THH Episode 40: Giving Voice: Sarah Halter

Transcript for Giving Voice: Sarah Halter

Beckley: I’m Lindsey Beckley and this is Giving Voice.

On today’s installment of Giving Voice, I had the pleasure of speaking with Sarah Halter, the executive director of the Indiana medical History Museum. If you haven’t listened to our latest episode, which covered the story of Rufus Cantrell, the so called King of Ghouls, I suggest you go do so now as we reference that story during our conversation and it might be helpful to be familiar with the story before going in. In this episode, we talk about the history of Central State Hospital and the steps the museum has taken to reintroduce the stories of the patients of Central State into the interpretation of the museum.

And now, Giving Voice.

I’m here today with Sarah Halter of the Indiana medical History Museum. We are so excited to have you on today Sarah, thanks for joining us.

Halter: Thank you.

Beckley: So I reached out to you because in our main episode, which is about Rufus Cantrell who was also known as the ghoul – or the King Ghouls – he, in his confession, in his long and varied confessions, claimed to have stolen upwards of 100 bodies from the cemetery on the site of what is now the Indiana Medical History Museum, but at that point would have been Central State Hospital. I was wondering, do you know if there is any truth in that claim or if he was just kind of blustering?

Halter: There certainly could be. It’s certainly possible. He also was supposed to have, I think he described it as something like he virtually emptied Mount Jackson Cemetery too, which is right west of the former grounds, just south of the later parts of the Central State Hospital Cemetery. The problem with Rufus Cantrell is that he was an interesting guy, he was quite a showman, and he was thought to have exaggerated or even made up things  One of the first things he did when he got out of prison, for example, was to try to get the gang back together to start a vaudeville act. He bragged a lot and it’s hard to know for sure. But it wouldn’t surprise me if he had.

Beckley: Yeah, I got a little bit of a sense of that from reading the newspaper reports. There was some truth definitely in there because there were a lot of graves that were found empty, but there was also at least a little bit of blustering in there as well. So, I thought that as far as with Central State Hospital, I was hoping that you would give a little bit of a general history on the hospital and how it became the Indiana Medical History Museum.

Halter: Sure, I’d love to. Central State Hospital opened in 1848 as the Indiana Hospital for the Insane, and that name doesn’t really sound very progressive to modern ears, but just using the word hospital in the name implied that the goal was to help patients recover, which was a far cry from the asylum system that had been pretty widespread before, where patients were just confined and sort of kept out of sight and out of the mind of the public and usually treated more as prisoners than as patients. So, this whole idea of treating mental illness as just that – these are something like other diseases, they can be understood and treated. So, the hospital opened in line with these new ideas and what was called moral treatment. And physicians and administrators had pretty high hopes for success. They had a lot of confidence in their own abilities. And it was a big step in the right direction, but unfortunately it was largely ineffective in many cases. It provided more humane treatment for patients and improved living conditions, and it certainly eased burdens on families, and in some ways it began a slow change in medical and public perceptions about mental illness and the people who suffer from mental illnesses , but they had a grossly deficient understanding of the nature of the diseases that they were working with. They didn’t have any effective arsenal of therapies and so the doctors really just kind of couldn’t do much regardless of their intentions. And many of the staff, including doctors, nurses, and attendants were poorly paid, poorly trained, and poorly equipped emotionally for the really high stress situations that they found themselves in.

So, from the beginning there were also serious allegations of abuse and neglect as well as mismanagement and misuse of funds, nepotism, political cronyism, all of those things. In the 19th century, hospitals were perpetually overcrowded and underfunded and most of the patients really couldn’t expect a quick recovery and these hospitals, you know, this was the 1st in Indiana, they would fill up with patience and they weren’t likely to go home, and so a new hospital would be needed. So, by the late 1880s, early 1890s, these massive state hospitals were popping up all over Indiana. They were huge, they were expensive to build and to operate, and one of their responses to this which happened here at Central State Hospital was the establishment of pathological departments.

So, Dr. George Edenharter, who was the Superintendent at the time, had this idea that by learning about these diseases using this new field of pathology that was just emerging, it was pretty unheard of in the United States, it was something that was being studied in Europe, especially in Germany and in France, we could use these new ideas and these new technologies to study physical causes of mental diseases. We could learn about them learn what causes them and how to treat them, and that way we can improve outcomes for patients, which weren’t that great at the time, but we could also save the state a lot of money by eliminating this seemingly constant need for new hospitals. And so, the Pathological Department here at Central State was established in 1896 for that reason. They were studying things like tumors, lesions, circulatory problems, inflammation, hermetic injuries, congenital defects – all of these things – to learn about them, to learn about the things that can go wrong with a person’s central nervous system and to develop treatments, hopefully, for them. And to ease the burden both on the patients and on the state of Indiana.

