Tag Archives: history of psychiatry

Surgery in the asylum I: Which way to the operating theatre?

On our lunch break a few weeks back, fellow postgraduate student Emily Andrews and I started to compare notes about post-mortem procedures in asylums (these are the kind of conversations you get into as historians of medicine – to our fellow diners, I can only apologise). Whilst both of us had uncovered quite detailed reports about the appearances of bodies at post-mortem, we had less information about the spaces in which post-mortems were performed. This led us to consider other medico-surgical spaces within the asylum.

There are many accounts in both archival and secondary literature of operations being performed on asylum patients. Alongside narratives of psychosurgery (covered previously on this blog) are tales of other types of operation: for cataracts, for removing foreign bodies ingested or inserted by patients, or for the excision of tumours. Rarely, though, are the practicalities of these operations mentioned. Where did they take place? Who performed them? Who benefitted (and who didn’t)?

The operating theatre of London's Metropolitan Hospital in 1896. © Wellcome Images

The operating theatre of London’s Metropolitan Hospital in 1896. © Wellcome Images. Is this perhaps what many asylum operating rooms looked like?

The need for surgical intervention within the asylum was graphically highlighted in an 1858 article by D.F. Tyerman, Colney Hatch Superintendent, in which he described various emergency situations involving suicide attempts by patients. In 1834, he had prevented the death of a male patient who cut his throat with a knife during dinner. Arriving at the scene, Tyerman ‘introduced into the wound [his] fore finger’ before plugging the wound with lint and tying the carotid artery. He was also called to attend situations in the immediate area beyond the asylum, including a man who had cut his throat in a nearby hotel. As institutions typically placed some distance from urban centres, Tyerman’s anecdote showed how basic medical skills possessed by asylum staff might be called upon by neighbours in an emergency.

This distance could be problematic for the asylum, however, especially if an institution lacked staff who were able undertake such heroic measures. J.H. Sproat, in 1899, related four cases of surgical intervention that had necessitated calling in outside help because staff at the Somerset and Bath Asylum lacked the necessary skills. In some cases, local doctors proved difficult to convince, being reluctant to operate in institutions lacking the usual facilities and no doubt fearing any ensuing coroner’s inquests. In large asylums, then, it was crucial to have, if not the staff, then at least the facilities to deal with medical emergencies, as well as to perform more routine operations. (Many asylum staff were able to perform minor procedures, though it appeared less common for them to undertake things such as amputation, as William Dudley had at the West Riding Asylum in the 1890s.) R.H. Steen, writing on asylum architecture, included an operating theatre in his plans of a model asylum; it should be located close to the wards and ‘centrally placed’.

Victor Horsley operating at Queen Square in the early 1900s. © Wellcome Images

Victor Horsley operating at Queen Square in 1906. © Wellcome Images

The importance of such facilities can be seen in accounts of the construction of Cardiff Lunatic Asylum, which opened in 1908 under the Superintendency of Edwin Goodall. Speaking at a meeting of the Medico-Psychological Association in 1908, he explained how ‘the object had been to give the Institution as much a hospital character as possible’ (indeed, he also considered the possibility of employing the term ‘mental hospital’ rather than ‘asylum’ – a change that did take place a few years later). In the original plans for Cardiff, an operating room was included at a cost of £600, then reconfigured to be accommodated within existing rooms for the lower cost of £500. A loan to cover the cost had been refused by the Commissioners in Lunacy, but ‘as the buildings were nearly completed at that time they went on with them, [reasoning that] the cost would have to be borne out of the rates’. The Commissioners, defending their refusal to provide the funds, ‘said the operations [undertaken in asylums] were few’ and ‘that operations were often done in private bedrooms’. Goodall countered by producing a telegram from Dr Bond at Long Grove Asylum ‘saying that he had an operating room, so that such had recently been allowed [by the Commissioners]’. Debates with the Commissioners aside, Goodall proudly reported that Cardiff now had a well-equipped operating room with ‘about £360 worth of … instruments’.

Though Cardiff still relied on outside expertise where necessary, the benefit of on-site facilities was soon evident: within two weeks of opening their operating room, ‘their Night Sister sustained a fracture of the base of the skull and … was operated upon [there]’. Evidently, then, staff as well as patients might be treated within the asylum. Many operations were described as urgent measures – to treat an injury or remove a life-threatening tumour – but for patients in particular, surgery might also be viewed as a route to improved quality of life. Robert Picqué in France considered this in a 1907 article ‘Ce que Doit Être à notre Époque La Chirurgie des Aliénés’ [‘The Needs of our Time in Respect of the Surgical Treatment of Insane Patients’]. As a review of his work related, Picqué suggested that ‘restoring the use of a limb [for example], may exercise an indisputable, though indirect, action towards the restoration of mental health’ by allowing the patient to resume a more active life.

All was not well, however. At the same time, doctors were increasingly expressing their concern about the often hasty recourse to surgery on asylum patients. A worrying faith in craniectomy as a ‘cure’ for idiocy was identified, as well as the phenomenon of post-operative insanity – insanity caused or exacerbated by surgery. Both of these though, will be stories for future posts…

– Jennifer Wallis

If you’ve found any information on surgical practices in an asylum you’re researching, we’d love to hear from you!

