Eli Hill Case Study IX: The (Racial) Politics and Economy of the Asylum
Eli Hill Case Study IX: The (Racial) Politics and Economy of the Asylum

Eli Hill Case Study IX: The (Racial) Politics and Economy of the Asylum

Cases from the Asylum Archive

Eli Hill (1832-1877)

Robert C. Allen

The (Racial) Politics and Economy of the Asylum

As the Raleigh Sentinel reported the following day, on Monday, January 17, 1870, the North Carolina House of Representatives was engaged in prolonged and vituperative debate over the alleged refusal of magistrates and other officials in some “insurrectionary” counties to protect “colored and White” Republican from violence.  They feared, claimed Representative Harris of Wake County, that they would be “ku kluxed”:  visited at night by groups of berobed armed men.

At this point, debate was suspended while Dorothea Dix– the great advocate for public asylums, for whom the North Carolina asylum was eventually named–was ushered into the house chamber by Republican Governor William Holden and several members of the Senate.  Holden showed her to a seat on the floor of the House and welcomed her on behalf of its members.  Her name, he said, “will ever be honored because of your services in behalf of the unfortunate throughout the world.”  On behalf of the Senate, Lieutenant Governor Tod R. Caldwell said she would always hold an esteemed place in its collective heart for her work on behalf of the “unfortunates of our race.”  A ten minute recess was called while the Governor introduced her to other legislators.  Once Miss Dix was escorted out of the chamber, debate resumed.  A Mr. Argo, the representative of Orange County, “ventilated the charges of outrages committed there,” which included assault against an African American teacher.  Argo, the article claimed, “proved, by facts, that wherever hanging had been done, it had been done under circumstances and provocations of the most aggravated description.” By hanging read lynching.

The Daily Standard, a pro-Republican newspapers, reported that she then was a guest of Dr. Eugene Grissom, the superintendent, at the asylum.  We are proud to know, it said, “that her valuable life has been spared to witness the success of the great object for which she labored so diligently—and it is gratifying to us all, that she now visits the Institution and can see with what faithfulness her dearest wishes have been carried into practice.”  (See also Marjorie O’Rorke’s brief accent of Dix’s visit in her history of Dix Hospital: Haven on the Hill: A History of North Carolina’s Dorothea Dix Hospital (Raleigh: N.C. Dept. of Cultural Resources, 2010), p. 26)

On the same page of the Sentinel’s coverage of the legislature was an obituary for Thomas Ruffin, who had died three days before at his home in Hillsborough at the age of 83.  Ruffin had served several terms on the North Carolina Supreme Court and over his long career influenced public life in the state in other ways, including serving on the University of North Carolina’s Board of Trustees.  His most famous/notorious decision was that in the case of State v. Mann in 1830.  A slave named Lydia had been hired out to John Mann.  When she fled to avoid being beaten, Mann shot and killed her.  At issue for the Supreme Court was whether a slave was the “absolute property” of the slave owner.  Ruffin wrote: “The power of the master must be absolute to render the submission of the slave perfect.”  (13 N.C. 263 [N.C. 1830])   Ruffin himself was the owner of one hundred slaves and a partner in a slave trading business that split apart slave families.  The Sentinel eulogized: “Though dead he will speak through these [words of wisdom] to posterity in all ages to come.”

Ruffin was remembered by the State of North Carolina and by the University of North Carolina.  In 1915, a statue of Ruffin was erected at the entrance of the North Carolina Court of Appeals.  In 1922, the University Board of Trustees voted to name a dormitory after him and his son, Thomas Ruffin, Jr., a Confederate veteran who also served on the State Supreme Court.  The resolution also mentioned that Ruffin senior had been a member of the North Carolina Secession Convention in 1861.

One hundred and fifty years after his death and a century after these memorials, Ruffin’s institutional legacy is being effaced.  On July 13, 2020, Ruffin’s statue was removed as a result of “public safety” concerns.  A week before, a UNC panel voted to change the name of Ruffin Hall “because of ties to white supremacy.”  Name changes for three other buildings were also recommended, their honorees having been “men who used their positions to impose and maintain a violent system of social subjugation.”  These were among some thirty place names on campus dedicated to “enslavers and white supremacists.”

Dix’s visit to North Carolina was political in purpose.  Eugene Grissom, superintendent of the state asylum, urged her to make her first trip to the South after the Civil War to support asylum directors who feared being replaced by Reconstruction administrations.  He also asked her help in lobbying North Carolina officials to increase their support for the impoverished and overcrowded institution he directed.  Thus, despite her wholehearted support for the Union and her service as Lincoln’s hand-picked superintendent of nurses during the war she found that by 1870 she received the most enthusiastic welcome in the South amongst “Democrats and Confederates.”  (See Thomas J. Brown, Dorothea Dix: New England Reformer [Cambridge: Harvard Univ. Press, 1998], p. 333.)

