Mad, Bad - or just Unwanted?A history of lunacy in England, with particular reference to the County and City of Worcester Pauper Lunatic Asylum.Robert J Ashworth Part TwoThe County and City of Worcester Pauper Lunatic AsylumThe building of the county asylum in Worcestershire was in direct response to the Lunacy Act (1845), which forced all boroughs and counties to make adequate provision for the pauper lunatics under their jurisdiction. To this end Worcester magistrates set up a committee, at the Michaelmas Sessions of 13th October 1845, "to consider erecting and providing an asylum for lunatics in this county" [Annual Report (1)]. To further this a committee was appointed to superintend the erection of the asylum. The City and the County signed an agreement on the 10th April, 1847, to combine in the provision of the asylum, and that there should be a committee of fifteen visitors, eleven to be elected by the County and four by the City [Annual Report (1)]. It was decided at the outset that the harmless lunatics, about a third of the total, should be allowed to remain in the workhouses. The committee decided that the asylum should be erected within five miles of the Worcester Shire Hall, in an open airy position with good access by road. The site should be of gravel or rocky subsoil with the means of providing a constant supply of good water. After deliberation they bought White Chimneys Farm at Powick for £2,800, which had 43 acres, three rods and three perches belonging to it [Map]. The committee declared at this time that the purpose of the hospital would be not only to "alleviate the sufferings of unfortunate individuals who may require our protection and care", but also "the means of effecting their cure in a very large proportion and thereby restoring them to their families and friends" [Hall (1988)] The committee advertised for plans to be submitted with a premium of £50 for the best submission. One stipulation was that the Medical Officer would be able to pass through all the wards and galleries without retracing his steps. There were a large amount of delays for various reasons, one was that the Commissioners of Lunacy insisted that the construction of the buildings be fire proof. As a result of this the asylum which was due to open on June 24th, 1852, was delayed till August 11th, 1852, the floor specification having to be changed at a late date. The eventual cost of the buildings was £58,065 7s. 8d. The asylum was built to receive 200 patients and initially received 175 from around the county, yet even in the first annual report it was deemed necessary to report: "It is obvious, from what has been reported, that the Asylum will require immediate enlargement". The pressures for expansion appear to have been strong from the outset, already by the time of the committee meeting of 7th November, 1853, there were 201 inmates rising from 175 in 1852.
The RegimeThe first Medical Superintendent was Dr. I. R. Grahamsley of the Royal Edinburgh Asylum who advised the committee making a list of recommendations and oversaw the building. Dr Grahamsley's tenure as superintendent was short as he committed suicide in July 1854 using prussic acid. It seems that he had been heavily criticised for employing his sister-in-law as Matron. The regime set up by Grahamsley was an enlightened one:
This regime, and the asylum itself, was the direct application of the Moral Management Movement in as much that many of the patients were engaged in some kind of work. The females did domestic work, and the males worked at such tasks as building, shoe mending, bread and beer making but primarily in the 552 acres of the home farm. This activity also had another great advantage as the produce was used in the asylum. The income raised from selling the excess, was used to lower the cost of keeping the inmates even further, for example the unit cost per inmate in 1852, was 12 shillings but by 1882 it was the lowest in the country at 7s. 3d, the average for the country at that time was 9s. 41/8d, weekly. Approximately seventy plus percent of patients were productive, leaving one third who were incapable of work and tended to be the incurable and chronic [Annual Report (30)].
