On Thanksgiving Day, 30 November 1893, then Governor William McKinley of Ohio, whose own wife had epilepsy (DeToledo et al., 2000), declared the opening of the Ohio Hospital for Epileptics for the admission of patients. The hospital, provisionally titled the “The Asylum for Epileptics and Epileptic Insane” (Fig. 1) by the Ohio Legislature, underwent a name change before opening (Kineon, 1913a), and became the first of the specialized epilepsy colonies in the United States, representing a new direction in the care of people with epilepsy in America. Following the model of Bethel, the widely admired epilepsy colony in Bielefeld, Germany (Peterson, 1887; Pfafflin, 2003), Ohio legislators, physicians, and citizens united to create a hospital for the “best possible methods of caring for the epileptic and epileptic insane”(Hurd et al., 1916).
This review examines the planning, development, and course of the first established colony for epilepsy in the United States—The Ohio Hospital for Epileptics. The events leading to the development of the colony, its early course, and the people who were instrumental in its establishment and maintenance are reviewed. At approximately the same time as the development of the Ohio Hospital for Epileptics, eugenics was gaining momentum in America, which affected epilepsy deeply. How this movement influenced thinking and practice at the Ohio Hospital is also reviewed.
Making the Case for a Specialized Epilepsy Colony in Ohio
The path to establishing this special facility for persons with epilepsy in Ohio was long and arduous. As reviewed by Letchworth (1900), the first formal expression for a publicly funded special institution for epilepsy in America was made by the Ohio State Board of Charities in 1868 in their Second Annual Report. There they alerted the Legislature to the poor condition of people with epilepsy who often resided in the poorhouses and other institutions of the State, and recommended better provision of care. In their 1869 Annual Report, these views “assumed a more tangible shape,” and specific recommendations were provided to the Legislature.
This recommendation was renewed in the Reports of the Board for the years 1870 and 1871. In the latter year, the Legislature, possibly finding it unpleasant to be importuned with appeals for humanity from this source, abolished the Board, and it was not re-established until 1876, when it renewed its recommendation for State care of epileptics in still more earnest terms.
(Letchworth, 1900, p. 63)
In 1877, the Board again brought forward a recommendation for a State farm for epileptics, and presented an estimate of the cost of 300 acres of land, an administration building, two pavilions, eight cottages, a hospital, shops, and so on, for the accommodation of 500 epileptics.
(Letchworth, 1900, p. 65)
After nearly a decade of work and appeals, the Ohio Legislature of 1877–78 finally passed a resolution that authorized the State Board of Charities to collect statistical information and report their findings and suggestions for improving the “protection, comfort, and care” of the populace with epilepsy (Letchworth, 1900; p. 65). In June 1878, the Board began the process of determining the number and condition of people with epilepsy in Ohio counties. Based on their research they estimated that there were approximately 7,000 Ohio residents with epilepsy, many residing in the community with varying degrees of success and supervision, with 417 in county infirmaries, 165 in state asylums, and 64 in county jails—646 in all (Brinkerhoff, 1901), adding:
The actual condition of these persons is such as no statistical tables will adequately display. Any attempt to describe in written words must fall equally short of conveying an idea of the utter and abandoned wretchedness of very many of this class now (if of quiet disposition) simply supplied with food and clothing, or (if dangerous) caged and chained in the narrow, dark, damp, and dirty cells of the ordinary infirmary, jail, or madhouse.
(cited in Letchworth, 1900, p. 66)
…while many [people with epilepsy] were safely cared for by relatives, others were at large, distressing their neighbors, or were crowded in insane hospitals, infirmaries and jails, creating conditions and environments unsuited and unjust to the epileptics so cared for, and detrimental to the care of the proper residents therein.
(Hurd et al., 1916)
After visiting specialists in New York, New Jersey, and Pennsylvania, and armed with empirical data, the Board of Charities convened an October 1878 meeting in Columbus involving superintendents and trustees of insane asylums and other interested parties, where a resolution was passed recommending the Board to “urge the immediate establishment by the State of a separate asylum for epileptics” (Letchworth, 1900, p. 66). With this momentum, the time appeared to have finally come for official action by the Legislature, but unfortunately, sudden changes occurred in most departments of the State government, possibly reflecting election-related political turnover in 1878, and the critical moment passed without the hoped for action.
The State Board, however, with unflagging zeal, repeated its recommendation for an asylum for epileptics. In its reports of 1882, 1883, 1887, and 1889, the Board returned to the question of care for epileptics, urging special provision with irrefutable logic.