Grissom’s appointment to lead the asylum in July 1868 was itself the result political change.  A new state constitution had been passed earlier that year, giving Governor Holden power to dismiss state officials, among them the asylum’s superintendent, Edward Fisher.  A North Carolina native, Grissom had been a Confederate officer and state representative from 1862 to 1865.

Details of Dix’s visit to the asylum were not recorded, so we do not know how she might have judged “with what faithfulness her dearest wishes have been carried into practice” in the fourteen years of its operation.  We do not know if her tour included a visit to the nine African American patients (four women and five men)  there on January 17.  Nor do we know where they would have been kept.  As of 1868, the hospital had a total of 240 rooms, divided into six male and six female wards of 20 rooms each.  (O’Rorke, p. 22)   Would separate “accommodations” have been made for them?  Fisher’s comments at the asylum superintendents’ meeting in 1868 suggest that he feared violence against “colored” patients if they were placed on White wards.

Dix’s place in the history of North Carolina’s first insane asylum and, indeed, in the asylum movement as a whole is more complicated than is generally acknowledged.  She was without doubt one of the most dedicated social activists of the first half of the nineteenth century in America.   As biographer Thomas Brown notes, she also enjoyed a reputation as one of the most “intrepid” women in American public life.  Over the course of decades she traveled tens of thousands of miles exposing the horrible conditions under which the insane were kept in jails, alms houses, and, in some cases, by family members.  She befriended politicians in dozens of states advocating for the creation of state-funded asylums administered by superintendents who were champions of the “moral treatment” philosophy.  And she was effective: she influenced the establishment of more than thirty asylums, including, of course, the North Carolina Hospital for the Insane.  As a result her reputation by 1860 was of “epic proportions.”

To say that Dix was single-minded would be an understatement.  An indefatigable champion of the mentally ill, she showed little interest in addressing other pressing social and political issues.  Despite the fact that many of her New England associates were ardent abolitionists, she felt little sense of urgency in ending slavery.  When she traveled to the South to lobby for the creation of asylums, she was sometimes the guest of affluent slave owners.  She saw no equivalence between the condition of slaves and the plight of the insane.  During a previous trip to North Carolina she wrote that “negroes are gay, obliging, and anything but miserable.” (Brown, p. 175)

She was virulently anti-Catholic and anti-immigrant.  Irish peasants were “sorely degraded by a thousand causes,” representing a “vicious population” who were being sent to people “our now fast corrupted and overburdened society.”  By 1860 she saw worthy “native American citizens” being displaced in asylums by incurable immigrants, many of them Catholics who were “singularly low in intellect or dulled by their religion’s creed.” (Brown, p. 219)

Brown tells us that Dix remained in Raleigh for a month, which raises the intriguing possibility that she might have crossed paths with Eli Hill: he was admitted at the end of her first week there (January 23).

Some indication of the hospital’s precarious state at the beginning of 1870 comes from an appeal to the legislature from Governor Holden on February 18.  “The supplies of provisions and clothing for the insane are nearly exhausted, and the Treasurer of the Asylum is without means for its support,” he wrote.  O’Rorke briefly summarizes turbulent political waters Grissom had to navigate in the 1870s.  Conservatives (Democrats) gained control of the legislature in the fall of 1870, impeaching and removing Governor Holden.  In an 1874 report to the legislature, Grissom noted that appropriations per patient were are their lowest in the history of the asylum which, if continued, would mean that the hospital could provide only custodial care.

The asylum was chronically overcrowded with 232 patients recorded in the fall of 1870s.  Grissom noted that most of patient population was made up of individual judged as “uncurable” and thus likely to remain institutionalized for decades. Although considered a dangerous practice, some patients had to share a room built for one.  Violence among the patients increased.  Demand for institutional care of the insane increased in the post-war period (some blamed this in part on the admission of African Americans).  Grissom was able to accept only eighteen of 250 applications for admission.  A committee of the hospital’s board of directors recommended expanding the facility to accommodate 300 patients.  In 1872 then Governor Caldwell acknowledged the demand for more capacity, but proposed that it be addressed by building a second state insane asylum in his hometown of Morganton in the western part of the state.  It would not be until 1883 that it would be ready to receive patients.

Debates over the creation of a western asylum were entangled with those over the establishment of an asylum for African Americans in the mid-1870s.  As Reconstruction came to an end in 1878 and White supremacy regained political clout in North Carolina as in other Southern states, racial segregation in all state facilities became an inviolable practice.  In February 1870 a state senator could claim that in the state’s insane asylum and facilities for “the Deaf and Dumb and the Blind,” “[t]he White and colored races are all provided for alike.”  The Eastern North Carolina Insane Asylum in Goldsboro (renamed Cherry Hospital in 1959)  opened on August 1, 1880 as the state’s “colored” asylum.  On August 2, 1880, the six remaining African American patients at Dix (Susan Roy, Byrd Gunn, Elizabeth Allen, Logan Merriman, David Williams, and Joseph Boone) were transferred there.  There would be no more admission of African American patients at Dix for nearly a century.  So far as we know, the Morganton asylum (renamed Broughton Hospital in 1959) also denied admission to African Americans until sometime after the passage of the Civil Rights Act in 1964.

