USA > Massachusetts > Essex County > The story of Essex County, Volume II > Part 26
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There is a possibility that Mrs. Putnam's "fits" were part of a coolly calculated sham to secure the conviction of Rebecca Nurse, who belonged to a family with which the Putnams had been involved in a dispute. There is no doubt that Mrs. Putnam hated Rebecca Nurse and her sister, Mary Easty, but there is good reason to believe
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that she really was a victim of some sort of hysteria. Fiske explains the troubles of Mrs. Putnam and the afflicted children as follows :
"Mistress Ann Putnam, the sergeant's wife, was a beauti- ful and well-educated woman of thirty, but so passionate and high-strung that in her best moments she was scarcely quite sane. She was deeply engaged in the village quarrels; she also played an important part in supporting her daughter Ann and her servant Mercy Lewis in some of the most shock- ing work of that year.24
"She had once been the most sparkling and brilliant of women, but was sinking into melancholia at the time when the first stories of witchcraft came from the parsonage and she learned that her little daughter Ann, a precocious and imagina- tive child, was one of the afflicted. Mrs. Putnam and her husband were both firm believers in witchcraft. I 'do not think it strange that her diseased mind should have conjured up horrible fancies about Goodwife Nurse, member of a family she probably hated all the more bitterly for the high esteem in which it was generally held. Mrs. Putnam fell into vio- lent hysterical fits like her daughter, and their bright and active servant, Mercy Lewis, was afflicted likewise. These three, with the minister's niece, Abigail Williams, and her friend, Mary Walcott, were the most aggressive and driving agents in the whole tragedy. I presume Mrs. Putnam may have exercised something like what it is now fashionable to call hypnotic influence over the young girls. She honestly believed that witches were hurting them all, and she naturally sus- pected foes rather than friends. I see no good reason for doubting that she fully believed her own ghost stories, or that the children believed theirs. In their exalted state of mind they could not distinguish between what they really saw and what they vividly fancied. It was analogous to what often occurs in delirium.25
"It will not do to invest those poor girls with a nineteenth century consciousness. The same delusion that conquered
24. "Witchcraft in Salem Village," John Fiske, p. 24. Houghton Mifflin, Boston and New York, 1904.
25. Ibid., p. 58.
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learned magistrates led them also astray. Still more, they were doubtless in a morbid mental condition. A large part of Indian medicine consists of convulsive muscular move- ments, twitching, capering, and groaning, accompanied by an awestruck belief in the presence of some supernatural agency. Such convulsive movements tend to prolong themselves, to recur with spasmodic violence, and they are in a high degree contagious. Abundant instances may be found among the experiences of revival meetings, where multitudes of ignorant minds are at work after much the same fashion as the Indian's, though in connection with different religious symbols. This kind of hysterical excitement selects for its victims impres- sionable people with sensitive nerves; it attacks children more readily than adults, and women more frequently than men; vivacious and quickly responsive temperaments are more sub- ject to it than those that are phlegmatic and slow. Under suitable circumstances it easily develops into a thoroughly morbid mental state, in which convulsive movements are attended by partial and temporary hallucinations; the nervous impressions become so vivid that ideas are clothed with exter- nality and mistaken for realities. Such are the characteristics of hysteria and allied forms of mental disturbance, which dif- fer from true insanity in being merely temporary and func- tional, and not connected with any organic lesion. They are very striking phenomena, and often very shocking, but not more serious than many other phases of abnormal mental life."26
It has been said that there have been three periods in the history of the treatment of the insane and the mentally deficient-the bar- baric, the humane, and the remedial. Previous to 1845 the treat- ment of the insane in Essex County would, to a great extent, be included in the first category. Although the active connection of insanity with the work of the Devil had passed from the mind of the public before the eighteenth century was far advanced, the ancient, callous attitude toward the treatment of the mentally inca- pacitated persisted.