On the 11th of April, 1890, near the close of the session, the Legislature took the long-looked-for, long-hoped-for, and long-prayed-for action [of] looking to the establishment of a separate State asylum for epileptics. An act was passed providing for the appointment by the Governor of a commission consisting of three persons to determine upon the manner in which provision should be made for the care of “the epileptics and the epileptic insane of the State”.
(Letchworth, 1900, p. 68–69)
The three named members of this commission, Col. John L. Vance, C. C. Wait, and C. F. Bonnell, were authorized to select and purchase a site suitable to accommodate 1,000 patients. After inspecting several locations they selected Gallipolis as the site for the future facility, located in the extreme southeastern part of the state.
The site consists of a natural plateau, comfortably above flood stage of the Ohio River, perfectly drained, and splendidly protected by the surrounding hills…. After considering the natural advantages of healthfulness, drainage and protection of the proposed site, the ease with which a water system could be installed, the fact that practically no grading would be necessary, the presence of excellent building stone, sand, gravel and coal within its borders, which would greatly minimize the cost of construction of buildings and reduce the cost of operating the plant when in use, the commission recommended it as an ideal location for an asylum.
(Kineon, 1913b, p. 165)
Despite the commission's decision, Brinkerhoff (1901) stated that he was against this choice (we have been unable to ascertain why), whereas others viewed the land as not highly suitable for farming and thus less desirable, as well as unfortunate in location for the rest of the state.
On 4 March 1891 the first appropriation for $40,000 was passed and three stone residence buildings were begun, the cornerstone laid on 12 November 1891. In 1892 the General Assembly officially changed the facility name to The Ohio Hospital for Epileptics.
The first patients were received November 30, 1893, at which time provisions had been made for 250 males. September 1, 1894, cottages for 200 females were opened and immediately occupied. One year thereafter, two new cottages, with a capacity of seventy-six each, one for males and one for females, were opened.
(Rutter, 1897, p. 64)
The buildings (Figs. 2-5) overall were divided into five main groups encompassing administration, east and west groups, insane wards, and the farm group. The east group contained wards for male patients and was subdivided into an inner colony containing persons with evidence of dementia and/or those needing hospital or custodial care, and an outer colony for those with better mental and social function who craved more homelike surroundings and privacy. The west group consisted of cottages for women organized in the same fashion. The north group, approximately a half-mile away, contained the “insane” residents. Finally, the farm group contained male residents who were otherwise healthy and served as farm laborers (Hurd et al., 1916).
Thus, it was only after a prolonged, persistent, and dedicated 25-year struggle that the vision of the Ohio State Board of Charities was finally secured in the establishment of the first publicly funded specialized facility for epilepsy that they proposed so long before.
In the history of this movement in Ohio we find a lesson teaching us that by persistent effort, long-continued and dignified appeals to a legislative body, and by educating the public in its duties and responsibilities, success in philanthropic enterprises may eventually be reached.
(Letchworth, 1900, p. 70)
The Manager of the Ohio Hospital
Governor McKinley, who was to go on to become the 25th U.S. President in 1897, appointed Dr. Henly Chapman Rutter as the first Manager of the Ohio Hospital for Epileptics on 7 August 1893 (Smith, 1901) (Fig. 6), with his wife serving in the capacity of matron. In this era, positions in state hospitals, including superintendent, were highly political, tending to turn over as control changed hands among political parties (Cordingley, 2006), and this political reality affected aspects of Rutter's career as well. But, as will be seen, Rutter had garnered considerable experience and expertise in institutional management prior to being named Manager of the Ohio Hospital.
Rutter was born on 6 February 1849 in Pearisburg, Virginia; he moved to Bellefontaine, Ohio, with his family just before beginning high school (Cordingley, 2006). At age 15 he joined the Union Army, serving as a private in Company B of the 132nd Ohio Volunteer Infantry during the Civil War. He then followed in his father's footsteps and became a physician, receiving an M.D. from the Medical College of Ohio in Cincinnati in 1869 (Cordingley, 2006). His career serving in public institutions was distinguished, first working as an Assistant Physician and then (in his early 20s) as Superintendent of the Dayton Hospital for the Insane, then as Superintendent of Athens Hospital for the Insane, and then at the Central Insane Asylum in Columbus, the largest state hospital in Ohio. His wife passed away in 1882 and that same year Rutter left the Columbus facility to serve as treasurer of a U.S. pension board (Cordingley, 2006). Rutter was not unfamiliar with the attempt to establish an epilepsy colony, as he had been involved in earlier petitions of the Ohio Board of Charities; he submitted a paper that accompanied the Board's 1878 request to the Legislature, arguing for the colony on an essentially cost-benefit basis, and submitted suggestions for colony design. Rutter was a Republican, as was McKinley, but he was by all accounts a talented and effective administrator, which contributed to his selection as Manager. Despite his skills, the early days of the Ohio Hospital sounded tumultuous as later described by Rutter.
