Author: Darin

Last Days of Patient 33

In the afternoon of September 26, 1818, a family from Gloucester County, New Jersey arrived at Friends’ Asylum in Frankford, outside Philadelphia. They had brought their relative, a 26-year-old woman, fifteen miles from Woodbury to the asylum because she was suffering “in a violent state of insanity.” They hoped the asylum would be able to restore her health.

Staff recorded Patient 33 in the Asylum Register on September 26, 1818. Ten days later, according to the register, she died. The Asylum Register offers an accounting of patients admitted to the asylum, including basic information such as name, date, age, discharge date. Other copies of the register include more information, including sex. For reasons we can’t know, many of the most revealing columns remain empty.

Patient 33’s insanity had come on suddenly and without warning. According to the records she had been insane for only six days when they arrived at the asylum.[1] Before she could be admitted, however, the proper forms had to be completed. First, there was certificate of insanity, that had to be filled out by a physician. The superintendent called the resident physician who examined her and signed the necessary certificate. Second, the superintendent required the family to sign a contract agreeing to pay for room and board and any damages, and place a deposit. In this case, the superintendent required a deposit for 13 weeks, which could have cost the family as much $39.[2] The next morning the family returned home, leaving Patient 33 in the care of the asylum. Ten days later, they returned to the asylum to attend her funeral.

The Superintendent’s Daybook

The first superintendent, Isaac Bonsall, had no medical training. He had been hired to manage the staff and patients in the asylum. His concerns focused on maintaining order, ensuring that patients and staff were attending to their duties, and keeping the peace. Far from just a way to control patients, this approach was central to the asylum’s treatment of the insane, the “moral treatment” the asylum espoused. For Bonsall, then, Patient 33 was a challenge to be managed. Proper management and regulation of daily behavior would, in his view, restore her sanity. This approach shaped his understanding of Patient 33 and informed his responses to her condition.

In her first days at the asylum, Patient 33 behaved so violently that the staff felt compelled to restrain her. But she escaped her straps, either by slipping out of them or simply breaking them. Unattended, she risked harming not only herself but also the other patients and disrupting the calm, salubrious environment. Consequently, she was often confined to her room or to her bed except for meals. On September 28 Bonsall noted:

our new Patient very similar to Wm. B. [a particularly disruptive male patient] for getting out of her Straps & breaking them, eat [sic] her Meals tolerably well but had to be kept confined.

The superintendent, Isaac Bonsall, recorded in his day book the basic economy of the asylum, which patients were disruptive and which behaved, which ones worked and how much, etc. On September 28, 1818, he noted that the Patient 33, the “our new Patient” was disruptive but generally ate well.

As the head of the asylum symbolic patriarch of the family there, Bonsall was particularly concerned when patients damaged the building, especially the windows. His daybook is filled with reports of how many window panes disruptive patients broke. Soon he and his successor started hand writing on the admissions contracts a note that families were responsible for the cost of replacing broken window panes. Unsurprisingly, then, he noticed when Patient 33 seemed too interested in the window, though what exactly concerned him is unclear. He remarked:

…found it necessary to Shut the window of our new Patients [sic] Room She looked with so much earnestness out that we feared it would injure her.

Within a few days Patient 33 seemed to have recovered her sanity but now suffered from some physical ailment that required attention, Patient 33’s

…mind mostly rational today but great bodily debility — Doctor Lukens [the resident physician] being of the opinion it would be best to send for Doctor James to see her Samuel Raleigh [a worker at the asylum] went for him and he accordingly came and found her quite ill — much attention was given her.

Bonsall noted that Patient 33 seemed to have recovered her sanity but had grown so weak that they sent for a special physician to see her.

Over the next couple days Bonsall records all the attention he, his wife, and other members of the asylum paid to Patient 33—they took turns sitting with her all night and the next day; the women stayed home from meeting so they could take care of her. Although her physical health declined, she was increasingly lucid. Bonsall’s wife asked her one evening “if she did not feel her mind more comfortable than she had done her reply was ‘yes much more so’.” The following morning Bonsall noted that Patient 33 “appeared to possess a quiet mind” but was weaker than before. Later that morning Patient 33 passed away.

