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Side One
People with mental illness were confined to jails and almshouses, often suffering neglect, before Dr. John Evans and local physicians advocated for their treatment; 1840s state laws established hospital here. In 1848, first patients admitted to Indiana Hospital for the Insane; treated for mental illness and addiction. Farm colony work and recreation used as therapy.
Side Two
Since hospital’s opening, lack of funding and understaffing led to patient abuse and neglect; Superintendent Dr. Fletcher attempted to rectify this and burned patient restraints in a bonfire, 1883. Groundbreaking pathology lab opened 1896, served as state teaching hospital. Renamed Central State Hospital in 1927. Closed in 1994 with the goal of community-based care.
Annotated Text
Side One
People with mental illness were confined to jails and almshouses, often suffering neglect,[1] before Dr. John Evans and local physicians advocated for their treatment;[2] 1840s state laws established hospital here.[3] In 1848, first patients admitted to Indiana Hospital for the Insane; treated for mental illness and addiction.[4] Farm colony work and recreation used as therapy.[5]
Side Two
Since hospital’s opening, lack of funding and understaffing led to patient abuse and neglect;[6] Superintendent Dr. Fletcher attempted to rectify this and burned patient restraints in a bonfire, 1883.[7] Groundbreaking pathology lab opened 1896, served as state teaching hospital.[8] Renamed Central State Hospital in 1927.[9] Closed in 1994 with the goal of community-based care.[10]
[1] “Report of the Commissioners of the Lunatic Asylum, or Indiana Hospital for the Insane, to the General Assembly, December, 1845,” 179 in Documents of The General Assembly of the State of Indiana, at the Twenty-Ninth Session, Commencing December 1, 1845, Part II (Indianapolis: J. P. Chapman, State Printer, 1846), accessed Archive.org; “Third Annual Report of the Commissioners and Superintendent of the Hospital for the Insane, to the General Assembly of the State of Indiana,” (Indianapolis: John D. Defrees, State Printer, 1847), 64, Indiana State Library (ISL), Indiana Collection; “Memorial of D.L. Dix, Praying a Grant of Land for the Relief and Support of the Indigent Curable and Incurable Insane in the United States, June 27, 1848, 30th Congress, 1st Session, Miscellaneous, No. 150,” Box 1 of 1, Folder “Dorothea Dix Report, State Board of Charities, Correspondence, 1848-1940,” Indiana Public Welfare, 1847-1961 Collection (L196), ISL, Rare Books and Manuscripts; Gayle Thornbrough, ed., Messages and Papers Relating to the Administration of Samuel Bigger, Governor of Indiana, 1840-1843 (Indianapolis: Indiana Historical Bureau, 1964), 44, accessed Indiana Memory Digital Collections; Philip M. Coons, M.D. and Elizabeth S. Bowman, M.D., Psychiatry in Indiana: The First 175 Years (Bloomington, IN: iUniverse, 2010), xxix.
According to Psychiatry in Indiana: The First 175 Years, Hoosiers afflicted by mental illness and epilepsy were without medical treatment and housed in county jails, family residences, and poor houses until the opening of the Indiana Hospital for the Insane. In her June 27, 1848 “Memorial to Congress,” social reformer Dorothea Dix noted that 18,000 sufferers of mental illness were “unsuitably placed in private dwellings” in the US and that the existing 20 state mental hospitals were woefully inadequate, given the need. Dix described the abhorrent conditions she witnessed in Indiana, reporting:
I found one poor woman in a smoke-house, in which she had been confined more than twenty years. In several poorhouses the insane, both men and women, were chained to the floors, sometimes all in the same apartment. Several were confined in mere pens, without clothing or shelter; some furious—others for a time comparatively tranquil.