For the first few months the difficulties of management were so great, owing in part to the limited facilities for classification, as to be almost discouraging. The enormous task will be recognized of harmonizing so many discordant elements, suddenly brought together, placed under the guidance of untrained attendants, and with only the scantiest means at hand for assorting them into harmonious groups.
Many of the patients came from almshouses, many from the lower walks of life, and were uncouth in their manners and dress, filthy in their habits, and rude in their conversation. The improvement most noticed by visitors has been the wonderful change in their deportment…. The day-schools, Sabbath-schools, and regular religious services in the chapel, the prayer meetings in the cottages, as well as the social enjoyments of the amusement-hall, have all contributed to the up-building of the polite as well as the moral character of the inmates.
(Rutter, 1898b, p. 65)
Perhaps the strongest argument in favor of the congregation of epileptics lies in the safety insured by their association. No sooner is the premonitory cry, which so often ushers in a seizure, heard than willing hands fly to the sufferer's assistance. Everything is instantly dropped, so that no time may be lost in reaching him before he falls.
(Rutter, 1898b, p. 66)
Letchworth (1900) visited the Ohio Hospital and credited Rutter for setting an overall positive tone.
…there appeared to be about this institution an air of quietness and contentment that was gratifying to witness. This I attributed in a great degree to the demeanor of the Superintendent. (p. 86)
As Rutter himself said:
I make it an invariable rule to listen to any complaint that may be made to me, and to show personal interest in the affairs of all patients, no matter how trivial they may seem to me, or how much my time may be needed for other purposes. They are all taught to feel they can come to me at any time with any complaint and receive kind and attentive consideration.
(Rutter cited in Letchworth, 1900, p. 86)
Rutter (1897, 1898a,b,c) believed that the colony presented the best place for the improvement of the quality of life for persons with epilepsy and an opportune place for treatment. The ideal of the Bielefeld colony was the initial and persisting standard held by Rutter, who personally visited the German facility while Manager.
We shall not find, in any State institution, a parallel to the establishment to Bielefeld…we may hope to bring lasting benefits to a hitherto neglected class of unfortunates, and to provide much better care than they are now receiving, at a greatly reduced cost. (Rutter, 1898b, p. 68)
During Rutter's term the Bulletin of The Ohio Hospital for Epileptics commenced publication in 1898, which bound together the scientific work conducted at the Hospital. Especially notable was Rutter's establishment of a Pathological Institute within the Ohio Hospital (Rutter, 1898c). His stated intent was to systematically “discover the source of disease, its cause and essence, or its prevention” through the Pathological Institute in addition to the well-established mission to “mitigate suffering and supply means for comfort through the usual ‘State machinery’ of patient care” (Rutter, 1898c; p. 74). The Laboratory was opened in a modest way in May 1894, for a few months under the part-time direction of Dr. B. Meade Bolton, whose principal work consisted of study of the blood in epilepsy, succeeded by Dr. A. M. Bleile of Columbus. The Trustees felt the position to be so important as to require the undivided attention of a director, and in July 1897, Dr. A.P. Ohlmacher of Cleveland, who was to become a controversial figure, was selected to lead the Laboratory (Rutter, 1898c). Over the next 4 years, Ohlmacher reported his findings including presentation in the Bulletin of the Ohio Hospital for Epileptics (e.g., Ohlmacher, 1898).
Rutter was also interested in treatment approaches and discharge of “cured patients,” which was operationally defined as a 2-year period of seizure freedom. These and other statistics were routinely tabulated in the Annual Reports (The Ohio Hospital for Epileptics, 1894–1900). In 1897 Rutter commented:
There has been a reduction in the number of attacks by more than three hundred per cent [of current patients] while in lessened severity the proportion has been relatively as great. At the close of the fiscal year, ending Nov. 15, 1896, fifteen patients were discharged as recovered. Patients are considered recovered after a residence of two years from the time of the last attack. These patients have been corresponded with since, and up to the present time have continued well, the majority without any return of the attacks for three years. From present indications we expect to send out more than double that number next November.
