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19th century

Attitudes toward disability in 19th-century America shifted due to a reclassification of criteria for disability that began in Europe with Jean-Etienne Dominique Esquirol, , as well as the effects of the Second Great Awakening, a Protestant religious revival that produced reforms on several fronts, which included the treatment of the disabled in America. Disability expanded in the public view in America during this time beyond its former visibility, leading to scrutiny of the treatment of the disabled and prompting the rise of “moral treatment,” which involved more humane care and led to the rise of asylums..

Mental and developmental disabilities

Institutions

The care of the disabled, typically taken on by poorhouses run by individual communities (which were often overcrowded and unhygienic) became the responsibility of the government starting in the early 1800s with the establishment of mental institutions.Although the first American asylum, the Eastern State Hospital, was founded in 1773, the popularization of institutions as treatments for mental disabilities rose in earnest in the mid-1800s along with the social reform brought by the Second Great Awakening.

Friends Asylum

Established in 1814 outside of Philadelphia by its Quaker community as the first privately run psychiatric hospital in the United States, the Friends Asylum was the first institution built specifically for the implementation of the program of moral treatment. It embodied this philosophy through its staff of volunteer citizens rather than limiting itself to medical professionals.The Friends Asylum’s dedication to the philosophy of moral treatment was an influence on the culture of institutions for the mentally disabled throughout the 19th century, popularizing the idea of moral treatment in several other institutions of the time.

Kirkbride Plan

Many mental institutions during the mid-19th century followed the Kirkbride Plan, developed by Dr. Thomas Story Kirkbride. Kirkbride’s hospital, the Institute of the Pennsylvania Hospital, was completed in 1859 and was constructed based on his philosophy about the treatment of the disabled. The plan served as a model for both the layout of the institutions and the treatments they should offer. Kirkbride’s model includes a hospital that would house no more than 250 residents, with a main building with sprawling wings that contained lecture halls, classrooms, workshops and studios where residents could occupy their time. Kirkbride felt strongly that institutions should be located in serene, rural locations away from distressing environments and should be surrounded by gardens to further eliminate stress from the surroundings of the patients.

Blackwell’s Island Asylum

Elizabeth Cochrane (Nellie Bly)

Blackwell’s Island, now Roosevelt Island in New York City, became home to the New York City Lunatic Asylum in 1839, after the island had operated a prison for seven years. The facility later received national attention due to the work of Nellie Bly (born Elizabeth Cochran Seaman), who committed herself to the women’s ward in 1887 under the name Nellie Brown in order to expose the institution’s inhumane conditions. Bly published her book, Ten Days in a Mad-House, in the same year, drawing severe scrutiny to Blackwell’s Island due to Bly’s description of her experience in unhygienic conditions, facing neglect and physical abuse at the hands of the nurses and medical professionals at Blackwell. Bly’s work, in the decline of the Second Great Awakening’s disability treatment reform movement, drew questions about the true state of treatment in the mental institutions across the United States that had become popularized since the early 1800s.

Physical disabilities

Schools for the deaf and blind

The 19th century marked the spread of schools for the deaf and blind, as well as schools for children with other sensory issues or disabilities across the United States. These schools were often modeled after European systems, which included the Institution Nationale des Sourds-Moutes, a school for deaf children in Paris. In 1817, the Connecticut Asylum for the Education and Instruction of Deaf and Dumb Persons, which later became the American School for the Deaf, was founded by Dr. Mason Fitch Cogswell, Laurent Clerc, and Reverend Thomas H. Gallaudet, who had studied European teaching methods to instruct the blind and deaf. The formation of these schools for the blind and deaf in the 19th century shifted the public view of physical and sensory disabilities and implemented the first educational methods for children with disabilities that would form the foundation for the education of physically disabled children in the United States in the future.

Civil War

Amputations

GANGRENE; Hospital gangrene of an arm stump Wellcome L0032206

The Civil War had a profound effect on the treatment of disability in the United States. Injuries sustained in battle required some 60,000 amputations to be performed on soldiers; amputations represented three quarters of all surgical operations during wartime. By the war’s end, the United States was home to more amputees than any other time in its history, requiring an expansion of industry and society to accommodate veterans.James Edward Hanger, a Confederate soldier who lost his leg in battle, invented the first modern prosthetic, and his innovation led to the birth of the prosthetic industry. During the war, Union veterans were allowed $50 to purchase artificial arms and $75 to purchase artificial legs by the federal government in response to the amputation crisis, and later, in 1874, the Confederacy began making similar allowances for its own soldiers.

Effects of war on mental disabilities

In addition to physical disability, the Civil War’s impact on the mental state of soldiers resulted in a nationwide increase in post-traumatic disorders and responses. Although medical professionals at the time were unable to link symptoms of post-traumatic stress disorder (PTSD), which was first published in the American Psychological Association’s diagnostic manual in 1980, to the behavior of soldiers who fought in the Civil War, medical professionals today have noted the connection. Civil War veterans commonly experienced suicidal thoughts, which led over half of the residents of the Indiana Civil War veterans’ home to take their lives, according to a study done by Eric T. Dean Jr. Civil War veterans were also common victims of paranoia and suffered from bouts of anxiety and violence.In the time after the Civil War, some doctors believed the suffering of veterans was linked to injuries affecting the heart, a condition they called “irritable heart” or “soldiers’ heart,” defined by anxiety, trouble breathing, and a rapid pulse. Though no accurate conclusions about the effects of war on soldiers were reached in the time after the Civil War, the chronicling of veterans’ symptoms contributed to the future discovery that traumatic wartime experiences led to physical and mental symptoms.