Growth, Scarcity, & the Impacts of War
After the dismissal of Dr. Cooper in 1845, the trustees of the asylum deliberated for some time on the right successor for the superintendent position, and finally chose Dr. Thomas A. Green, 34, of Milledgeville. Dr. Green was notable as the physician to Alexander Stephens (vice president of the Confederacy during the Civil War), and was credited with saving Stephens’ life when he contracted typhoid fever. Up until Dr. Green’s appointment, those committed to the asylum were only separated by gender. Green advocated for separation of patients into twelve classes (which he did not detail in writing), with special separate housing for convalescent (recovering) patients. He also advocated for a separate building for epileptics. At the time when Green became superintendent of the asylum, the budget was around $7,000, of which $1,500 went to the superintendent. Dr. Green promised to raise the recovery rate from 25% to 50% by providing occupational therapy, in exchange for an increased budget of $12,000.
Dr. Green’s first official act as superintendent of the asylum was abolishing the use of all restraints, such as chaining patients to the walls/floor or using straight jackets. Green also had a custom of personally releasing manacled patients upon their arrival to the asylum. In Green’s first annual report for 1845-1846, he states there were around 100 patients at the asylum and that he thought around 70% were incurable. Dr. Green felt that a major factor in this problem was that family members waited too long to hospitalize patients, and that recovery was much more rapid when patients were brought in early for hospitalization. Twenty out of 127 patients died in 1847, and sixteen out of 130 passed in 1848. According to hospital records, the high death rate during this time period was due to “malignant measles” in the winter, and “epidemic dysentery” and typhoid fever in the summer.
In the latter years of the 1840s, the asylum first started to experience overcrowding, and the Georgia legislature finally started to provide more funding. The funds were used to complete a western wing of the hospital, where females would be housed, and each wing would have a separate yard area for males and females. Dr. Green asked for $132,000 for completing all departments of the asylum, as well as for a library, chapel, and obtaining more land. After funds were approved by the legislature, they were used to purchase additional land, build a brick-making plant and female epileptic building, and to expand the farming program.
“This tendency to insanity, arising from hereditary predisposition, is a study deserving the most serious attention…It does not of itself excite disease, but when it strongly exists, a trivial cause will develop it.”
–Dr. thomas a. green, 1850
(But for the grace of god, p. 37)
Dr. Green pushed for many reforms during his administration of the asylum. Green hired expensive, white attendants for patient care, as all the current attendants were slaves and he feared that this led to resentment towards patients. Another effort made by Dr. Green was to bar all “incurable idiots” from the asylum, and he also fought to end the practice of inferior courts certifying people as paupers who were not in fact paupers. Some help came to the asylum after a visit in February 1858 from Dorothea Dix, famed advocate of the mentally ill who fought for reforms in mental healthcare across the nation and in Europe. Dix organized and delivered speeches in Augusta, Macon, Savannah, and Columbus on the needs of patients in the state asylum in Milledgeville, and was able to obtain badly needed reading materials, pictures, musical instruments, and games for the patients. During this time, a law was finally passed requiring the asylum to care for mentally ill slaves. Governor Brown estimated that there were less than fifty slaves needing treatment, and proposed that a small slave tax be assessed in order to build separate buildings.
With the outbreak of the Civil War in 1861, the operational costs of the asylum rose sharply, due to the fact that cotton could not be sold and many pay patients’ families thus became delinquent on their accounts. Another factor was that the state only allowed $70 for the care of each pauper patient, and this amount was no longer sufficient to provide adequate treatment. By the end of 1863, the asylum became over-crowded because many healthy people had to leave to help the war effort and could no longer care for their mentally ill family members and friends. Additionally, Dr. Green took in mentally ill refugees from other Southern states. The overcrowding soon became so severe that Green asked the legislature to repeal the new law providing care for slaves, free blacks, and alcoholics, and also requested higher pay for attendants, which was denied.
“Over the years then, the hospital began to serve two functions: (1) to care for the truly insane; (2) to serve as a haven for those who for a variety of reasons had no other place to go.”