The Messages and Papers Relating to the Administration of Samuel Bigger, Governor of Indiana, 1840-1843 noted that afflicted Hoosiers were so desperate for help that 13 had applied for admittance to the Ohio Lunatic Asylum, but were refused due to lack of space. Dr. John Evans and other local physicians confronted this need and reported in an 1845 address to the Indiana General Assembly that “The numerous enquiries which have been made during the past year from different parts of the State, in reference to the admission of patients, show but too forcibly the great amount of suffering, now within our borders, endured for want of such an institution.” Dr. Evans and his colleagues successfully advocated for the establishment of the Indiana Hospital for the Insane to combat the widespread neglect and abuse of the state’s mentally ill (see footnote 2).
[2] “Education Committee of the House: Report on Lunatic Asylum, January 26, 1842,” in Messages and Papers Relating to the Administration of Samuel Bigger, Governor of Indiana, 1840-1843, 411-417; “Report on the Subject of Hospitals for the Insane, by John Evans, M.D., Made to the Commissioners of the Lunatic Asylum of Indiana, June 22, 1845,” (Indianapolis: J. P. Chapman State Printer, 1845), 185, ISL, Indiana Collection; “Report of the Commissioners of the Lunatic Asylum, or Indiana Hospital for the Insane, to the General Assembly, December, 1845,” (Indianapolis: J. P. Chapman, State Printer, 1845), [175]-176, 179 in Documents of The General Assembly of the State of Indiana; “Second Annual Report of the Commissioners and Superintendent of the Hospital for the Insane, to the General Assembly, of the State of Indiana, October 31, 1846,” (Indianapolis: J. P. Chapman, State Printer, 1846), [55], ISL, Indiana Collection; Dorothea L. Dix, “Report on Indiana’s Jails and Poor Asylums Visited,” (Indianapolis: Indiana State Journal): August-October, 1847,” 18-19, Box 1 of 1, Folder “Dorothea Dix Report, State Board of Charities, Correspondence, 1848-1940,” Indiana Public Welfare, 1847-1961 Collection (L196), ISL, Rare Books and Manuscripts; Psychiatry in Indiana: The First 175 Years, 12.
According to Psychiatry in Indiana, Dr. John Evans and colleagues, including Dr. Isaac Fisher, Edward Hannigan, and Dr. Caleb Jones established the Hospital for the Insane. They formed a “small society” in Attica, Indiana to encourage State care of the blind, mute, and “insane.” Early hospital reports frequently reference the leadership of Dr. Evans, who was later appointed the hospital’s first superintendent. In his 1845 Report on the Subject of Hospitals for the Insane, Dr. Evans described his visit to state “insane” hospitals to the East, where he gathered information for an Indiana hospital through observation and speaking with physicians.
The hospital’s 1846 annual report directly credits Dr. Evans with the founding of the hospital, stating he “had been the first to press the duty of making provision for the insane of this State upon the attention of the Legislature.” Following her 1847 trip to inspect the status of Indiana’s mentally ill, Dorothea Dix credited him with the “remedial care and recovery” of Indiana’s mentally ill via the forthcoming hospital. She noted that it was Dr. Evans to whom “the citizens of Indiana owe a debt of gratitude which few can estimate, because it is but few who have the opportunity of understanding the measure of his labors or the ability requisite for devising and carrying out such plans as are comprised in the Indiana State Hospital for the Insane.” Following Dr. Evans’ and colleagues’ appeals to Indiana legislators, the Indiana General Assembly approved acts in 1845 and 1846, establishing a state hospital in Indianapolis for the mentally ill (see footnote 3).
[3] “An Act to Provide for the Procuring a Suitable Site for the Erection of a State Lunatic Asylum,” Approved January 13, 1845, Chapter 73 in General Laws of the State of Indiana, Passed at the Twenty-Ninth Session of the General Assembly, Begun on the First Monday in December, 1844 (Indianapolis: J.P. Chapman, State Printer, 1845): 58-59, accessed Googlebooks.com; “Report on the Subject of Hospitals for the Insane, by John Evans, M.D., Made to the Commissioners of the Lunatic Asylum of Indiana, June 22, 1845,” (Indianapolis: J. P. Chapman State Printer, 1845), 186-187, ISL, Indiana Collection; “Report of the Commissioners of the Lunatic Asylum, or Indiana Hospital for the Insane, to the General Assembly, December, 1845,” (Indianapolis: J. P. Chapman, State Printer, 1845): 176 in Documents of The General Assembly of the State of Indiana; “An Act Authorizing the Erection of Suitable Buildings for the Use of the Indiana Hospital for the Insane,” Approved January 19, 1846, Chapter 192 in Local Laws of the State of Indiana, Passed at the Thirtieth Session of the General Assembly, Begun on the First Monday in December, 1845 (Indianapolis: J. P. Chapman, State Printer, 1846): 220-222, accessed Googlebooks.com.
