Guest column

OPINION | RAY HANLEY: From the inside

A detailed report from 1936 by the superintendent of the Arkansas State Hospital reveals the influence one man’s vision can have on an institution.

Allie Carl Kolb, M.D., who went by A.C., was the superintendent of the Arkansas State Hospital in December 1936 when he prepared a long typed report on the activities, expenses and condition of the hospital from 1935-1936.

His report was directed to "His Excellency, The Governor of Arkansas (Junius Futrell) and the Board of Control of the State Hospital." It offered remarkable insight into the challenges of the state's efforts to provide mental health in the depths of the Great Depression.

The story goes back to legislative action during Civil War Reconstruction, when what was formally known as the Arkansas Lunatic Asylum was established via a $50,000 appropriation in 1873. Land was purchased west of Little Rock at the site today of the modern State Hospital and UAMS.

Political feuding delayed any construction until 1881, when the Legislature levied a one-mill property tax in the state to last two years and provide $150,000 to build and equip the asylum, which opened on March 1, 1883.

The first patient was admitted by legislative order. A pattern soon emerged of overcrowding that would continue for decades. After all available patient bed space was filled, the Legislature was moved to provide funding for expansion, and by 1915 the facility sprawled across over a dozen buildings.

An early superintendent of the Arkansas Lunatic Asylum was Dr. Philo Hooper, who became a key figure for the state's medical school; today a street leading to the facility is named for him. Dr. Hooper's wife later became a patient at the State Hospital.

By the time of WWI, the hospital had acquired perhaps a more politically correct name of State Hospital for Nervous Diseases.

During the cash-strapped 1930s, the state pushed the hospital toward more self-sufficiency. A hospital farm was established at Baucum east of Little Rock, where about 100 able-bodied patients were employed to operate a dairy.

In the face of ever-expanding demand for more patient space, a facility that was at first called the Benton Farm Colony opened near Haskell south of Benton along the newly-paved U.S. 67. In April 1935, Dr. Kolb, who had had previously served on the hospital's governing Board of Control for three years, took over the program; he submitted his first annual report in 1936.

Born in 1886 and a native of Sevier County, he was a 1917 graduate of the University of Louisville Medical School. He practiced medicine for a time in Hope and was 49 years old when he took the reins of the challenged Arkansas State Hospital.

A review of newspaper clips revealed a bit of his views on mental health before he arrived at the State Hospital. In 1932, he was already viewed as an expert in his field when he spoke to the Hope Rotary Club on the topic "Law and Medicine on Insanity," which was reported in the Hope Star.

"Law and medicine never have been able to reach a common ground where insanity is an issue," Dr. Kolb observed. "The law is concerned with mental disease only when it enters into a criminal act, or the disposal in a civil case. But medicine is concerned with the task of restoring the mentally diseased individual to normal health."

Dr. Kolb went on to explain by using terms which would no longer be acceptable today but seemed standard for the time. "There are two general classes of mental disease, the defectives and the quantitative cases. Defectives include idiots with brain development almost absent, no power to speak, and rarely attaining a mental age beyond 2 years; imbeciles, with partly developed brains and a mental age of 3 to 7 years, and morons who when devoid of love, sympathy and other human emotions are dangerous criminals, but otherwise may travel along peaceful pursuits all their lives and make good, orderly citizens."

Per the newspaper account, "Dr. Kolb paid particular attention to the mental disease dementia praecox, so frequently mentioned in criminal trials. This, he said, occurs usually from ages 15 to 30, and generally may be traced to some departure from normal previously in the individual's family tree."

Dr. Kolb's report from the State Hospital described physical conditions, existing challenges, and pages of statistics about the facility and its patients.

"Probably the most difficult problem with which we have had to contend during the past two years has been the badly overcrowded condition of the Hospital. Twice as many patients were in the institution as there was capacity for. This has been relieved because of the occupancy of the new Benton Unit, which will be completely occupied during this month."