Muscle and mind in the asylum

The bodies of the insane held a particular fascination for the 19th-century asylum doctor. Actions might betray a person’s psychological state in the most striking ways, with bodies subjected to tics and spasms, and facial expressions revealing the deepest thoughts and feelings.

The late 1800s was a climate in which the relationship between body and mind was being ever more meticulously refined. In the 1890s, for example, Charles Sherrington discovered a feedback mechanism in muscles that was important for the regulation of posture and movement. Sherrington’s work suggested that bodily attitudes – such as seated posture, or how a person ‘carried’ themselves – could indicate inner psychology.

L0057988 Dynamometer, France, 1890-1910

A dynamometer, just one of a range of tests that might be used to assess patients’ bodies upon admission. © Wellcome Images

This was an idea that had obvious application within the asylum. At admission, patients were physically assessed, a process that often included testing of the reflexes and bodily strength using contraptions such as the dynamometer (to measure the grasping power of the hands). Thus, a doctor might note something like this: ‘Patellar tendon reflex absent in each limb, no cremasteric reflex. Tactile sensibility of lower limb is diminished.’ For this patient, his mental state was also found wanting; he showed ‘great obtuseness in understanding what [was] said to him’ and was characterised throughout his case notes as dull, unresponsive, and generally ‘diminished’. In a seamless melding of body and mind, both were in a state of decline. It was the body that succeeded in speaking for the patient, his appearance compensating for his difficulties with verbal communication (his articulation was ‘thick and indistinct’).

N0006653 Tabes dorsalis

Demyelination seen in tabes dorsalis. © Wellcome Images

Apart from indicating a general deterioration in a patient’s condition, the state of muscles and reflexes might also indicate the seat of a problem with surprising specificity. David Ferrier noted that the knee jerk was a crucial indicator of disease – it was absent in cases of tabes dorsalis, for example. (Tabes dorsalis is a neurosyphilitic condition characterised by nerve degeneration.) The importance of the muscular sense in health and disease was clear in many physiological and psychiatric tracts. ‘That the muscles possess a sensibility of their own’, wrote Ferrier in The Functions of the Brain, ‘…is proved beyond all doubt by their nervous supply and by physiological and clinical research’. He described a hierarchically-organised community of muscles, varying in strength, ‘thus the powerful extensors of the back, and muscles of the thighs keep the body arched backwards and the legs rigid’. Guillaume Benjamin Amand Duchenne de Boulogne (phew!) had also credited the muscular system with an independent intelligence, reasoning that coordination required a harmonious relationship between different muscle groups. The use of the term ‘muscular sense’ by many physiologists gave muscular tissue an almost anthropomorphic character – muscles were independent entities capable of action and reaction in response to external influences.

L0033543 Spasms in hysterical patients

Muscular spasms in ‘hysterical’ patients. © Wellcome Images

It was up to the patient, then, to keep their muscles in check. The will, an elusive but enduring concept in alienist science, was most forcefully expressed – or most notably absent – in the movements of the body. The view that only the will stood between order and chaos, as Roger Smith tells us, ‘translated easily to physiological descriptions of the economy and hierarchical arrangement of the nervous system’. Loss of control over bodily movements was viewed as a ‘de-education’, or erasure of learned automaticity, seen for example, in the tottery but energetic gait of tabes dorsalis patients.

The central explanations for such loss of control, by emphasising the co-existence of reflex action and the will, allowed mental science to move closer towards natural, biological science without discarding that essence of being human that marked men apart from other animals. Thus, as Stephen Jacyna points out, bodily actions could be explained in a mechanistic way, but also as a consequence of manipulation by the soul. If a person lost their powers of control, the body could descend into a state of chaos. In this way, the patient’s movements and attitudes frequently served as a diagnostic tool in the asylum, particularly if the patient’s own verbal testimony was unreliable or impossible.

Further reading

W.F. Bynum and F. Clifford Rose (eds.), Historical Aspects of the Neurosciences: A Festschrift for Macdonald Critchley (New York: Raven Press, 1982)

David Ferrier, The Functions of the Brain (London: Smith, Elder & Co., 1876)

L.S. Jacyna, ‘Somatic theories of mind and the interests of medicine in Britain, 1850–1879’, Medical History 26 (1982).

Roger Smith, Inhibition: History and Meaning in the Sciences of Mind and Brain (London: Free Association Books, 1992).

– Jennifer Wallis

Notes on a scandal: infection control in the asylum

We’re fast-forwarding 100 years today, out of our usual 1880s comfort zone  and into 1984, to look at an event that suggests something of a failure of science in the asylum. This was the year when an outbreak of Salmonella at Stanley Royd Hospital in Wakefield (formerly the West Riding Asylum) led to widespread criticism and investigation of hospital hygiene, also feeding into contemporary debates about deinstitutionalisation.

Salmonella enterica. © Mark Jepson/Wellcome Images.

Salmonella enterica. © Mark Jepson/Wellcome Images.

It was the August Bank Holiday weekend of 1984 that marked the beginning of what would become a significant event. On Sunday morning, a few patients were found to be suffering from sickness and diarrhoea – not a particularly unusual occurrence in the hospital – but it became clear something serious was afoot when, by 9.15am, 36 patients across eight different wards were affected.

