health, and heredity.  There was no major difference between the causes of female deaths and the causes of male deaths.  The only differences were that females had a higher number of deaths from senility (commonly known as “old age”) and males had a high number of deaths from epilepsy.  The hospital admitted more females and males with a social status of married, rather than singled, widowed, or divorced.  The top three occupations of females and males were farmers, farmer’s wives, and laborers – the last of which was closely tied with farmers’ daughters.

            So what does all of this mean?  Why have there been more women than men to demand admission and treatment?  There are not any books, to my knowledge, written specifically explaining why in 1896 there was such a need to house women patients more so than men.  When I started this project it seemed as though women were treated unfairly based on gender, the issue now seems to point to issues of class overlapped with issues of gender, but my sources do not allow for me to fully explore this further.  It seems like society saw these women that were institutionalized at Broughton Hospital and many other hospitals at the time, as not just physically unfit, but also as culturally unfit to handle the pressures of life.[99]  Look, for example, at the alleged causes of insanity of females and males admitted from the years of 1883-1891.  The most interesting cases of insanity from 1883-1891 did not necessarily consist of physical ailments, but the cases included reasons for insanity that may have caused greater tension or may have been deemed culturally unfit to society’s standards of class and gender.  Some causes of insanity that may have been related to gender include: desire to marry, early marriage and child bearing, nursing son, and seduction.[100]  An example of gender would be that a man or woman may desire to marry early therefore they would be considered unfit based on societal standards. 

            Some causes of insanity that may have been related to class include: business troubles, excessive use of cigarettes, excessive use of snuff, financial trouble, hard study, law suit, over-work, political excitement, religious excitement, and studying, to name a few.[101]  An example of class would be that a man or woman may be over-worked depending on whether they were in the upper or lower class.  Some people may have to work harder for their money depending on what type of skills and schooling they have obtained, which all relate to issues of class.  Another example of class might be that males and females were admitted for business troubles or financial troubles. This reflects the notion that these individuals knew that they would eventually have to file bankruptcy; they would come to Broughton and voluntarily admit themselves because they knew that as long as they were at Broughton they would have a place to live, food to eat, and clothes on their backs.  This became easier than living on the streets, even if you were thought to be insane by society. 

            There are three causes of insanity that may have overlapped between both gender and class issues, such as disappointment, solitary life, and jealousy.[102]  An example of both gender and class would be that a man or woman could have been disappointed with the opposite sex or could have also been disappointed that they were brought up in a working class environment instead of being born into a wealthy family.  These were the issues that people did not want to face in life, so when it became necessary they would have themselves admitted to an insane asylum or someone else would have them admitted because they did not fit into society’s standards.[103] 

           

IV. Attitudes on Male and Female Admissions of Southern Institutions in a Wider World.

            In the 1900s, five of the ten southern states opened “training schools,” which was a way for states to show their commitment to younger patients.[104]  The idea behind the training schools was that younger patients would benefit more from the institutional training procedures they received than adults.  In the 1941 biennial report from the Superintendent of the Florida Farm Colony, J. Maxey Dell wrote, “When admission is delayed until after the applicant is sixteen years or over their established habits are such that they are not a good influence on the morale of the institution.”[105]  The idea was to start them in a program while they were still young and train them to establish good habits.  The training schools became revolving doors for male patients in that they were usually admitted and then released rapidly.  At the Caswell Training School in North Carolina, the female patients were not released as rapidly as males.  Noll wrote, “From 1914 to 1919 at Caswell Training School, for example, 52.1 percent of the males admitted were discharged within three years of admittance, compared with only 31 percent of the females.”[106]  These figures from North Carolina reflected national attitudes towards sex roles.  Women were staying longer lengths of time in the training schools.  Historian Peter Tyor’s figures suggest, “Both mean admission ages and periods of retention were higher for women than men.”[107]  The Florida Farm Colony would verify Tyor’s findings.  When males composed nearly sixty percent of the institution’s 1,165 admissions from 1922 to 1937, they made up sixty-five percent of those discharged in the same period.[108]  The demographics here prove the trend found at Broughton Hospital, that more females were not necessarily being admitted, but instead that more females needed to be treated for longer extended periods of time more so than males in southern institutions.  Hence the numbers of female patients were always higher than male patients. 