In response to the advocacy of local physicians, the Indiana General Assembly approved an act to provide for the “procuring [of] a suitable Site for the erection of a State Lunatic Asylum” in January 1845. The act appointed Dr. John Evans, Livingston Dunlap, and James Blake as commissioners to select a tract of land for the facility. According to an 1845 “Report of the Commissioners of the Lunatic Asylum,” they purchased farmland along the “McAdamized national road,” belonging to Nathaniel Bolton, co-editor of the Indianapolis Gazette, and celebrated poet Sarah Bolton. The tract was purchased, in part, because it could serve as a potential source of hospital produce and its cultivation could “afford the patients that exercise and employment which are so necessary for their restoration, and which are generally most cheerfully performed.” (See footnote 6 to learn how farm labor and the manufacture of goods was considered therapy). In January 1846, the Indiana General Assembly approved an act authorizing the construction of buildings for the hospital, designating it the Indiana Hospital for the Insane. The hospital officially opened in 1848.
[4] “Fourth Annual Report of the Commissioners and Superintendent of the Hospital for the Insane, to the General Assembly, of the State of Indiana,” (Indianapolis: John D. Defrees, State Printer, 1848), 5, ISL, Indiana Collection; “First Annual Report of the Commissioners and Medical Superintendent of the Hospital for the Insane, to the General Assembly, of the State of Indiana,” (Indianapolis: John D. Defrees, State Printer, 1849), [89], 100-103, ISL, Indiana Collection; “Thirty-Ninth Annual Report of the Trustees and Superintendent of the Indiana Hospital for the Insane, for the Fiscal Year Ending October 31, 1887, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1888), 22-25, ISL, Indiana Collection; “Ninety-Fourth Annual Report of the Board of Trustees and Superintendent of the Central State Hospital at Indianapolis, Indiana for the Fiscal Year Ending June 30, 1942, to the Governor,” (Indianapolis: C.E. Pauley & Co., Inc.), Table III-A, ISL, Indiana Collection; Central State Hospital, The Central Scene 20 (June 1994): 15, 20, ISL Indiana Collection; Lucy Jane King, MD and Alan D. Schmetzer, MD, Dr. Edenharter’s Dream: How Science Improved the Humane Care of the Mentally Ill in Indiana, 1896-2012 (Carmel, IN: Hawthorne Publishing, 2012), 2-3.
Annual reports note that the Indiana Hospital for the Insane opened in 1848, embracing “an equal number of either sex.” The hospital represented a change in response to the mentally ill, from simply housing them, often in poor conditions, to providing them with security and medical treatment. Since its opening, patients were treated for addiction and mental illness. The 1849 annual report states that patients were treated for “intemperate drinking,” “loss of sleep,” “raving mania,” and tobacco use. Although the report noted that “there are no specifics known to us in the treatment of insanity,” attempts to treat patients included warm baths, nauseants, laxatives, narcotics, and tonics such as wine and iron. The report noted “There are great advantages resulting from the use of baths—from a well regulated diet—change of scenery and old associations—change of habits of life where they have been pernicious to health—regular exercise in the open air, at some useful employment,” as well as “diversion of the mind by various innocent amusements.”
