1900's MEDICINE 

Let's talk about the 1900's medicine as far as psychiatry surgical procedures, how they managed anesthesia, and physicals on spychiatric patients that were dangerous for sociaty

The early 1900s were a turbulent and often grim chapter in psychiatric medicine—marked by a mix of scientific ambition, limited understanding, and ethically fraught practices. Let’s break it down into the three areas you mentioned:

1. Psychiatric Surgical Procedures

The most infamous was the lobotomy, introduced in the 1930s by António Egas Moniz. It involved severing connections in the prefrontal cortex to treat conditions like schizophrenia, depression, and mania. While it was initially hailed as a breakthrough, the procedure often left patients with severe cognitive and emotional impairments. By the 1940s, the transorbital lobotomy—popularized by Walter Freeman—used an ice-pick-like instrument inserted through the eye socket, often without anesthesia.

Other “heroic therapies” included:

Insulin coma therapy: Patients were injected with insulin to induce comas, based on the belief it could “reset” the brain, especially in schizophrenia.

Chemical shock therapy: Convulsions were induced using drugs like cardiazol, under the theory that seizures could alleviate psychosis.

Electroconvulsive therapy (ECT): Introduced in the 1930s, ECT was used to treat severe depression and psychosis. Early versions lacked anesthesia and muscle relaxants, leading to fractures and memory loss.

2. Anesthesia Management

Anesthesia in the early 20th century was still evolving. Ether and chloroform were common, but their administration was imprecise and risky. By the 1930s–40s, thiopental, cyclopropane, and curare were introduced, improving sedation and muscle relaxation. However, in psychiatric settings, especially for procedures like lobotomies or ECT, anesthesia was often minimal or skipped entirely—particularly in underfunded institutions.

The development of anesthetic machines like the Boyle’s apparatus and the Copper Kettle vaporizer in the 1940s helped standardize delivery, but these were more common in surgical hospitals than psychiatric wards.

3. Physicals and Management of “Dangerous” Psychiatric Patients

Patients deemed dangerous were often subjected to involuntary confinement in asylums, sometimes for life. Physical exams were rudimentary and often focused more on containment than care. Common practices included:

Straitjackets and restraints to prevent self-harm or aggression.

Isolation rooms with barred windows and locked doors.

Forced sterilization, especially under eugenics policies, which targeted those labeled as “feebleminded” or socially deviant.

Malaria therapy: In some cases, patients with neurosyphilis were intentionally infected with malaria to induce fevers, which were believed to kill the syphilitic bacteria.

Patients were often treated more like prisoners than patients, and many were institutionalized for reasons that today would be considered social or behavioral rather than medical.

It’s a sobering history—one that underscores how far psychiatry has come, and how essential ethical oversight and patient rights are in medical practice. Would you like to explore how these practices evolved into modern psychiatric protocols or how pharmacology began to replace surgery in the mid-20th century?