            In the South, as well as nationwide, males tended to remain in institutions for shorter periods of time and were also admitted at earlier ages.[109] Therefore, we see that longer retention rates and later admission ages for female patients, demonstrated concern that noninstitutionalized girls and women of child-bearing age would constitute a threat to the social order.[110]  This is probably why women were admitted for reasons such as early marriage, child bearing, desire to marry, nursing son and heredity, because these reasons were seen as heredity-based carried by immoral and easily influenced mentally deficient women who were unfit to handle the pressures of life that men faced.[111] 

 

V. Conclusion.

            Broughton Hospital may have been the first mental institution in Western North Carolina founded to meet the urgent demands to house the insane of the Western District who before then had lived in jails and poor houses, but it was not the first institution or training school to grapple with the problems of gender and class issues.  Although modern studies suggested, “overall rates of psychiatric disorder are almost identical for men and women,” from the beginning Broughton Hospital and other southern institutionalized residents were disproportionally female.[112]  This was due to society thinking that many of the institutionalized women were deemed mentally ill, because they were troubled women who could not deal with the pressures of life that men faced.[113] 

            So the question remains, why have there been more women than men to demand admission and treatment?  Even though it seems like the facts points to issues of class as to why women were admitted into hospitals like Broughton, it seems as though women were treated unfairly based on gender.  Women and girls that were institutionalized at Broughton Hospital and many other hospitals, such as the Caswell Training School, at the time were seen as not just physically unfit, but also as culturally unfit to handle the circumstances of life. 

            There was a trend in the South, as well as nationwide, that showed females to have longer retention rates, and later admission ages, which demonstrated a concern that noninstitutionalized girls and women of child-bearing age, would constitute a threat to the social order.  Several factors contributed to the rise of this trend found in the Broughton Hospital ledger book tables 1) the movement of patients for the year, 2) the ages of those admitted and of those discharged for the year, 3) the duration of insanity before admission of those admitted and discharged for the year, 4) the alleged cause of disease of those admitted for the year, 5) the cause of deaths for the year, 6) the social relation of those admitted for the year, and sometimes the residence of those admitted for the year.  After looking at these factors we see that males tended to remain in institutions for shorter periods of time and were also admitted at earlier ages, therefore revolving in and out of the hospitals doors.  Compared to men, females needed admission into hospitals and treatment for longer periods of time than males because they were seen as immoral and easily influenced mentally deficient women.

 

 


 

                [1] Velma Ree Turner, “A History of Recreation at Broughton Hospital: 1883-1973” (MA Thesis, The University of North Carolina at Greensboro, 1976), 8.

                [2] Elizabeth Wisner, Social Welfare in the South: From Colonial Times to World War I (Baton Rouge: Louisiana State University Press, 1970), 58.

                [3] Turner, 10.

                [4] Turner, 10.

                [5] Turner, 8.

                [6] Ledger Book, 1883-1884.  Broughton Hospital Archives.  Tables are unpaginated, but can be found at the end of each book. 

                [7] Turner, 10.

                [8] Turner, 10.

                [9] World Health Organization, 2005, <http://www.who.int/about/copyright/en/> (30 October 2005). 

                [10] Mary E. Odem, Delinquent Daughters: Protecting and Policing Adolescent Female Sexuality in the United States, 1885-1920 (Chapel Hill: University of North Carolina Press, 1995), 187.

                [11] Harold N. Cooledge, Jr., Samuel Sloan Architect of Philadelphia 1815-1884 (Philadelphia: University of Pennsylvania Press, 1986), 103.

                [12] Henry M. Hurd and William F. Drewry and Richard Dewey and Charles W. Pilgrim and G. Alder Blumer and T.J. W. Burgess, The Institutional Care of the Insane in the United States and Canada, 4 vols. (Baltimore: The John Hopkins Press, 1916), 3: 284.