Patients represented a variety of professions and religious backgrounds. The hospital’s 1887 annual report listed railroaders, saloon keepers, teachers, and ministers among those admitted, with farmers and housewives admitted in the highest numbers. Patients were treated for ailments such as “acute mania,” “chronic melancholia,” “senile dementia,” and “hypochondriacal mania.” Early suspected causes of insanity included syphilis, menstrual disturbance, religious excitement, and novel reading. As part of the 19th century reform movement, the hospital opened a state-of-the-art pathological department in 1896 to study the scientific origins of mental illness. According to Dr. Lucy Jane King and Dr. Alan D. Schmetzer, clinicians hoped that through the lab they could “discover specific treatments for specific diseases, treatments that might even lead to cure, a forward-thinking attitude for the time.” (See footnote 8 to learn more about the lab).
The 1942 annual report reflected modernized medical diagnoses, using terms such as schizophrenia, paranoia, and psychopathic personality. The report also noted that psychotherapy was utilized to “give the patient the best possible professional care, to be administered in such a way that he feels that all in the hospital are interested in him as an individual.” According to the hospital’s bulletin The Central Scene, in the 1950s the use of psychotropic drugs, new facilities, and “new thinking” about mental health ushered Central State into the “modern era of public psychiatric treatment.” Throughout Central’s history “occupational therapy,” via farm work and the manufacture of goods, was used as a form of therapy (See footnote 5 for more).
[5] “Report of the Commissioners of the Lunatic Asylum, or Indiana Hospital for the Insane, to the General Assembly, December, 1845,” 176; “First Annual Report of the Commissioners and Medical Superintendent of the Hospital for the Insane, to the General Assembly, of the State of Indiana,” (Indianapolis: John D. Defrees, State Printer, 1849), 92, 103, ISL, Indiana Collection; “Forty-First Annual Report of the Trustees and Superintendent of the Central Indiana Hospital for the Insane for the Fiscal Year Ending October 31st, 1889, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1889), ISL, Indiana Collection; “Forty-Third Annual Report of the Trustees and Superintendent of the Central Indiana Hospital for Insane for the Fiscal Year Ending October 31, 1891, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1892), 12, ISL, Indiana Collection; “Seventy-Eighth Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for Insane at Indianapolis, Indiana for the Fiscal Year Ending September 30, 1926, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1926), 19-20, ISL, Indiana Collection; Skip Hess, “Release 600 Patients, Central State Ordered,” Indianapolis News, June 11, 1968, 7-8, ISL, Clippings File, Institutions-Central Hospital; Nicole R. Kobrowski, Fractured Intentions: A History of Central State Hospital for the Insane (Westfield, IN: Unseenpress.com, Inc., 2014), 33-35, 38-40.
Land for the Insane Hospital for the Insane was purchased with the objective of establishing a farm colony, where patients would labor as part of their treatment. The hospital’s 1849 annual report noted that male patients cultivated the farm, which was a “great source of amusement and recreation . . . as well as of profit to the institution,” and that female patients were given materials with which to work, not for profit, but “as a source of pleasurable amusement to the convalescent.” According to Nicole Kobrowski’s Fractured Intentions, farming at the hospital proved productive and provided the institution with crops and money generated by their sale. The farm colony was closed and sold in 1968 and used for other purposes, such as Bahr Park. The hospital’s 1891 report noted other forms of “out-of-door employment,” such as grading and excavating by male patients, were thought to contribute to “their own health and to the economical management of the different funds.” Kobrowski stated that early writing, art and occupational therapy was considered “moral therapy.” Artisans and tradesmen taught patients skills, enabling male patients to farm, butcher, and repair, and women to wash, sew, clean, and serve as secretaries. The 1926 annual report summarized the value of work and recreational therapy, stating “We do not want to seem to emphasize the finished articles—after all they are only by-products; it is the betterment of the patients for which we are striving” and that “even if we can not bring about a recovery in a mentally ill person we can [aid?] in their happiness and keep them contented.”
Patients were also “rehabilitated” through social and recreational activities, such as playing sports, touring the hospital grounds, reading at the hospital library, and participating in dances, hobby clubs and stage productions. The hospital’s 1891 report noted that patients attended “concerts, dramas, masquerade balls” and that 60 “inmates” were given free access to the State Fair, along with “space for the exhibition of a large display of rugs, mats, quilts, knitted work and fancy ornaments made by the patients.” The 1926 annual report concluded that “Work and play seem to be more efficacious than any other form of treatment that can be given.”
