The institutionalisation of the mentally ill - and other marginalised people - created the dehumanising conditions ideal for the exploitation of their disenfranchisement.
Though its reputation for the horrific treatment of patients might have come to rival that of its transatlantic contemporary Bedlam, Massachusetts’ Saltwell Sanatorium and its founder were eventually spared the consequences - and the inevitable infamy - of a full accounting of their most terrible practices when the cliffside facility collapsed without warning (along with much of the underlying bedrock) into the Atlantic ocean in the Winter of 1889. Built around fifty years earlier by Dr Spencer Allen, an English physician who had emigrated just prior, the former farmland had been sitting fallow since the water in its well had become unusable. This well, for which first the area and later the Sanatorium were named, had originally opened into a freshwater aquifer which, over time, eroded through the bedrock until it connected directly with the ocean.
Designing the Saltwell Sanatorium almost as though it were a fort, the disused well was restored as the main feature to the central courtyard (around which the rest of the facility was situated) and finally opened the Sanatorium to long-term residents in 1837. Almost immediately, rumours began to abound that Allen’s criteria for choosing who to admit were not purely medical. Institutionalisation was sometimes seen as a tool, a means of oppression by which the troublesome and the quarrelsome (namely women and other marginalised and disempowered people) might be quietly removed, and Allen was keenly sympathetic to this position. The residents were seldom deemed fit to return to society; many had been admitted privately, and at quite considerable cost, on the understanding that their conditions would be determined to be chronic and incurable - their confinement therefore being, necessarily, lifelong.
While the sanatorium maintained a full suite of the latest equipment for surgical treatments - all of which would be unbearably barbarous to more modern sensibilities - the majority of medical interventions (both surgical and, more routinely, chemical) which were undertaken served primarily to keep the patients placid and pliable. Although he occasionally brought in temporary orderlies, Allen (who lived in a suite at the sanatorium) was loathe to employ other staff, instead relying heavily on the confinement of the residents in order to maintain control of an increasingly large cohort. He was, eventually, joined by his wife and her two sisters, all of whom were pressed into service as nurses. They had stayed in England whilst the sanatorium was constructed but, as noted by those who lived nearby, never left the confines of the facility once they had taken up residence there.
Not well-liked by the local population, Allen only further raised ire by refusing even the most cursory or desultory of his medical attentions to those who were not in his full-time care; even in cases of emergencies. In fact, he had demonstrably little interest in any medicine that fell outside his field and even less in any practice that would not benefit him financially. Truly, only one aspect of his work seemed to hold any real interest for him: A regimen of experimental drug therapies, disguised as dietary supplements, that he had fed to his female patients. Most of his so-called work was little more than a cover for these experiments, experiments outlandish enough that he had had Saltwell Sanatorium built in order to procure subjects no-one would miss. Women whom he had been paid to, in essence, make disappear.
Where the conditions were already inhumane for those either not suited or not appreciably responsive to the experiments, the considerable attentions lavished on those unfortunate enough to be selected as promising candidates were simply inhuman. Outwardly and performatively Christian on those rare occasions where he interacted with people outside Saltwell Sanatorium, Allen’s preferred religious iconography (the ichthys) was a wry and literal nod to his true beliefs. In some of the few pages of his notes that survived the destruction of the sanatorium he expounded - briefly - on the gnostic revelation that shaped his theology and his work. A near-death experience - drowning in a tempestuous sea - had brought him into communion with an ancient and immortal intelligence; the thing that our most ancient shared ancestors had evolved out of the oceans in order to escape.
This was an affront approaching blasphemy, but one Allen chose to reinterpret as a test. We had abandoned our true God (worse, we had forgotten Them!) and had been cast out of Their sight and Their domain, but he would rip and rend - he would mutate and mutilate - until we were able to grovel and prostrate ourselves before Them. The specifics and particulars of the drugs he was giving to his patients were presumed lost, but records of purchases held by the sanatorium’s various suppliers indicate that his attempts involved mutagenic and teratogenic chemicals and increasingly exotic and ritualistically significant materials. Still, even if his efforts had exceeded his most ambitious hopes the work to undo evolution and return humanity to the sea would have been interminably slow (perhaps even generational) and Allen was impatient.
The sanatorium was well-stocked, in addition to the more usual surgical tools, with devices - both antique and unique - which were intended to assist and accelerate his patients’ transformation into viable human/fish hybrids: One creation of Allen’s own creation was an implement for scraping away skin without damaging the development of subcutaneous scales. Whether or not this was ever utilised, it is absolutely certain that Allen was a monstrous person who would have had no compunction against using it. Whether his religious experiences were real or not - they have some similarities with other, less violently-expressed beliefs - Allen was a prolific and sadistic serial killer. In the years it was operating, Saltwell Sanatorium housed upwards of a hundred residents - most of whom were women - and only a handful of them were ever seen or heard from again.
The investigation into the cause of the sanatorium’s collapse was already somewhat perfunctory, most glad to be rid of its oppressive blight, but the discovery of some of Allen’s notes gave those in charge a reason to quietly draw a line under the disaster. Later, and with the benefit of more advanced equipment (offset somewhat by the amount of time that had passed and the ocean’s efforts to scour away anything inculpatory), a privately-funded team excavated down to the compromised aquifer. They found evidence that the well at the centre of the sanatorium had been used to dispose of dozens of bodies and, moreover, that not all of the remains were - strictly-speaking - entirely human. There was no proof that Allen’s heinous experiments ever truly succeeded, but the area remains notorious for fleeting sightings of unknown sea creatures.