Thanks to the admissions ledgers, we know the names and admission dates of the African American patients at the time of Eli’s admission on January 23, 1870:

Susan Roy (8-23-1869)

Byrd Gunn (8-13-1869)

David Merrick (8-27-1868)

Jane Hall (7-25-1868)

Elizabeth Allen (6-20-1868)

Jennie Griffin (8-31-1867)

Robert Watkins (5-11-1867)

Hannah Simmons (4-30-1867)

Rebecca Collins (4-14-1867)

These were not the only African Americans in the asylum in 1870, however.  The 1870 census (taken in July 1870) shows 18 staff noted as B (Black) or M (mulatto) working there:

Matilda Beaman (nurse)

Henry Collins (nurse)

Adeline Edwards (washing)

William Edwards (living room attendant)

Jane Freeman (nurse)

Harrison Garrett (nurse)

Albert Hopkins (nurse)

Amelia Johnson (nurse)

Stella Johnson (domestic servant)

Eugenia Jones (nurse)

Sarah Kelly (nurse)

Cedy Locklear (nurse)

Altona Mclean (nurse)

Hardy Ragland (dining room servant)

Robert Rogers (nurse)

Jack Shutt (nurse)

Alan Skinner (nurse)

Alice Towers (washing)

There was a total of 51 staff listed in the 1870 census, but only two doctors: Eugene Grissom, the asylum superintendent; and Frances Fuller, the assistant physician.  With a patient count of 229 on the day of the enumeration, the doctor to patient ratio was 1:114.  There were 15 attendants (all White) and 13 nurses (all African American) who were responsible for direct patient care and supervision.  The continuous presence of and dependence upon African American staff across the history of Dix Hospital has yet to be acknowledged, much less made the object of historical attention.  The distinction between “attendant” and “nurse” here is probably more a racial than functional one: even if the work itself was similar, “attendant” connoted a higher status than “nurse.”

As O’Rorke notes, the asylum’s first superintendent Edward Fisher recruited young (White) men and women from nearby farms and trained them to provide rudimentary patient care and ward supervision.  According to her, attendants were taught to “teach patients respectfully and address them gently.”  They lived on the wards, providing “constant attendance” to everyday patient needs (including assisting in dressing and eating) and safety.  They also had responsibility for cleaning the wards and patient rooms.   They were instructed not to use violence except in self-defense or forms of restraint without the superintendent’s permission (O’Rorke, p. 10).  It is likely that African American “nurses” assumed some of these responsibilities.  The racial (and racist) delineation of job titles at the hospital continued into the 20th century.  In the 1900 census, White workers are “employees” and African Americans—regardless of role—are “servants.”

It is, of course, impossible to know how Fisher’s ideal of attendant care was actually implemented in practice.  Recruiting and retaining good attendants was a persistent problem for all asylum superintendents.  Despite a high standing among his peers (he became a vice-president of the American Medical Association in 1882), Grissom was the target of criticism in the late 1870s for mismanagement and allegedly allowing cruel treatment of some patients.  The asylum’s board of directors reaffirmed its support, but a decade later allegations were again made of malfeasance, including cruel treatment.  A three-week public “trial” was held, covered in great detail by the press.  He was found innocent, but resigned and relocated to Colorado.  In 1902 during a visit to his son’s home in Washington, D.C., Grissom, then 71, committed suicide by pistol shot to the head.  Despite its being covered at the time by the national press, O’Rorke omits the circumstances of Grissom’s death. (O’Rorke, pp. 28-30.)

A history of Dix Hospital during Reconstruction–and, as a key part of it, the presence of African American patients and staff–has yet to be written.   Nor have we thoroughly examined what administrative records and reports have survived from the period.   One historiographic strategy we might consider at this point in a case study is to look for records and historical accounts of sites that might shed some light–however obliquely–on the forces at play that we are most concerned with.  Fortunately, there are very well-researched monographic studies of the relationship between race and the nineteenth-century asylum in both Virginia and South Carolina.