(This interpretation relies on official hospital records and does not reflect the perspectives of patients, which have proven difficult to locate and are outside the scope of this project).
[6] “[Senate] Report of the Joint Committee, Appointed by the Senate and House of Representatives to Investigate Certain Charges Against the Commissioners and Other Officers of the Indiana Hospital for the Insane,” (Indianapolis: J.P. Chapman, 1851), 4, ISL, Rare Books and Manuscripts; Albert Thayer, The Rough Diamond (Indianapolis: Albert Thayer, January 1, 1886), 3, 11-16, ISL, Rare Books and Manuscripts; Legislative and State Manual of Indiana for 1903, By Authority of the Sixty-third General Assembly, Compiled from Official Records by William E. Henry, State Librarian (Indianapolis: Wm. B. Burford, 1903): 345, accessed Archive.org; Richard Lewis, “Legislators Walk Among the Living Dead at Central State,” Indianapolis Times, March 6, 1949, 3, ISL Clippings File, Institutions-Central Hospital; Skip Hess, “Hospital Lacks 303 Employees,” Indianapolis News, March 12, 1968, 23, ISL Clippings File, Institutions-Central Hospital; Richard D. Walton, “Family Decries Patient’s Tragic Chain of Events,” Indianapolis Star, October 14, 1990, 1, ISL, Clippings File, Institutions-Central Hospital; Psychiatry in Indiana, 10, 15; Charles Mahtesian, “The Last Days of the Asylum,” Governing (March 1993): 32, ISL, Clippings File, Institutions-Central State Hospital; Rachael L. Drenovsky, “Humanity’s Bonfire: William B. Fletcher, M.D., 1837-1907,” Traces (Spring 2001): 25, ISL Clippings File, Institutions-Central State.
The Indiana General Assembly routinely failed to provide the hospital with adequate funds, resulting in understaffing and neglect since the institution’s inception. According to Psychiatry in Indiana, “criticism often ran in cycles; a period of legislative neglect was usually followed by a period of legislative concern where more monies were made available to operate the state hospitals.” As early as 1851, investigations into patient abuses were undertaken. An investigation committee found that:
Facts were elicited clearly, proving to all, that instances of severity of treatment towards inmates had occurred, and their frequency at the early period of its history, resulted from the want of a sufficient number of attendants present, their inexperience and the fact that every class and grade of patients were then crowded together in the same ward.
The Legislative and State Manual of Indiana for 1903 reported that the failure of the legislature to allocate funds was so severe that in 1857 all patients were temporarily “sent back to their counties; some went into the poor houses, some into jails, and the remainder to their homes.” Albert Thayer, a former patient at the Indiana Hospital for the Insane, wrote about the abuses he witnessed in his 1886 publication The Rough Diamond. He alleged that the abuse was not a new occurrence and that although there were “good” employees, if they “sometimes felt compelled to resort to violence to subdue vicious patients, it was the fault of the system under which they worked rather than their own.” Thayer published a letter by Superintendent Dr. William Fletcher in The Rough Diamond, in which the doctor alleged that lack of money was “the essence of the whole matter.” (See footnote 7 for how Superintendent Fletcher attempted to halt these abuses). According to a Traces article, a committee from the House of Representatives investigated the hospital for abuse in 1887, charging the hospital with feeding patients infected pork and hiring incompetent employees.
Allegations continued into the 20th century and Psychiatry in Indiana concluded that “Over time the abuse cited included unclean rooms, physical and verbal abuse of patients, patient suicides, inadequate nursing staff, too few psychiatrists, beatings, poor administration, patients dying in accidents, rapes, infestation of rats, and patients lying naked amongst their excrement.” In a 1949 Indianapolis Times article entitled “Legislators Walk Among the Living Dead at Central State,” state representatives toured the hospital, describing patients as “skeletonic. Some lie in shapeless lumps under thin, dirty blankets.” The newspaper reported gruesomely that “Some on the tour suggested the infirmaries smelled worse than the Dachau concentration camp near Munich, but having smelled Dachau, too, I can point out one principal difference. The inmates of Dachau were liberated.”
