The Best Specimen of a Tyrant: The Ambitious Dr. Abraham Van Norstrand and the Wisconsin Insane Hospital

10. “A Second Class Man”

T E N A Second Class Man In the fall of 1863 at the hospital for the insane in Madison, Dr. John Clement was consumed by resentments of his own. Unlike Dr. Van Norstrand, whose declining workload left him time to find ways to compensate himself for his good work, Clement contended with mounting disaffection within the hospital and poisonous rumors without.1 His predecessor, J. Edward Lee, had been sacked after only nine months on the job.Lee had been an assistant toThomas Kirkbride at the Pennsylvania Hospital in Philadelphia, probably the most highly regarded superintendent in America and one of the founders of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). In effect, Lee had come to Wisconsin as a gift of the Association. For years he worked without pay as an adviser to the hospital’s building commissioners, but once on the payroll as superintendent he became an easy target. Construction lagged behind schedule. Contractors had defaulted. A skeletal roof stood over expensive, space-hogging extras such as an unauthorized chapel. “The Institution was designed for practical utility,” legislators scolded, “and not for mere gaudy show and empty splendor.” Out went the commissioners and their designated man; in came a hastily assembled board of trustees to grapple with lingering financial chaos, equipment shortages, construction delays, and staffing dilemmas, to say nothing of mounting pressure from across the state to open the hospital’s doors. Even so, it took the trustees a full day 130฀฀•฀฀The Best Specimen of a Tyrant and seventeen ballots to settle upon Clement as Lee’s successor.2 He barely had time to learn his way around and hire an assistant before the first patient was escorted up the front steps. By mid-December of 1860, a structure designed to house 32 patients in comfort and safety held 78. A few months later there were over a hundred. Clement struggled through those chaotic early years when pressure to make room—state-of-the-art care and treatment be damned—undermined the original plan to increase admissions only as the physical plant expanded wing by wing. He had to control men and women hauled in raging, terrified, or full of mischief, and to revive others dredged from jails, barns, and backrooms who arrived sprawled on wagon beds, pucker-mouthed, evil-smelling, barely alive. Books had to be balanced and supplies ordered for the teamster ’s daily trip to Madison. The grounds were still wild. There were trees to fell, stumps to grub, fields to clear, fences to erect. In time the hospital would be expected to raise much of its own food, and so livestock had to be acquired, sheltered, and cared for, vegetable gardens and fruit trees planted. And of course beneficial activities had to be organized for patients who grew restless with time on their hands. Clement had symptoms of his own. He was a drinker, a shouter, a tightly wound man. Constant pressure to improvise, to bend without breaking, put an awful strain on a man who was by nature unbending. Relations with his subordinate, Harvard-trained Dr. John Favill, were bad from the start. Favill protested the dearth of meaningful activities and the overuse of belts, cuffs, straitjackets, and seclusion rooms. Clement was furious. His own assistant was undermining his authority, damaging him in the eyes of employees and trustees alike. Although pressed to accommodate ever more patients, to shepherd the facility through its growing pains and to favorably impress legislators and taxpayers who came to marvel or gawk, he was primarily responsible for curing the sick. That is what the hospital movement was all about. It was why dozens of nearly identical facilities had gone up throughout the nation over the past thirty years.3 Specialized hospitals providing humane treatment could drive away madness for good. Like new-age asylum doctors of France, England, and Germany before them, superintendents back east had demonstrated this time and again. Some boasted cure rates of 70 to 90 percent.4 Faith in the effectiveness of hospital treatment became so pervasive that one historian labeled it, “The Cult of Curability.”5 Thirteen of those eastern doctors came together in 1844 to form the Association of Medical Superintendents of American Institutions for the Insane.The association met annually, launched The American Journal of Insanity, and, as it grew, so did its influence with medical organizations, newspaper editors, and...