26. Ibid.
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The keepers of jails and almshouses where these unfortunates were confined are hardly to be blamed for the conditions, for they lacked both the adequate facilities for proper care and a comprehen- sion of the nature of the problem with which they were obliged to cope. If a maniac of the most violent sort were delivered to an almshouse, the keeper was forced to prevent him from escaping or injuring the other inmates by any means that could be found. When possible, a violently insane person was confined in a well secured cell of some sort, and allowed no contacts with others, or sympathy of any kind. Doubtless the loneliness and close restrictions were instru- mental in driving many persons, who might otherwise have recov- ered, permanently insane. Moreover, the presence of a raving mad- man in an almshouse with other less violent cases, and worse, with infirm or aged paupers, was a very disturbing influence. In some instances the violently insane were confined in poorly heated outbuild- ings in the interests of the other inmates.
A survey made about 1840 revealed a great deal of unnecessary suffering among the insane and the mentally deficient, which was due in some cases to the gross cruelty, or at least the negligence, of those trusted with their care. Idiots and insane people were sometimes found chained in squalid cells of jails or almshouses, and many in the care of their families fared little better. Damp cellars and attics were often places of confinement, while in Newburyport a woman was kept for years in a dark, unventilated closet under the stairs, her food being passed to her through a small aperture pro- vided for the purpose.
By 1840 humanitarian thought had advanced to the point where such conditions could no longer be knowingly tolerated, and a State- wide survey set a strong movement under way to improve the treat- ment of the insane. Institutions for the care of the mentally defec- tive were provided, to an increasing extent, and gradually jails and almshouses were used less as places of confinement for these unfortunates.
About this time an institution known as "the Receptacle for Idiots and Insane Persons in Essex County" was in operation in Ips- wich. Kind treatment and clean surroundings were provided, thus greatly improving the conditions of the insane in the county. A set
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of rules and regulations governing the "Receptacle" were issued in 1844. The clause governing admission reads as follows :
"Any idiot or insane person, not furiously mad, may be confined therein by order of two justices of the peace . . . or by any police court having jurisdiction in the case."
A description of the Ipswich Receptacle is found in the "Report on Insanity and Idiocy in Massachusetts by the Commission on Lun- acy Under Resolve of the Legislature of 1854":27
"The receptacle for lunatics at Ipswich is connected with the House of Correction, and under the same roof; yet it is entirely separated from the prison by the center building. . A closed brick wall, also, prevents all access from one to the other. . . The internal arrangements of the sev- eral stories are similar to those usually found in the wings of lunatic hospitals. There is a hall in each . . . running the entire length, with lodging rooms on each side. These rooms are ten feet long and six feet wide, and of the same height as the hall. There is a large window at the end of each hall, and a smaller one in each lodging room, all with iron sashes. Besides these rooms, there are several strong rooms or cells in the basement story for the excited and furious patients. These have grated windows, like those of a prison, and some of them are provided with strong shutters, to pre- vent the violent inmates from breaking the glass. . . . . Besides these means of security there are provided hand straps, mittens, muffs, &c., to restrain those who need them. . The whole is warmed by hot-air furnaces in the basement, and perfectly ventilated by Emerson's apparatus. . "
In addition to these features, facilities for exercise were pro- vided, and the less violent male patients were allowed to work in the fields. Proper bathing and toilet conveniences were also avail- able. There were sixty-eight patients in the institution at the time the report was made.
In 1855 the State Lunacy Commission estimated that there were three hundred and nine insane in Essex County, or one in four hun-
27. Pp. 116-17.
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dred and eighty-five. Of these, one hundred and sixty-seven were classed as paupers and one hundred and forty-two as independent. Only forty were considered to be curable, while two hundred and forty-six were pronounced definitely incurable. By this time consid- erable progress had been made toward providing care for the insane, one hundred and thirty-three patients from Essex County being in some form of institution. An argument for hospitalization appears on page 56 of the report :
"In some cases, the family of an insane patient, although independent, are unable to pay for the expenses of his support at a hospital. They have a becoming self-respect which will not permit them to ask for aid from the public, and yet they are too poor to furnish the means of restoration themselves; consequently the lunatic is neglected, and his malady suffered to become chronic and hopeless. His family maintain him at home until both their means and his chance of recovery are exhausted; and then he is sent to the poorhouse, and at once swells the list of incurable paupers."
