Introduced the radical concept that incarcerated persons, whether convicted criminals or mentally ill, have the right to be treated with respect and humanity
DOROTHEA DIX
(1802–1887)
Dorothea Lynde Dix revolutionized the treatment of a grossly abused segment of society, and also introduced a new standard of hygiene and humanity to nineteenth-century American medicine. The odds were heavily against her in both endeavors, and there was nothing in her early life to suggest that she would make any impact on the world. Indeed, there was much that portended a brief life as an invalid. Yet she proved herself a force of nature, so fierce in her determination that friends and enemies alike called her “Dragon Dix.”
Born in Hampden, Maine, Dorothea Dix soon moved with her family to Worcester, Massachusetts. Both of her parents traced their lineage to the founding of the Massachusetts Bay Colony in the seventeenth century. Dorothea’s father, Joseph Dix, was an itinerant Methodist minister. Like his wife, Mary Bigelow, he was an alcoholic. Where Mary was feckless and negligent, Joseph was violently abusive. When she turned twelve, Dorothea decided that she could take her hellish home life no more. She fled to Boston and the house of her grandmother, Dorothea Lynde, for whom she was named, and her grandfather, Dr. Elijah Dix, a physician.
Young Dorothea’s grandparents had the means and the generosity to take the girl in. While still living with them, the nineteen-year-old started a school, which attracted the children of wealthy Bostonians. Dix took to teaching with a passion—but instructing the well-to-do left her wanting to do more. In her spare time, she took in neglected and impoverished students, whom she taught in an improvised schoolroom set up in a barn on her grandmother’s property.
Young Dorothea Dix worked to exhaustion. Her health was frail, and she suffered from increasingly severe and frequent spells of profound depression, which exacerbated a growing list of physical ailments. She soon retreated from active teaching to the privacy of her room. There she began writing religious books and children’s stories, which occupied much of her time between 1824 and 1830. Among her works was one best seller, Conversations on Common Things, first published in 1824 and appearing in a sixtieth edition in 1869. She also turned out a dictionary of flowers titled The Garland of Flora in 1829. Her breakthrough publication, Prisons and Prison Discipline, would not come until 1845.
During her long spell of ill health, Dix supplemented her writing income with a position as governess for the family of the country’s most celebrated Unitarian preacher: William Ellery Channing. She traveled with the Channing family on a tour of St. Croix in the Caribbean, where she had her first glimpse of slavery. The experience created a deep impression, and she became a committed abolitionist.
Dix’s stint as a governess seemed to restore her health, and in 1831 she opened a girls’ school in Boston. Five years later, however, in 1836, she was swept by another wave of despair, depression, and illness. This being the Victorian age, when most physicians believed the sovereign cure for just about any ailment was travel, Dix’s physicians recommended a European tour. If the doctors envisioned a span of relaxation for her, however, they were very much mistaken. On the trip, she met a group of social reformers. Elizabeth Fry, Samuel Tuke, and William Rathbone were advocates for the rights of the “feebleminded” and the “insane.” They espoused the radical position that those afflicted with mental illness should be granted rights equal to those of any other person. Rathbone invited Dorothea to stay as a guest at Greenbank, his family’s ancestral seat in Liverpool. As Quakers, the Rathbones were all ardent social activists, and Greenbank was always alive with visiting reformers, most of whom held to the socialist doctrine that government had a duty to ensure the economic and social welfare of its citizens. Of special interest to the Rathbones was an issue referred to before the mid-nineteenth century as “lunacy reform.” It is through the Rathbone family and their circle that Dix was made aware of the horrific conditions in asylums in England. She was privy to the studies the Rathbone circle made of English and Scottish asylums, even before they were published and debated in the House of Commons.