(Rutter, 1898b, p. 68)
The Hospital's Annual Reports to the Governor contained summaries from the Board of Trustees, Manager, Pathologist, and Steward that documented the developments and progress in establishing a school; employment at various levels that served to both train residents and eventually serve as a source of revenue for the hospital; and provided an overview of the diverse recreational and religious activities, diet alterations, treatments to control seizures, character of comorbid psychiatric disorders, and the details of patient intake, discharge and death—all of which were carefully described—as well as the ever-growing practical issues involved in dealing with an expanding census that included land acquisition, building, building repairs, and even sewage disposal, along with asides regarding achievements of the residents.
The O.H.E. [Ohio Hospital for Epileptics] baseball team, composed almost entirely of patients, carried off the pennant from many a hotly contested field in which they are opposed by the champions from the neighboring counties of Ohio and West Virginia, thus earning for themselves the warmest praises for activity and intelligence.
Treatments were many, including diet, which was viewed as key during Rutter's and subsequent Superintendents' terms. This included not only the content of the diet, but especially the etiquette of eating.
By giving plenty of time for meals, the habit of bolting food is discouraged, and more thorough mastication prevents the train of evils following in the wake of indigestion, such as accumulation of gases, etc., and no doubt prevents many attacks …. The experience fully demonstrates the powerful influence of indigestion as an existing cause of the epileptic seizures.
(Rutter, p. 112)
Five years after opening (November 1898) 1,295 patients had been admitted with total discharges including 81 recovered, 180 improved, 104 unimproved, and 108 deaths (which spoke to the lethality of the disorder), with a total of 822 current residents.
Rutter's Course and Fate
Published documents, both internal and external to the Ohio Hospital, contained nothing other than supportive and laudatory comments about Rutter and his management of the institution, and it was therefore a surprise when in 1901 he was asked to resign by then Governor Nash following a disagreement with Dr. A. P. Ohlmacher, Director of the Pathological Institute. This was a very public and contentious falling out (The Philadelphia Medical Journal, 1901). In the Echos and News section of The Journal of the American Medical Association (JAMA) in 1901, it was reported that on May, Dr. Ohlmacher was summarily discharged by Rutter. On learning this, Governor Nash requested Rutter's resignation “…a step he had long contemplated on account of the personal and political indiscretion of the Manager, but from which he was deterred by his respect for the opinions of the medical profession” (p. 874). Letters to JAMA from Rutter and Ohlmacher followed immediately (Rutter, 1901; Ohlmacher, 1901). Ohlmacher charged Rutter with (unspecified) acts of offensive political partisanship. Rutter responded by reproducing his original note to Ohlmacher, which essentially stated that his contract would not be renewed, then offering his opinion that Ohlmacher's view of himself and his importance to the Laboratory were overstated, charging him with opportunistic political maneuvering. Per Rutter:
Broadly stated his services were unsatisfactory for the reason that he constantly neglected his work, and in the opinion of his employers did not earn the salary paid him. This matter has been a subject of discussion in the Board of Trustees for more than one year and hence it cannot be said that a conclusion was hastily reached. In addition to his neglect of work his disposition has been so intensely disagreeable that he has been a focus of continual discord and inharmony.
(Rutter, 1901, p. 871)
There was a significant salary discrepancy between Rutter and Ohlmacher, which seemed to be a smoldering issue. Salary for the superintendents of Ohio institutions was capped at $1,200 by law, whereas Ohlmacher was paid considerably more ($3,000 per year), with additional support for him, his wife, and children, bringing the total to $5,000, a sum one of the institution's trustees defended publically (Mack, 1901). Mack also offered that he believed Ohio could afford the expense and that it was good policy, “provided the manager had confidence in the pathologist” (p. 10) (our italics), which was clearly no longer the case. In published statements regarding Ohlmacher's dismissal, Rutter referred directly to the fact that Ohlmacher “received an ample salary and his services were unsatisfactory for the reason he constantly neglected his work, and in the opinion of the employers did not earn the salary paid him.”
The timing of the conflict between Rutter and Ohlmacher coincided with the first meeting of the National Association for the Study of Epilepsy and the Care and Treatment of Epileptics held on May 14 and 15, 1901 (Letchworth, 1901). Rutter, selected to serve as Treasurer of the Association, sent a telegram stating that a severe illness in his family prevented his attendance, and there was no documented mention at the meeting of the conflict with Ohlmacher or Rutter's upcoming resignation.