Bonsall recorded the various preparations for her funeral—sending the family a letter, assembling a coffin, planning the burial, arranging for other patients to attend the funeral. Even in her death, Patient 33 required proper management.

The Physician’s Casebook

In contrast to Bonsall’s managerial account, Dr. Lukens’s version of Patient 33 tends toward impersonal and clinical. Patient 33 is a series of symptoms that require different prescriptions and treatments. Lukens carefully recorded the initial conditions, daily symptoms—e.g., any discharge, her appetite and pulse, physical strength and vigor—and his treatments and their effects.

The first few days Lukens prescribed various purgatives, e.g., Calomel and Jalap, to expel harmful fluids and calm the violence:

28 — Bowels costive Rx. Calomel gr. x Jalap gr. xij it did not operate in the evening—but she could not be prevailed to take any thing now—apetite [sic] very poor—
29 — Rx Calomel gr. x Jalap 2j—it operated well—she is some better.
30 — Bowels lax—apetite [sic] very poor—a slight dawning of reason appears

In Dr. Lukens’s casebook Patient 33 is reduced to a series of symptoms and treatments. His spare prose, however, suggests the various ways he understood the relationship between somatic symptoms and mental conditions.

Perhaps hoping to apply a more targeted treatment, Lukens first applied cups to Patient 33’s temples to draw out harmful fluids but soon stopped. Instead, he chose to apply a blister to her head and neck. He left the blister on for two days, dressing it on the second. Later he applied blisters to her ankles, though he seemed to think they weren’t especially effective because they produced inflammation but very little discharge. The next day he applied a blister to her breast. Clearly Lukens had a complicated understanding of how the blister functioned when applied to different parts of the body. Although blisters had been used for years treat insanity, at this time their efficacy was being questioned, e.g., J. G. Spurzheim Observations on the deranged manifestations of the mind, or, Insanity (London, 1817). Nevertheless, there was a strong local tradition of using blisters, and Dr. Lukens remained committed to them.

As Patient 33 grew weaker, Lukens increasingly prescribed nourishment along with his other treatments. And like Bonsall, he noted when she became more rational. As she became increasingly rational, he noted her manic violence caused by an insanity was slowly replaced by an uncontrollable restlessness caused by some physical debility.

In the end Patient 33 died. On October 7, 1818 her family returned to witness her burial. Bonsall and Lukens understood their efforts to have helped restore her sanity, even if they couldn’t restore her physical health. There is probably nothing anybody could have done to save her. Rather than condemn Bonsall and Lukens for what we consider barbaric treatment, perhaps we should see them in a more generous light. We should see two people struggling to save and comfort a young woman. Bonsall deployed all the care-giving resources of asylum, with people attending to Patient 33’s needs. Lukens exercised his medical expertise to treat first a mental illness and then a somatic illness.


  1. When modern physicians hear that she had been insane for six days, they have a number of plausible diagnoses. Those diagnoses do not interest me. While we can safely conclude that she was not “insane,” and equally safely we can conclude that she suffered from some acute medical illness, we cannot determine her illness.  ↩

  2. It is unclear how the superintendent determined either weekly room and board charges or how much of a deposit to require. The records for Patient 33 don’t survive, but typically the weekly rate was around $2.50-$3.00.  ↩

Astrolabes and S•Town

On Thursday, February 16, at 5:36 PM I was standing in a faculty meeting when my phone vibrated. I fished it out of my pocket and looked at the screen. I had just received a voicemail and a text from the same number, a number I didn’t recognize. The text asked, simply: “Is this the phone of Darin Hayton?”

I stepped outside and listened to the voicemail. The person identified himself as a researcher for This American Life, asked if he had reached Darin Hayton, and wanted to ask about astrolabes. His message sounded urgent. I was intrigued. Why would anybody feel a pressing need to learn about astrolabes, at 5:30 on a Thursday evening? And why would that person not just turn to Wikipedia or some other on-line resource?[1] So I decided to respond.

As I was still, at least physically, in a meeting, I texted rather than phoned and offered to call later that evening or the next morning. He asked that I call him as soon as I was free.