                [13] Thomas S. Kirkbride, Construction, Organization, and General Arrangements of Hospitals for the Insane (Philadelphia: Lindsay & Blakiston, 1854; reprint, New York: Arno Press, 1973), 51.

                [14] Turner, 13.

                [15] Turner, 13.

                [16] “The Kirkbride Method,” Unpublished manuscript, no author given, no date given, 2, Broughton Hospital Archives. 

                [17] “The Kirkbride Method,” 3.

                [18] “The Kirkbride Method,” 4.

                [19] Turner, 12.

                [20] J. K. Hall, M.D., Bettie Waddell Murphy (Mrs. P.L. Murphy) February 10, 1854 – February 7, 1933, Pamphlet, no publisher given, no date given, 7-8.  Broughton Hospital Archives.   

                [21] “Broughton Hospital Tribute Paid to Mrs. P.L. Murphy, Charter Member of the U.D. C.,” The News Herald, 28 November 1935.  Broughton Hospital Archives. 

                [22] “Broughton Hospital Tribute.”

                [23] Hurd, 1:156.

                [24] Hurd, 4:460.

                [25] Hall, 9.

                [26] Hall, 6-8.

                [27] Hall, 9-10.

                [28] P.L. Murphy, Colony Treatment of the Insane and Other Defectives (Charlotte: N.C. Medical Association, 1906), 1.

                [29] Murphy, Colony Treatment, 1.

                [30] Murphy, Colony Treatment, 2.

                [31] Murphy, Colony Treatment, 2.

                [32] Murphy, Colony Treatment, 3.

                [33] As quoted in P.L. Murphy, M.D., The Treatment and Care of the Insane in North Carolina: What it is, What it was, and What it ought to be [Address] (Raleigh: Agricultural & Mechanical College, 1900), 23.

                [34] Murphy, Colony Treatment, 4.

                [35] Murphy, The Treatment and Care of the Insane, 23.

                [36] Murphy, Colony Treatment, 5.

                [37] Murphy, Colony Treatment, 6.

                [38] Hurd, vol. I, 157.

                [39] “Doctor Patrick Livingston Murphy Superintendent of State Hospital,” Unpublished manuscript, no author given, no date given, 6.  Broughton Hospital Archives. 

                [40] Murphy, The Treatment and Care of the Insane, 27.

                [41] Murphy, The Treatment and Care of the Insane, 27-28.

                [42] Murphy, The Treatment and Care of the Insane, 27.

                [43] Murphy, Colony Treatment, 4.

                [44] Murphy, Colony Treatment, 13.

                [45] Hurd, vol. I, 157.

                [46] Murphy, The Treatment and Care of the Insane, 28.

                [47] By-Laws and Regulations of the Western North Carolina Insane Asylum, at Morganton, N.C. (Raleigh: Presses of E.M. Uzzell, 1887), 4.

                [48] By-Laws and Regulations, 6.

                [49] By-Laws and Regulations, 5-6.

                [50] By-Laws and Regulations, 6.

                [51] By-Laws and Regulations, 7.

                [52] By-Laws and Regulations, 8.

                [53] By-Laws and Regulations, 8.

                [54] By-Laws and Regulations, 11-12.

                [55] Ledger Books, 1883-1891.

                [56] Board of Public Charities of North Carolina, An Appeal: To the People of North Carolina in Behalf of the Insane that are now Without Hospital Care in this State (Raleigh: Presses of Edwards & Broughton, 1900), 6.

                [57] Board of Public Charities of North Carolina, 6.

                [58] Board of Public Charities of North Carolina, 6.

                [59] Board of Public Charities of North Carolina, 7.

                [60] Board of Public Charities of North Carolina, 7.

                [61] Board of Public Charities of North Carolina, 13.

                [62] Board of Public Charities of North Carolina, 14.

                [63] Board of Public Charities of North Carolina, 14.

