Ohio History Journal

PETER WITT                        377

 

irascible exterior and his biting invective there were qualities of

honesty, fidelity, and generosity that made him the loyal, senti-

mental friend of many people. He had genuine oratorical gifts,

though he sometimes attacked unreasonably and without full in-

formation about the facts, and he had a tongue that he always found

it hard to curb. He never attacked with a rapier. A meat cleaver

was his favorite tool, as he himself readily admitted to his friends.

But he never lacked courage, and he regarded himself as the keeper

of Cleveland's conscience. As he grew older he earned enough

money to live comfortably and to provide for his children the ed-

ucational opportunities he had been forced to forego. But he never

lost the common touch. His ferocity in battle grew less with ad-

vancing age, but he always loved a brisk encounter and got consid-

erable joy and satisfaction from his crusading activities.46

Debs described his friend as "clean, brave and wholesome."47

A friend in Bermuda wrote, "Tom [Johnson] gave Cleveland char-

acter and warmth, and in addition to those qualities, you have

given it color."⁴⁸ "Peter Witt can only be bought through love and

justice," was the final judgment of Tom L. Johnson.49 Whatever

the ultimate appraisal of his biographer may be, Peter Witt lived

his own life in his own way wholly unmindful of what others might

think or say, and like Debs he believed that he who loves the com-

mon man must rise with the ranks, not from the ranks.

 

46 See Clarence Darrow to Witt, July 17, 1928.

47 Debs to Witt, February 15, 1910.

48 Letter of February 12, 1938.

49 Elizabeth Johnson Mariat to Witt, no date, 1934.

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PSYCHIATRIC PROGRESS IN OHIO IN THE

TWENTIETH CENTURY*

 

by JOSEPH L. FETTERMAN, M.D., and JACK HORROCKS, M.D.

The Fetterman Clinic, Cleveland, Ohio

 

At the turn of the century psychiatry in the state of Ohio was

a rather backward specialty, limited as to the number of those who

practiced it, limited as to facilities, and limited as to techniques of

treatment and concept. Yet psychiatry in Ohio was linked with

the state of scientific knowledge throughout the world. We may

compare the progress of a specialty in one community with its

status elsewhere as a shadow which precedes or follows but is

always close to the individual casting the shadow.

A glimpse into the status and the type of practice at about

1900 may be gained from the fact that there was only a small

number of doctors in this field. Among those who were the earliest

to specialize in psychiatry in Cincinnati were H. H. Hoppe, David

I. Wolfstein, and Frank W. Langdon. These three men with the

aid of Philip Zenner organized a neurological society in Cincinnati

in 1902. At about the same time in the city of Cleveland, Henry

S. Upson was the professor of nervous diseases at the School of

Medicine, Western Reserve University, J. R. Horner was connected

with the Homeopathic Hospital, and A. B. Howard was superin-

tendent of the Cleveland State Hospital. We may mention among

the pioneers in the field Dr. Christian Sihler, who initiated the use

of hydrotherapy for many illnesses and established the old Windsor

Hydrotherapeutic Institute. This became the forerunner of the

present Windsor Hospital at Chagrin Falls. Among others who

practiced at this time in the Cleveland area were Charles Aldrich,

Walter Laffer, and John S. Tierney.

Private practice in psychiatry was rather meager, but the state

hospital system was already well established and accommodating a

 

* This article was given as a paper at the annual meeting of the Committee on

Medical History and Archives of the Ohio State Archaeological and Historical Society

held at the Ohio State Museum, Columbus, April 23, 1949.

378

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PSYCHIATRIC PROGRESS IN OHIO            379

 

fairly large number of patients. For instance, the Ohio Hospital

for Epileptics had been founded in 1893 and was considered the

first of its kind in the world supported by public revenue. The

Toledo State Hospital was opened in 1888 and Massillon State Hos-

pital opened its doors in 1898. The report from the Cleveland

State Hospital in 1898 has a familiar ring to those who are prac-

ticing today in this community. "The overcrowded conditions

have been relieved by the transfer of 140 patients to the Massillon

State Hospital."  Apparently the Cleveland state hospitals have

not been relieved of their overcrowding even during the five decades

of growth and progress.