In the mid-1990s historian Peter McCandless discovered that some records of the South Carolina asylum in Columbia survived in the state archives and, like us, that those at least one hundred years old at that time were accessible to the public.  These and other primary sources became the basis for his book, Moonlight, Magnolias, and Madness: Insanity in South Carolina from the Colonial Period to the Progressive Era (Chapel Hill: UNC Press, 1996), and “Curative Asylum, Custodial Hospital: the South Carolina Asylum and State Hospital 1828-1920,” a chapter in The Confinement of the Insane: International Perspectives, 1800-1965 (edited by Roy Porter and David Wright [Cambridge: Cambridge Univ. Press, 2003]).  More recently Wendy Gonaver’s The Peculiar Institution and the Making of Modern Psychiatry (Chapel Hill: UNC Press, 2019) uses records from the Eastern Lunatic Asylum in Williamsburg, Virginia, and the Central Lunatic Asylum in Petersburg, Virginia, as the basis for her argument that slavery and ideas about race were “fundamental to modern psychiatry.”

Gonaver’s excellent and nuanced theoretical contribution to the scholarship on the Southern asylum  demands much more attention than can be given it here.  Its focus is on what was in the South and at the national level as well a singular antebellum institution and the maverick superintendent who shaped it, John M. Galt, whose ideas Gonaver acknowledges, were on the “ideological margins” of early psychiatry. (p. 1).  At a time when asylum superintendents nationally were refusing to admit African American patients to their own asylums and were calling for racially segregated facilities as a general practice, Galt’s Eastern Lunatic Asylum treated Whites, slaves, and free persons of color together.  More controversial still, he trained slaves to be attendants for both White and African American patients.  “Through nursing,” Gonaver argues, “slaves demonstrated their own humanity and recognized that of patients.”  (p. 15)

When Galt died from an overdose of laudanum in 1862, his experiment also came to an end.  A few weeks before Eli Hill was admitted to Dix in January 1870, all Black patients were ordered transferred out of the Eastern Lunatic Asylum to a make-shift private facility taken over by the Freedman’s Bureau in 1868.  It was turned over to the state by 1870 and its name changed to the Central Lunatic Asylum.  Gonaver’s study is greatly deepened by her reliance on individual patient records that survive from the Eastern asylum; what happened to the 35 patients transferred to Central, however, is unknown.

We must pause to note here that some 800,000 records of the Central Lunatic Asylum have been saved and preserved by an extraordinary project at the University of Texas, led by Professor Emeritus King Davis.  He and his colleagues have created a “dark archive” for these records and have been working with them for the past ten years.  In a major study, they compared causes for admission and diagnoses during the period of segregation (1868-1968) and during the post-segregation era.

In Chapter Six of her book, Gonaver chronicles the sad, if predictable, history of Central in the first two decades following the war.  Patient numbers exploded from 70 in 1870 to nearly 500 in 1872, to more than 1000 by 1881.  At the same time, funding per patient remained at less than a quarter that appropriated for white patients at the Western State Hospital in Staunton.  The facility was chronically overcrowded and understaffed.  The White administration of the hospital viewed African Americans as incapable of responding to moral treatment because they had no moral conscience.  It was abandoned in favor of mechanical restraints and forced labor.  Many of the patients were regarded as uncurable.  Conditions at other asylums during the period were deteriorating, but Central was “at the opprobrious vanguard of a shift from the optimism of moral therapy to the therapeutic pessimism of the late nineteenth and early twentieth centuries.” (p. 176)

Essentially, Gonaver argues, for African Americans in Virginia the asylum became a “purely carceral institution.” (p. 180)  As in North Carolina, commitment to a public asylum occurred at the county level.  She has uncovered commitment papers from the 1870s revealing that local lunacy commissions saw little difference between the asylum and the prison.  About one African American man they sent to Central, “they had nothing to say with regard to his insanity, except the ‘general deportment of a man who loafs and refuses to labor for any consideration.'” (p. 180)

McCandless’s work also asks “How did issue of race influence the care and treatment of the insane?” (“Curative Asylum,” p. 174), focusing on South Carolina’s first and for many years only public asylum.  It opened in Columbia in 1828 but had difficulty attracting patients in its early years.  It was allowed to admit African Americans in 1849—one of the very few asylums in the country to do so–but had only a few prior to the Civil War.  (The other significant exception is the Eastern Virginia Lunatic Asylum.)  The South Carolina asylum suffered badly during the Civil War, and the contexts of its operation in the war’s aftermath are similar to those we see in North Carolina: military defeat, economic dislocation, social and political unrest, and, of course, emancipation.  One significant difference between the two Carolinas was the proportion of African Americans: roughly one-third of N.C.’s total population in 1860, compared with more than half in S.C. between 1820 and 1920.

As in North Carolina, emancipation and the presence of Union troops in 1865, followed by Republican state governments during the Reconstruction period (1868-1877), opened the asylum to African Americans.  However, in S. C., they became and remained a significant part of the asylum population through the 1920s.  In part this was because the overall patient population exploded over the second half of the 19th century (from 12 in 1860 to 2200 by 1920), but also because state authorities dithered for decades over whether to expand the Columbia facility to accommodate African American patients or to build a second asylum.  The latter approach was eventually adopted but not until the 1930s.  (“Curative Asylum,” pp. 174-176).  By 1920, the African American patient population had grown to nearly 1000.