At the May 17th Ohio Hospital Board of Trustees meeting, Rutter reportedly tendered his resignation but tried to gain the support of the Trustees in his discharge of Ohlmacher; however, a letter from Governor Nash to the Board was read that expressly forbade this action. It is interesting that more was said in the pages of JAMA than in the official records of the Ohio Hospital where precious little was mentioned. In the 1901 Annual Report it is stated that a new Manager was named, Dr. W.K. Coleman of West Union, who assumed his duties on September 1, 1901. The discussion in the Annual Report was terse and included only the following:
The Board, as at present constituted, was organized on August 5th, 1901, and its first duty was the election of a superintendent to fill the place made vacant by the resignation of Dr. H.C. Rutter
. (Foshay et al., 1902; p. 5)
….the Board records with much regret the retirement on October 1, 1901, from active connection with the laboratory of the Director, Dr. A.P. Ohlmacher, who was called to the Professorship of Pathology in the Northwestern University at Chicago. Dr. Ohlmacher through our laboratory has established himself as one of the foremost of the world's students of the cause of epilepsy, and his promotion is a keenly felt loss to the Institution. We are pleased to add that Dr. Ohlmacher has consented for a time to retain connection with the laboratory as nonresident director, serving without compensation. In this way the scientific work of the Hospital will profit by this skilled guiding hand.
(Foshay et al., 1902, p. 6)
Coleman, in his first Manager's Report, made no mention whatsoever of Rutter. Coleman did state that Dr. Ohlmacher “resigned to accept the Chair of Pathology in the Chicago Medical College, Medical Department of Northwestern University, and is now with his estimable family pleasantly and profitably located in that city” (Coleman, 1901, p. 13). Coleman's term lasted less than 1 year—his replacement a point we will return to.
Therefore, H.C. Rutter, the man who was among those who fought to establish the Ohio Hospital, helped shape its design, led it through its formative years, and oversaw its growth was summarily fired. He relocated to Columbus and entered the private sector, assuming the position of co-owner and medical director of a private institution, the Park View Sanatorium (Cordingley, 2006). Rutter's life ended unexpectedly and abruptly by suicide in 1910 during a visit to Cleveland. He was reportedly despondent because his private business venture was failing, although others speculated that chronic illness was a contributing factor (Cordingley, 2006). The suicide was carefully planned. On Saturday morning he gave the hotel clerk a package to mail to his second wife, the package containing his watch, jewelry, and “a letter of 16 sheets” (Cordingley, 2006). Despite Rutter's clear directive, the package was sent not to his wife but to local relatives by messenger. However, Rutter had sent a prior letter to his wife stating his intent that she received the day before his suicide. At 3:15 p.m. Rutter was observed downing the contents of a small vial across the street from a local hotel (Gillsy Hotel), then entering the lobby and telling the proprietor “I have begun to commit suicide.” In his obituary in JAMA (1910) it was stated that Rutter “died September 17, in an ambulance, while on the way to Lakeside Hospital, Cleveland, from the effects of poison, believed to have been self-administered with suicidal intent while mentally irresponsible, age 61” (p. 1213). The nature of the poison was never identified.
The Ohio Hospital after Rutter
As noted, after Rutter's departure from Gallipolis, Dr. W.K. Coleman was appointed Superintendent, but his tenure was quite short (September 1901–May, 1902), only to be followed (surprisingly so) by the return of Ohlmacher (Supplemental file 1), returning after his very short academic stay at Northwestern University in Chicago. Ohlmacher had been fired from Gallipolis on 15 May 1901 but then elected as Superintendent on 6 July 1902. There was an attempt, supported by the Board of Trustees, to recoup his lost salary from the time of his suspension, but in a published ruling by the Attorney General of Ohio, this appeal was denied (Sheets, 1902,b). Of interest, on 15 October 1901, the Pathology Laboratory was entirely destroyed by fire and all the material and specimens collected since its inception, including during Ohlmacher's 4-year stewardship of the Laboratory, was lost (Indiana Medical Journal, 1902). It was feared that the fire was of “probable incendiary origin” which, per the Cleveland Journal of Medicine (1901) “gives the affair a most malignant aspect.” The loss was noted in Coleman's report where he specifically bemoaned how a building with no heat or fire could be destroyed by fire.
In his first formal report as Superintendent, Ohlmacher (1904) came out swinging. He took a critical view of the previously reported “recoveries” (by Rutter) and viewed “essential epilepsy” as quite incurable, petitioned to change the name of the institution to the “Ohio Colony for Epileptics,” was critical of existing treatments including bromides (“overdone in this institution”), and expressed interest in expansion of treatments including to hydrotherapeutics (hot and cold baths, plunges, packs, showers, vapor). He continued to stress dietary treatment and recommended employment of an expert cook, and was quite critical of ambient attitudes of the residents (“an atmosphere of laziness pervades the place”). He criticized the recreational and amusement facilities (“far behind those of other progressive institutions”), and was especially critical of the physical plant (“the colony idea not followed…the place has more of a military or penal feel…there is a dearth of color”), and he requested alternate types of residences including more homelike cottages, which could be used for “first class epileptics.” Ohlmacher rearticulated his dedication to the scientific study of epilepsy, but expressed his view that “the true function of the Hospital is to furnish a retreat in which the victims of epilepsy may be segregated and pass their lives” (p. 440).