We may mention in passing that the first hospital for the men-

tally ill in Ohio was established in 1821 under the name of the Com-

mercial Hospital and Lunatic Asylum of Cincinnati. This city also

has one of the oldest private hospitals specializing in mental illness

west of the Alleghenies, the Cincinnati Sanitarium.

Of considerable interest in review of specialty practice and

the concepts of the day are some of the published reports of the

hospitals and the articles contributed by the psychiatrists of the

time. The state hospitals submitted semiannual reports of their

activities which were abstracted in the American Journal of Insanity.

These reports deal largely with physical improvements of the

plants: "New buildings added, various amusements for enjoyment

of all improved, cozy corners tastefully furnished with divans have

been made in the institution--new buildings housing a barber shop

and tailor shop have been erected;--a new bathing system has

been installed." Some reports deal with the hopeful therapeutic

procedure of the day, hydrotherapy: "A building has been com-

pleted for acute and curable cases of insanity. The basement con-

tains Turkish baths, needle and spray baths, showers."

The prevailing concepts were still those of phrenology and

localization, and interest in organic neurology preceded that in

psychiatry. State hospital physicians held meetings, and their

papers had a scientific and progressive ring which was largely

neurologic. At a session of the assistant physicians of the state of

Ohio in 1904, W. W. Richardson presented a case of syringomyelia,

Guy H. Williams reported a case of sudden death due to an

aneurysm of the heart, G. P. Harding, Jr., described the symptoms

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380   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

in a patient, age nine, with the diagnosis of psychical epilepsy, and

observations on status epilepticus was the subject of a talk by

R. W. Holmes.

Therapeutic methods were extremely limited at this time, but

in addition to hydrotherapy, electricity was quite popular. Indeed

even in the early 1920's when one would visit the office of a neurol-

ogist, he would see on the walls or in interesting cabinets very

involved electrical equipment. The neurologists busied themselves

with all kinds of electrical therapy. Charles E. Sawyer of Marion,

Ohio, contributed in 1904 a rather comprehensive paper dealing

with "Electricity in the Treatment of Nervous Diseases." Sawyer

described in great detail four modalities of electricity: faradic,

galvanic, sinusoidal, and static. He then listed the indications for

each method, such as faradic to improve nutrition, galvanic for

tissue destruction, sinusoidal to correct faulty elimination, and

static to free ozone serving either as a tonic in some cases or to

enervate in others. Sawyer's dissertation was substantiated by J. R.

Horner of Cleveland.

With reference to the comparative values of different types of

hydrotherapy, a little may be learned from an interesting editorial

in the Lancet-Clinic of Cincinnati in 1900 dealing with the value

of "Turkish baths": "There is a great improvement in the statistics

of cured and death rates among the insane since using Turkish

bath which is preeminent among baths."

^The emphasis upon electricity and upon the Turkish baths as

a preeminent form of hydrotherapy is an indication of what one

might term styles of therapy. At present physicians have resorted

to the use of hormones and vitamins. The medical historian fifty

years from today may comment with more derision than admiration

upon the use of these two injection techniques.

Many of the contributions of this period represent scholarly

observations, whereas certain modes of treatment were but a reflec-

tion of the concepts of the times. For instance, in the American

Journal of Insanity in 1898 there is an interesting article on

melancholia, stressing the danger of suicide: "66% of patients show

suicidal tendencies." This statement is equally true today. William

Gillespie wrote an article in 1902 on the obstetrical aspects of

idiocy, in which he attributed this disorder to asphyxia in the new-

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PSYCHIATRIC PROGRESS IN OHIO             381

 

born.  Today we speak of cerebral anoxia, but the concept is

virtually unchanged.