As McCandless notes, few first-hand accounts of everyday life in the asylum at this time survive, and those are from White men.  Asylum records do reveal that African Americans were “provided with markedly inferior care and accommodations, and worked more and died faster than their White counterparts.” (Moonlight, Magnolias and Madness, p. 10)  Several forces combined to produce “tragic results” for the asylum in the post-war period.  The rapid influx of new patients—some but by no means the majority of whom were African American—did not lead to a proportionate increase in state funding; indeed funding decreased, with a greater impact on African American patients than Whites. Post-Reconstruction state administrations—led by White supremacists—had no interest in ameliorating the condition of former slaves.  The number of private patients—upon whom superintendents relied to supplement state appropriations—dropped precipitously.

A 1909 investigation of conditions in the asylum concluded that five hundred African American patients had died unnecessarily between 1903 and 1908 because of the dirty and overcrowded conditions under which they were forced to live.  It is not possible to verify the accuracy of this claim.  Assuming a total Black patient population of 1000 in 1900, this would have meant approximately 100 deaths each year during that period on top of deaths from other causes.  Like Gonaver, McCandless argues, that the “moral treatment” ethos upon which the asylum movement was based completely broke down under pressure from numbers, staffing, and inadequate funding.  Increasingly the asylum became a refuge of last resort for the chronically mentally ill, filling asylum beds with difficult to manage patients for years.  Doctors lost all confidence in their ability to “cure” their patients.

We know little about the conditions and circumstances of patients—Black and White.  The 1909 investigation found that overworked doctors stopped performing physical or mental examinations of new patients, relying on information in commitment documents.  McCandless discovered that the asylum kept no regular clinical records.  (“Curative Asylum,” pp. 276-287).  Patient care was left to attendants and “nurses.”  Hospital officials constantly complained about the difficulty of finding and retaining competent attendants.  Hospital standards called for an attendant/patient ratio of 1:10.  By 1909 the ratio in White wards in the S. C. asylum was 1:18 and for African American men 1:36.

Despite O’Rorke’s lofty ideals, being an attendant in an insane asylum was hardly a desirable occupation, and it got much worse as asylums became overrun.  Prospective attendants were drawn from local farms, with no prior training or understanding of mental illness.  Some were illiterate.  They were expected to live on the ward to which they were assigned and to devote all their waking hours to their duties.  Attendants and nurses endured all the ways insanity was expressed by their patients: taunts, insults, physical violence.  They had to clean the cells of patients suffering from all manner of physical ailments.  Communicable diseases were rife, especially tuberculosis—one of the leading causes of death in the asylum.  The pay was terrible.

Not surprisingly, the tenure of the average attendant was brief: a few months at most.  Ineffective, inebriated, and abusive attendants were kept in their jobs because replacing them would have been so difficult.  The hiring of African Americans as attendants and nursing was hardly an enlightened act.  Superintendents recruited African Americans because they had few employment opportunities beyond farm labor and would work for less than their White counterparts.  Wages for attendants actually declined by the end of the century: African Americans were paid $12.50 a month, at a time when they could earn $1 per day shoveling dirt.

We need to be careful about mapping the history of the asylum in one state upon another, even contiguous Southern states such as Virginia and North and South Carolina.  However, McCandless’s detailed and well-documented account of the relationship among politics, race, and insanity in the upland South in the nineteenth and early twentieth century does shine a light on the history of the asylum in North Carolina, particularly during Reconstruction (1865-1878)—the brief historical moment of racial inclusion at Dix and, of course, the period of Eli Hill’s internment.

McCandless argues–and Gonaver would certainly agree–that the asylum in South Carolina and, by extension, in every state was literally a political institution.  The establishment of state-funded and administered asylums was propelled by the efforts of philanthropists and social activists.  Dorothea Dix is, of course, in this account the shining light–and for good reason.  Galt certainly saw himself as a social reformer–despite his obviously problematic use of slave labor at the Eastern asylum.  South Carolina had its own indefatigable reform champions in the 1820s, but the process that led to the authorization and construction of the asylum in Columbia between 1815 and 1828 was in large measure a function of the state’s “rollercoaster political and economic fortunes.”

