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Indiana's Man for All Seasons
by Lucy Jane King, MD

Lucy Jane King, MD, speaking at the Indiana Medical History Museum. November 21, 2002

The Pathology Building on the grounds of what was Central State Hospital was dedicated by the Marion County Medical Society on December 18, 1896. In an address on that occasion, Dr. Ludwig Hektoen of Chicago noted, "The present occasion marks a most significant step in the advancement and improvement of the humanitarian work in which institutions like the Central Indiana Hospital for the Insane are engaged. The inauguration . . . of a fully equipped, substantial department of this hospital, built in accordance with the best modern views, reflects great credit upon the development of American [psychiatry], upon the intelligence of the Board of Control of this institution and of its Superintendent."

A couple of weeks earlier, Dr. Burr of Flint, Michigan had commented to the society about ". . . this superb, and in many respects, unique, pathological laboratory, which in the perfection of its design and equipment will ever remain a monument to the enthusiasm, sagacity and philanthropy of . . . Dr. George F. Edenharter."

Who was this state hospital superintendent that colleagues around the Midwest were complimenting so highly? George Frederick Edenharter's story is in many ways similar to that of others in the lower Midwest at the turn of the twentieth century, but it is unusual in terms of the qualities on the man, himself.

His parents had come from Germany about 1848, possibly as a result of the rise of populist opposition to authoritarian governments there and the suppression of nascent revolutions at about that time. His mother was from Saxony and his father from Bavaria where he had learned the trade of cabinet maker. After immigrating to the United States, they lived in various towns in southwestern Ohio. Their three daughters died at early ages, but the two sons would grow into adult life and become professional men in Indianapolis. Their son, George was born in 1857 in Piqua, Ohio and completed his early education in Dayton. There he met Marion Swadener, the girl he would later marry.

In the late 1870s Edenharter's family moved to Indianapolis. George, like his father, entered a trade, in his case cigar making at a local factory, and was a member of the cigar maker's union. He was active in the Knights of Labor, an early organization of workers in the developing labor movement, possibly reflecting views that his parents had brought from the turmoil of Europe in mid-nineteenth century. George was also involved in politics and was elected a member of the Indianapolis City Council in 1884 and 1886. Edenharter ran for Mayor of Indianapolis in 1887, barely losing as a Democrat in a heavily Republican city and running well ahead of the rest of the ticket. He was later asked by his party to run for Governor, but by that time he had become very much involved in being a medical administrator. His ethical perspective was such that he was rigorously nonpartisan as an administrator. He was elected unanimously by bipartisan boards to city and state hospital administrations. Although he was no longer a partisan in his work, his knowledge of politics sometimes stood him in good stead. He maintained close ties with members of the State Legislature of both parties during his tenure as Superintendent of the Central Indiana Hospital for the Insane and often visited the state house to talk with legislators.

George Edenharter's medical education reflects several trends of the time just before the development of medical education in universities in which he would play an important part. After a few years as a cigar maker that allowed him to save money for advanced education, he apprenticed to a local physician, Dr. Frank Morrison, and then attended Indiana Medical College from 1884 to 1886. As a full-fledged M.D., he returned to practice with Dr. Morrison until 1890. Another aspect typical of young physicians of the time was that he did not marry until 1888, after two years in medical practice, presumably again saving money for an important life change.
While practicing with Dr. Morrison, he was physician to the Marion County Asylum for two years and then to the Marion County Work-House for over a year. The Board of Aldermen unanimously appointed him Superintendent of the City Hospital in 1890. When his first two-year term was completed, the new Board of Health, now in charge of the city facility, appointed him to another two-year term.

The Indiana Medical Journal, December, 1892, commented, "[ Indianapolis City Hospital] was never in better order than under the present superintendent. Dr. Geo. F. Edenharter is a master of the multitudinous details that make perfect a modern hospital. The surgery is a model for any institution of like character to copy. In it are a hundred devices showing the superintendent's thoughtful care and ingenuity. The operating-table, the serving-table, the sterilizing apparatus, the arrangement and supply of instruments, the dispensing of medicines, the pathological and clinical laboratory, the system of signals are all devices [designed by] the superintendent." Edenharter had undoubtedly learned craftsman's skills from his cabinet maker father. The medical journal author continued, "Over and above all this, the patients are not neglected. [This] writer has asked scores of them, when presented at the clinic, how they liked the City Hospital. There is never any complaint. The hospital is becoming popular among the poor. They have no fear of it, and are ready to go there when sick. The relations existing between the superintendent and the internes and the training-school for nurses are of the most friendly and helpful kind." It is no surprise that the Board of Trustees of the Central Indiana Hospital for the Insane asked George Edenharter in 1893 to become superintendent here nor that Dr. Edenharter would plan and build, over opposition, the Pathology Laboratory. He had already designed many innovations in the facilities of the City Hospital. Initially, reappointment was required every four years, but after five such appointments, the Board of Trustees unanimously appointed him as Superintendent, indefinitely, as long as he chose to remain. He served another ten years until his death in 1923.