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After her return to the United States in 1840, Dorothea Dix volunteered to teach a Sunday school class at the East Cambridge, Massachusetts, jail. In this squalid prison, she found her calling. Appalled by the primitive, brutal treatment of prisoners—especially those suffering from mental illness—Dix set out on a mission of reform. It began with her own one-woman fact-finding investigation into how the indigent mentally ill were treated throughout Massachusetts. She found that most towns simply contracted with local people willing to provide the service, requiring neither credentials nor evidence of competence. The result was predictable: underfunded care and mistreatment of the persons entrusted to the contractors’ custody. Fraud and corruption were rampant. Dix wrote a report to the Massachusetts legislature, which was widely published. She described how “Insane Persons [were] confined . . . in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”
To Dix’s immense satisfaction, her “Memorial to the Legislature of Massachusetts,” a comprehensive report on the treatment of the mentally ill in that state, moved passage of a bill to expand the state mental hospital in Worcester. The report also made Dix a national celebrity. She used her notoriety in 1844 to launch an investigation into similar conditions in New Jersey. She took it upon herself to visit every almshouse and jail in the state—New Jersey having no state hospital for the indigent mentally ill at the time.
Dix was meticulous in compiling facts; but, even more, she was a keen and coolly empathetic observer. She wrote of human beings, not of mere statistics. Her description of an inmate confined to a cot in the basement of one New Jersey county almshouse is typical: a “feeble and depressed old man, a pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past.” She asked: “This feeble old man, who was he?” The passage, typical of many in her reports, would have been affecting in itself, but Dix had taken time to answer her own question before she published the example. She knew that the old “pauper” had been a distinguished New Jersey jurist, now fallen on hard times in his old age. She knew that many of the state’s legislators knew this man, and she was not above shaming them into action. In March 1845, the New Jersey legislature appropriated funding to build the state’s very first public facility to house and treat the indigent mentally ill.
Between 1844 and 1852, Dix toured more states, including New Hampshire, Rhode Island, Louisiana, Illinois, North Carolina, and Pennsylvania. In 1853, her efforts led to the building of the first public mental hospital in Pennsylvania. Her efforts often moved legislators to build new facilities or to expand and modernize existing institutions. In fourteen states, she helped pass reform legislation to provide what she described as “moral treatment” for the mentally ill, defining this as treatment that promoted three values—modesty, chastity, and delicacy. Among the most basic reforms Dix advocated were the separation of mentally ill persons from the general prison population and the humane incarceration of the mentally ill, without ropes, chains, or the other prevalent and primitive methods of restraint and control.
Her work at the county and state levels was innovative, but in her appeal to the federal government she was downright disruptive. In the 1850s, there was strong opposition to federal appropriation for anything resembling “welfare” programs. These were considered the province of private philanthropy, religiously funded charities, and local and state initiatives. Dix promoted a Bill for the Benefit of the Indigent Insane, which got around the issue of cash appropriation by using something the federal government had in abundance: public lands. The bill set aside 12,225,000 acres for sale, the proceeds of which were to be distributed to the states for the benefit of the mentally ill—with some portion also benefitting the blind and deaf. Congress responded with passage in both houses, but President Franklin Pierce refused to sign the legislation, arguing that he did not want to set a precedent for federal financing of social welfare projects. Congress lacked the votes to override his veto.
Staggered by this blow, Dix did what she had done as a young woman when illness and depression assailed her: she traveled to Europe. This time, she made no pretense of a pleasure tour, but instead undertook to investigate conditions in mental hospitals and institutions in Scotland, the Channel Islands, and throughout the Continent. The Methodist Dix even gained an audience with Pope Pius IX, who, at her urging, visited the asylums in and around Rome and was duly shocked at conditions in them. He publicly endorsed her work.
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Despite President Pierce’s shortsightedness where federal involvement with welfare expenditures was concerned, Dorothea Dix had successfully involved local and state government in the struggle to bring humanity to the treatment of the mentally ill. Her work also launched a dialogue about the proper role of government in promoting the welfare of its citizens, a dialogue that continues to this day, often in rancorous tones.