During a greater part of the latter half of the nineteenth century there was constant improvement in the facilities for the care of the insane. More and more stress was placed on the curative angle, which had previously been almost entirely neglected. The greatest progress during this period, however, was made in providing for the greater comfort and happiness of the patients, since medical knowl- edge of the nature and treatment of insanity was still very limited. In the latter field the greatest advance has occurred during the past thirty years.
The establishment of a State hospital for the insane at Danvers was an important step in the advance of medical science in this sec- tion. The hospital was built on the summit of Hathorne Hill, a beautiful situation with a splendid view of the surrounding country, and was opened in the spring of 1878. The original plant included two center buildings, with four wings radiating from them. The administration building was ninety by sixty feet, and had a tower one hundred and thirty feet in height. The accommodations for the patient were on a scale considered grand in those days for such an institution. The original capacity was for five hundred patients, but
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since that time many additions have been made, until at present about 2,1 50 inmates are accommodated.
Since the establishment of the Danvers State Hospital, remark- able progress in the treatment of mental diseases has been made. In the 1890's, Dr. Charles W. Page, then superintendent, was respon- sible for a very important step in the advance of psychiatry. Dr. Page believed that mechanical restraint was unnecessary and harm- ful in the care of mental cases, and proceeded to put his idea in prac- tice, with the result that no up-to-date mental hospital employs the straight jacket or the padded cell. The purpose of modern insane hospitals is to change the outlook of patients and to strengthen their morale and self-reliance, so that such patients as are capable of recov- ery can be restored to normal life. Even the violent and incurable patients have a favorable reaction to sympathetic treatment. The atmosphere of peace and quiet at Danvers, in conjunction with the prospect of the pleasant countryside, are most conducive to the heal- ing of mental ills. Excellent results have been attained in some cases by finding means to keep the patients occupied, such as gardening, basket making, and carpentry. The Danvers State Hospital has originated, or been quick to adopt, the most advanced principles of psychiatric practice, particularly in relation to the most violent patients of the maniac type. The importance of the development of curative treatment is reflected in the facts that fifty-two per cent. of all hospital beds are devoted to mental cases, and that now almost half of those admitted are returned to society, as against the mere eight per cent. in the days before institutional treatment of mental cases was revolutionized.
The superintendent of the Danvers State Hospital is Dr. Clar- ence A. Bonner, and a staff of twelve resident officers is maintained. The board of trustees includes S. Herbert Wilkins, chairman, of Salem; James F. Ingraham, of Peabody; Dr. Arthur C. Nason, of Newburyport; William W. Laws, of Beverly; Mrs. Annie T. Flagg, of Andover; and Albion L. Danforth, of Winchester.
Tuberculosis is a disease which long baffled medical science, and for which no specific and dependable cure has yet been found, although important progress has been made in discovering its extent and fatal- ity. Consumption was a frequent cause of death in the early days of the colonies, but it was not until the decades immediately follow-
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ing the Revolution that it became the plague that it has been since that time. Previous to the Revolution, consumption was a disease of many years' duration, and middle-aged and elderly people were most often the victims. When a youth of nineteen died of consump- tion in 1727, it was considered a remarkable occurrence, but from the beginning of the nineteenth century to the present day, the dis- ease very frequently has resulted fatally to young people after illness of only a few months. In the First Parish of Lynn, of the three hun- dred and sixteen people who died in the twenty years before 1824, one hundred and twelve were victims of consumption. In this town, in some years since that time, more than half of the deaths can be attributed to this malady. In other Essex County communities a similar situation existed, and for over sixty years consumption was a veritable scourge. After a time the fatalities from the disease declined gradually, but as late as 1880 it was the leading cause of death in many places.