The admission of African Americans to the S. C. asylum was authorized by the state legislature in 1849.  Again, humanitarianism played a role, but, as McCandless puts it, “the act admitting Blacks to the state asylum was largely a political exercise.”  At a time when few asylums anywhere in the U.S. admitted Black patients, South Carolina politicians hoped that by admitting African Americans, in particular African American slaves, they would blunt anti-slavery and abolitionist “propaganda.”  This turned out to be a flimsy gesture, however.  Mixing African American slaves and White patients would have been politically incendiary in South Carolina, but the asylum had no provisions for separate housing or supervision even for the few who were admitted.  Even though there were only 7 African Americans out of 180 patients, in 1858 the decision was made to release all the male patients and henceforth admit only women.  When the war ended, there were only five female African American patients left.  (Moonlight, Magnolias and Madness, pp. 76-77)

It is during the Reconstruction period that the inextricable and persistent connections among politics, race, and treatment for the mentally ill come into sharpest relief in South Carolina and, by extension, in other Southern states.  By the end of the war in April 1865, most of Columbia had been destroyed by fire, and the asylum grounds were still littered by hundreds of makeshift tents erected by Whites who had sought refuge from Sherman’s troops in February.  Its resources were exhausted.  It was in this context that, as McCandless puts it, “the outcome of the Civil War revolutionized the situation of the Black insane, at least in theory.” Moonlight, Magnolias and Madness, pp. 217-219)  In Columbia as in Raleigh, occupying Union authorities insisted that African Americans be admitted.  This policy was continued by the Freedmen’s Bureau and endorsed by White Republican politicians and their newly-enfranchised African American allies, who took control of the state government in 1868.

Almost immediately the asylum found itself the object of a political tug of war between Republicans and their conservative (Democrat) enemies.  A new state constitution—written by Republicans—turned political appointments, including the regents of the asylum, over to the (Republican) governor, Robert K. Scott.  Other Republican politicians called for him to immediately replace the serving asylum superintendent, John Parker—who was supported by Dorothea Dix–and the regents with fellow party supporters, on grounds, in part, that African Americans were being denied equal treatment.   Scott replaced the sitting board of regents with 9 new appointees: six African Americans and three Whites.  Conservative politicians and newspaper editors accused the governor of sacrificing the care of the insane on the altar of political expediency.  However, as McCandless argues, their outrage was more a matter of politics than concern for the mentally ill.  They feared that the new board and superintendent would be political partisans whose policies would humiliate White patients by mixing the races and putting Black attendants in charge of them.

In 1870, Scott replaced Parker with Joshua Ensor, who had received his medical training at the University of Maryland and served as a surgeon in the Union army during the war.  He was a Republican, but not the political hack the Conservatives feared.  McCandless regards him as a person of “ability, integrity, and courage.”

Ensor found the institution he inherited to be “a shame upon the humanity of the age.”  The original building was overcrowded, unsanitary, and totally unsuited for the treatment of the insane.  He turned to his fellow Republicans to support his plans to improve conditions and repair the decrepit facility.  Again and again over his seven-year tenure as superintendent, Ensor was denied the funding he needed just to keep his inmates housed, safe, and fed.  Even when made, appropriations were irregular and chronically late.  The asylum was seriously in debt and kept afloat only by credit.  McCandless notes that “at times Ensor was reduced to virtual begging on the streets of Columbia and Charleston in attempts to secure credit and loans.”  He paid for food out of his own pocket. (Moonlight, Magnolias and Madness, pp. 225-227)

In desperation, he used his annual report and newspaper articles to chide his fellow Republicans for their failure to provide even a minimum level of support.  Conservatives seized upon Ensor’s criticisms and used them in their attempts to oust the Republican administration.  Although he remained a Republican, Ensor’s dire warnings fed a Conservative narrative—repeated by generations of historians–of “Radical misrule,” corruption, and incompetence foisted on the South by opportunist Northern carpet-baggers and illiterate former slaves.  The asylum becomes politically “weaponized.”  McCandless argues that like many post-war Southern institutions in the tumultuous years after the war, the asylum was not exempt from bad appointments and petty corruption; however, the “traditional” interpretation of Reconstruction is “both exaggerated and misleading.”

In short, Ensor’s term as superintendent was clouded by constant political turmoil—much of it within his own party.  Fast forward to 1877.  Federal troops have pulled out of South Carolina, effectively ending Reconstruction, facilitating the victory of Democrats and a return to power of White supremacists.  Although Ensor was praised by members of both parties for his courage, integrity, and attempts to improve the lot of his patients under the most testing of circumstances, politics once again prevailed: he was removed from his post and replaced by a Democrat.