In When Food Kills, Hugh Pennington describes the course of events and illustrates the frightening rapidity of the outbreak: by Sunday’s close it  had claimed its first fatality. Being a Sunday – and a Bank Holiday – staffing levels were already low and medical care fell to a junior medical officer who had only been at Stanley Royd for three weeks. By Tuesday, when the Environmental Health Department was contacted, several staff were affected, along with a staggering 240 patients. That day, the agent was identified as Salmonella, but it was a development that did little to alter the outbreak’s toll. Within days, around half of the hospital’s 788 residents had been ill and 19 died. All 19 were elderly and less able to withstand the fluid loss of severe diarrhoea.

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub).

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub; you’ll need an institutional login).

Stanley Royd was propelled into the media spotlight: TV news documented the frantic attempt to clean the wards, as well as the somewhat defensive attitude of public health officials. Blame was placed on everyone from managers to kitchen staff. The patients themselves also became a key part of the explanation for why the outbreak had taken hold so quickly: the difficulty of ensuring that patients ate the food intended for them, of policing special diets, and of maintaining adequate standards of personal hygiene, were all cited as hindrances to ‘barrier nursing’ methods that might reduce the risk of infection.

Stanley Royd’s kitchen and food preparation procedures turned out to be the heart of the matter. The outbreak was traced to roast beef that had been cooked, cooled, and left in the open for 10 hours before being served to patients in salads. The details of the hospital’s catering arrangements were meticulously scrutinised, and the results were far from acceptable: cleaning schedules not kept, dirty cloths soaked and re-used, a lack of cold storage facilities. The very fabric of the hospital was problematic, the Victorian architecture (described as ‘Dickensian’) and repeated ‘building-on’ hindering modernisation. The kitchens, built in 1865, had such high ceilings that it was impossible to clean them properly.

Indeed, the hospital had struggled for many years with the spread of infection, as demonstrated by Claire Jones at our recent conference, ‘Science in the Asylum’. A 1913 report by West Riding pathologist Harold Gettings claimed the asylum had never been free of diarrhoea since it opened in 1818, and annual reports of the 19th century frequently showed a concern for the quality of the water supply.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS  C85/1111.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS C85/1111.

The inquiry that followed the Stanley Royd outbreak (also prompted by the discovery, in 1985, of Legionnaires’ disease at Stafford General Hospital) culminated in the 1988 ‘Acheson Report’ (Committee of Inquiry into the Future Development of the Public Health Function and Community Medicine). The Report pinpointed ‘a decline in available medical expertise’ in the control of communicable diseases, and a lack of forward planning in the event of an outbreak. The Salmonella outbreak had come at a time when food poisoning was increasingly on the agenda (Campylobacter, for example, had been isolated in human faecal specimens in the 1970s). Preventing the spread of food poisoning was a matter that concerned all levels of hospital staff; kN0029437 Scientist in a microbiology labitchen workers played a significant role, but the role of the microbiologist was repeatedly emphasised too. With medical training and knowledge of local epidemiology, consultant microbiologists began to play an increasing part in hospital infection control – an area that had previously relied on the cooperation of nurse/doctor/microbiologist for its success, and with few clear guidelines. Just as the asylum Superintendents of the late 19th century had stressed the uses of the laboratory in mental health care, the ‘behind the scenes’ scientific labour of the psychiatric hospital was once again brought to the fore.

What was suggested in the whole Stanley Royd scandal was a certain degree of apathy towards the psychiatric patient: it transpired that the kitchens had been described as ‘a culinary disaster area’ back in 1978, but that renovation proposals were steadily lost in local bureaucracy, the hospital not seen as a redevelopment priority. The public response to the episode, however, showed that people viewed it as far from a trivial issue. It was perhaps the final nail in the coffin for Stanley Royd: in the midst of moves towards deinstitutionalisation and community care, the Salmonella outbreak was a powerful argument for the inefficacy of the large, Victorian psychiatric hospital, and the hospital closed just over 10 years later. The far-reaching effects of the outbreak are reflected in its continued use as an example par excellence of how not to approach infection control – such as the title of Brian Keeble’s article ‘Sleep walking to another Stanley Royd?’ It was a rather sad and embarrassing end to an institution that was hailed in the late 19th century as a model of ‘scientific psychiatry’.

Further reading and viewing

Anon., ‘Stanley Royd: the epidemiological lesson’, BMJ (8 Mar. 1986).

H.S. Gettings, ‘Dysentry, Past and Present‘, Journal of Mental Science 59/60 (1913/1914).

Philip Johnston, ‘Defending 19 deaths from food poisoning’, BMJ (1 Feb. 1986).

Carol A. Joseph & Stephen R. Palmer, ‘Outbreaks of salmonella infection in hospitals in England and Wales 1978-87’, BMJ (29 Apr. 1989).

Mukesh Kapila & Roger Buttery, ‘Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?’, BMJ (2 Aug. 1986).

Brian Keeble, ‘Sleep walking to another Stanley Royd?’, BMJ (7 Sept. 2006).

T. Hugh Pennington, When Food Kills: BSE, E. coli, and disaster science (Oxford, OUP: 2003).

Debbie Weston, Infection Prevention and Control: Theory and Practice for Healthcare Professionals (Chichester: John Wiley & Sons, 2008).

Food Poisoning at Stanley Royd Hospital, ITN (7 Sept. 1984).