Texting with the guy who turned out to be a researcher for This American Life.
When I phoned he immediately started asking about astrolabes. He had clearly done some research on them but wanted to confirm what he had learned—e.g., Hipparchus had developed the mathematics but not an instrument; early instruments dated from the late 9th century; you could use it to tell time. He was particularly interested in developments introduced by 10th-century Islamic scholars. He asked about different innovations we might attribute to them and wanted to know how they improved the astrolabe. Most of the innovations he mentioned cannot easily or definitively be traced back to early Islamic instrument makers. We chatted for 10–15 minutes. As our conversation wound down, I tried to find out why he was so interested in astrolabes. He offered few details, saying only that he was doing research for an up-coming This American Life show on a man from Alabama who had studied astrolabes and had even built his own. He wouldn’t tell me the man’s name, but did mention that he had recently died.[2]

After we hung up I tweeted about my brush with fame. I am clearly a nerd since I think having This American Life phone me constitutes fame.

I tweeted about my brush with fame—clearly I’m a nerd because I think talking to This American Life constitutes fame.
Fifteen minutes or so later as I stood in my bathroom brushing my teeth, my phone rang again. Same guy confirming a couple points and asking if his formulation was correct. Something to the effect: the Greek astronomer Hipparchus developed the mathematics behind the astrolabe and 10th-century Islamic scholars refined it to time their daily prayers. Yes, I said, that’s fine.

Because I am always late to the party, I didn’t hear about S•Town until late April, a month or so after it was released and became an instant hit.[3] Finally, when a friend suggested I listen to it because they “talk about astrolabes,” I downloaded it and listened while I repaired my washing machine. Sure enough, about 15 minutes in John B. McLemore (the main character) mentions astrolabes:

Because kids are talking about getting girls, or deer hunting, or football. Whereas I was interested in the astrolabe, sundials, projective geometry, new age music, climate change, and how to solve Rubik’s cube.


But he doesn’t say much more. Then, 30 minutes later, the astrolabe suddenly returns in the context of telling time.[4] Brian Reed, the host, reflects on various methods for tracking time, then describes the astrolabe:

BRIAN REED: The astrolabe looks kind of like a clock crossed with a compass. It’s a flat dial with a map of the night sky laid over it, and a pointer, or I guess a sight, attached on top of that. You pick a star in the sky, and aim the sight at it, twist the sky map until it aligns with the sight in a certain way. And then the dial shows you your direction, as well as the month, day, and time.

It’s a beautiful, complex device. And as a kid, John longed to figure it out, to put himself inside the brains of the people who puzzled through the earliest versions—the Greek astronomer Hipparchus, who devised the mathematics behind it, or the 10th century Islamic scholars, who refined the invention to help them time their daily prayers.

John wanted to go through what they had to go through to create an astrolabe. Which is why he made his own, designed specifically for the coordinates of this house. It hangs on the wall of his mother’s bedroom. That’s what he’s showing me, his astrolabe, when Skyler Goodson happens to walk in the front door.

When I heard this, I immediately recalled the man who had phoned six weeks earlier asking about astrolabes. There, in Brian Reed’s brief description, was the final version of what the man on the phone had crafted. It turns out that the man on the phone had been doing research for S•Town.

Thanks to S•Town and John B. McLemore, astrolabes are enjoying their 15 minutes of fame. Reddit pages on S•Town have astrolabe discussions. Websites promise to show you “How to Build an Astrolabe Like John B. McLemore From ‘S- Town’.” S•Town fans are turning up in museums asking to see astrolabes.

Visitors to Harvard’s museum are S•Town fans and want to see astrolabes.
Hey This American Life, perhaps you would like to do a whole show on astrolabes. While not as eccentric as John B. McLemore, I have built my own astrolabe, I know its history better than most, and I’m available. Your researcher/fact checker has my number. Have him give me a call.