Throughout his time at the asylum, Ensor kept his opinions about race to himself.  It was not until his final annual report in 1877 that he stated his belief that African Americans and Whites should not be “mixed” in the asylum because of the “mutual antagonism of the races.”  This did not keep him from pointing to the “miserable cattle stalls” in which African Americans were housed as the unnecessary cause of death for many.  They were he said, “a cruel imposition upon humanity, a reproach to the Republican party, and a disgrace to the state.”  He also claims that horrible conditions contributed to hundreds of African American patient deaths.  Moonlight, Magnolias and Madness, pp. 226-231)

O’Rorke devotes only sixteen pages of her 320-page history of Dix Hospital to the period between 1865 and 1889.  The admission of African American patients prior to 1965 is covered in two paragraphs (p. 16) and is limited to the immediate post-Civil War era.   Thus, much research is left to be done on the period leading up to and spanning Eli Hill’s time at the hospital and the turbulent politics of which it became a part.  However, there is enough for us to draw some general comparisons with the situation in South Carolina.  O’Rorke begins her chapter on Eugene Grissom’s tenure at the asylum (1868-1889) by saying “The asylum, as a state agency, became entangled in the political squabbles of Reconstruction between Republicans and Conservatives. . . .” (p. 19)  A watershed was the election of Republican newspaper editor William Holden as governor in 1868, and the drafting of a new state constitution, which (as in S.C.) gave him the power to appoint state officials and governing boards.  He removed all members of the hospital board and replaced superintendent Edward Fisher with Eugene Grissom—although this does not appear to have been a strictly political appointment: Grissom was a Confederate veteran and state legislator during the war.

Like Ensor, Grissom assumed responsibility for an institution in crisis.  In his first year he faced outbreaks of typhoid and dysentery, a facility damaged by war, and lack of funds.  The Republican legislature did provide much needed appropriations in 1868 and 1869, but Conservatives gained power in 1870 and impeached Holden.  Struggles over governance of the asylum resumed, alleged financial improprieties were discovered and investigated, and Conservatives (unsuccessfully) attempted to remove Grissom in 1876.  As in South Carolina, Federal troops pulled out of North Carolina, leaving the political landscape for the (now) Democrats to seize.  Despite the fact that Grissom became more publicly associated with the Republican party (some in the party urged him to stand as its candidate for governor in 1880), he survived Democrat control of the levers of power.  O’Rorke calls the political struggles of the 1870s a “distraction” from Grissom’s challenges in administering the hospital, which included an increase in the number of patients and resultant overcrowding.

At this point O’Rorke’s attention turns to debates over the expansion of the hospital in Raleigh or the establishment of a second (White) asylum in the western part of the state.  She also notes that “On the same day that legislators authorized the western hospital, they also provided for a state asylum for African Americans.” (p. 24).  Her discussion of the founding of what became Cherry Hospital in Goldsboro and the only public mental health hospital in North Carolina admitting African Americans between 1880 and 1965 occupies four paragraphs. (pp. 24-25)

The decision to build a separate asylum for African Americans in North Carolina and the timing of its opening are both critical factors in the history of race and mental health in the state.  The question of whether to expand the existing state asylum or to build a second facility in another part of the state was cast as a response to overcrowding and the most economical way to accommodate 300 additional patients.  For two years, Grissom presented his case for expanding Dix, supported by the finding of a special committee of the hospital’s board, but to no avail: Governor Caldwell and his supporters were determined to build a second asylum in the western part of the state.  It opened in 1883.

This process was clearly tied to the decision to create a segregated facility that as soon as possible would absorb the few remaining African American patients at Dix, and assure that both Dix and Broughton Hospital in Morganton would henceforth deny admission to ALL the African Americans in the state.  Cherry Hospital opened three years prior to Broughton (August 1, 1880), and within 24 hours there were no more African American patients at Dix.

But even before a site was found for the hospital, the state legislature wanted to make sure that from the day it opened the care African Americans received would be inferior to that given White patients at the other two facilities.  As O’Rorke notes, the legislative plan that authorized creation of a Black asylum also stipulated that the annual cost per patient to limited to $200.  In 1872 Grissom had complained that the $244 per patient expenditure at Dix was inadequate and was, in fact, the smallest amount in the asylum’s history (O’Rorke, p. 24)

The first superintendent of Cherry Hospital, J. D. Roberts, boasted in his annual report for 1884 that the board of directors “can flatter itself for having built the cheapest institution of its kind in the United States.”  He complained that most patients “are but indifferently clothed” when they arrived at the asylum, requiring a new set of clothes.  It was also the practice to give them new clothes when they were discharged.  “These look to be small matters, but the grant total.  He argued that the asylum should admit only patients who stood a good chance of being cured and discharged within months, “leaving the harmless and incurable ones in the care of the counties or friends.” (He reported the cure rate as 32% and an average stay of six month.)  Suicide among the patients was not a worry for him because, he said, it was well known that suicide was not nearly so common in “negroes” as in “whites.” Costs were kept down by having all physically able women work in the asylum sewing room.  He boasted that they produced 1000 pieces of clothing and mended 1700.  The most pressing issue Roberts addresses–again and again–is the need for separate housing for the superintendent and his family, far enough away from patient wards so that his wife and daughters would not have to hear their screams and profanities. There is next to nothing in the report regarding patient treatment or amenities.  Some patients were allowed to attend Sunday church services, accompanied by attendants.  A donation of “odd numbers” of magazines the previous spring “were much appreciated by the patients, especially the pictures.”  The one mention of a treatment regime raises many questions:  “The Battery asked for in my last report was bought and set up in the summer.  I have not yet used it much, but think it was of material benefit to the mental condition of one patient, who commenced to improve and made a good recovery under its use.”  (Superintendent’s Report of Eastern North Carolina Asylum for Year of 1884 https://docsouth.unc.edu/nc/eastern84/eastern84.html )

