Part 1 of a 3 part series
“…aims at making the Institution really and truly an Asylum, a place of refuge and retreat from pain and sorrow; an Hospital and a home.”
Extract from the Essex Lunatic Asylum Medical Superintendent’s Annual Report, 1874
Notes From An Asylum
During a recent clear out at my place of work, a colleague unearthed records from the old Essex Lunatic Asylum, later named Warley Hospital.
The first history of Warley Hospital was written by the Medical Superintendent Dr. G. S. Nightingale in 1953 (updated in 1969), which included an account by the first Medical Superintendent, D. C. Campbell from 1853.
They give a fascinating glimpse into mental health care in the 19th and early 20th centuries, and combined with the wider social and political perspectives of the time, offer insights into psychiatry today.
First, a brief summary of the events leading up to the asylum era.
The Asylum Movement
The era of the state asylum began in the early 19th century. In the preceding few centuries, there had been a shift in the care of the mentally unwell – from family support, with occasional parish authority assistance, to more widespread containment in private madhouses. Concerns began to grow about the ill treatment of ‘lunatics’, and there were calls for more compassionate treatment. In 1813, on the back of the Enlightenment towards rationality and science, Samuel Tuke started the York Retreat. This was a charitable Quaker asylum, offering religious ‘moral therapy’.
Tuke’s aim was:
“to encourage the influence of religious principles over the mind of the insane as a means of cure”.
The underlying assumption, widespread amongst the population at the time, was that patients’ difficulties were a result of a personal failing, a conscious decision to chose madness over rationality. ‘Moral’ treatment was also advocated by Philippe Pinel in Paris, who famously unchained the patients at the Bicetre and La Salpetrière hospitals.
In England, the County Asylums Act of 1808 laid the groundwork for institutions to house ‘pauper lunatics’ and the criminally insane. The County Asylums Act of 1845 spurred on this process. At the same time, the Lunacy Act officially labelled ‘lunatics’ as mentally unwell patients in need of care, with the treatment to be provided by Medical Superintendents at the public asylums now mandated in every county.
The ‘Pauper Lunatic Asylum for the County of Essex’
The site chosen for the Essex Lunatic Asylum was Brentwood, at that time a hamlet containing Warley barracks, cottages, and a number of beer houses, ‘at least one of which was “used for other and less moral purposes”’.
The asylum was built in an area surrounded by fields and woods. The style of the building, to quote the architect, was ‘mediaeval, of the Tudor period…being substantial, cheerful, English in character…and not expensive’. The grounds were not laid out before the first patients arrived, in order to ‘provide useful employment’ for them.
Inside, the walls were whitewashed, galleries unfurnished, and dormitories unheated. The beds were low wooden boxes with straw mattresses. There was only one basin per ward and no lights in patients’ rooms until 1920. Gas lighting was used until the building became generally electric in 1930. It was said that the wards were deliberately plainly furnished and decorated, in order to make them “more acceptable to persons of labouring classes”.
The asylum’s water came from surface supply, which was easily contaminated by sewage. In 1854 an outbreak of ‘Asiatic Cholera’ led to the installation of a filter bed, before a typhoid epidemic in 1884 led to the construction of a deep well.
In practice, it seems that little water was actually drunk. The asylum had its own brewery, which supplied patients and staff. All the patients were given half a pint of beer at 11am and dinner, whilst staff allocation was linked to seniority. The Medical Superintendent received ‘a sufficiency’. At entertainment events, the patients were treated to gin and water, and later, gin and lemonade.
In 1863, an unfortunate patient fell into the ‘brewery copper’ and died of ‘lockjaw’ (tetanus).
Less is written about the food, although it was noted that the diet was ‘ample but monotonous’.
In 1853, the asylum housed 307 patients. The annual running cost was 11 shillings. By 1900, there were 2081 patients, with the cost now 9 shillings and 4 pence. The asylum underwent a number of extensions to accommodate the increasing numbers of patients over these years.
The Great War of 1914-18 dealt a significant blow to the asylum. 102 of the staff left to fight, 7 of whom died. Food rationing in England led to many of the asylum patients dying, 525 in 1917 alone.
Building work resumed in the interwar years, before pausing for the Second World War. Again, staff were called up, but fortunately food rationing was much less severe for the patients. A large proportion of patients, staff, and equipment from the London Hospital from Whitechapel, was evacuated to the asylum, which, apart from the loss of farm stores buildings in 1940, survived significant bomb damage.
By 1950, patient numbers had reduced to 2002, with running costs of 3 pounds, 13 shillings, and 5 pence.
From the middle of the 19th century, before they came to be known as psychiatrists, doctors specialising in the mad were known as alienists, from the Latin ‘alienus’ (of another). In charge was the Medical Superintendent, who for the first 27 years was accompanied by two medical officers. One of these, employed at the age of 23, was a certain Dr Henry Maudsley. Maudsley resigned in 1859 to become Superintendent of Cheadle Asylum near Manchester, before famously founding the Maudsley Hospital in London.
Lying at the other end of the pay scale to alienists were the ward attendants. They worked 14 hours per day, looking after a ward of 28 to 34 patients each, with one day off every 23 days. Male attendants received £28 and women £18 per year, as compared to £500 for the Medical Superintendent. The poor pay was said to lead to poor employees, with drunkenness on duty a common problem. A further disciplinary issue arose from having a married couple on duty together, this experiment ended with both being dismissed for fighting one another on duty.
In 1877 the staff were made to wear a uniform: a suit and cap for men and a black dress, cap and apron for women.
A description of the typical patient emerges from contemporary thoughts on the causes of their madness. Alongside ‘hereditary factors’, the most frequent cause was thought to be, ‘in a wholly agricultural population, bad housing, low wages, and large families – leading to starvation, and alcoholism to escape’. The records state that ‘it was not unusual for a farm labourer, his wife and up to eleven children to try to exist on a wage of seven shillings a week’. It was the plight of such people that Benjamin Disraeli had highlighted only a few years earlier in his 1845 novel ‘The Two Nations’.
According to the early records, admitted patients were of the ‘most unpromising clinical material…chronic with a very high proportion of epileptics and frequently moribund on admission’. In 1853, 240 of the 274 admitted patients were regarded as incurable, and efforts were made for patients to be sent in earlier, when chances of a recovery were thought to be higher.
Patient number expanded rapidly, with the asylum becoming overfull by 1860. Rather than extend the original building, there was the construction of additional ‘distinct houses with as much as possible the plain arrangement of a country home’, as well as a ‘rather fine dining hall’.
At the time, asylums were not meant to contain more than 800 patients, but numbers in Essex continued to rise, to 904 in 1880, and to 1999 in 1899. Plans were made to build another asylum, but this was abandoned, and patients were instead transferred to other asylums.
By the turn of the century there was some relief from overcrowding, with 680 patients moved to the newly constructed asylum at Goodmayes in 1901, but soon afterwards patients previously sent to other asylums returned to Essex.
A key reason for overcrowding was said to be workhouses refusing to accept senile patients, who no longer needed asylum treatment.
38% of the admissions in 1896 were for people deemed ‘mentally defective’, which led to calls for an ‘asylum for idiots’. Many other admissions were for people suffering from delirium tremens, a serious form of alcohol withdrawal, which can lead to delusions and hallucinations, as well as seizures and death. The supply of beer to patients was eventually stopped, though not because of problems with dependency, but because it was found to be ‘too weak to be a stimulant’. The brewery was converted into a lab and a mortuary.
At least for the first few years, the patients wore a uniform: black dresses with bonnets for women, and corduroy suits and hobnailed boots for men.
Next time – Part 2: Treatments