– Jennifer Wallis

The strange case of the cerebro-graphometer

This week’s post continues a theme that’s been addressed in a couple of previous contributions: the drive to identify and chart brain lesions. Already, we’ve seen how brain slates and printed diagrams were used as a means to map the location of lesions found at post mortem, marking out pathological findings in permanent visual form. But what about less invasive methods – those that could be applied to the living patient?

Phrenology – making deductions about an individual’s personality or state of mind by examining the shape of the skull – is generally agreed to have been waning in popularity by the late 19th century. Its basic tenets, however, could still be seen within localisation theory, as mental diseases were increasingly viewed as the result of somatic, localised lesions.

This melding of phrenological and localisation theory is wonderfully illustrated by an instrument described in the British Medical Journal in 1896. At a meeting of the Royal Academy of Medicine in Ireland that February, Robert H. Cox described a new method of localising brain lesions: his ‘cerebro-graphometer’.

Robert H. Cox’s ‘cerebro-graphometer’.

The instrument was employed alongside ‘a diagrammatic map of a hemisphere of the brain, prepared from readings made by the use of the same instrument on the cadaver and casts of the brain in situ’ (casts were often taken of the brain or inside of the skull at post mortem for museum and teaching purposes). The brilliantly-named cerebro-graphometer consisted ‘of the mechanical device, technically known as “lazy tongs”’. Despite its rather sinister appearance, it was met with positive acclaim by members of the meeting, who were impressed with its simplicity and durability (it could be rendered aseptic for the next use by boiling, for example).

By April 1897, Cox was able to report that the instrument, now perfected, was being manufactured by the surgical instrument makers Arnold & Sons. Describing the cerebro-graphometer’s use, localisation became an activity with its own specialised, performative ritual:

‘Localising is performed as follows: Extend the instrument and apply the end of the lettered loop, marked V, to the occipital protuberance and the other end to the glabella, then press down the loop to the scalp in the middle line and close the circle round the head, so that the 10 on the numbered loop will lie on the lettered loop. Consult the chart for the bearings, and place the number 10 on the letter of longitude, when the number of longitude will rest over the part sought for.’

Once in position, ‘to find any given point – say Broca’s lobe – it was only necessary to consult the map or list of indices for the bearings’. (Keep in mind that one of the selling points of this was the instrument’s ‘simplicity’; the mind boggles at the complexity of alternative methods…)

Diagram for use with Cox’s device.

Like all the best stories, however, there was a minor scandal to come. A month after Cox’s triumphant article in April, a letter to the BMJ begged to inform him that ‘the instrument has been forestalled, for I have possessed for the last ten years an instrument so exactly like his that the illustration might have been taken from it’. The author, William Warwick Wagstaffe, called his own instrument a ‘brain mapper’ (a name, he noted, that he ‘certainly prefer[red] to “cerebro-graphometer”’) and it had been made by Maw & Sons in 1886. Upon its production, Wagstaffe had distributed it to several colleagues for their observations, but ill health had prevented him from collating the final results (after a ‘breakdown in health’ in 1878, he was never to return to active work, having previously acted as Senior Assistant Surgeon and Lecturer in Anatomy at St Thomas’s Hospital in London).

William Warwick Wagstaffe’s ‘brain mapper’.

Cox maintained that the cerebro-graphometer was superior to the brain mapper as ‘[o]nly one motion is necessary to directly localise any given point on the surface of the brain’. Neither Cox’s nor Wagstaffe’s device appeared to enjoy great fame, however. References are almost entirely absent from contemporary journals, and one imagines that the simplicity of the design was its downfall, with individual doctors crafting their own versions rather than buying a more costly one via a surgical instrument retailer. One wonders what happened to those few that were properly manufactured (I have a ridiculous mental image of the lab Christmas party, full of tipsy doctors wearing them as party hats). Perhaps some examples survive in medical museums?

Unlike some other instruments discussed on this blog, the cerebro-graphometer (or brain mapper, if you’re in the Wagstaffe camp) was interesting in its ability to be applied to both the living and the deceased patient. Missing from Cox’s and Wagstaffe’s accounts, however, is the practical issue of how such instruments were employed in a hospital context. Other than reference to the difficulty of hair being caught within the instrument’s folds, we know nothing of how patients actually experienced the process. Perhaps they were fascinated, as William Lauder Lindsay noted of some of his patients when he took blood samples – they badgered him with questions about what their samples revealed, even persuading him to demonstrate his own blood under the microscope. For some, the experience may have been more disturbing, especially if one had deduced that such examinations were also made upon the dead. For others, it was perhaps just another in a long list of physical investigations that were simply a tedious nuisance.

Though it’s difficult to uncover the patient experience via brief reports like those found in the BMJ, looking at evolving investigative techniques can – as Jacyna and Casper note in The Neurological Patient in History – show us ‘how the patient has been constituted in the era of modern medicine’. By asking this question, we can in turn find out much about the knock-on effects of new medical technologies and practices: on theory, everyday routines, and therapeutic efforts. Unfortunately for Cox and Wagstaffe, it seems that their devices were limited in their impact – yet they remain for me an intriguing illustration of medical thinking and innovation in the last part of the 19th century.

Further reading

Robert H. Cox, ‘A New Method for Localising Brain Lesions’, British Medical Journal (3 Apr. 1897).

Robert H. Cox, Correspondence: ‘A New Method of Localising Brain Lesions’, British Medical Journal (30 Oct. 1897).