In 1861, with the outbreak of the American Civil War, Dix confronted a new problem. Most immediately, it was how to provide a decent level of medical care for the overwhelming number of wounded the war was producing every day. More generally, it was how to reconcile the values of civilized society with warfare.
In Europe, the Crimean War (1853–1856) had already revealed the appalling inability of the British military to care for those wounded in battle. In that theater of conflict, it was a woman, Florence Nightingale, who not only brought professional nursing into the war, but who cast a glaring light on the neglect and abuse of wounded and sick soldiers, effectively shaming the government into action. The Crimean War introduced a new class of weaponry into warfare, firearms and artillery produced on an industrial scale. The American Civil War (1861–1865) brought that industrialized warfare to a far more devastating level. The rifle-musket and the minié ball (precursor of the modern rifle round), dramatic improvements in the destructiveness of artillery and ammunition, the emergence of iron warships and their vastly more destructive firepower, all ratcheted up the ruin.
The technology of devastation outstripped the progress of medical science, which lagged far behind in its capacity to repair flesh torn and bones shattered by iron, lead, and high explosives. The Civil War produced a volume and severity of wounds that even the most experienced military surgeons had never imagined. Rapid amputation was virtually the only treatment available for wounds to extremities. Gut and head wounds were generally untreatable and therefore almost invariably fatal.
A minority of those wounded were taken to poorly equipped field hospitals. Most were treated at so-called dressing stations, which were far more rudimentary. If a soldier survived amputation, the odds were very high that, in an era before the germ theory of disease was fully understood, he would later succumb to infection. There was a great need for medical volunteers with the courage to stand up to such grueling sights. Already famous as a tireless crusader for the humane treatment of the mentally ill, Dix secured an appointment as Superintendent of Women Nurses for the Union Army. In this post, she created the basis of what would become the U.S. Army Nursing Corps.
In the days of high Victorian morality, because medical work brought them into intimate contact with any number of men, female nurses were typically regarded as little better than prostitutes. The army had long employed untrained male nurses. Convinced that women naturally made better nurses than men, Dix set about recruiting women of impeccable moral character, strength of mind, and sternness of will. Determined and deliberately overbearing, she ruled her nursing corps with an iron hand. Despite her own bouts of depression and ill health, she presented an unassailable exterior, and the men with whom she worked, from generals down to privates, took to calling her “Dragon Dix.” Her demeanor made enemies of some and created resentment among others, but she not only eased unspeakable suffering and saved untold lives, she created a legacy that made the profession of female nursing both respectable and respected.
Indefatigable, Dix was everywhere in the war—in the front lines and the rear-echelon hospitals. She supervised all recruitment and training personally, and she did so with an absolute genius for combining high moral purpose with unglamorous, practical effectiveness. She was careful to discourage her nurses from romanticizing or sentimentalizing their work. She demanded both a strong attitude of compassion and a high level of basic sanitation. Both, she was convinced, were essential to ameliorating suffering and preventing death from post-traumatic infections.
Like Florence Nightingale in Europe and fellow Civil War nurse Clara Barton, Dix’s example inspired a higher level of medical treatment for soldiers. It also influenced an ongoing movement to bring a degree of humanity to warfare, with the series of Geneva Conventions in the twentieth century drawing their inspiration from her work.
During and immediately after the Civil War, Dix established thirty-two hospitals in the United States and influenced the creation of others internationally. Her antebellum work to bring compassion to the treatment of the mentally ill extended to a campaign to improve the treatment of prisoners and the disabled, including the many permanently disabled by war wounds. After the war, she personally toured the South in the immediate aftermath of the war and reported comprehensively on the damage to the region’s prisons, hospitals, and asylums.
Among the hospitals Dix founded was New Jersey’s Trenton State Hospital, where she herself took up residence in 1881. By this time, she was ill and all but spent, a semi-invalid. The grateful state had established a suite in the hospital for her to use as long as she might live, and from this facility she spent the last six years of her life corresponding with politicians, administrators, and citizen activists in the United States, England, Japan, and elsewhere. She died on July 17, 1887.