In their 1909 report, the Board of Trustees of the hospital reported, "The wards of the state entrusted to this institution receive the most modern and progressive treatment known to hospital practice; in fact, the work being done here is so favorably received by the profession that many leading . . . [psychiatrists] of not only this country but of other countries visit this hospital and, in written communications and otherwise, evidence their most hearty and enthusiastic approval of methods employed and results accomplished. These results are the outgrowth of the theories and plans of Dr.George F. Edenharter. . ."

The superintendent provided research reports from the hospital to colleges throughout the state in order that they might benefit from the work done here. In 1904 he was given an honorary Master's Degree by one of them, Wabash College. He was chairman of the Indiana State Conference of Charities and Corrections in 1908 and was a Fellow of the American Medical Association. His other professional memberships included the American Medico-Psychological Association and its successor the American Psychiatric Association, the New York Medico-Legal Society of which he was Vice President for Indiana, the Indiana State Medical Society, and the Indianapolis Medical Society. He had won national recognition and respect. In the local community he was a thirty-third degree Mason and a member of the Knights of Pythias. The department here had become the locus of teaching and research in psychiatry when the Indiana University School of Medicine was opened in 1903. Both Indiana University and Purdue University had medical schools at the time and both sent students to study psychiatry, neurology, and neuropathology here. Within a few years, Indiana University became the only medical school in the state, and this was the location of teaching and research in psychiatry until the 1950s.

During the first year of Edenharter's superintendence the census averaged about 1500 patients. As was the custom, his wife, Marion, served as matron, a sort of ombudsman and kindly visitor among the patients. There was a pathologist, F.A. Morrison, two assistant physicians in the department for men, three assistant physicians in the department for women. In other words, there were a total of seven physicians, six general physicians and a pathologist, in a hospital for 1500 patients. Later, there would be three physicians each for the Men's Department and the Women's Department and an assistant pathologist as well as the pathologist.

Dr. Edenharter noted in his first annual report, for 1894, that, "It affords us much pleasure to announce that plans have been matured and perfected, whereby we will be enabled to completely reconstruct and reorganize our pathological department. It will be placed on such footing as to meet the requirements of the most exacting pathological investigations."

There was a great deal of controversy about the building of this facility, including the concern that such an elaborate and expensive laboratory was unnecessary for a state hospital for the insane. Ultimately, Edenharter managed to construct it with very creative use of existing funds and very little help from his friends in the state legislature. He worked carefully with the architect in the design of all the features of the building using the skills he had developed at the city hospital to design a facility for the efficient use of the latest laboratory techniques. Once the building was opened in 1896, pictures of the building and floor plans of its layout were included in subsequent annual reports to the governor. Later reports by both trustees and superintendent continued to supply reasons for the importance of the Pathology Building. For example, the 1905 trustee's report states, "The wisdom of the establishment of this department is becoming recognized more and more as the work therein continues, and while at the time of its erection and establishment it was an entirely new departure in hospital management, yet today it is taken advantage of by the medical profession of the state and medical students receive therein a course of practical instruction with apparatus and facilities more complete that can be found in many [other] medical colleges."

That same year the superintendent noted the importance of autopsies in educating staff physicians about their cases as an aid to diagnosis of future cases. These opportunities were extended to medical students and to physicians in the community. It was suggested that the duty of the state to provide the best possible care to patients in state institutions included provision of this kind of education for physicians. [It was not only important, it was their duty!] Several points addressing this were added. Providing instruction to the physicians and students prepared them to render early skilled attention to the mentally afflicted in their community. This directly benefited the citizens. Such education increased the ability of the physician to deliver an intelligent judgment in insanity inquests and to dictate a description of the case that would be of value to the hospital. Such work by educated local physicians who testified in insanity hearings economized for the counties and the state by decreasing the number of persons annually committed to "this or institutions of like character." In addition the training would encourage medical students' interest in psychiatry and provide future staff for the hospital. The public would be educated about these matters as well by publications and lectures of the staff.

Detailed reports of autopsies and collection of statistics about clinical cases, their demographics and diagnoses, as well as preparation of specimens for the pathological museum continued throughout his tenure and beyond. Staff presented papers to the Marion County Medical Society and later the Indianapolis Medical Society. Some publications appeared in journals including the Indianapolis Medical Journal, the Alienist and Neurologist published in St. Louis for a national audience, the Journal of the American Medical Association, and the American Journal of Insanity predecessor of the American Journal of Psychiatry. New books and journals were added annually to the physicians' library.