In the first decades of the present century the concept of auto-

intoxication as a cause of mental disease was quite popular. For

instance, one of the psychiatrists blamed much of mental illness

upon auto-intoxication within the stomach, and he therefore advo-

cated the washing of the stomach with boracic acid. A skillful

surgeon was removing parts or all of the colon as a cure for

insanity on the concept that the colon harbored germs which were

leading to mental illness. Other psychiatrists held that the female

pelvic organs were responsible for mental disease in that sex.

One writer therefore advocated the removal of all pelvic disease,

deformity, or disturbance to cure insanity. However, this opinion

met with disapproval by others, and one psychiatrist spoke out with

words which are equally true today. "Extirpation of the ovaries is

a more prolific cause rather than a cure of insanity.... Many an

ovary is thus sacrificed. When the patient hangs a neurotic ail-

ment on a cardiac hook, the surgeon cannot suggest that the offend-

ing organ be removed."

In a personal discussion with two living Cleveland psychiatrists

who obtained their medical educations before 1900 and whose pro-

fessional lives have spanned a period of over fifty years, namely,

J. S. Tierney and Guy H. Williams, Sr., it was learned that the

education of students in neurology and psychiatry was scanty. One

of these men spoke about having been exposed to only a few clinics

and some visits to the Cleveland State Hospital. Emphasis was

on neurology where localization or even references to phrenology

were still mentioned. Few men were doing private practice and

there was no systematic program of treatment. One of the doctors

mentioned that diagnosis was limited to three major concepts:

depression, exaltation, and circular insanity.

However, progress became evident even in the first decade of

the present century. Charles Aldrich in 1908 clearly pointed out

that a neurosis was a functional illness and not dependent upon a

discoverable localized lesion in the brain. C. G. Mills in 1909

stressed the importance of psychotherapy not only for specialists

but for general practitioners. Orpheus Evarts urged active treat-

ment for the insane "soon after impairment, even if the treatment

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382   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

be experimental." Evarts recommended discipline-to correct lack

of control-rest, nutrition, and symptomatic medication. A par-

ticularly modern note is heard in his urging of baths, exercise, fresh

air, sunlight, and occupation and amusement as accessory forms of

therapy. He correctly warned against travel as a treatment for

insanity, "since the patient would be preoccupied with himself and

suicide is considered a constant danger." Mumaugh in 1907 wrote

about the close relationship between mental excitement and physical

disease and described disorders which are clearly recognized as

anticipating the popular concept of psychosomatic illness.

Howard in 1908 wrote a critical paper on insanity and crime.

His words are timely even for 1949. "A commission of impartial

experts should be appointed by the court-it is possible to obtain

divergent theories from experts chosen by both sides."

The value of follow-up care, a forerunner of the concept of

mental hygiene for discharged patients, was stressed by Guy Wil-

liams in 1910 who stated, "As a means of relieving hospital con-

gestion and of saving one-fourth of the time spent in institutions,

we should arrange for people to advise and look after the welfare

of patients outside of the hospital."

In the following decade Ohio marched forward with the march

of medicine. Langdon of Cincinnati and also Kirk had written

about Huntington's disease, a familial disorder whose chief features

were heredity, chorea in adulthood, and dementia. Huntington had

practiced in Ohio before moving to Long Island, at which residence

he described the disease now known by his name. Charles W.

Stone in 1912 described the mental symptoms of osteitis deformans

(Paget's disease). H. H. Drysdale in the same year reported on

Freud's technique of psychoanalysis, commenting on the use of

free association and upon the therapeutic value of analysis in

selected cases.

We may interpolate at this time that the last decade of the

nineteenth century and the first decade of the twentieth century

were fruitful years for psychiatry largely because of the original

and searching observations of Sigmund Freud on the deeper

causes of mental disease. His theory called psychoanalysis, then

in its infancy, had shown the connection between symptoms of

• 6
 

PSYCHIATRIC PROGRESS IN OHIO             383

 

nervousness and experiences in infancy and childhood. Freud had

shown that a conflict between instincts and inhibitions led to a re-

pression of certain impulses, which though repressed remained

charged with energy. Such repressed instincts become manifest in

disturbed forms in dreams, in protective symptoms, in fears, and

in a variety of bodily dysfunction. Freud's views have been con-

firmed and accepted throughout the years. It is of interest to note

that Ohio was also accepting such views even though at a late date

and rather slowly.