Beckley: I have this memory of one of the first times I went to the medical History Museum and, I can’t suss out whether it is a false memory or not, that the treatment for syphilis – the malarial treatment for syphilis – was that discovered at that pathology lab, or was it just , is that some weird memory that I’ve come up with?

Halter: It was not discovered there, but that was kind of their claim to fame. That’s one of the areas that I researched quite a lot. I don’t like this, but people sometimes refer to me as the Queen of syphilis. But yeah, it was introduced there in 1925 by doctor Walter Bruetsch, who was the chief pathologist there at the time, and he had learned about it from – he was from Germany – and he had learned about it there an brought the treatment to the US. He was one of the first in the US to use it and he used it so much and so successfully that when the US public health service started their research on the topic in 1936 they invited doctor Bruetsch and Central State Hospital to participate not only by testing the efficacy of various treatments, but also by supplying all of the data that they had accumulated over the decade or more that they were using this treatment. And then when penicillin was available for research beginning in 1943, they also participated in penicillin trials. So, though malaria therapy –

Beckley: So, just for listeners at home, what is the malarial treatment for syphilis if they have never heard of it, what all does that encompass?

Halter: It sounds like a pretty scary thing, and it was potentially disastrous. Essentially, there weren’t ways to treat neurosyphilis – third stage tertiary neurosyphilis – and that was a leading cause of institutionalization before penicillin was available. So the treatment for syphilis – the first big manmade miracle drug that was on the market – was Salvarsan 606 , which was introduced in 1910. And it was pretty effective, though it had some pretty horrible side effects, and even killed some people. It was an arsenical compound that would be injected into the patient. It was more effective with primary and secondary syphilis infections, but because it couldn’t penetrate the blood brain barrier, it was useless against neurosyphilis. And so, throughout the late 19th century and into the early 20th century, there were a couple of doctors who were sort of dabbling in this idea that you could use one disease to treat another.

So, we could intentionally infect patients with malaria, which induces a high fever, and in fact cycles of fever, and at the time they thought that it was the heat from the temperature of the fever itself that was killing the spirochete, but it was actually discovered later to be an immunological response of the body. But at any rate, they had noticed over the decades that people who had recovered from bad fever diseases often saw improvement in their psychiatric symptoms. And so, by the mid World War One and into the early 1920s, this was sort of being developed into an actual therapeutic option for patients with tertiary syphilis.

So, you would infect the patient with a particular strain of malaria that was pretty weak and fairly easy to treat with quinine – this was before penicillin, this was before any of the sulfa drugs – there really weren’t any antibiotics at the time and malaria was one of the few infectious diseases that they could actually treat because of quinine. So they used this week strain – they would inject the patient with malarial blood, so someone else’s blood who had malarial infection in their blood, would be injected into the patient to kind of give them the disease and then after 8 or 10 or maybe 12 cycles of fever, again they thought that was the mechanism by which it worked, they would then treat the patient with quinine, but not before drawing blood from them to inject into the next patient. So, that’s where it could have been really ugly, and there were instances over the years where contamination was a problem, and there were at least three instances that I know of where patients died from other infections that they contracted that way. But that was the idea that you are using one potentially deadly infectious disease to treat another.

Beckley: That’s so interesting and kind of sounds medieval to a lot of people’s ears, but it was such an advancement from absolutely no treatment to a disease that was almost a death sentence and to at least you have some hope to recover from an awful disease.

Halter: Right.

Beckley: I guess this is a good time to kind of turn to some of your work that you’ve been doing incorporating the stories of the patients of Central State into your interpretation of the museum. Because, I know that you all have a lot of specimens and I know some of maybe the more popular ones are the brain slides that you can see the tumors and stuff. Could you talk a little bit about your reinterpretation of some of those things and how you’re introducing a little bit of humanity into what goes into your interpretations?

Halter: Sure. Well, we have those because when the laboratory closed in 1968, within the year it re opened as a museum and so, there wasn’t a lot of time in between for all of this wonderful stuff to be lost. So, when it reopened in 1969 as the museum it had all of the original furnishings and equipment and some of the chemical jars and records and all of these things. And it also had all of these specimens. So, we have histological specimens, we have tissue blocks, we have some skeletal material, and then what we’re really known for are these specimen jars. They are like glass specimen jars that are on display in the museum with various organs – most of them are brains, but there are a few other organs sort of here and there – and these are organs that were collected from patients to study these different physical causes of mental illness, and also to teach students about them, about the research that was being done there. So, for the first 40 years or so that we were a museum, a lot of the interpretation of those was based on how they were interpreted when it was a functioning lab.

So, it was a place for medical students and practicing physicians could come and learn about these different problems that can develop in the brain and spinal cord and to learn about the research that was being done. So, the labels that were next to these specimen jars were very clinical descriptions of tumors and lesions. Most of them did not really give you any sense that it was even a person that was being referred to in the label. They didn’t have names, only initials and an autopsy number. They had the year and then they had these very technical descriptions of what it was that was preserved and why it was important for the students.

