Improvements, Overcrowding, & Tuberculosis
Dr. Theophilus Orgain Powell, who had served as assistant physician to Dr. Green for seventeen years prior to Dr. Green’s death, became superintendent of the Milledgeville asylum in 1879. Powell was known for his affinity for the military system and he enforced military discipline, training, and inspections during his years as superintendent, but he was also known for his attention to patients and their families. Powell wanted the institution to stay true to Green’s edict that “the patient comes first.” One of the first changes to happen under Powell’s administration was the construction of a new African American building in 1880, to increase accommodations to house about 350 patients.
Another major development came when a law was passed in 1877 that provided free admission to the asylum for all citizens of Georgia. The trustees protested this, and also pushed the idea of building a second institution in the northern part of the state, with which Dr. Powell agreed. By 1881, the patient population was over the 1,000 mark, and more buildings were desperately needed to accommodate the new admissions filling rooms as soon as they became available. Powell also faced constant political pressure from politicians throughout Georgia to accept the mentally ill of their particular county. In the same year, Powell claimed a restored rate of 40%. Of 220 new admissions, Powell stated that 88 went home “apparently well,” and another 25 left “improved.” Powell believed in occupational therapy as being the most beneficial to patients, and he also added numerous amusements for patients, including billiards, concerts, dances, games, picnics, theatrical performances, and tableaux. Church activities were also expanded, with services being held twice weekly, and the deceased were given a decent burial on the hospital cemetery grounds.
The patients who were willing to work–the “help patients”–were classified by the doctors and assigned to work for which they seemed best suited and that fit their interests. Patient progress was observed and those who appeared “recovered” were sent home to make room for the constant influx of new patients. One problem that was increasingly concerning to the staff over the next few years was the growing number of children who were being committed to the asylum. Most of these children were considered to be “feeble minded,” and the concern was that this deprived the adult mentally ill who were forced to wait in county jails.
In 1883, a new African American building was completed to house around 450 patients, and in 1884, the railroad came to the hospital from a spur from Midway. In 1885, a badly needed hospital building was completed, but this too became immediately filled with patients. The trustees then adopted a resolution, supported by the state Attorney-General, instructing Dr. Powell “not to receive in this asylum, harmless Epileptics, Idiots, Paralytics, Physically Infirm or Mentally Imbecile Persons, who in his opinion cannot be benefitted by treatment, etc.” (But for the Grace of God, p. 59). In 1886, the Georgia legislature added an amendment to the act of 1874, thereby allowing the trustees to return to their home counties all the patients who were incurable but harmless. One hundred and twenty-five patients were sent back–some having been at the asylum for up to thirty years–and most ended up in the county jails. This allowed the hospital to admit more “hopeful” patients, and Dr. Powell believes this was one of the explanations behind the apparent “increase in insanity” seen across the state.
As to the true causes of insanity, Dr. Powell echoed Dr. Green’s belief that heredity was the main cause, but that “bad environments foster defects and good ones ameliorate them” (But for the Grace of God, p. 60). Powell also believed that alcoholism was another cause of insanity, as well as “syphilis, domestic troubles, commercial speculations, losses, religious excitement, worry, over-work, head injuries, the tensions of living and inefficient moral education” (But for the Grace of God, p. 60). Powell noted that there was a significant increase in mental illness among African Americans immediately following the Civil War, and believed that this was due to the assumption of new roles and responsibilities without adequate preparation. In 1887, Powell suffered his second breakdown due to overworking and stress (the first being around 1884), and first assistant physician Dr. James A. Whitaker took over management of the institution for several months. During this time, Dr. Powell was elected president of the Georgia Medical Association, and returned to his position in 1888, then making numerous improvements to the hospital grounds, such as expanding flower gardens and helping in the push to connect by rail directly to the Milledgeville train depot two miles away.
“During the past fifty years a large number of chronic and incurable cases have accumulated in the institution, and to this population there is a constant yearly addition of the chronic and incurable, amounting generally to more than one-half of the number received each year…I might say that of the 1,823 patients now on hand, we would not be justified in encouraging hopes of the full and complete recovery of more than 250…perhaps not so many.”
–Dr. T.O. Powell, ca. 1895 (But for the Grace of God, p. 63)
By 1890, the asylum’s population was over 1,500, and there was a growing number of criminally insane being admitted with no measures for segregating them from the rest of the patients, who were already overflowing the accommodations. Dr. Powell suggested that small hospital units for the criminally insane be constructed, and that it would be difficult to provide individual care to patients because of the increasing overcrowding. Powell recommended that another institution be established elsewhere in the state, creating two asylum districts, as the overflow at the Milledgeville asylum went into the reception rooms, the dining rooms, the parlors and halls, and there were an additional two hundred waiting in the jails to be admitted to the asylum. The state legislature debated for some time, and finally decided that it would be more economical to enlarge the asylum rather than build a second institution, which greatly upset Dr. Powell, who felt that the welfare of patients was more important than economics. The new buildings were completed by 1895, and they accommodated “900 patients–500 whites and 400 colored–which is an average per capita of $111.11 — a feat without precedent in the history of Georgia, and, so far as we have been able to ascertain, has no equal in asylum construction in the world” (But for the Grace of God, p. 62).