Growth of the Asylum PopulationThe numbers of inmates grew steadily, in 1852 when first opened there were 175, in 1862 there were 425, in 1872 there were 660, in 1882, there were 777, in 1892 there were 926, and by 1902, there were 1,203 [Annual Reports]. These increases in the numbers of inmates was partly due initially to the growth in public confidence leading to families admitting to the asylum their relatives that formerly were kept hidden at home. These patients tended to be the chronic incurables and thus a core of permanent patients began to build up. Socially attitudes changed in general and lunatics were no longer tolerated as once they were, causing an increase in the committal rate. The asylum became a convenient place to put the unwanted, the awkward, and the potentially troublesome elements of society [Hall (1988)]. Worcester Lunatic Asylum was repeatedly enlarged to accommodate the growing population, and as a result the environmental conditions gradually declined as extension upon extension was built. These extensions were built cheaply with huge wards that had unplastered walls and insufficient heating, in cold spells, wards could not be kept warm (below 600F ). The water supply was of particular concern as it was of poor quality and great scarcity, this led to several outbreaks of illness the worst of which was the typhoid outbreak of 1889 [Hall (1988)]. Hand in hand with the expansion of the asylum the regime altered, it became more utilitarian and institutional. The daily routine was strictly regulated and the divisions were marked by the ringing of the asylum bell, this strict adherence to "the hours to be observed" included the staff as well, for example, "3.00p.m...Night Attendants are not to rise before this hour" [Rules (1898)]. Every aspect of their lives was regulated. The ever increasing numbers of patients over-stretched facilities and staff could not keep the original standards in operation and the ideological drift away from cure to containment and confinement as the problem seemed to escalate. All through this period the doctors complained that they did not receive the patients early enough to allow a cure to be a viable expectation, if a lunatic was treated early in the illness many could have been cured adequately. This led to the core asylum population of chronic incurables growing even further. The medical establishment itself helped to expand the asylum population. As medical knowledge advanced, the classifications of illness expanded. This brought into the asylum system still more patients, that previously, would not have been included. In 1854 the categories referred to in the main were, lunatic, imbecile, and idiot. This rapidly grew till in 1882 [Annual Reports (30) and (40)] the categories were
All of these had subheadings, such as:
These too had subheadings:
Classifications and treatments were noted in the case book, together with the physical and mental condition of the patient.
The treatmentAll through this period the treatment of the patients remained essentially the same, in that they were generally separated from their ordinary environment and given appropriate occupations to encourage their minds to right themselves. If this was found to be insufficient the medical treatment was basically limited to manual restraint, straight jackets, padded cells and harnesses to strap the patient into bed to force them to lie quiet with the hope of release for the "calls of nature". The physical welfare of the patient was equally important, as they believed this promoted mental welfare, so much so that if any improvement in the patient often prompted special food allowances to be administered. There were few drugs administered at this time, and those that were mainly sedated the patient. Laudanum, camphor, bromides and chloral hydrate were those used most. When a patient showed any form of recovery they were "relieved", discharged, to ease the burden on the parish, regardless of the possibility that remission was only temporary and that the patient would most likely to be readmitted at a later date. In the 1890s one third of new admissions achieved effective cures. The crucial time-scale for curing insanity was regarded as the first two years of illness. In this period most cures were affected the first month being the best time to effect a cure, but after the third year fewer than one in thirty were cured [Abney (1976)]. This would appear to bring into question whether the treatment was efficacious at all. If the best time for the patients to be cured was the first month, would the patient have recovered anyway, not being mentally ill but temporarily emotionally overwhelmed?
The Female PopulationThe question of why there should be consistently more female than male inmates in the asylum seems perplexing until the position of the female in society is looked at in context. At the beginning of this period, in the 1850s, women had no control over their lives. In fact they did not even have power over their own bodies according to the law at that time. They were regarded as possessions of their nearest male relatives. Among the lower levels of society in the latter part of the nineteenth century with the capitalist system was in full unfettered flow, women were under pressure to go to work, plus look after the home and family with little or no respite and even less reward and encouragement. This set of circumstances inevitably led some to despair and melancholia. Being sent to the asylum must for many female pauper lunatics have been like exchanging one oppressive regime for another. This would not seem conducive in aiding recovery at all. Also during this time what better way to rid yourself of an awkward wife, than to have her certified and locked away indefinitely. It was precisely these kind of fears that led to the improvement of the asylum admissions system, which became law in The Lunacy Act (1890), this provided an improved method of admission into lunatic asylums [IMHL].
© RJ Ashworth, 1999 |