L. Stephen Jacyna and Stephen T. Casper (eds.), The Neurological Patient in History (NY: University of Rochester Press, 2012).

‘Reports of Societies’, British Medical Journal (21 Mar. 1896).

W. W. Wagstaffe, ‘A New Method of Localising Brain Lesions’, British Medical Journal (1 May 1897).

– Jennifer Wallis

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Animals and the Asylum: A comparative approach to the science of mind

This week’s post comes from Liz Gray, who is currently undertaking doctoral research at QMUL’s Centre for the History of the Emotions. Liz also blogs about her work at Tales of Animals Past.

William Lauder Lindsay. © Natural History Museum

During the second half of the 19thcentury the discipline of comparative psychology was a mixture of methods and approaches. Anthropologists, physiologists, and alienists all used the title for their studies of the mind in man and animals. Scottish naturalist-physician and alienist William Lauder Lindsay (1829-1880) had his own interpretation: the study of mind in the lower animals, in particular the mind in a diseased state.

His theory was that the lower animals and man shared a ‘community of disease’ – that physically and mentally all animals (including man) could be affected by the same pathologies. Having begun his experimental career investigating the transmission of cholera between humans and dogs, a topic to which he returned on many occasions, by 1870 he had turned his attention to psychopathology.

The study of the animal mind offered the chance to garner an insight into the human mind, in particular the diseased or insane mind:

‘…their study [morbid mental phenomena] in other and lower animals by the physician or veterinarian, naturalist or comparative psychologist, cannot fail to bring to light many data of the highest interest to man’s knowledge of human insanity.’

By the 1870s this was not a unique idea. In 1873 James Crichton-Browne invited David Ferrier to use laboratory space at the West Riding Asylum, providing him with a variety of animal subjects (pigeons, guinea pigs, cats, and dogs), for his investigations into the pathology of epilepsy. French physiologist and neurologist Charles-Édouard Brown-Séquard also explored the artificial production of epilepsy in small mammals.

What set Lindsay apart from the physiological approach was his method of investigation, and his interest in a moral and mental,  rather than physical, hierarchy of species. Darwinian morality of the 19th century placed the intellectual, upper-class white man at the ‘top of the tree’. In mental and moral terms, dogs (man’s most loyal companion) were ranked below men; women were equal or lower to dogs. Children, ‘savages’ and the mentally ill all occupied lower rungs on this particular evolutionary scale.

One of Crichton-Browne’s photographs of a West Riding patient. © Wellcome Images

Whilst conducting his research for The Expression of the Emotions in Man and Animals, Charles Darwin was struck by the notion that ‘the insane ought to be studied, as they are liable to the strongest passions, and give uncontrolled vent to them.’ He was put in touch with Crichton-Browne, who provided him with ‘copious notes and descriptions’ based on his observations of his own patients. Although the photographs of these patients were not included in the final book, the information they provided were integral to Darwin’s views on the subject of emotional expression. (The Expression of the Emotions is often referred to as a founding text of comparative psychology, even though he doesn’t use the terminology).

Observation of behaviour and expression were the tools that Lindsay and others utilised in their studies – methods of the naturalist rather than the physiologist. What enabled Lindsay to draw comparisons between his patients at the James Murray Royal Asylum in Perth and the animals he observed, was his experience of the insane and ‘idiotic’ who were unable to communicate verbally. In these cases changes in behaviour, facial expression, and vocal noises were seen as indications of mental disturbance. Herbert Major (a contemporary of Crichton-Browne’s, who also worked at the West Riding Asylum) provided Lindsay with a case study where the same could be seen in animals:

‘…a case of association of irritability of temper, with loss of memory and diminished intelligence, including failure to recognise her master, coincidently with the development of fits, apparently of an epileptic character, and with partial paralysis of the limbs, all in an old terrier bitch, these conditions, moreover, being coincident with senile atrophy or degeneration of the brain.’

Head of a dog, from Charles Bell’s Essays on the Anatomy of Expression in Painting (1806). © Wellcome Images

Animals acted as experimental models of disease, as well as providing insights into behaviour and expression as diagnostic tools for mental disease and derangement. Lindsay took this approach one step further. By interpreting these links as evidence of a ‘community of disease’, he turned towards possible environmental factors that could influence the mind.

One of the simplest experiments of Lindsay seems to have been inspired by the saying, ‘Like a red rag to a bull’. By changing the colour of the light in the sleeping rooms of some of his patients, he studied the reaction of the mind to different colours. He was unconvinced by the anecdotal animal evidence of reactions to colour, and his human experiments produced ‘negative conclusions’.

A snarling dog from Darwin’s Expression of Emotions. © Wellcome Images

Metrological data can be found in the medical reports of Perth asylum for a period of almost 5 years. It was used to analyse changes in both the behaviour and physical health of patients. Climatic changes seemed to have little effect on the types of mental disease at the asylum, and physical effects mirrored  the health of the more general population of Perthshire. But the observation of climate was part of a wider area of interest in the causes of mental disease.  Lindsay was well-travelled and wrote papers on the etiology of mental illness around the world. One such study focused on the impact of the colder climate experienced in Norway, Iceland, and other Arctic countries. People and animals, in particular dogs, were affected by both the climate and latitude of these countries. They suffered predominantly from depression and melancholia as a result of the low levels of sunlight, solitude due to sparse populations, and the monotonous scenery.