Diagnoses used the clinical schemes recently developed in Europe, the first efforts to define psychiatric disorders as syndromes rather than as variations of imbalances in body fluids, the millennia old "unitary theory of disease," that is that there is just one mental illness with variations in individual patients. Kraepelin had differentiated manic-depressive psychosis from dementia praecox in the late nineteenth century. Earlier in the nineteenth century, European psychiatrists had delineated dementia as related to medical diseases and characterized by disorientation and memory loss among other "organic" symptoms. A list of diagnoses at Central Indiana Hospital for the Insane in the first decade of the twentieth century included manic-depressive psychoses and involutional psychoses, both mood disorders delineated by Kraepelin that would be subsumed under Bipolar Disorder and Major Depression today. Dementia Praecox, or what we would call Schizophrenia, and Paranoia had been described as "thought" disorders [in contrast to mood disorders] by Kraepelin, and were now being diagnosed at Central Indiana Hospital in contrast to other vaguer diagnoses used here in the nineteenth century. Organic psychoses, intoxication psychoses, paresis, and exhaustion psychoses, apparently usually associated with severe medical illnesses, were included as were psychoneuroses, now subsumed under anxiety and somatoform disorders. Important to developing useful classifications of psychiatric disorders was separating out those that didn't meet criteria for then known disorders so that more research could be done. Thus, there were a small number of patients considered to have diagnoses that were "unclassified."

Dr. Charles Neu, who was pathologist at the hospital from 1903 to 1906, issued a lengthy report of his three years of work in the first of the reports of the Pathological Department. One hundred forty-seven autopsies had been performed. In classes open to physicians in the city as well as to medical students, Neu lectured on topics like the neuron concept and the role of axons and dendrites, the relation of the peripheral nerves to the central nervous system, and tertiary syphilis of the brain or paresis, all recent discoveries by European scientists like Ramon y Cajal, Nissl, Golgi, and Ehrlich. In the days when only light microscopy and gross and microscopic pathology as well as blood counts and some blood chemistries were available, physicians here were trying to discover the physical basis of mental disease.

In 1898, Edenharter hired Max Bahr, an Indianapolis native who completed medical school here and then served as chief resident physician at the Government Emergency Hospital, in Washington, D.C. where he saw patients from the Government Hospital for the Insane and had become interested in psychiatry. After serving as an Assistant Physician at the Central Hospital for a decade, Bahr was given leave of absence in 1908 to study for a year in Germany. With his Doctor of Psychological Medicine from the University of Berlin, Bahr became the first physician trained as a psychiatrist at the hospital here and was promoted to Chief of Clinical Psychiatry.
Bahr presented a paper to the medical society based on notes from his work with Professor Theodor Ziehen, chief psychiatrist at the Berlin Charity Hospital, "The General Treatment of the Insane in the Practice of Professor Ziehen." In line with the theories of the time, it was emphasized that prevention of mental illness was important in terms of providing a healthy and structured environment for children. [The mental health movement, overly optimistic at the time, was beginning in this country.] Hospitalization would become necessary for suicidal patients and those dangerous to the community. Dr. Ziehen had taught Bahr that bed rest, proper diet, physical occupation, avoidance of external stimuli, and hydrotherapy would be beneficial. Application of galvanic current to the head didn't seem to help. Since the early nineteenth century, electricity had seemed important in the cure of "nervous and mental" illness. Electroconvulsive therapy, the first electrical treatment that benefited psychiatric patients did not become available until the late 1930s, and it would be used by Max Bahr and his staff. Medications at the time Bahr studied in Europe included morphine, alkaloids [atropine and scopolamine], chloral hydrate, paraldehyde, bromides, and some of the early barbiturates. [Anti psychotics, mood stabilizers, and antidepressants were a half century in the future.] Continuing his outline of Professor Ziehen's practice in Germany, Bahr described general principles of "psychical therapy" as including encouragement, not arguing about delusions, and being truthful with patients. Hypnosis was helpful in some cases. Restraint was to be limited to a few exceptional cases and restraint and seclusion permitted only on a physician's orders, not just implemented by unsupervised attendants.
Bahr developed a detailed plan for routine careful clinical examination to be performed on all patients and began what were in essence epidemiological studies. He catalogued summaries of patients by gender and other demographic characteristics and by diagnosis, reporting first on over three hundred patients and later on over twenty-six hundred patients. His findings were correlated with pathological findings in research reports published by the hospital, presented to the local medical society, and distributed to colleges and universities throughout Indiana.

Papers presented to the medical society by Bahr and others of the staff included topics such as pathology and clinical manifestations of brain tumors, 3 cases of acute suppurative meningitis of pneumococcal origin, a case of hemorrhagic pancreatits, the significance of fear in mental diseases, a report of a case with claustrophobia, psychotherapy as applied to the insane, and clinical observations of twenty-two cases of paresis. They were covering the field as it was then known, including evidence based on the work here.