                [64] David Mechanic, Mental Health and Social Policy, ed. Howard E. Freeman (Englewood Cliffs, NJ: Prentice-Hall, Inc., 1969), 95.

                [65] Ledger Book, 1883-1884.

                [66] Ledger Book, 1884-1885.

                [67] Ledger Book, 1885-1886. 

                [68] Ledger Book, 1885-1886.

                [69] Ledger Book, 1886-1887.  

                [70] Ledger Book, 1886-1887. 

                [71] Ledger Book, 1887-1888. 

                [72] Ledger Book, 1888-1889. 

                [73] Ledger Book, 1189-1890. 

                [74] Ledger Book, 1890-1891.   

                [75] Ledger Book, 1890-1891. 

                [76] Ledger Books, 1883-1891.   

                [77] Ledger Book, 1889-1890. 

                [78] Gerald Gurin, Joseph Veroff, and Sheila Feld, Americans View Their Mental       Health: A Nationwide Interview Survey (New York: Basic Books, Inc., 1960), 212.

                [79] Gurin, 213.

                [80] Gurin, 214.

                [81] Gurin, 214.

                [82] Ledger Books, 1883-1891.  

                [83] Ledger Books, 1883-1891.  

                [84] Ledger Books, 1883-1891. 

                [85] Ledger Books, 1883-1891. 

                [86] Ledger Books, 1883-1891.   

                [87] Ledger Books, 1883-1891. 

                [88] Ledger Books, 1883-1891. 

                [89] Ledger Books, 1883-1891. 

                [90] Ledger Books, 1883-1886.

                [91] Ledger Books, 1883-1887. 

                [92] Ledger Book, 1884-1885. 

                [93] Gurin, 232.

                [94] Gurin, 232-233.

                [95] Ledger Books, 1886-1891. 

                [96] Ledger Books, 1886-1891.

                [97] Gurin, 226.

                [98] Gurin, 226.

                [99] Odem, 187.

                [100] Ledger Books, 1883-1891.

                [101] Ledger Books, 1883-1891.

                [102] Ledger Books, 1883-1891.

                [103] Odem, 187.

                [104] Steven Noll, Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900-1940 (Chapel Hill: The University of North Carolina Press, 1995), 127.

                [105] Noll, 127.

                [106] Noll, 132.

                [107] Peter L. Tyor, “‘Denied the Power to Choose the Good’: Sexuality and Mental Defect in American Medical Practice, 1850-1920,” Journal of Social History 10 (1977): 472-489.

                [108] Noll, 132.

                [109] Noll, 132.

                [110] Noll, 132.

                [111] Odem, 187.

                [112] World Health Organization, 2005, <http://www.who.int/about/copyright/en/> (30 October 2005). 

                [113] Odem, 187.

 

Table 1:

Showing Movement of Patients Admitted During the Years 1883-1891.

This information was obtained from the Ledger Books from 1883-1891 located in the Broughton Hospital Archives.

 

Table 2:

Showing Movement of Patients Treated During the Years 1883-1891.

      This information was obtained from the Ledger Books from 1883-1891 located in the Broughton Hospital Archives.

Picture 1

 

Outside of Avery Building

Picture taken by the author, March 2005.

 

Picture 2

 

Outside of Avery Building

Picture taken by the author, March 2005.

Picture 3

Outside of Avery Building

Picture taken by the author, March 2005.

 

Picture 4

The name of the hospital was changed from Western North Carolina Insane Asylum to the State Hospital at Morganton in 1890.  This name was retained until 1959 when it was changed to Broughton Hospital after Governor Joseph Melville Broughton.

Picture taken by the author, March 2005.

Picture 5

 

Current Picture of North Colony Building

Picture taken by the author, October 2005.

 

Picture 6

Broughton Hospital Farm Area

Picture taken by the author, October 2005.

 

Picture 7

Broughton Hospital Grave Yard

Picture taken by the author, October 2005.

 

Picture 8

Underground tunnels, no longer used, that were for transporting patients in the winter time or patients who might try to escape. 

Picture taken by the author, March 2005.