In 1968, the Indianapolis News published a series of articles detailing the hospital’s unsanitary conditions, inspiring multiple former patients and their relatives to report neglect. They claimed they were unable to see a doctor for as long as six months due to personnel shortage. Incidents of neglect occurred into the 1990s, when the drowning of a patient contributed to the hospital’s eventual closing (see footnote 10 for closing).
[7] “Thirty-Fifth Annual Report of the Trustees and Superintendent of the Indiana Hospital for the Insane, for the Fiscal Year Ending October 31, 1883,” (Indianapolis: Wm. B. Burford, 1884), 7, 10, 11, ISL Indiana Collection; Monroe’s Iron-Clad Age (Indianapolis), January 12, 1884, 4, accessed NewspaperArchive.com; “Thirty-Sixth Annual Report of the Trustees and Superintendent of the Indiana Hospital for the Insane, for the Fiscal Year Ending October 31, 1884, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1884), 9, ISL, Indiana Collection; Albert Thayer, The Rough Diamond, 11-16; Rachael L. Drenovsky, “Humanity’s Bonfire: William B. Fletcher, M.D., 1837-1907,” 19.
(See footnote 6 about allegations of abuse and neglect at the Indiana Hospital for the Insane).
In her Traces article, Rachael Drenovsky noted that Superintendent William Fletcher “displayed a penchant for reform that he continued to demonstrate throughout his career.” Son of Calvin Fletcher, a prominent early land developer and lawyer in Indianapolis, William was appointed Superintendent of the Indiana Hospital for the Insane in June 1883. Drenovsky noted that Fletcher “employed a regimen of moral treatment” for patients and that “moral treatment required hospitalization, firm but kind discipline, a structured schedule, and mental and physical diversion.” As part of this moral reform, The Iron-Clad Age reported that on Christmas Day of 1883, Fletcher collected all of the hospital’s “machinery and implements for physical restraint,” and burned them in a bonfire before a crowd of patients and staff. The paper asserted that “This is a step in advance. The state can well afford to lose these horrible relicts of past ignorance and barbarity.” According to the hospital’s 1883 annual report, the process of abolishing restraints began prior to the bonfire under Dr. Fletcher’s supervision. The report concluded that “moral force methods are stronger than physical restraints in aiding the mind to recover its balance.” In addition to abolishing restraints, moral therapy included reducing the use of “medical agents,” like stimulants and tonics.
[8] “Forty-Seventh Annual Report of the Board of Control and Superintendent of the Central Indiana Hospital for Insane for the Fiscal Year Ending October 31, 1895, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1896?), 7, 13-14, ISL, Indiana Collection; “Forty-Eighth Annual Report of the Board of Control and Superintendent of the Central Indiana Hospital for the Insane, for the Fiscal Year Ending October 31, 1896, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1897), 8, 14, ISL, Indiana Collection; “Forty-Ninth Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for the Insane for the Fiscal Year Ending October 31, 1897, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1898), 13, ISL, Indiana Collection; Ludvig Hertoen, M.D., “An Historical Outline of the Methods of Anatomical and Pathological Investigation of the Nervous System,” Indiana Medical Journal 15 (January 1897): 264, submitted by applicant; “Course of Lectures to be Given at the Pathological Department of the Central Indiana Hospital for the Insane (1908-1909),” 2, ISL, Indiana Collection; “An Extract from A Statement by the Superintendent to the Board of Trustees of the Central Indiana Hospital for the Insane,” September 30, 1915, 5-6, 13-14, 17, 24, 26, ISL Indiana Collection; “Paresis Treatment,” Logansport Press, August 18, 1927, 4, accessed NewspaperArchive.com; Oren S. Cooley, Director, Indiana Medical History Museum, Indiana Preservationist 1 (January/February, 1997): 13, ISL, Clippings File, Institutions-Central Hospital; Dr. Edenharter’s Dream, 6, 9, 12-13, 15, 26-28, 31.