During this time also Kraepelin had published his extensive

observations and his classification of psychoses. This classification

was accepted in Ohio. In the meantime studies of physical changes

in the brain by a variety of methods had revealed that certain

psychoses were caused by organic disease. The most conspicuous

of these, of course, was paresis. The proof of its true syphilitic

nature was being established by the findings of spirochetes in the

brain by Noguchi and Moore in 1913 and later by the use of the

Wasserman test of the blood and spinal fluid. Therefore discarded

were the views of S. W. Langdon, who claimed to have found "the

bacillus paralyticans in the cerebral spinal fluid." John D. O'Brien

in 1906 reported an interesting theory of paresis and quoted statis-

tics to the effect that the disease was on the increase. It was

believed at that time that alcoholism, stress, and toxemia, as well

as syphilis, were responsible for this condition.

Another paper of interest in the second decade was the

report on the treatment for delirium tremens by Kramer con-

sisting of the injection of 50 cc. of 1% solution of sodium

bromide subdurally. This author claimed a prompt improvement

and often disappearance of symptoms. Such a procedure is in a

sense a forerunner of the present measures consisting chiefly of

intravenous injection of glucose in normal saline, thiamin chloride,

and insulin. Such an injection supplants fluid loss, stimulates

cellular metabolism, and makes glucose available for oxidation. Its

use has reduced the period of illness and has cut down the high

mortality to practically zero. Tom Spies and Marion A. Blanken-

horn, then working at Western Reserve University, were among the

earliest in the 1930's to establish the role of avitaminosis in

delirium tremens and in the psychosis associated with pellagra.

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384   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

During this decade also, Wagner Von Jauregg had proved con-

clusively that fever therapy, especially malaria, was curative for

paresis. Within a short time the psychiatrists and the hospitals

of Ohio were using malaria to bring about a profound reduction

in the severity of the symptoms and the death rate from this serious

disease. C. W. Stone and L. J. Karnosh applied fever therapy to

paretics at the psychopathic wards of the Cleveland city hospitals

and were among those to confirm Von Jauregg's brilliant discovery.

In addition to the progress in the treatment of organic disease

of the nervous system, Ohio was keeping abreast of expansion in

the field of mental hygiene. A committee consisting of Earl Baker,

Emerson North, and O. O. Fordyce started a state society for mental

hygiene in 1918. At the Jewish Hospital in Cincinnati, the Child

Guidance Home was established for the care of problem children.

Louis A. Lurie was its chief who lead his clinic in doing a signifi-

cant job for the community and in doing research on this subject.

Sometime later the Child Guidance Clinic of Cleveland was set up

after a demonstration by L. G. Lowrey and was then taken over by

Henry C. Schumacher as its director.

Then as now there were economic problems to be faced by

state hospital physicians and by nurses. We may note this com-

ment in 1910. State hospitals were paying physicians $600 per

year as a starting salary, which was then raised to a maximum of

$1,200. The statement reads: "When physicians became experi-

enced, they left. Politics were deplored. Staff physicians' especially

superintendents' jobs were considered political spoils."  At the

American Medical Psychological Association meeting held in

Cleveland in 1920, it was decided there should be no change in the

twelve-hour duty of psychiatric nurses and attendants, because

"they do not work steadily in their twelve hour tour." It was

reported that the cost per capita for 1901 at the Ohio Hospital for

Epileptics had been reduced $42.50. At the same time, the difficulty

in obtaining a high grade of service was continued because of

inadequate wages.

As we approach the second quarter of the twentieth cen-

tury, we can see an expansion in concept, in effectiveness of

therapy, in building facilities, in theory and teaching methods, and

especially in the private practice of psychiatry.

