In January 1870, author Charles Reade wrote to the Pall Mall Gazette to make some sensational claims about the conduct of asylum attendants. Whilst researching his book Hard Cash – in which a young man ends up confined in a lunatic asylum – Reade said he had seen alarming evidence of the tactics used by attendants to subdue the patients in their care. ‘The refractory patient’, he wrote, ‘is thrown down and the keeper walks up and down him on his knees, and even jumps on his body, knees downwards, until he is completely cowed.’ He thus suggested that he had hit upon the answer to a burning question of the day: how was it that so many patients in asylums seemed to sustain fractures?
Within the space of a few months, a number of cases were reported in which patients had been found to have extensive fractures at post mortem – one exhibiting an astonishing eight broken ribs and broken breastbone. The Pall Mall Gazette was not the only media outlet to voice its concerns about the care of the insane in Britain; an article in the British Medical Journal listed several instances of broken ribs, prompting a significant backlash from alienist members of the British Medical Association when it asserted that ‘rib-crushing, though the favourite, seems not to be the only mode in which lunatics are hurried out of existence … [In] 1869 a patient … was boiled in his bath’.
These were serious allegations, and the last quarter of the nineteenth century saw the issue of ill treatment in the asylum gain prominence. In the 1880s and nineties, with the development of training and certification for asylum nurses, handbooks advised staff on how to handle patients carefully, to spot the signs of fracture, and to subdue excitable patients who were especially vulnerable to injury.
The dialogue around broken bones also spread to the asylum laboratory, with some pathologists undertaking post-mortem tests to determine if the bones of the insane were inherently weak or brittle. Visual evidence of bone disease was mentioned in a number of articles on the topic: doctors and pathologists described bones that were ‘soft and boggy’ or ‘like sponge soaked in fat’. There was also a desire, though, to quantify such anomalous appearances more minutely. Theo Hyslop, when working as a Clinical Assistant at the West Riding Asylum, had used ‘an ordinary concrete testing machine’ to measure the strength of ribs at post-mortem. In 1893 Charles Mercier distributed a special instrument he had devised for the purpose. First, one ‘extract[ed] a certain length of the eighth pair of ribs’. Then, the lengths were put into the instrument, one tested against its concavity, the other against its convexity.The instrument ‘had a stirrup at one end and a screw at the other, and between these was a spring which registered the number of pounds pressure exerted. The bone … was put through the stirrup resting on the fork of the machine; the screw was then turned till the rib broke’. He sent this instrument to a number of asylums, as well as some London hospitals; though it is difficult to find much evidence of its use, it was certainly employed at length by Alfred Campbell at Lancashire’s Rainhill Asylum, who attempted to tabulate ‘breaking strain’ by type of mental illness.
Alfred Campbell’s results were most specific, confidently identifying an average breaking strain of 44.8lbs convex and 44.4lbs concave in his male general paralytic (neurosyphilitic) subjects, compared to 62lbs and 65lbs respectively in a healthy adult male. (Similar meticulous records of breaking strain can be seen in Francis Simpson’s Pathological Statistics of Insanity, where breaking strain by mental disease/sex etc. was recorded alongside brain weights.) Campbell’s second paper on the subject was more hesitant. Published only a few months later, this paper cast doubt on the link between fragile bones and insanity: ‘The difference between the average breaking strain of the ribs of the insane and that of the ribs of persons free from mental disease is not so great as one would anticipate’. In his comparative sample of 58 Rainhill Asylum patients and 50 Royal Southern Hospital patients, Campbell found very little difference between the rib breaking strain of the male asylum patient and that of the male general hospital patient. Explaining this, he theorised that wasting diseases had greater influence upon bone structure than mental afflictions – and indeed, many pauper asylum patients were in poor health.
Though the results of experiments like Campbell’s were often inconclusive and of little help to the living patient, the idea of bone fragility was incorporated into asylum administrative practices: at the West Riding Asylum, ‘breaking strain’ was consistently recorded at post-mortem from 1895 until around 1902.
Mercier’s instrument was not enduring in its impact: analysing 200 post-mortems at the West Riding, William Maule Smith in 1903 chose not to use it, instead basing his conclusions ‘on the ease with which fracture was produced by digital compression’ (Mercier, in the audience listening to Smith’s paper, unsurprisingly did not agree with Smith’s method!).
Bizarre as these experiments may seem to us now, the idea that the insane were peculiarly prone to bone disease and fracture was one that fitted logically alongside wider theories about both disease susceptibility and the general health of the asylum patient in the late nineteenth century. Quantifying rib strength did not, though, change the basic fact that patients were vulnerable individuals: the key figure remained the asylum attendant whose responsibilities were unchanged by the suggestion that some patients were especially liable to fracture. Via the lab then, the bones of the patient became capable of mediating not only asylum research, but also everyday practices and social relations – objects both constructed and constructing, and a sign that the insane body was not a merely passive one, even in death.
Anonymous, ‘A social blot’, British Medical Journal (22 Oct. 1870).
Alfred W. Campbell, ‘The breaking strain of the ribs of the insane: an analysis of a series of fifty-eight cases tested with an instrument specially devised by Dr C.H. Mercier’, Journal of Mental Science 41 (1895).
Alfred W. Campbell, ‘A comparison between the breaking strain of the ribs of the sane and insane’, British Medical Journal (28 Sept. 1895).
W. Lauder Lindsay, ‘Mollities ossium in relation to rib-fracture among the insane’. Edinburgh Medical Journal 16 (1870).
Charles Mercier, The Attendant’s Companion: a manual of the duties of attendants in lunatic asylums (London: J & A Churchill, 1898).
George H. Pedler, ‘Mollities ossium and allied diseases’, in James Crichton-Browne (ed.) West Riding Lunatic Asylum Medical Reports 1 (London: J & A Churchill, 1871).
Charles Reade, ‘How lunatics’ ribs get broken’, Pall Mall Gazette 1541 (20 Jan. 1870).
Francis O. Simpson, The Pathological Statistics of Insanity (London: Baillière, Tindall & Cox, 1900).
William Maule Smith, ‘On the nature of fragilitas ossium in the insane’, British Medical Journal (3 Oct. 1903).
– Jennifer Wallis