For Lindsay, the science of comparative psychology was located within the asylum and the research opportunities it offered. His explanations of animal behaviour with their anthropomorphic basis were used in his ideas of human mental disease. Animals were introduced into the asylum as scientific subjects, but not objects of physical experimentation. The asylum patient was seen as an equally valid object for research, although carefully designed as part of the moral treatment approach.

– Liz Gray

Further reading

Charles Darwin, The Expression of the Emotions in Man and Animals (London: J. Murray, 1872).

W. Lauder Lindsay, ‘Community of Disease in Man and Other Animals’, British and Foreign Medico-Chirurgical Review 53 (1874).

W. Lauder Lindsay, Mind in the Lower Animals in Health and Disease, 2 vols. (London: C.K. Paul, 1879).

W. Lauder Lindsay, ‘On Insanity and Lunatic Asylums in Norway: Being the Narrative of a Visit made in the Summer of 1857’,  Journal of Psychology Medicine 11 (1858).

W. Lauder Lindsay, ‘The Causes of Insanity in Arctic Countries’, British and Foreign Medico-Chirurgical Review 14 (1870).

Robert J. Richards,  Darwin and the Emergence of Evolutionary Theories of Mind and Behavior (Chicago: University of Chicago Press, 1987).

Medical technology in the asylum – and plans for the blog

With the Science in the Asylum conference completed, we’re excited to begin a more regular blog schedule, with posts each Monday from myself, Mike, and guest contributors. Submissions are strongly encouraged – the conference brought us into contact with several people working on the history of science and medicine in relation to the asylum, and we’d love to find more of you! Please get in touch here.

This is the first of our Monday blogs, and takes up a theme we plan to revisit in some future posts: the use of medical technologies within the asylum.

By the 19th century, as doctors increasingly focused on bodily lesions as the site of disease, there was hope that disturbances of the mind might also have somatic origins. It was commonsensical, for example, that the activity of the brain depended upon its blood supply; thus, blood vessels were often identified as the starting point of disease. Daniel Hack Tuke’s Dictionary of Psychological Medicine noted that ‘capillary disorder could lead to a wide variety of dysfunctions’, and suggested that circulatory issues were the cause of many mental diseases. Indeed, during microscopical and post-mortem investigations, the poor state of patient’s blood vessels was often noted.

How could such bodily change be examined in the living patient though? In Medicine and the Reign of Technology, Stanley Reiser lists the new pulse-recording instruments that appeared in the 19thcentury. Among these, Étienne-Jules Marey’s sphygmograph of 1860 was crucial. By resting one end of a piece of metal on a pulsating artery, and attaching a pen to the other, the pulse could be made visible as each movement was traced onto a strip of paper.

Marey’s sphygmograph. © Wellcome Images

By the 1880s, Marey’s device had been eclipsed by Robert Ellis Dudgeon’s ‘pocket sphygmograph’, a smaller device that was especially useful for the asylum physician who dealt with restless or excitable patients.

Dudgeon’s less cumbersome ‘pocket’ sphygmograph. © Wellcome Images

Sphygmographs had their problems: each model might produce a slightly different result, or be further affected by the technique of the person using it. Nevertheless, George Thompson at Bristol Asylum said that he ‘implicitly trusted [the] instrument as a means of discovering at least one form of brain-disease’. He applied the sphygmograph to almost every form of mental disease found in the asylum, but found the most striking results in general paralysis (now understood to refer to neurosyphilis).

In the West Riding Medical Reports in 1871,Thompson described his experiments on the pulse of general paralytic patients at the West Riding asylum. He presented two tracings, one from his own research and one from W.B. Carpenter’s Principles of Human Physiology. They bore a remarkable resemblance. Whilst Thompson’s example represented the pulse of a general paralytic, Carpenter’s showed the pulse of a healthy person in a state of chill.

Thompson’s pulse tracing of a general paralytic patient.

…And Carpenter’s tracing of a healthy individual suffering from ‘chill’.

To Thompson, it was evident that in both cases a contraction of the vessels was being recorded. He concluded that general paralysis was ‘a disease … owing to a considerable extent to persistent spasm of the vessels’.

Could halting this spasm also halt the degenerative process that was characteristic of general paralysis? James Crichton-Browne was one of several alienists who used Calabar bean for this purpose. Calabar is a poisonous seed from an African plant, lethal if ingested in anything more than minute quantities. It was put to a number of uses in the 19th century due to its ability to paralyse muscle, and proved to be the first effective drug treatment for glaucoma. It was suggested that Calabar could lead to an improvement in general paralytic patients such as ‘S.M.’:

‘When admitted to the West Riding Asylum he had exalted ideas; there [was] inequality of the pupils, tremor of the lips, and awkwardness of gait. … [After three months of treatment with Calabar bean] there was such marked improvement in his condition that the use of the extract was discontinued.’

Calabar beans. © Wellcome Images

Calabar’s relative scarcity in the historical record suggests it was seen as an occasional palliative measure rather than cure, however. Writers on the subject were at pains to point out that they knew of no authenticated cases of cure; those patients who recovered enough to be discharged were often re-admitted later, any improvement proving only temporary.