A 1915 “Extract from A Statement by the Superintendent to the Board of Trustees” noted that in 1893 the hospital began a movement to methodically explore the cause of mental diseases and promote the “systematic clinical training” of students. In 1895, the hospital began to establish a pathological laboratory to facilitate this scientific study. The extract reported that the lab was fully equipped with a “commodious amphitheatre in which to hold society meetings, lectures, demonstrations, clinics and autopsies for the instruction of the outside practitioners and students of the medical colleges.” An 1897 article in the Indiana Medical Journal reported that the laboratory was dedicated on December 18, 1896, proclaiming that it “marks a most significant step in the advancement and the improvement of the humanitarian work in which institutions like the Central Indiana Hospital for the Insane are engaged.”
The hospital’s 1897 annual report stated that the pathology department provided medical staff with courses in histology, clinical chemistry, pathology, and bacteriology. Examination of “blood, pus, urine, new growths” assisted with understanding clinical cases. In Dr. Edenharter’s Dream, Dr. King and Dr. Schmetzer succinctly summarized how the lab contributed to identifying the scientific origins of mental illness:
By comparing clinical symptoms in a live patient in the wards with his or her later autopsy findings, and accumulating data on many such cases, some idea could be gained of which parts of the brain were associated with what symptoms and which disorders caused what kinds of damage to the brain.
According to the authors, the hospital collaborated with teaching schools in the state in order to champion the scientific movement. Laboratory facilities were opened to medical students, allowing them to observe autopsies and attend lectures in the amphitheater. A 1908-1909 “Course of Lectures to be Given at the Pathological Department” noted that professors from the Indiana University School of Medicine and a representative of the hospital’s pathological department provided a series of lectures about topics such as “Anatomy of the Brain and Cerebral Localization” and “Development of the Nervous System.” Dr. King and Dr. Schmetzer contended that the hospital also contributed to the medical community by publishing pathological findings in reports, “presented to the local medical society, and distributed to colleges and universities throughout Indiana. Such data provided a picture of sociological factors in disease, thus opening possibilities for understanding causes.”
According to the Logansport Press, in 1927 the pathological department undertook pioneering experiments for the treatment of paresis, the softening of the brain typically caused by syphilis. Under Superintendent Max Bahr, the lab successfully inoculated patients with malarial germs, inducing a fever which killed the paresis germs. Within two years, 160 afflicted patients left the institution cured. (Learn more about the revolutionary technique with Dr. Edenharter’s Dream: How Science Improved the Humane Care of the Mentally Ill in Indiana, 1896-2012). According to the Indiana Preservationist, Central State Hospital utilized the pathology building until the 1960s and in 1969 the Indiana Medical History Museum was established in its place.