–Dr. Peter G. Cranford, But for the Grace of God (p. 51)
In 1864, growth in facilities and services at the asylum stopped completely. In his March to the Sea, General Sherman burned virtually all of Milledgeville to the ground, but spared the asylum and posted a few guards there to look for Confederates and others that were supposedly hiding in the underground tunnels of the institution. As resources dwindled, Dr. Green appealed to military sources for badly-needed supplies and was given some items below market-price by Confederate and state quarter-masters, but food and medicines were soon lacking and an epidemic “bowel infection” broke out at the asylum, killing one in seven patients. Green then went to Macon and met with Major-General Wilson who was in command of Union troops and petitioned for resources. Wilson initially said that he first had to feed his own troops, was already caring for many destitute Southerners, and was distant from sources of supplies, but was moved to assist after Green said that his only other option was releasing the patients, and gave Green a ten day ration of corn and meat. Dr. Green and the assistant steward of the asylum then traveled throughout the state looking for meat, corn, and money. They sold items from the asylum that were not directly needed for patient care, and Green also borrowed $1,000 from his friend John P. King of Augusta for freight charges.
After the war was over, Dr. Green foresaw the increase in mentally-ill black patients, and asked the trustees of the asylum to remodel two one-story buildings for housing sixty patients, but this was not initially approved. This problem resulted in many mentally-ill blacks being turned away and abandoned, as no separate quarters for blacks were required by law and Dr. Green refused to admit them to the same quarters as whites. Finally, General James B. Steedman (serving as the United States Military Commander of Georgia during Reconstruction from 1865-1866) forced the asylum to accept mentally-ill African Americans. A building for African American patients was completed in August 1866, and by 1867, there were thirty-four African American patients at the asylum, almost all of whom were classified as “idiots” (special needs) and epileptics. Dr. Green pleaded with the chief surgeon of the Freedman’s Bureau to exclude these patients from admission to the asylum, and an order was approved to this effect–while white patients in these classifications were still admitted to the institution. Further evidence of Jim Crow policies during this era can be found in the fact that the Georgia legislature provided no funds for furniture, supplies, or food for the African American building at the asylum. Dr. Green again had to appeal to the Freedman’s Bureau in order to obtain food, and obtained other supplies by using some money that was dedicated to general support of the hospital.
Another post-war issue of the asylum was the high cost of living. Funds from the Georgia legislature were often received very late, and Dr. Green had to obtain credit using his influence at local banks. As of 1867, there were 431 patients at the asylum, and 300 of these were classified as “idiots”, epileptics, and “seniles”. Dr. Green tried to exclude these groups from admission to the asylum, claiming that the Milledgeville hospital was the only such institution in the nation that admitted “idiots”. By July 1872, the institution was in the process of repairing a variety of issues with the buildings on campus, including: room for an additional 150 white and African American patients; tin roofs; modern gas lighting; more efficient heating, ventilating, and bathing facilities; bridges over creeks; and a wall around the campus completed. Most of the work was completed by patients.
In 1872, there were four doctors for the 448 patients–one doctor for every 112 patients–a figure that would remain largely unchanged for another century. Another problem causing overcrowding at the asylum during Reconstruction was the increased admission of alcoholic patients, many of whom became involved in illicit liquor trading between patients and outsiders. An additional issue was that many records about patients committed to the asylum were poorly kept, and frequently nothing was known about patients other than that they had been declared insane. Dr. Green also expressed concern that some physically fit patients (who had been in the asylum for ten to twenty-eight years) could be safely and better cared for by family and friends. There was a short-lived movement to open another institution in the Atlanta area, but Dr. Green was successful in speaking with the governor in defense of the Milledgeville hospital, and effectively prevented the institution from being broken up by the trustees. On February 11, 1879, Dr. Green was caring for a patient when he collapsed from a stroke or cerebral hemorrhage, and died a few days later.
SOURCE: Cranford, Peter Gordon. But for the Grace of God: the Inside Story of the World’s Largest Insane Asylum. Milledgeville, GA: Old Capital Press, 2008, p. 33-53.
Echoes of Central State Hospital 