These experiments with the sphygmograph in the Victorian asylum are interesting for a number of reasons. Many historians have emphasised how new medical technologies in the 19th century served to remove the patient’s subjective experiences from the picture, with doctors relying on supposedly ‘objective’ mechanical data. In the case of the sphygmograph, data didn’t necessarily eclipse the patient, with the tool employed alongside established methods of clinical examination including consideration of the patient’s own testimony.

Looking at the use of such technology in an asylum context can also expand our understanding of the asylum’s place within contemporary medical landscapes. Christopher Lawrence describes the sphygmograph as a tool with limited usage, partly because experimental physiology only developed as a specialty in the 1870s. The use of it in the asylum suggests that researchers there were drawing inspiration from a wide variety of medical disciplines – a spirit of innovation also evident in the invention of instruments and post-mortem tools by members of the alienist community.

Examining such research can also problematise wider assumptions about the development of the medical profession and the resulting impact on patients. As described above, post-mortem findings could raise questions that were investigated further in the laboratory, the findings of which then informed clinical intervention. The notion of an easy split between the laboratory and clinical contexts, then, is perhaps less applicable to the asylum at this time.

Forgotten episodes within the history of asylum research are often forgotten because they don’t involve a breakthrough discovery, a success story, or a bizarre intervention that raises our anxieties about patient care. Yet they can also be places where we might find alternative viewpoints to the pictures presented in broader histories of medicine. Perhaps then, unusual endeavours such as Thompson’s should grab our attention not as side projects in the historiography, but as narratives with wider historical significance.

Further reading

William Bevan Lewis, ‘Teachings of the Sphygmograph in General Paralysis of the Insane’, Journal of Mental Science 27 (1881).

T. Duncan Greenlees, ‘Observations with the Sphygmograph on Asylum Patients’, Journal of Mental Science 32 (1887).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 1. The Marey Sphygmograph’, Medical History 22 (1978).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 2. The Dudgeon Sphygmograph and its Descendants’, Medical History 23 (1979).

Alex Proudfoot, ‘The Early Toxicology of Physostigmine: A Tale of Beans, Great Men and Egos’, Toxicological Reviews 25 (2006).

Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: CUP, 1978).

George Thompson, ‘On the Physiology of General Paralysis of the Insane and of Epilepsy’, Journal of Mental Science 20 (1875).

George Thompson, ‘The Sphygmograph in Lunatic Asylum Practice’, West Riding Lunatic Asylum Medical Reports 1 (London: J & A Churchill, 1871).

Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997).

– Jennifer Wallis

A museum of mental health

Yesterday, Mike and I met with the lovely Jane Pightling at the Stephen Beaumont Museum of Mental Health in Wakefield. Secreted within the grounds of Fieldhead Hospital, walking into the museum is a little like walking into an Aladdin’s cave: it’s full of fascinating items that tell the story of the West Riding Pauper Lunatic Asylum (later, Stanley Royd Hospital), from its beginnings in 1818 to its closure in the 1990s.

Mortuary table

Walking into the museum, we were met with an imposing marble-topped mortuary table – an item that invites the visitor to consider both the long-term nature of many patients’ stays within the asylum, but also the importance of post-mortem and brain research in casting light upon the pathology of mental disease.

Just a few steps away is a padded cell; elsewhere are iron manacles and a straitjacket. These stock items of asylum history are, however, set alongside other objects that tell a much deeper story about the care of the asylum patient: a hydrotherapy bath, printing blocks, hand tools, and patient art.

Wooden printing blocks

In a corner stands a beautiful wooden lectern in the shape of an eagle, and on the opposite wall is a cleverly fashioned mirror frame – both made by patients. On one wall are photographs and programmes from theatrical productions put on by patients and staff, and sheet music and scripts testament to a staging of Gilbert and Sullivan’s ‘Trial by Jury’.

Sheet music and scripts from one of the asylum’s performances.

The museum contains many stories and voices – of patients, attendant and nursing staff, doctors, and local people. Its location  within the hospital grounds is, we discovered, ideal: Jane explained to us how school groups might arrive in the museum to learn about the history of electro-convulsive therapy, before going to look at the hospital’s modern ECT suite.

Under the umbrella of South West Yorkshire Partnership’s Change Lab project, the museum staff are currently looking at how to get even more out of their collections in order to raise awareness of the history of mental illness, and the experience of those with mental health problems.

Anaesthesia apparatus

Delegates at the Science in the Asylum conference on 19 October are warmly invited to visit the museum after the conference for a look at the exhibits, as well as some light refreshment, where Jane and her colleagues will be on hand to talk about the collections and future plans.

For those not attending the conference, the museum is free to visit and currently opens each Wednesday between 10am and 3.30pm. Visits outside these hours can also be arranged by contacting Jane or another member of the museum team on 01924 328654.

– Jennifer Wallis

Forgotten histories of psychosurgery, and facing our fears

In 1890, T. Claye Shaw and Harrison Cripps related the case of a male patient at Banstead asylum who was suffering from general paralysis of the insane – a diagnosis now believed to refer to neurosyphilis. Post-mortem examinations of these patients often found large amounts of cerebro-spinal fluid (CSF) in the skull, and it was findings like these that could be used to inform treatment of the living patient. Under Cripps’s care, it was suggested that the patient had excess fluid in the skull that ‘was exercising considerable pressure’ and causing excruciating headaches. As a means of relieving this intra-cranial pressure, trepanation was performed – the removal of a small piece (or pieces) of bone from the skull.