The total patient census at the end of 1934 was reported at 4,996, rising to 5,046 by the end of 1935; the normal capacity of the hospital was 1,750.

The hospital, in Dr. Kolb's report, counted 429 deaths in 1935 and another 486 deaths in 1936. The leading causes of death for 1935 included "cerebral hemorrhage" of 59, myocarditis at 125, senility at 13, and "exhaustion due to psychosis" at four, with one death caused by a spider bite and 11 due to syphilis.

For 1936, cardiac issues were again the leading cause of deaths. Three were listed as suicides, nine from dementia praecox, one from gangrene of the foot, and 49 from senility. Surprisingly few deaths from cancer were listed.

The report went into the ages of the deceased patients during the two-year reporting period and the duration of their hospital stays: 23 had been hospitalized for 20 years or more upon their deaths, with 219 dying after less than one month.

Male patient deaths were about twice that of female patients. Their ages ranged from 10 under the age of 15, 14 for ages 16 to 20, and 76 who died at age 80 or older.

The presence of children in the State Hospital at a time when little existed in Arkansas in the way of child psychiatry is telling. Progress, however, did at least begin in 1936, with the hiring of the hospital's first female physician, Dr. Elizabeth Fletcher, who would spearhead advancement in the care of mentally ill children.

Dr. Kolb's report broke down the mental diagnosis of the patients in detail, tracking admissions and readmissions. Some 80 patients with psychosis were noted to have "syphilis of the central nervous system;" while 44 had alcoholism, 460 suffered from dementia praecox, and 212 were listed as senile.

Finishing his statistical report, Dr. Kolb went on to talk about progress he thought the hospital had made and the challenges and funding needs he foresaw. "I can say, without hesitation, that a higher type of medical service is now being rendered the patients than ever before.

"Better laboratory work is also being done. Every patient admitted to the hospital is given a complete chemical and microscopical urinalysis, complete blood count, and Wasserman test for syphilis. The laboratory has been rebuilt recently and fully equipped with modern apparatus. It is now one of the best in the state.

"All patients are sent to the dentist as soon as possible after admission for complete checkups on mouth conditions. New dental equipment has been installed, replacing that which has been in use for the past 25 years."

In his statistics Dr. Kolb had 3,251 patients visiting hospital dentists, with 3,923 teeth extracted. The facility produced 75 pairs of dentures, and reported 361 "artificial dentures trimmed," an impressive delivery of care for the era.

"Every patient is immunized against smallpox and typhoid fever immediately after being received in the hospital."

A major health finding among the hospital's patients was related to syphilis which required treatment. Total syphilis treatments for the two-year reporting period totaled 14,459.

"For the past 18 months the State Hospital staff has been doing the surgery for the penitentiary," the report said. This had apparently been done at the request of the governor, intent on saving the state money.

Remarkably, the State Hospital had its own surgical facilities. "Some equipment has been purchased and installed in the operating room in order to improve the surgical service of the institution, but the operating rooms are very inadequate. The surgical wards of the hospital should be enlarged and additional wards built for acutely sick and surgical cases of negros. At present there is no provision to take care of the negro cases of this type."

In that highly segregated and discriminatory era, apparently the white patients got needed surgery while the Black patients seemingly did not.

One casualty of the funding cuts during the Great Depression had been the occupational therapy program at the hospital, long an important service in mental health. "This department was discontinued in 1933, owing to lack of funds. It was established again in 1935. It has been limited mostly to rug making, fancy work, and other needle craft."

Dr. Kolb provided several pages which itemized the many products cleaned by the hospital's laundry department, which seemed mostly staffed by patients using equipment he described as "practically worn out."

The conditions of the sewing room got some discussion. "Previous to the summer of 1936, the sewing room was located on the fourth floor of the B Building North. There was only one stairway leading up to it [which] was a winding stairway around a wooden dust chute. In case of fire, these 25 or 30 women would have been cremated. During the summer of 1936 a new sewing room was constructed in the basement under the Chapel. It is large and commodious, with plenty of light."