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PSYCHIATRIC PROGRESS IN OHIO            385

 

The growth of psychiatry during the second quarter of the

twentieth century has been amazing. If we use the analogy of a

growing individual, we may compare psychiatry in 1900 to an

unwanted infant left on the doorstep of medicine.  Its earlier

development was stunted and retarded, its adolescence backward

and awkward. Then it reached adulthood and grew rapidly into a

respected, successful, and influential specialty.  Whereas thirty

years ago when one of us--Joseph L. Fetterman--was a student

in medical school, only one member of his class showed any interest

in this specialty, today a majority of medical students, yes, prac-

tically every premedical student talks, dreams, and plans to go into

psychiatry. It is a subject of books and of radio stories. It is

the theme of many movies. The couch of the psychiatrist is becom-

ing one of the best known, or joked about, pieces of equipment in

a doctor's office. Psychiatry today has become the most popular

subject for humor in cartoons, stories, and jokes.

We may view the progress of psychiatry during the past two

decades along three lanes, divergent to a certain degree, yet closely

winding and interwoven in many places. Let us look at these three

lanes under the headings of Psychoanalysis, Shock Therapy of

Psychoses, and the Popular Acceptance of Psychiatry.

Psychoanalysis is both a body of theory and a method of

practice. As a source of knowledge, Freud's concepts have infil-

trated into all medicine, yes, into practically all human endeavors.

His terms, his explanations, his enlightened viewpoints have helped

psychiatry to look beneath the surface, to understand as well as to

classify mental illness and human behavior. Psychoanalysis is a

sub-specialty of psychiatry, inasmuch as it is time-consuming,

requires a special training, and permits only a limited number of

patients to be handled by an analyst. Among the early psycho-

analyists in the Cleveland area were George Reeves and Alan

Finlayson. Finlayson was analyzed and later took further training

with Franz Alexander, a former colleague of Freud himself and

the founder of the Chicago Psychoanalytic Institute. In the

Cincinnati area, Maurice Levine, Milton Rosenbaum, and T. A.

Ratliff were among the leaders in the practice of psychoanalysis.

Later they established a training analysis program in their com-

munity. More recently at Western Reserve University, Douglas

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386   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

Bond became professor of psychiatry and with the collaboration of

Maurits and Anny Katan has established training analysis for

graduate psychiatrists as well as an increased program of teaching

of psychiatry with analytic orientation. There are a large number

of psychoanalysts in the Cincinnati and Cleveland areas and, no

doubt, there are others who are practicing this specialty in other

cities throughout the state. Analytic concepts, analytic papers,

and analytic practice are now well established throughout Ohio as

they are throughout the world.

The expansion in shock therapy is of particular significance

in this paper because the authors have been pioneers in the subject

and particularly because this paper deals largely with the treatment

of psychoses. Sakel, then of Vienna and now a citizen of the United

States, had demonstrated in the early 1930's the value of large doses

of insulin as a treatment of schizophrenia. The use of insulin

shock therapy, as this method is called, was soon taken up in Switz-

erland and later brought over by visiting American psychiatrists to

the United States. Fetterman successfully treated his first patient

with insulin shock therapy in January 1937. Within the next year,

insulin shock therapy became popular throughout the world and

was the subject of a symposium at the meeting of the American

Psychiatric Association held in Pittsburgh in June of 1938. Shortly

after the development of insulin, Meduna, 1936-37, introduced

metrazol shock treatment. Guy Williams, Jr., was one of the first

to employ metrazol in the Cleveland area, using this procedure

successfully in the treatment of melancholy patients at the Haw-

thornden State Hospital in Macedonia. Next came the introduction

of electroshock treatment by Cerletti and Bini in Rome in 1938.

Within a year or so, Douglas Goldman, working with the coopera-

tion of E. A. Baber, superintendent of the Longview State Hospital

in Cincinnati, was one of the first to use electroshock therapy in

the United States. The work of Goldman, E. B. Tietz, and of Baber,

of Cincinnati, was a significant achievement. Within a matter of

a year or more, this treatment procedure was in use in practically

every state hospital and private sanitarium in Ohio. Recently An-

derson of the Harding Sanitarium reported a seven year follow-up

of results by Harding and his group showing the value of electro-

shock therapy and methods of preventing failures. Howard Fabing

• 10
 

PSYCHIATRIC PROGRESS IN OHIO             387

 

of Cincinnati has introduced certain modifications, and Fetterman,

who introduced electrocoma therapy in Cleveland, later demon-

strated the feasibility and safety of ambulatory shock treatment.

