When Anna Salzer died while a patient at Rochester State Hospital in 1897, her death was first reported as the result of heart failure after a twelve-hour illness. Later, the cause of death was changed to pneumonia. But another patient, Lydia B. Angier, reported details about Salzer’s death to officials, writing that “every day I saw her abused—shoved about—and on the last day actually kicked.” The incident reveals how abuse contributed to excess mortality among patients confined to insane hospitals at the turn of the twentieth century.