Ohlmacher himself was eventually forced out in 1905 when Governor Myron T. Herrick directed the board of trustees of the Hospital to ask for the resignation of Ohlmacher and who was directed to leave his post on March 15, the position not to be filled before July 1 (The Journal of the American Medical Association, 1905; American Medicine, 1905). The events leading to this point apparently centered on Ohlmacher charging others with theft and graft. He moved on to become director of the Biological Laboratory at Fredrick Sterns and Company in Detroit, and then moving into private practice private practice with specialties in epilepsy and treatment of infections by bacterial and vaccine therapies. He died in 1916 at age 51.
After Ohlmacher, Dr. W.H. Pritchard was appointed Superintendent (February 1905–May 1911) (Hurd et al., 1916) followed by Dr. George Goodhue Kineon (Supplemental file 2), who headed the Ohio Hospital for Epileptics for 32 years.
It seems clear that there was growing acceptance of eugenics in the general environment of institutional care in Ohio. By an act of the Legislature during the 1910–11 session, a Central Board of Administration was created to oversee all state benevolent institutions, uniting 18 state institutions under one administrative authority. In 1912, Allen W. Thurman, President of the State Board of Administration, declared that if a law for sterilization was not passed the State of Ohio would be bankrupt within 10 years by the expense of caring for the weak-minded (New York Times, 9/25/1912). In 1918, The Ohio State Institution Journal was established, publishing articles from staff and superintendents across Ohio's institutions. Here eugenic views were publicly espoused, advocating the need to segregate “the unfit” of many types, including those with epilepsy, and curtail their ability to reproduce through surgical means (Emerick, 1918; Haynes, 1920; Clark, 1920; Goebel, 1920).
Henry Goddard, who was an early key figure in eugenics, relocated from the Vining School for the Feebleminded in New Jersey to assume the position of Superintendent of the Bureau of Juvenile Delinquency in May 1918, a relatively high level position. His earliest writings in Ohio were eugenic in nature, advocating sterilization of defectives and doing so, interestingly enough, in official state of Ohio periodicals. He argued that defective children should be segregated during their entire reproductive lives to prevent them from spreading “their kind” and he attempted to open a segregation colony for such children. Goddard garnered administrative power quickly. All juveniles were to be committed to the Ohio Board of Administration, instead of to the various institutions, and detained there for observation and determination of physical and mental condition, with investigators visiting the juvenile's home so their surroundings and antecedent conditions could be probed. Goddard's Bureau would then determine whether the children were normal or defective, the latter remaining in the custody of the state and sent to the appropriate institution to be designated by the Bureau (Goddard, 1918a,b). Goddard appeared to have no direct connection with Gallipolis per se.
It seems that under Kineon, eugenic thinking clearly took hold in Gallipolis. The Annual Report of The Ohio Board of Administration, 1912 reveals a change in patient flow with fewer patients discharged, but The Ohio Hospital under Kineon seemed to maintain much of the clinical work as in the days of previous superintendents (Kineon, 1913a,b). Kineon requested more funding for physicians, entertainment, improved religious services, recreation, and logistical aspects of labor, but he went on to offer, “Finally we desire to call your attention to the supplement to our report on the subject of ‘Sterilization of the Epileptic’” (Kineon, 1913ab, p. 173).
In 1919, in “Heredity as a Factor in Epilepsy,” Kineon discussed the causes of epilepsy with an emphasis on hereditary. He showed a bias to assume a hereditary etiology in those cases in which families were uncertain of the cause of the patient's epilepsy, inferring that they were not disclosing known family histories:
Fifty-three percent with no assigned cause would indicate that the relatives withheld information, because in most cases they hesitated to disclose what they thought to be a family skeleton. Possibly there may have been a lack of knowledge of family histories and again there may have been a lack of interest on the part of the examining physicians, who took it as a matter of small importance whether the records were correct or not. Twenty-three percent show heredity, there being epilepsy or insanity in their immediate families
(Kineon, 1919a, p. 52).