It is difficult to explain the sudden increase and change in tuber- culosis since the Revolution. It may be that a new type of the disease evolved, or reached this country about that time. Some writers explain it as the result of changes in living conditions, which involved more general confinement in hot, poorly ventilated rooms, and habitual lack of exercise.
Great strides have been made in the treatment of tuberculosis since the days when bleeding was a favorite remedy. In the last twenty years the prevention of the spread of the disease has received great attention. The pasteurization of milk, the governmental inspection of meat, camps for building up the resistance of children susceptible to tuberculosis, and various other expedients have been effective in reducing the death rate from this cause.
The Essex County Health Association has for several years con- ducted such a camp for undernourished children at Middleton. Dur- ing the first decade of its existence the association cared for 668 chil- dren, of whom only one has died of tuberculosis. The camp is under the supervision of Vera D. Griffin, field secretary; Rae E. Kaufer, educational secretary; a staff of eight councilors, and a camp nurse. Dr. Olin S. Pettingill, superintendent of the Essex Sanatorium, and president of the Essex County Health Association, gives periodic examinations to determine the condition of the children. The aver-
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age gain in weight for each child at the summer preventorium is about five pounds.
As to the treatment of consumption, the Essex Sanatorium in Middleton is the last word in modern tuberculosis hospitals. The Essex Sanatorium was opened for the reception of patients on May 26, 1921, at that time having accommodations for two hundred and eight patients. In May, 1930, the Infirmary Building, consisting of sixty-eight single rooms and six double rooms, was opened, increasing the capacity of the institution to three hundred and sixty. The sana- torium is operated by the county of Essex, under the supervision of the State Department of Health, the appointment of physicians to the medical staff being subject to the approval of this body. Patients are admitted upon application, signed by a local board of health. Except for $5 per week allowed by the State for board of patients, the institution is supported entirely by Essex County.
The original board of trustees consisted of Moody Kimball, chairman; James M. Grosvenor, Jr., and James N. Poor. Dr. Olin S. Pettingill was intimately connected with the founding of the insti- tution, and is now superintendent. Besides Dr. Pettingill there are eighteen resident officers, and in 1932 there were nearly one hundred other employees, including attendants, nurses, and student nurses.
The most up-to-date methods of treatment are used in the Essex Sanatorium. Rest and fresh air are, of course, prime requisites in treating tuberculosis, but additional expedients are necessary in some cases.
The mental attitude of the tubercular patient is often an impor- tant element in arresting the disease, and the Essex Sanatorium uses occupational therapy as a means of keeping the minds of some of the patients occupied. Correspondence courses supplied by the Massa- chusetts State Department of Education are used with this end in view, there having been sixty enrolled on December 1, 1932. Courses in English and first aid are particularly popular.
The modern "Collapse Therapy" has also been used with some success in the Essex Sanatorium. A collapsed lung in many cases will heal better than an active one, and with this fact in mind, artificial pneumothorax was attempted in fifty-eight cases in 1932. That year two cases received phrenicectomy, and extrapleural collapse was per- formed upon eight patients. During the year one hundred and forty patients received some form of collapse therapy.
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The Essex Sanitorium, situated in the pleasant country near Mid- dleton, and furnished with the best modern buildings and equipment, has received wide recognition as one of the country's leading tuber- culosis hospitals. It does a great service in the county, giving a renewed chance for life to over six hundred sufferers each year, a large proportion of whom would certainly have succumbed twenty years ago.
Medical training, and the standards of the medical profession, have seen a great improvement, which correlates in a general way with the increasing effectiveness of the treatment of disease. In the earliest days, as has already been mentioned, much of the medical work was done by clergymen who had acquired a knowledge of medi- cine along with other phases of their liberal education. A few well- trained medical men did arrive with the first settlers, but on the whole the physicians were a rough and ready group of men, intelli- gent and resourceful, though but poorly trained. It is doubtful if a single practitioner holding a medical degree settled permanently in Essex County until well into the eighteenth century.