 

Bibliography

Primary Sources:

“Broughton Hospital Tribute Paid to Mrs. P.L. Murphy, Charter Member of the U.D.    C.” The News Herald. 28 November 1935.

 

By-Laws and Regulations of the Western North Carolina Insane Asylum, at Morganton,    N.C. Raleigh: Presses of E.M. Uzzell, 1887.

 

Cooledge, Harold N. Samuel Sloan Architect of Philadelphia 1815-1884. Philadelphia:         University of Pennsylvania Press, 1986.

 

Denson, C.B. Board of Public Charities of North Carolina. An Appeal: To the People of         North Carolina in Behalf of the Insane that are now Without Hospital Care in this      State. Raleigh: Presses of Edwards & Broughton, 1900.

 

Hall, J. K. M.D., Bettie Waddell Murphy (Mrs. P.L. Murphy) February 10, 1854 –   February 7, 1933. Pamphlet. No publisher given. No date given.

 

Hurd, Henry M., William F. Drewry, Richard Dewey, Charles W. Pilgrim, G. Alder      Blumer, and T.J. W. Burgess. The Institutional Care of the Insane in the United            States and Canada. 4 vols. Baltimore: John Hopkins University Press, 1916-1917.

 

Kirkbride, Thomas S. Construction, Organization, and General Arrangements of    Hospitals for the Insane. Philadelphia: Lindsay & Blakiston, 1854; reprint, New   York: Arno Press, 1973.

 

Ledger Book (1883-1884).  Broughton Hospital Archives.

 

Ledger Book (1884-1885).  Broughton Hospital Archives. 

 

Ledger Book (1885-1886).  Broughton Hospital Archives. 

 

Ledger Book (1886-1887).  Broughton Hospital Archives. 

 

Ledger Book (1887-1888).  Broughton Hospital Archives. 

 

Ledger Book (1888-1889).  Broughton Hospital Archives. 

 

Ledger Book (1889-1890).  Broughton Hospital Archives. 

 

Ledger Book (1890-1891).  Broughton Hospital Archives. 

 

Murphy, P.L. Colony Treatment of the Insane and Other Defectives. Charlotte: North          Carolina Medical Association, 1906.

 

---- The Treatment and Care of the Insane in North Carolina: What it is, What it was,      and What it ought to be [Address]. Raleigh: Agricultural & Mechanical   College, 1900.

 

Secondary Sources:

 

“Doctor Patrick Livingston Murphy Superintendent of State Hospital.” Unpublished       Manuscript. No author given. No date given.  Broughton Hospital Archives.

 

Gurin, Gerald, Joseph Veroff, and Sheila Feld.  Americans View Their Mental            Health: A Nationwide Interview Survey.  New York: Basic Books, Inc., 1960.

 

Mechanic, David.  Mental Health and Social Policy.  Edited by Howard E. Freeman.             Englewood Cliffs, NJ: Prentice-Hall, Inc., 1969.

 

Noll, Steven.  Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the     South, 1900-1940.  Chapel Hill: The University of North Carolina Press, 1995.

 

Odem, Mary E.  Delinquent Daughters: Protecting and Policing Adolescent Female           Sexuality in the United States, 1885-1920.  Chapel Hill: University of North     Carolina Press, 1995. 

 

“The Kirkbride Method.”  Unpublished Manuscript.  No author given.  No date given.              Broughton Hospital Archives.

 

Turner, Velma Ree.  “A History of Recreation at Broughton Hospital: 1883-1973.”  M.A.         Thesis, University of North Carolina at Greensboro, 1976.

 

Tyor, Peter.  “‘Denied the Power to Choose the Good’: Sexuality and Mental Defect in             American Medical Practice, 1850-1920.”  Journal of Social History 10 (1977):     472-489. 

 

Wisner, Elizabeth.  Social Welfare in the South: From Colonial Times to World War I.         Baton Rouge: Louisiana State University Press, 1970.

 

World Health Organization.  2005.  <http://www.who.int/about/copyright/en/> (30        October 2005).