In 1920, John Schwartz, an Assistant Physician at the Ohio Hospital for Epileptics wrote:
The State of Ohio alone has between eight thousand and nine thousand recorded epileptics within its boundaries, and of this number sixteen hundred are either wholly or partially taken care of by the State, the balance are at large and a great many of these are unrestricted and allowed to propagate their species only adds to the existing misery, this is a big mistake and a gross injustice to the people of our State.
And now that innumerable medicinal and dietary treatments have been faithfully carried out, also surgery and the much vaunted crotalin or snake venom have thus far been unsuccessful as to a cure, may it not be well to consider sterilization of the chronically defective as a means of preventing the propagation of their species?
(Schwartz, 1920, p. 54)
Kineon later recruited an outside researcher to conduct a typical eugenic “field study” of resident families (Brown, 1930).
At the request of Dr. G.G. Kineon, Superintendent of the Ohio Hospital for Epileptics, the writer has made an investigation of the relatives of patients in the epileptic hospital at Gallipolis, Ohio, with the purpose of securing as much information as possible regarding the sickness, causes of death, disorders, and social conditions of these persons.
The method of securing the material was similar to that used by Davenport, Goddard and other social investigators—that is, by interviewing as many relatives and friends as possible and from securing information regarding the relatives of the particular patient being investigated.
At the Ohio Hospital for Epileptics the number of patients has been increasing as the rate of a hundred each year. The cost of segregation places such a burden upon the taxpayer that this method of negative eugenics is extremely unsatisfactory. It is necessary that some method be adopted that will materially lessen the number of epileptic individuals, and it is probable that sterilization would prove immeasurably valuable in this regard.
(Brown, 1930, p. 634–635)
Although this measure would by no means free the human race of epilepsy, inasmuch as the taint may be carried in the germ plasm of the epileptic's siblings, it would, nevertheless, materially help in preventing increase.
(Brown, 1930, p. 635)
The July 1920 edition of The Ohio State Institution Journal presented more of Kineon's findings regarding heredity and epilepsy and suggested a significant genetic cause to epilepsy with eugenic language:
…if the family genealogy of the 1600 patients at the Ohio hospital could be traced, it undoubtedly would be found that their epilepsy had its start in less than five original families.
Our failure [at treating epilepsy] is largely due to the fact that we are trying to tackle the problem from the wrong end. We try to cure the individual who develops epilepsy and neglect to cure those who may succeed him. In other words, we wait until the thistle grows to seed and when the wind blows the seeds abroad, we start to find a way to prevent them from developing into new plants like the parents from which they sprang.
It is practically impossible to gather all the seeds, and each mature seeds [sic] is capable of producing its kind and crowding out more profitable crops. If you cut down the parent thistle plant, there can be no production of its kind. The same holds good with the epileptic—only we cannot actually cut down the parent, but the production of the offspring can be prevented to a greater or lesser extent.
There are different methods by which a reduction in the number of defectives may be accomplished; first, by education of the general public concerning the laws and possibilities of heredity and the best methods to prevent the continuance of undesirable hereditary taints so far as they have come to our knowledge. Education is the only method which will induce people to adopt such preventative measures as segregation and sterilization.
(Kineon, 1920, p. 59)
The Ohio Hospital under Kineon and his supporters revealed the logic of the eugenics movement: that heredity was a fundamental cause of epilepsy, which therefore supported the concept of segregation and/or sterilization. Kineon died suddenly from cardiac disease in 1943.
Trends over Time
Although our narrative suggests that eugenic views and their implications for epilepsy gained momentum over time, they were clearly present much earlier. Even Letchworth in his classic text, Care and Treatment of Epileptics (1900), used the analogies and language of eugenics:
All familiar with rural life are aware of the care agriculturists exercise to mate animals in such a way as to secure vigorous progeny….but in the procreation of the human species the fact that the condition of the body may determine whether a life be one of wretchedness or usefulness is but lightly considered or entirely overlooked. (Letchworth, 1900, p. 11)
In colonizing epileptics society is relieved in some measure of a dangerous element and the public safety promoted, while the procreation of degenerate offspring is brought under restriction. (Letchworth, 1900, p. 21)
Quoted in Letchworth's text were more extreme proponents, including for example, Dr. F.M. Powell, Superintendent of the Iowa Institution for Feebleminded Children,
Of all hereditary factors, except feeblemindedness, none are so prolific in entailing a blight upon succeeding generations as epilepsy. I earnestly coincide with the opinion of those who are seeking to establish separate institutions or colonies for them, feeling that this mild imprisonment would prove a human and effectual means of cutting off another of the production of, not only feeblemindedness, but other forms of mental and physical degeneracy. (p. 21–22)
The interesting last paragraph in the early announcement of the Ohio colony (Fig. 1) could be viewed as consistent with eugenic motivations, that is, segregating the sexes to prevent reproduction (as was done at other epilepsy colonies). From almost the first days of the Ohio Hospital Annual Report, Rutter included a table (typically Table IX in his reports) summarizing the heredity or familial distribution of both epilepsy and/or insanity in the patients' parents, siblings, grandparents, and aunts and uncles.This information continued to be provided over the immediate (e.g., The Ohio Hospital for Epileptics, 1901, 1902, 1903) and later years.