  1. In talking to him, it seems he started with on-line resources, including my An Introduction to the Astrolabe.  ↩
  2. He probably used a euphemism, but somehow I think John B. McLemore would have preferred “died,” and I prefer it.  ↩
  3. And because I can’t just be late to the party, I find out late that I am late to the party, I learned about S•Town while listening to an old podcast of Wait Wait…Don’t Tell Me featuring Sarah Koenig[3a] that I had downloaded and then didn’t listen to for nearly a month. And even then I was in no hurry to listen to S•Town.  ↩

    3a. I should probably point out that the name Sarah Koenig meant nothing to me because I am one of perhaps only a handful of people, including John B. McLemore, who has never listened to Serial and only vaguely knows what it is.  ↩

  4. To be exact, Brian Reed’s description of the astrolabe comes at 44:05 into chapter 1. Astrolabes are mentioned in two other places: the first time is about 16 minutes into chapter 1; the last time is 2:35 into chapter 7. I don’t think I would say, as my friend did, that they “talk about astrolabes” in S•Town, but any popular culture reference is better than none.  ↩

Facts Are Never Enough

Scientists hope to dispel antiscience prejudices by better science education, and pundits hope to sway public opinion on issues like Obamacare or global warming by presenting the public with accurate facts and expert reports. Such hopes are grounded in a misunderstanding of how humans actually think. Most of our views are shaped by communal groupthink rather than individual rationality, and we cling to these views because of group loyalty. Bombarding people with facts and exposing their individual ignorance is likely to backfire. Most people don’t like too many facts, and they certainly don’t like to feel stupid.

Y. Harari “People Have Limited Knowledge” in NY Times—A review of S. Sloman & P. Fernbach’s The Knowledge Illusion.

Yet Another Flat Earther

In a footnote to a previous post I worried that in a post on Columbus and the flat earth myth Valerie Strauss had preferred the opinions of a mathematician over the expertise of a historian. And in fact, Strauss did prefer the dilettante to the expert. She rejected the historian’s conclusions, which were based in training, evidence, and experience, and relied instead on the opinions of a non-expert, which ignored both evidence and experts.

Perhaps because she is awed by mathematics or assumes scientists are smarter than everybody else, Strauss aped the mathematician Robert Osserman’s fantasy about people in the early middle ages believing in a flat earth. Osserman was an accomplished mathematician at Stanford. He was also celebrated for bringing “math to a broad audience.” Turns out, he also happens to have been a flat earther.

Rober Osserman’s Poetry of the Universe

For reasons that make little sense, Osserman repeats a particular version of the flat earth myth in his Poetry of the Universe. Chapter 2, “Encompassing the Earth,” opens with a rejection of the idea that Columbus proved the earth was round. Osserman even calls out this myth, saying

One of the enduring myths of the Western world is that in order to gain support for his expeditions, Christopher Columbus had to first overcome a pervasive belief that the earth was flat rather than round …

So far, so good. But then Osserman succumbs to the fantasy,

The myth undoubtedly stems in part from a compression of the historical past, conflating the early Middle Ages, when a belief in a flat earth was indeed widespread in Europe, with the late Middle Ages…

Osserman too traffics in the flat earth myth.

No, the myth doesn’t stem from a “compression of the historical past” but rather a willful rejection of the historical past, a willful rejection of historical fact, a willful rejection of evidence, and a profound intellectual laziness validated by arrogance and hubris. I am confident that Osserman had multiple colleagues at Stanford who could have explained to him how his beliefs were wrong, were myths. All he had to do was dial an extension or walk across campus and ask them. But he chose not to. He chose, instead, to traffic in a myth, to spread misinformation, and to do so with the authority of being a “mathematician.”

That authority was persuasive. It dazzled Strauss and convinced her to reject the expertise of the historian in favor of the unfounded beliefs of the mathematician. Her preference for the mathematician has, in turn, disseminated the myth yet further, now robed in the authority of a Washington Post column that claims to be grounded in research and to be a resource for teachers and parents. Unfortunately, Strauss has mislead the teachers, parents “(and everyone else)” who reads her column.

Another Flat Earther

I marvel at the power of that old chestnut about people in the middle ages believing the earth was flat. Even a person who rejects the myth that Columbus proved the earth was a sphere nevertheless trots out the poor, benighted medieval Europeans as believers in a flat earth. Consider, for example, Valerie Strauss’s post for the Washington Post: “Busting a myth about Columbus and a flat Earth.” Despite the promising title, she traffics in one of the typical versions of the flat earth myth.

