Alabama Insane Hospital is governed by a series of rules and regulations established in 1861 by the Alabama legislature on admitting patients like Andrew Sheffield, how staff should treat patients, how Alabama Insane Hospital receives revenue and other necessary administration rules.

To start the process, a patient like Andrew needed a certificate from a physician to verify if the patient was insane.  The physician legally swears that the physician has “examined into the state of health” and states the “opinion that he is insane.”  Interested parties could obtain that from a physician or, if necessary, by court order.  These certificates are to come with the patients for the superintendent to document.

Patients needed to fulfill other requirements before being admitted to Alabama Insane Hospital.  The first requirement is that future patients must be free from any contagious disease.  Doctors and staff at the Hospital were concerned about disease outbreaks.  The second requirement was that all patients must bring a set of clothes.  Male patients needed two “new shirts, a new and substantial coat, vest and pantaloons, of strong woolen cloth, two pair of woolen socks, a black stock or cravat, a good hat or cap, and a pair of new shows or boots, together with a comfortable outside garment.” Women patients needed to have the same quality of clothing as their male counterparts.  Women patients needed “shoes and stockings, shall have a flannel petticoat, two good dresses, also a cloak or other outside garment.”  Good quality garments are required when the patient “attend religious worship, walk, or ride out, their self-respect may be preserved.”  The Hospital cautioned patients that jewelry could easily be lost, so they should be left home.

The cost of boarding at the Hospital varied between indigents and private patients.  “For board, including washing, mending, and attendance, of all who are supported at public charge, the counties will be charged 3 dollars per week.”  For private patients or people supporting the patient, the charge would vary “from five to ten dollars, according to the trouble and expense incurred.”  Patients could get “extra attention and accommodations.”  The price for that would be higher.  Family, friends, or the county needed to pay the Alabama Insane Hospital every quarter.  The Alabama Insane Hospital required a bond “with satisfactory sureties, will be required for the payment of the board and expenses, and for the removal of the patient when discharged, of all persons, excepting those sent at the expense of the counties.”  The bond amounts to three months before the cost of that patient’s board.

Attending physicians asked parties of all indigent and private patients a series of questions to understand the patient further.

1. What is the patient’s age?  Married or single?  If children, how many?
2. Where was the patient born?  Where is ——– place of residence?
3. What has been the patient’s occupation and reputed pecuniary circumstances?
4. When were the first symptoms of the disease manifested, and in what way?
5. Is this the first attack?  If not, when did others occur, and what was their duration?
6. Does the disease appear to be increasing, decreasing, or stationary?
7. Is the disease variable, and are there rational intervals?  If so, do they occur at regular periods?
8. Have any changes occurred in the condition of mind or body since the attack?
9. On what subjects, or in what way is derangement now manifested?  Is there any permanent hallucination?
10. Has the patient shown any disposition to injure others?  And if so, was it from sudden passion or premeditation?
11. Has suicide ever been attempted?  If so, in what way?  Is the propensity now active?
12. Is there a disposition to filthy habits, destruction of clothing, breaking glass, &c?
13. What relatives, including grandparents and cousins, have been insane?
14. Did the patient manifest any peculiarities of temper, habits, disposition, or pursuits, before the accession of the disease? – any predominant passions, religious impressions, &c?
15. Was the patient ever addicted to intemperance in the use of ardent spirits, opium, tobacco, in any form, &c?
16. Has the patient been subject to any bodily disease?  To Epilepsy, suppressed eruptions, discharges of sores, or ever had any injury of the head?
17. Has restraint or confinement been employed?  If so, of what kind, and how long continued?
18. What is supposed to be the cause of the disease?
19. What treatment has been pursued for the relief of the patient?  Mention particulars, and the effects.

The questionnaire finally asked that representatives for the patient mentioned anything not already asked for that pertains to the patient’s mental illness.

If Andrew Sheffield is to be believed, she was an indigent patient, so Marshall County paid for her stay at the Hospital.  By the time of her stay at Bryce Hospital, James Sheffield had lost his mercantile business and got a job as an assistant to Education Secretary Thomas Palmer in the 1890s.  Her half-brother, T. A. Street, was a probate judge.  Yet neither he was willing nor able to pay the $5 to $10 a week to keep Andrew Sheffield at the Alabama Insane Hospital.

As for those questions, question 15 may have sealed her fate at Bryce Hospital.  This question may explain why her family wanted to send her to Bryce.  The family simply could not handle her.  Her addiction to chloral hydrate caused a lot of pain to the family from possible dramatic behavior by Andrew.  James Sheffield could not deal with Andrew’s problems since he was far away in Montgomery.  Other family members were perhaps less favorable to Andrew’s addiction and her overall personality, so they simply dumped her at Bryce Hospital.  Other than her father, who visited her, her family members perhaps tried to forget everything about her.

Citation:

Acts of the Legislature, and By-Laws, for the Erection, Organization and Government of the Alabama Insane Hospital at Tuscaloosa (Tuscaloosa: Observer Book & Job Office, 1861) 3 – 5.