Dr. Kolb discussed briefly the hospital's carpenter shop, as well as a tin shop that repaired and painted around the hospital.

The State Hospital made its own soap. During 1936 a total of 91,898 gallons of semi-liquid soap was made at a total cost of $1,399.31 or 1 ½ cents per gallon. The soap was used for cleaning purposes on the wards and in the laundry.

A lot of food was consumed by the thousands of patients at the State Hospital. Its own dairy farm on the Arkansas River some 12 miles east of Little Rock initially encompassed 240 acres; when the great flood of 1927 subsided, only 80 acres remained.

The hospital, with state-appropriated funds, had secured another 246 acres near England, apparently land in foreclosure. Eventually the farm expanded to some 3,200 acres to produce food for the hospital.

Dormitories were built to house the hospital farm workers, most of whom seemed to be patients. One dormitory was for white patients, one for Black patients. Dr. Kolb proudly listed farm production, which included 1,800 bales of hay, 7,000 bushels of corn, 128,585 gallons of milk, 219,460 pounds of beef, and 2,692 gallons of sorghum syrup. A separate report was given for the farm output at the new Benton Colony Farm, which provided among other products 550 pounds of butter and 88 bushels of sweet potatoes.

From the hospital's industrial shop, which employed an average of 25 patients and a foreman, Dr. Kolb reported duties like making mattresses, repairing shoes, and making cemetery markers. "The large number of mattresses made were mostly old mattresses renovated. Destructive and untidy patients using most of the mattresses."

A mention of making cemetery markers came in the era when the State Hospital had its well-used cemetery. "During the years 1935 and 1936 there were 262 cemetery markers made."

The cemetery had recently been relocated. "The Cemetery on the hospital grounds, consisting of 1,200 graves, has been moved to the Hospital Cemetery at the Annex, four miles west, by the WPA, without any expense to the institution, except for trucking the bodies to the new location. This will add greatly to the appearance of the grounds." During the 1935-1936 period Dr. Kolb reported 915 patient deaths.

He closed his report with a financial statement, which showed an operating cost at the State Hospital for the 1935-1936 period to be $571,345.

Dr. Kolb resigned his position at the state hospital in 1946 and took a medical officer job with the Veterans Administration in Little rock. He eventually returned to private practice in Little Rock and became the first chairman of the Arkansas Psychiatric Society in 1951.

He shared leadership roles in the organization with his son Dr. William Payton Kolb, born in 1919 when the elder Dr. Kolb had a practice in Hope.

A.C. Kolb closed out his life in 1959 at the age of 74. His death created a banner headline in Louisville, Ky., where he attended medical school. His body was returned for burial there beneath a simple stone that belied the outsized role he had played in advancing mental health care in Arkansas.

By 1960, after 80 years of use, most of the original buildings comprising what had started as the Arkansas Lunatic Asylum were dilapidated and beyond repair. The Legislature anted up $6 million for renewal of the facilities, a large sum for the time. A federal grant was also obtained to update the Benton facility, which had carried much of the patient load.

Still, while progress was made, it remained inadequate to meet the state's needs. In 2008, a new 130-bed 152,000-square-foot building adjacent to UAMS opened. In 2011 the federal Center for Medicare and Medicaid would cite the Arkansas State Hospital with an "immediate jeopardy finding." prompting additional money to be appropriated and improvements made.

The former State Hospital Benton campus is today the Benton Services Center, a long-term care facility administered by DHS especially for patients with serious head injuries and those who are ventilator-dependent.

While Arkansas still lacks sufficient mental health services, especially in rural areas, the State Hospital continues to improve as the state's flagship for mental health care.

If he were here today, Dr. Kolb would be proud to write another annual report of what his successors have done along the path he set before them.

Ray Hanley is CEO of Arkansas Foundation for Medical Care.