[9] “An Act to Amend Section 10 of an Act entitled ‘An Act Regulating Insanity, Inquests, and the Committal of Insane Persons to Hospitals for the Insane, and Their Discharge Therefrom,’ Approved April 14, 1881, and Adding Supplemental and Declaratory Sections 24, 25, 26, 27 and 28 Thereto, Repealing All Laws in Conflict Therewith, and Declaring and Emergency,” Approved March 11, 1889, Section 2 in William F. Elliott (of the Indianapolis Bar), Elliot’s Supplement to the Indiana Revised Statutes, 1881, Embracing Without Abridgement All the Acts of the General Assembly from 1883 to 1889, Inclusive, with Reference to Prior Statutes, and with Copious Notes of the Decisions of the Supreme Court of Indiana and of Other Courts, Construing the Text of the Acts and Bearing Upon Analogous Questions (Indianapolis: The Bowen-Merrill Co., Law Publishers, 1889): 163-164, accessed HeinOnline.org; “Seventy-Eighth Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for Insane at Indianapolis, Indiana for the Fiscal Year Ending September 30, 1926, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1926), 4, ISL, Indiana Collection; “Unnecessary Bill,” The Republic [Columbus, IN], January 21, 1927, 4, accessed Newspapers.com; “An Act to Rename the Hospitals for the Insane, Prescribing the Rights, Powers and Duties of such Hospitals as a Result of the Change in the Names and Providing for the Conclusion of Proceedings Begun Under or By the Name By Which Hospitals Were Formerly Known,” Approved March 3, 1927, Chapter 47 in Laws of the State of Indiana, Passed at the Seventy-fifth Regular Session of the General Assembly, Begun on the Sixth Day of January, A.D. 1927 (Indianapolis: Wm. B. Burford, 1927): 129, accessed HeinOnline.org; “Mental Sickness,” Garrett Clipper, January 10, 1927, 2, accessed Newspapers.com; “Seventy-Ninth Annual Report of the Board of Trustees and Superintendent of the Central State Hospital at Indianapolis, Indiana for the Fiscal Year Ending September 30, 1927, to the Governor,” (Indianapolis: Wm. B. Burford, Contractor for State Printing and Binding, 1927), ISL, Indiana Collection.
In 1889, an amendment to an 1881 act changed the name of the institution from the “Indiana Hospital for the Insane” to “Central Indiana Hospital for the Insane.” The addition of “Central” differentiated the hospital from other mental health facilities located in other areas of the state, including those in Evansville, Richmond, and Logansport. In 1927, the Indiana General Assembly approved an act eliminating the word “insane” from the institution’s name, designating it the “Central State Hospital.” The reasoning behind the change is not listed in the act or the hospital’s 1927 annual report. However an article published by Columbus, Indiana’s The Republic alludes to changing perspectives about “insanity.” Although the article opposed the removal of the word “insane,” it noted that:
As time advanced, and brought medical advancement, it was realized that insanity was a condition that required specialized attention rather than mere imprisonment and hospitals were founded where it is successfully treated in many cases.
The Garrett Clipper noted that Superintendent Dr. Max A. Bahr suggested the word “insane” be removed from the hospital’s name, as it “brings out the manner in which such afflictions are viewed officially.” Dr. Bahr added “’a stigma is attached to persons who are adjudged to be insane and for that reason their relatives and friends hesitate to avail themselves of the opportunities the state offers for treatment and care.”
[10] Indiana Family and Social Services Administration, Central State Hospital Bulletin (Winter 1992), submitted by applicant; The Central Scene, 16; “The Last Days of The Asylum,” Governing (March 1993): 16, 32; Fractured Intentions, 149-150, 153-155.
Central State Hospital closed in 1994 with the objective of returning to community-based care. According to a 1993 Governing article entitled “The Last Days of the Asylum,”
The emptying of the state mental hospitals has been going on now for more than three decades. The process began in the late 1950s, with the introduction of antipsychotic medication that made the release of large numbers of patients feasible. It was fed in the 1960s and 1970s by the growing concern over patients’ individual rights and by the portraits of institutional tyranny being presented in One Flew Over the Cuckoo’s Nest and other popular fiction.
Central State Hospital followed the trend toward community-based health care when Governor Evan Bayh announced June 1992 that the hospital would shut down. The decision was partly motivated by the drowning of a patient, one of many instances of neglect in the hospital’s history. The Central State Hospital Bulletin noted that the decision “continues an ongoing trend in Indiana and the rest of the country to downsize psychiatric hospitals” and was the result of “patient deaths of a suspicious nature; serious, persistent staff morale problems; treatment practices that require oversight from clinicians outside the facility; and shortages in psychiatric and nursing staff.”
The Central Scene reported that the hospital officially closed June 30, 1994 and patients were temporarily transferred to the Larue D. Carter Memorial Hospital before being placed in community centers. According to Kobrowski, patient outcomes were mixed. A 10 year tracking study found that the majority of patients were placed in semi-independent living programs, private residences, and supervised group living. Another study showed that although data is lacking regarding outcomes, patients’ quality of life generally improved after leaving Central State Hospital.
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