Much of McCandless’s study of the South Carolina insane asylum is devoted to a succession of superintendents’ attempts to navigate constantly changing political waters—a situation that would have been familiar to their counterparts in other states.  Superintendents were, of course, themselves political appointees who could and were replaced when political winds shifted.  The explosive growth of patient numbers in the latter decades of the nineteenth century made asylums among the most expensive items in states’ budgets.  Superintendents became convenient political targets: one party would make charges of malfeasance and financial extravagance; the other of deplorable conditions under which patients were kept.

For the asylum and for potential patients, the politics of the asylum in both North and South Carolina began at the county level, however.  In some states (including, at times, North Carolina) it was not uncommon for places in the asylum to be apportioned by county, with counties also being required to pay for the care of “indigent” patients.  Such patients were not necessarily paupers, but rather individuals whose families could not afford the cost of open-ended asylum care.  In South Carolina in 1871, for example, the state relieved counties of financial responsibility for indigent patients, which had the effect of increasing demand for places in the asylum.  By the same token, some asylum superintendents allowed and, indeed, sought private patients whose families could afford better accommodation and care and more attention from the superintendent and staff.  Anna Cameron Kirkland (remember her?) was one such patient.

The determination of insanity itself was political as much as it was medical, being the result of a county-level legal vehicle commonly called the lunacy commission.  Any citizen (but usually family members) could request a county judge or magistrate to appoint a small committee (usually including two doctors) to determine someone’s mental competence.  If a determination of incompetence was made, the individual was effectively deprived of his or her rights (as a part of the process a guardian was appointed to manage their affairs) and, in the case of those sent to the asylum, their personal liberty as well.  One South Carolina superintendent charged that local doctors and judges based their decisions less on the condition of person under consideration for insanity and more “to relieve families and friends of unpleasant burdens.”

The discharge of a patient could be political as well.  As we’ve seen, the care of chronic, uncurable patients was a persistent problem for superintendents.  They might attempt to return so-called “harmless and quiet” patients to their communities, but if there was no one to care for them, they became wards of the county poor house—something county authorities were unlikely to welcome Patients (both acute and chronic) could be released to the care of family or friends for a probationary period of several months, at any time during which they could be re-committed   Some families were reluctant to take responsibility for such an arrangement, fearing the patient might regress to uncontrollable behavior or that the family would not be able or afford to care for them at home.  (See McCandless, Chapter 12, “The Study of Economy: Managing the Postbellum Asylum.”)

Take a deep breath.

It is at this point in the case study that what we most want know and hence to tell is met with the archive’s terrible silence.  As Steedman puts it, “You find nothing in the Archive but stories caught half way through: the middle of things; discontinuities.”  The question everyone asks upon first seeing an admissions ledger entry is, in effect, “What happened in between?”  Where does the story go when the asylum’s door clangs shuts?  Where is the evidence of treatment?  In this case, How do we get from Eli Hill’s admission in 1870 to his death seven years later?  And the answer is . . . that we don’t know and most probably won’t ever know.  We can point to the world outside the asylum where history and narrative proceed apace, and to those rare historical moments when the two worlds are forced together.  As Steedman reminds us:

And nothing happens to this stuff, in the Archive.  It is indexed and catalogued, and some of it is lost.  But as stuff, it just sits there until it is read, and used, and narrativised.  In the Archive, you cannot be shocked at its exclusions, its emptiness, at what is not catalogued, at what was—so the returned call-slip tells you—“destroyed by enemy action during the Second World War,” nor that it tells of the gentry and not of the poor stockinger.  Its condition of being deflects outrage: in its quiet folders and bundles is the neatest demonstration of how state power has operated, through ledgers and lists and indictments, and through what is missing from them.  (Carolyn Steedman, Dust: Cultural History and the Archive [New Brunswick: Rutgers Univ. Press, 2002), p. 45, 68)

As I write this (July 27, 2020) we are in correspondence with the administration of Cherry Hospital in Goldsboro, which is an inpatient psychiatric facility serving 38 counties in eastern North Carolina.  We are following up on contacts made by Nursing PHD student Lis Bernhardt who, as a participant in the spring 2020 iteration of our graduate seminar, was determined to discover if any publicly accessible records of the hospital’s history as the state’s African American asylum survived.

What we know so far is: “We do have some old log books that have the patient’s name, age and diagnosis listed but the information is pretty limited to just that.”

This project started with some old log books.  What will these reveal and conceal?

Proceed to next chapter.