Strauss celebrates scholars in antiquity who knew the earth was a spherical. Aristotle, Euclid, Ptolemy, these people got it right. Medieval Europeans, however, were apparently not so bright. On the basis of no evidence, she claims:

During the early Middle Ages,[1] it is true that many Europeans succumbed to rumor and started believing that they lived on a flat Earth.

In her story, medieval Europeans were back on the right track by the 1200s CE, when texts like Sacrobosco’s De sphaera “discussed the Earth’s shape.”

Strauss has no excuse for making this claim. She is simply and demonstrably wrong. And she should know it.

Strauss cites Jeffrey Burton Russell’s book, Inventing the Flat Earth, implying that she has read it. If she has, she can’t also believe that people in the early middle ages thought the earth was flat. If she has read even the first 30 or so pages of Russell’s book, she will recognize her version of this myth as one of the most common. Russell spends some time surveying this form of the flat earth myth:

Another version of the Error is that the ancient Greeks may have known that the world was round, but the knowledge was lost (or suppressed) in medieval darkness.… Many inconsistent varieties of this version exist: The knowledge was lost in the first century A.D., or the second, or the fifth, or the sixth, or the seventh; and on the other end it was lost until the fifteenth century, or the twelfth, or the eighth. The mildest variety, therefore, posits only a few years of darkness from the flattening of the Greek earth to the rounding of the modern one.[2]

Yet Strauss seems as committed as ever to a Dark Ages model of history, complete with its flat earth fantasy.[3]

Orlando Ferguson’s amazing map of a flat earth, from 1893.

Two further thoughts:

First, I am particularly worried because Strauss’s myth-busting post appeared on her regular column, “The Answer Sheet,” which she characterizes as a “A school survival guide for parents (and everyone else).” How many parents and everyone else’s have read and been misinformed by Strauss’s “survival guide?” At least one other person has read, believed, and repeated Strauss’s claim about medieval Europeans thinking the earth was flat.

On April 15 the anonymous blog, “Today in History,” posted “Columbus’s Flat Earth.”[4] Borrowing closely from Strauss, the author asserts:

Since Columbus owned a copy of an ancient Greek book [i.e., Ptolemy’s Geography] that outlined the reasons why the earth must be round, he did not believe that the earth was flat. So did anyone ever believe that the earth was flat? Actually, yes. During the Middle Ages in Europe, many people began to believe the rumors that the earth was actually flat.

Actually, no. During the Middle Ages in Europe, almost nobody began to believe or likely even heard any rumors that the earth was actually flat. The person who runs “Today in History” claims to be “someone who love history” and is “passionate about learning” and hopes to “provide more insight into event in the past.” Alas, duped by Strauss’s “survival guide” the person who runs “Today in History” is passing on misinformation and falsehoods.

Second, I also worry that Strauss believes expertise in mathematics is somehow a) applicable to other, non-scientific domains of knowledge and b) superior to historical expertise. Why else would she gratuitously cite a mathematician for evidence that “Columbus did not worry that he would fall off the Earth’s edge.”

On the one hand, Strauss’s post reflects willful ignorance and dogmatic rejection of evidence. On the other hand, Strauss’s post reflects historians’ failure to dispel this myth. Despite all our ranting and raving, we historians have failed to communicate with audiences, e.g., scientists, journalists and authors, politicians, educators, etc. I have fared no better in various efforts to combat this myth (some of which you can find by searching this blog for flat earth).

I am going to give it another go next week, at Taste of Science Philadelphia, where I am speaking along with climate scientists at “Climate change: How we got here, and looking to the future.” Maybe lubricated with some beer and good food I’ll have better luck.


  1. I can only guess that Strauss means by “early Middle Ages” some portion of the millennium between Ptolemy and Sacrobosco.  ↩

  2. J.B. Russell, Inventing the Flat Earth (1991), 28–29.  ↩

  3. Perhaps the other book Strauss cites, R. Osserman, Poetry of the Universe makes this asinine claim. I haven’t had a chance to look at it. If it does, and if she preferred to accept the comments of a mathematician over those of a historian, i.e., to accept the opinion of a non-expert over the knowledge of an expert, we have other problems.  ↩

  4. The “Columbus’s Flat Earth” post linked to my “Washington Irving’s Columbus and the Flat Earth,” which led me to Strauss’s post and, in turn, prompted this current post. ↩