“…we are under the necessity of keeping the worst of this class confined to their rooms or wards most of the time, which deprives them of the most potent remedial factor in their treatment, judicious employment…it is a flagrant injustice to both the insane convict and the better class of the insane…Is it not a reflection upon our humanity and Christian intelligence that the better class of the insane…should be forced to associate with the worst class of criminals?…”
–Dr. T.O. Powell, on care for the criminally insane–1890
(but for the grace of god, p. 61-62)
Beginning in 1895, Powell started to formalize the training of hospital attendants in a special school, as they numbered around 150 at this time. He also hired the hospital’s first pathologist, expanded the sewing rooms (all sewing and mending was done by patients), continued to add resources to the patient library, and purchased more items for amusements. In 1896, Dr. T.E. Oertel (the pathologist) issued a concerning report that found that more than half of all African American patient deaths were due to tuberculosis. Oertel immediately implemented segregation, disinfection, exercise for patients, microscopic analysis of sputum, and other medical practices of the time. Infirmary wards became standard in the numerous buildings in 1897, and both black and white nurses were hired. In the same year, the African American building had to be rebuilt after a fire burned it to the ground.
Also in 1897, Dr. Powell was elected as president of the American Medico-Psychological Association (later the American Psychiatric Association), and his presidential address, “Psychiatry in the Southern States,” remains an important historical reference. By 1898, surgical care for patients was provided–a large operating room, two rooms for post-operative patients, and an aseptic apparatus enabled major surgeries. Consultants from the medical college in Augusta were called in for any complicated cases, and many successful hysterectomies were performed that year. The asylum’s population was well over 2,000 at this time, with around 600 new admissions annually, and requiring about 350 employees to keep the institution running. Of these annual admissions, around 200 were discharged, with most deemed as “restored” by the doctors.
Up to 1900, dental work at the hospital had been performed by two medical physicians. At the suggestion of the trustees, the hospital then hired its first dentist. Also at the turn of the twentieth century, the asylum changed its name to the Georgia State Sanitarium, and the hospital became known across the country–and even internationally–as “second to none” in its administration and treatment of patients. The spread of “consumption” or tuberculosis among the African American patients at the sanitarium remained a problem at the turn of the twentieth century, with 63 of over 1,000 patients dying in 1902 alone. It was estimated that around 25-50% of all African American deaths were due to tuberculosis during this time period. In 1903, two large buildings for white patients were finished, still known today as the Twin Buildings.
By this time, essential food needs of the sanitarium were provided from 800 acres of farmland, most of which was located about four miles from the institution. The fields were cultivated by both white and black patients, and this land was, and still is, known as the “colony farm”. Despite his failing health, Dr. Powell continued his efforts to make the sanitarium a model institution, and numerous out-of-state official visitors came to the Milledgeville hospital every year, hoping to borrow ideas for their own institutions. In 1906, when nearly 1,000 patients were admitted throughout the year, those who were too “feeble” were sent to the infirmary wards, while those who were not were placed in reception wards for complete physical and mental examinations by one of the physicians. These examinations included laboratory tests of the sputum, blood and urine, and the nurses recorded notes for ten days of the patient’s pulse, temperature, amount of urine passed, habits, conversation, and general behavior. After this time period had passed, the physician made their tentative diagnosis, and the patient was sent to the building best suited for their care. In the following year, the 64th annual report of the board of trustees opened with a statement recognizing and honoring Dr. Powell’s seventeen years of service as assistant physician and twenty-eight years as superintendent and resident physician of the institution, and by paying respect to his death on August 18th, 1907, by renaming the main building of the sanitarium the “T.O. Powell Building,” and a bronze tablet honoring Dr. Powell’s service was placed in the vestibule of the building.
Inscription on the bronze tablet in the vestibule of the Powell Building:
THEOPHILUS ORGAIN POWELL
Seventeen years Assistant Physician and twenty-eight
years Superintendent and Resident Physician of this
Institution.
A Christian of simple faith and consistent life; a
man of strong character and lofty ideals; a citizen
of proven loyalty and true worth; an officer of rare
judgement and distinguished ability; an alienist of
great skill and wide renown whose single act in
first substituting humane for harsh measures in the
hospital treatment of the insane made him a
benefactor of the human race.
"In recognition of his virtues this tablet and
building are dedicated to his memory by the Board of Trustees."
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. 55-73.
Echoes of Central State Hospital 