A Bronze Age skull showing the marks of trepanation. © Wellcome Images.

In the historiography of psychosurgery, the use of trepanation in general paralysis is frequently absent. Searching index entries for ‘Psychosurgery’ often instructs one to ‘See Lobotomy’, reflecting our modern view of psychosurgery as those infamous methods instituted by Egas Moniz and Walter Freeman. Many accounts of psychosurgery’s development jump from ancient practices of trepanation to the early twentieth-century interventions of Moniz and Freeman, sometimes interrupted by reference to the work of Swiss alienist Gottlieb Burckhardt in the late nineteenth century. Burckhardt is then credited with the ‘discovery of psychosurgery’ – by his almost contemporaries and pioneers of lobotomy, Walter Freeman and James Watts, for example.

There was significant interest in the topic before Burckhardt’s work, however: Paul Broca examined a Peruvian skull that bore the marks of trepanation sent to him by an anthropologist acquaintance. That such findings would occasion a rejuvenation of interest in the topic amongst the alienist community appears an almost foregone conclusion, yet there are few references to the Shaw episode – or similar undertakings – within histories of psychiatry and psychosurgery. An exception is German Berrios’s work – in 150 Years of British Psychiatry (volume 1, 1991) and his 1997 article, ‘The Origins of Psychosurgery: Shaw, Burckhardt and Moniz’. Berrios places the work of Shaw alongside that of Burckhardt, and also addresses the moral implications of such invasive treatments. Though there is little evidence that it was a particularly common intervention, looking back on trepanation within the asylum appeals to our worst fears about the patient as experimental object. Berrios shows, though, that the use of trepanation in cases of general paralysis was not presented unproblematically by asylum doctors, and that its proponents ‘were aware of the potentially serious consequences of their treatment, and of the fact that they needed scientific, ethical and social warrants’.

Though logical considering contemporary understandings of the disease, Shaw’s surgical solution to general paralysis was not without controversy. In the British Medical Journal during the late 1880s and early 1890s, a number of articles and letters debated the appropriateness of trepanation for the asylum patient. Shaw and Cripps were enthusiastic about the operation, appealing to data that demonstrated the ‘increased arterial tension’ in the early stages of general paralysis. It was a surgical response that depended on early diagnosis, said Shaw and Cripps: they were convinced that the benefit for the patient was clear if trepanation was performed as soon as possible. One such case was presented as a resounding success: ‘The present state of the patient is a great improvement upon what it was; in fact he is no longer insane, and I propose to discharge him’, Shaw related triumphantly. The patient from Banstead, however, fared less well: though initially discharged when his headaches and delusions disappeared, his wife later wrote to say that he had been unable to retain his job and had become increasingly irritable. To Shaw and Cripps, the operation still had its merits, as the ‘painful urgent symptoms’ had been relieved.

Trephination set, 1771 – 1800. © Wellcome Images.

Trepanation was of course an extreme response to the symptoms of mental disease. For some commentators, the intractable nature of general paralysis merited such measures. Others displayed contempt for the practice. Prestwich Asylum’s George Revington wrote to the British Medical Journal in 1890, criticising Shaw: ‘I may mention the practical point’, he said, ‘that general paralytics are quite sufficiently apt to injure themselves, and to be injured by others without the additional facilities which a trephine hole in the skull would afford’.

Ultimately, trepanation could not cure general paralysis. In Berrios’s analysis, it was symptoms rather than cure that were foremost in contemporary doctors’ minds: Shaw and Burckhardt were able ‘to target individual (troublesome) mental symptoms without committing themselves to having to treat the entire disease’. Just how far doctors saw themselves as relieving symptoms – rather than precipitating cure – is unclear, however. At the time, the cause (or causes) of general paralysis remained obscure, so that any anomalies – such as the abundance of fluid on the brain – might hold out the promise of a solution.

Last week, a friend posted a link on Facebook to the Science in the Asylum conference. The first comment on the link read ‘It was terrible what they used to do people back then’. But as well as what was done, shouldn’t we also be asking why it was done? It’s very easy to look back at medical treatments of 100 years ago with horror from our present viewpoint, and to assume that interventions were doled out by sadistic doctors based on little more than poorly-informed medical speculation. The reality, however, was rarely so clearcut, and debates between doctors much richer and varied than we often give credit for, as demonstrated by the correspondence around the Shaw affair. Whilst we should never lose the patient from the history of psychiatry, we must take care not to lose the doctor too.

 – Jennifer Wallis

Further reading

Joel Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley: University of California Press, 1997).

Stanley Finger et al, Trepanation: History, Discovery, Theory (Lisse: Swets & Zeitlinger, 2003).

Walter Freeman and James W. Watts, Psychosurgery: Intelligence, Emotion and Social Behavior following Prefrontal Lobotomy for Mental Disorders (Springfield, Illinois: Charles C. Thomas, 1942).

John Macpherson and David Wallace, ‘Remarks on the Surgical Treatment of General Paralysis of the Insane’, BMJ (23 Jul. 1892).

George A. Mashour et al, ‘Psychosurgery: Past, Present, and Future’, Brain Research Reviews 48 (2005).

Andrew Scull, ‘Somatic Treatments and the Historiography of Psychiatry’, History of Psychiatry 5 (1994).

T. Claye Shaw, ‘The Surgical Treatment of General Paralysis’, BMJ (16 Nov. 1889).