The Ohio psychiatrists have taken a prominent place on the na-

tional scene in the pioneering efforts and improvements in tech-

niques.

These methods have made disturbed patients more calm, have

shortened the stay of depressed patients, have reduced the tendency

to suicide, and have increased the recovery rate significantly.

These procedures have mobilized psychiatrists from passive ob-

servers and classifiers into active therapists. The most significant

change has taken place in the confidence and thinking of the psy-

chiatrists, who can now face the seriously depressed patient with

an assurance of a successful treatment program.

Although electroshock, or electrocoma, a term which we pro-

posed in 1942, is a specific for depressions, neither that nor insulin

is able to cure all cases of schizophrenia. In some cases the sever-

ing of the fibers from the frontal lobes to the thalamus, a procedure

introduced by Walter Freeman of Washington, D. C., and called

lobotomy, can benefit certain patients. This method has been em-

ployed by Ohio neurosurgeons including Drs. E. W. Shannon and

W. J. Gardner of Cleveland, Dr. Le Fevre of Columbus, and Dr.

John Dillon Wakefield of Cincinnati.

The expansion of psychiatry on the popular scene and the re-

ferral of patients to psychiatrists by their fellow practitioners as

well as the wide acceptance of this specialty by the public has been

one of the amazing advances in medicine of the last decade or two.

The Cleveland neurological society was founded in 1932 with

twelve charter members; today its membership exceeds sixty.

The popular interest in psychiatry made it possible for the state to

appoint a commissioner of mental hygiene. J. Fremont Bateman

of Columbus was the first commissioner; Frank Tallman occupied

the post later, and the present commissioner is E. A. Baker of

Dayton. These men have worked arduously to improve the physical

plants, to better the education and facilities of the staffs, and to

raise the standards of care of the mentally sick. Unfortunately

they have encountered resistance from tradition, from politics, and

from alleged economies. It is hoped that the present and future

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388   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

governors and legislators will refrain from politics where human

health and life are involved and realize that the salvaging of sick

people and converting them into healthy human beings is the best

economy regardless of cost in dollars and cents.

The expansion of psychiatry has included more extensive teach-

ing programs. Maurice Levine of Cincinnati and his teaching staff

have arranged not merely a thorough course for students, but for

graduate physicians as well, and seminars for religious leaders and

others. Dwight Palmer and his staff at Columbus have a large

teaching schedule and are participating in the growth of the new

medical center being erected on the Ohio State campus. A program

at Western Reserve University is many times larger than it had

been in the previous several decades.

Not only the three large medical centers but hospitals, clinics,

and private psychiatrists are making psychiatry more available and

useful. John D. O'Brien has established a psychiatric ward at the

Mercy Hospital in Canton. Howard Fabing at the Christ Hospital

and Douglas Goldman at the Good Samaritan have been among

those who have pioneered in the care of the mentally sick on the

wards of general hospitals. Recently James Sagebiel at the Miami

Valley Hospital in Dayton and others have demonstrated the value

of close collaboration of psychiatrists and other physicians in a

general hospital.

Significant is the large number of well trained, serious minded

psychiatrists who carry out private practices in their offices and in

hospitals. They are not restricted to one school of thought or one

procedure. Using psychotherapy to unravel the deeper threads,

yet they furnish sedation, vitamin therapy, and other physical and

medical methods as needed. They advise or use insulin and electro-

shock in selected cases, helping to the utmost to benefit those who

have psychoses. Such men, working in large and small cities, are

changing the very concepts of the practice of medicine.

The war has contributed significantly to this expansion of

psychiatry and the acceptance of psychiatry by practitioners and the

public. Every inductee had to pass psychiatric examination and

came in contact with psychiatrists during combat and in general

hospitals. Later, when they or their families required help for

• 12