Previous to the Revolution most physicians received their train- ing under the guidance of older men who were engaged in medical practice. Frequently physicians took their scholars with them on their daily rounds, in order to show them the various forms of dis- ease, and to teach them the rules of diagnosis. On return home, the student was questioned upon what he had observed. The value of this sort of training depended upon the knowledge and wisdom of the physician, and in many cases, unfortunately, both qualities were wanting. Then, too, with the limited means of communication avail- able in those days, it was hard for even the keenest of physicians, particularly in the smaller towns, to keep abreast of the additions to medical knowledge. Men who had studied medicine abroad, and were qualified to write "M. D." after their names, were very rare. There were, of course, the quacks and charlatans who professed training, but lacked it, and the "barber-surgeons," who claimed no medical education whatever.
Attempts by the more conscientious physicians to improve pro- fessional standards gradually bore fruit in the formation of the Massachusetts Medical Society, in 1781, of which more is said in an account of the work of Dr. Edward A. Holyoke, to follow.
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The founding of the Harvard Medical School also helped to raise the standard of the medical profession. In 1805, the Essex South District Medical Society was founded by ten physicians who met at the Sun Tavern in Salem. Dr. Holyoke, of Salem, was the first presi- dent, and Dr. John D. Treadwell, also of Salem, was secretary. A similar organization, termed the Essex North District Medical Society, was organized in 1841. These societies, which are divisions of the Massachusetts Medical Society, have done much to improve medical knowledge and ethics in the county. In their first years, par- ticularly, clinical cases of interest were reported, and questions of medical science and professional ethics were discussed. At present these district societies serve a valuable purpose in the presenting of courses, prepared by the Massachusetts Medical Society, designed to broaden and keep up-to-date the knowledge of the practicing physicians.
Today, the standards of medical practice in Essex County are very high. Strict State laws require every physician to hold a degree from some approved school of medicine, and provisions have been made to bar from practice such physicians as have not lived up to the tenets of their profession. It is not possible here to discuss, indi- vidually, the many eminent physicians now practicing in Essex County, but an attempt will be made to describe the lives and works of some of the outstanding physicians of years gone by.
John Winthrop, Jr., son of the Governor of Massachusetts, was probably the first man well versed in medicine to take up his abode in Essex County. Winthrop, who was in Ipswich at an early date, and later became Governor of Connecticut, was a noted physician, although his other activities rather overshadowed his medical prac- tice. He was an accomplished scholar, and was one of the earliest members of the Royal Society of London. His large correspondence with scientific men is a source of many interesting facts about medi- cine in the early days of the Colony.
Giles Firmin, Jr., who came to this country in 1632, was another early settler who practiced medicine. His father, an apothecary of Sudbury, England, came over about the same time, and probably was a medical practitioner also. Giles, Jr., had been educated at the University of Cambridge, and apparently was a very learned man. According to Green: "He is the first man known to have taught in
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New England this branch of science, and he seems to have left a pro- fessional imprint on the minds of his students."28 He had a wide reputation as a successful physician in Ipswich, where he lived for some years. His statement in a letter to Winthrop somewhat later showed the financial status of a physician in those days: "I am strongly sett upon to studye divinitie, my studies else must be lost : for physick is but a meene help."29
Firmin eventually did study theology, and left his practice in Ipswich to return to England, where he was ordained and settled as a rector. It is said that he continued to practice medicine along with his new duties.
The reputation acquired by Firmin as a teacher of medicine is demonstrated in a letter from the apostle Eliot to Mr. Shepard, the minister of Cambridge, dated September 24, 1647. Eliot desired that "our young Students in Physick may be trained up better than yet they bee, who have onely theoreticall knowledge, and are forced to fall to practice before ever they saw an Anatomy made, or duely trained up in making experiments, for we never had but one Anatomy in the Country, which Mr. Giles Firmin (now in England) did make and read upon very well, but no more of that now."30
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