Meanwhile, Dr. Edenharter had seen to the construction of a hospital for the [medically] sick insane with wards for infectious diseases and complete surgical facilities. There were five buildings connected by corridors and connected as well by corridors to the Men's Building and to the Women's Building. In these days before air conditioning and much in the way of central heating, a special ventilation system with conduits in hollow walls ventilated from the basement and a system of fans was incorporated into the building. Bathrooms and lavatories were lined with enameled brick, the entire building complex was wired for "incandescent electricity with iron-armored conduits," all rooms faced the southwest so that they would be healthily sunny and cheerful, and there were "airing roofs" so patients could be taken outside in all weather.

Edenharter's legacy continued through the years. When he died in 1923, his protégé, Dr. Bahr, became superintendent of the hospital. Like Edenharter, Bahr would serve thirty years, until shortly before his death, and would expand the work Edenharter had begun. There had been some difficulty keeping a pathologist long-term to supervise this facility. After becoming superintendent, Bahr soon hired Dr. Walter Bruetsch, a neuropathologist who was born in Germany and trained there and in Switzerland. This began a partnership of Bahr, the clinician, and Bruetsch, the neuroscientist, who studied all the new treatments in the developing field of psychiatry in the early twentieth century. More importantly, they carried out follow-up studies to see what worked. They met weekly on Saturday mornings to discuss their studies and to plan new studies that they and their associates would perform. On Saturday afternoons, Bahr and other staff held lectures and clinical demonstrations for medical students in this auditorium.

Among other studies, Bruetsch tackled an important question about the immune system in brain in infectious disease that would not be elucidated for over sixty years. It is only in the past couple of decades that techniques have been available to explore the role of neuroimmunology in psychiatric disorders. Dr. Bruetsch had been sixty years ahead of his time.

In 1938 Central State Hospital was described in a national report as having: "one of the largest and best equipped . . . laboratories in the country for research in mental diseases. It is closely affiliated with the University Hospitals of Indiana University, and serves as a teaching center in psychiatry for Indiana University School of Medicine. . . . There is a training program for residents in psychiatry." It remained a state-of-the art facility until about the time of the Second World War.

Research carried out here in the early days is still important at the medical school. Specimens from the early twentieth century from patients with dementia as well as the detailed clinical reports of the same patients are being used by Dr. Ghetti in the Pathology Department to compare Alzheimer 's disease then with his studies of current patients. Thus the legacy of George Edenharter has been important in psychiatry in Indiana for a century.

By the early 1920s, Edenharter's parents, his wife, and his brother, an Indianapolis lawyer, had died. Only his son, Ralph, then living in Pennsylvania, remained of his family. Edenharter, himself, suffered courageously from long-standing diabetes mellitus, treatable at the time only by diet. Ironically, the newly discovered insulin was being developed commercially at that time by Eli Lilly and Company in Indianapolis, but the discovery of insulin in Canada and its commercial production in Indianapolis did not occur soon enough to benefit Dr. Edenharter. Not long after the celebration of his thirty years as Superintendent by four hundred of his friends in April, 1923, he had a stroke with paralysis of the right side. After eight weeks confinement in bed, he was able to get about the grounds of the Central Hospital. He became ill again in October with a gastroenterological disorder, suffered another stroke with paralysis, and died December 6, 1923 at age sixty-six. According to his wishes, his body lay in state in the chapel of the hospital where funeral services, open to the public and widely attended, were conducted. He was buried in Crown Hill Cemetery, Indianapolis, next to his parents.

R. French Stone, M.D., Biography of Eminent American Physicians and Surgeons. Pp.155-156, Indianapolis: Carlon and Hollenbeck Publishers, 1894.
Jacob Piatt Dunn, Greater Indianapolis, The History, the Industries, the Institutions, and the People of a City of Homes. Vol. 2, pp.975-978, Chicago: Lewis Publishing Company, 1910.
Jacob Piatt Dunn, Indiana and Indianans. Vol. V, pp.251-253, Chicago:The American Historical Society, 1919.
Indiana Medical History Quarterly, 7:10, September, 1981.
Obituary, pp.31-32, Indianapolis News, December 7, 1923.
Obituary of Frank T. Edenharter, Indianapolis Star, August 22, 1920.
Obituary of Ralph Edenharter, Indianapolis News, April 6, 1927
All references at Indiana State Library, Indianapolis.

Lucy Jane King, M.D. Dr. King is a clinical professor emeritus in the Department of Psychiatry, Indiana University School of Medicine. She is author of a recently published history of Central State Hospital that includes a memoir of a patient there in the 1880s: From under the Cloud at Seven Steeples, the peculiarly saddened life of Anna Agnew at Indiana Hospital for the Insane, 1878 - 1885, Zionsville: Guild Press/ Emmis Publishing, 2002.