All this said, we could find no evidence of direct collusion with the Eugenics Records Office (ERO), no indication that ERO field workers were integrated into the fabric of the institution, and no indication that visits or travel were actively restricted; and we could find no direct evidence of sterilization of residents. But from the time of Rutter to Kineon, clearly the tone and philosophy changed substantially. In fact, Kineon lamented the inability to obtain detailed family history/hereditary information, stating that it was gleaned only from the patients and occasional visitors, and that a staff member dedicated to obtaining family history would be very desirable. He assumed that hereditary was underdetected as an etiology in part due to lack of trained and dedicated staff. Such staff was indeed available at other epilepsy colonies, such as the New Jersey Village for Epileptics, who actively colluded with the ERO and welcomed eugenic field workers whose responsibility it was to take detailed family histories that included family visits to obtain such information (Hermann, 2010). And for Kineon (1919a,b), among the essential core staff of an ideal epilepsy colony were eugenic field workers.
But to its credit, Ohio failed to pass a sterilization law. Harry Laughlin of the ERO published his Model Eugenical Sterilization Law in 1914, and the ERO later produced a map depicting the legislative status of eugenic sterilization in the United States and the number of operations per state to January 1, 1935 (Supplemental file 3). Ohio neither had a law or bill pending at that time nor any official sterilizations in the ERO tally. Ohio was in the ‘bills vetoed since 1907’ column of the map (Supplemental file 4). However, five attempts were made to pass a sterilization law in Ohio between 1915 and 1963, and judicially ordered sterilizations of “feeble minded” occurred in the early 1960's. In 1925, a proposed sterilization law passed both houses of the Ohio legislature but it was vetoed by Governor Alvin Victor Donahey. The would-be proposals varied somewhat in their targets, but they were said to generally target the feebleminded and persons with epilepsy. As early as 1904 Ohio enacted a marriage law that excluded “habitual drunkard, epileptic, imbecile, or insane persons” from obtaining a marriage license.
The Ohio Hospital for Epileptics was the first of its kind in the United States and the first publically supported facility in the world. Although commonly referred to as a colony, some argued that it was not a “colony” at all in the purest sense of the concept, especially in regard to the model of Bethel. But it was clearly a “planned community” dedicated to improving epilepsy care and including a research arm to advance understanding of epilepsy. Although eugenic thinking seemed increasingly present, it did not appear to have the same influence in Ohio as in other early epilepsy colonies we have reviewed in the past (New Jersey Village for Epileptics) (Hermann, 2010) and will review in the future (Monson State Hospital in Massachusetts).
From a broader perspective, what appeared in stark contrast in Ohio, as well in some other early epilepsy colonies, was the undeniable charitable intentions of those who sought to establish special facilities for people with epilepsy to improve their care and lives, compared to the eugenic views and at times practices that developed over time to influence care years later by the very people assigned to oversee these special resources and the residents with epilepsy. Fourteen years before the opening of the Ohio Hospital, the Ohio Board of Charities, who without question was a force for good, and who had no idea what lay ahead for the colony they envisioned, argued:
An asylum, consisting of a farm, ample in size and productive in character, upon which plain, neat, and substantial pavilions might be erected, under the general direction of an accomplished agriculturist of good administrative ability, aided by efficient medical skill and competent foreman and attendants, would fully meet the demand. With such provision, the curable might be restored, the labor of others, physically strong, properly developed, and the general comfort of all others promoted. (Letchworth, 1900, p. 63–64, citing the 1869 submission of the Ohio Board of Charities).
Finally, as has been the case with many famous as well as infamous U.S. institutions, the forces of deinstitutionalization, cost-cutting, de-specialization, and other factors led to changes at Gallipolis. In 1950, the Ohio Hospital for Epileptics was renamed The Gallipolis State Institute and, in 1979, further renamed the Gallipolis Developmental Center, serving a broader range of persons with developmental disabilities and a census that was adjusted downward over the years.
The authors declare no conflicts of interest. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.