And so, in the last five or six years, we’ve been doing a lot here to kind of expand our focus beyond the science and the technology that was used in the building and beyond the doctors and administrators who worked here at the hospital and beyond the architecture of what, really is a pretty amazing and well preserved 19th century laboratory, to really focus more on the patients themselves and their experience. You know, this was a very vulnerable an often forgotten – and all too often mistreated – group of people who were isolated and stigmatized from their lives. There were very few people who would speak up for them and they had no real voice of their own. And so, we’ve done a lot to kind of shed more light on what their experiences were like, what their lives were like, and this was just one component of this larger effort. So, when we were working to rehumanize these specimens, it started with just a lot of research. We have a lot of records here and a lot of the medical records and autopsy records are also at the Indiana State Archives . So, we started with what we knew, and then used more genealogical and historical methods to find out more about these people. We wanted to know who they were as people, what their lives were like, what their family dynamics were. We wanted to know about their diseases, but from their perspective. So, not what went wrong inside of their brains but what were the symptoms that impacted their daily lives and their ability to build friendships and raise families and hold a job and all of those things? And we were also very curious about how their prognosis, diagnosis, treatment, and all of those things would be different today. We’ve come a long way since many of these specimens were collected and when many of these patients died, so a lot of things that might be a death sentence today – or would have been then – are not really so much now. Some of the diagnosis have changed, there are things that patients were diagnosed with which are no longer accepted diagnosis, and for a lot of things our understanding has changed. So, a person with a particular type of tumor today would have a very different experience than someone who had the same kind of tumor 100 years ago. So, we just wanted to kind of tell those stories.

It took us about five years to get all that research done. We have 53 specimens on display in our anatomical museum, and we learned a lot more about some than others, but we have information about each of them. And, last year, July 2019, we unveiled this new interpretation of the specimens. We kept the old labels, those are important too, it’s part of the specimen’s history in terms of kind of the specimen as an object, if you will, and it’s important for the medical folks who come to visit the museum to see those as well because they understand more of it than a layperson who comes in. So, we didn’t want to get rid of that interpretation, but we wanted to tell the whole story. And so, the new labels tell the human story next to the old labels with those clinical details.

Beckley: That’s an amazing project and I imagined visitors can connect on a whole different level to your new labels, even if those two labels are side by side, you’re going to learn one thing from the older labels but then you’re going to connect at a whole different level to seeing the details of somebody’s life and how their diagnosis affected their daily life and their relationships and everything like that. I imagine it just brings a whole new depth to the museum.

Halter: Yeah, I think it does. I like to kind of listen in when groups are in there. It’s very interesting. I mean, the project is something that I tried to do before I was the director, but it wasn’t a priority for the organization, so until I was the director of the museum, we weren’t really able to move forward with it, but it’s something that has been really important to me personally for a very long time . And the process of learning about these people, I mean it was emotional and it was overwhelming at times, it was just very inspiring, and it felt well worth the effort. So I like to see how other people kind of relate to these stories. It’s very interesting.

Beckley: If our listeners are wanting to learn more about these stories and see them than ourselves, could you tell them how to do that, whether that be online during covid era or whether that be in person if you guys are open – do some plugs. Where can folks find you guys?

Halter: Sure, we have reopened. We have a pretty limited capacity at the moment because we have small spaces in the building and we have an older volunteer core and want to make sure that we keep everybody here safe and all of the visitors as well. We also want to, frankly, set a good example for the community as a medical museum. We felt a responsibility to do that. So we can’t have drop-ins like we used to, but we are open by appointment. You can call to make an appointment or visit our website for more information . It’s IMHM.org. You can see all of the specimens here on site. We also are adding new stories to the website periodically. If you go to www.imhm.org/speciman, you can find an online version of this exhibit and there is a lot of interpretive material and all of that, but also all of the individual specimens, and you can see photographs of the specimens and then read both the new labels and the old labels right there on our website and we add a few of those every once in a while. I think there are maybe 10 or 15 of them right now.

Beckley: I will make sure that we will go in and link all of those links in the show notes which can be found at blog.history.in.gov and we will make sure that we get all of those in there. Thank you so much, Sarah, for coming on the show today. It was a real pleasure to talk to you.

Halter: Thank you.

Once again, I want to thank Sarah for taking the time to talk with me today. Remember, if you are interested in learning more about the work being done at the Indiana Medical History Museum, you can visit their website at IMHM.org or find the links to their site in the transcripts for this episode which can be found at blog.history.in.gov. We’ll be back next month with the final episode of 2020. In the meantime, follow the Indiana Historical Bureau on Facebook and Twitter for daily doses of Indiana history tidbits. Subscribe, rate, and review Talking Hoosier History wherever you get your podcasts.

Thanks for listening.

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