Tag Archives: history of the body

Post-mortems in the asylum: What were they for?

DSCF1077Last month, the Idaho State Journal reported that 120 headstones had been placed on the graves of former patients at State Hospital South (previously Idaho Insane Asylum). The new markers were unveiled as just one stage in an ongoing project of placing headstones on over 1,000 unmarked graves in the area. The unmarked or numbered graves of the asylum cemetery provoke strong feelings for present-day observers, suggesting large numbers of people who were forgotten by relatives, as well as raising questions about past psychiatric treatment. Reports on the unveiling of the latest headstones noted that some patients underwent lobotomies and other procedures. The Hospital’s current administrator said that, in the treatments they had undergone, these patients could be considered ‘pioneers’ in the treatment of mental illness whose legacy can still be seen today. Commemorating the dead in a cemetery leads us inescapably to the body of the asylum patient, something that is present throughout my own research and that can’t be overlooked when considering the history of psychiatry.

In the 19th century, the physical body was at the heart of much psychiatric research, but it is the body at post-mortem that this and a subsequent post will focus upon. In the search for the origins of mental illness, the post-mortem was crucial for asylum doctors and was a practice increasingly encouraged by the Commissioners in Lunacy in order that the ‘scientific spirit’ of asylum research be kept up. At the West Riding Asylum for instance, an 1885 Commissioners’ report noted that ‘[t]he number of post-mortem examinations, 193, [was] very satisfactory’.

What were the purposes of the post-mortem?

Why were the Commissioners so interested in the amount of post-mortems being performed? Firstly, as in any other medical arena, the post-mortem was crucial in identifying the cause of death. The West Riding’s Regulations and Orders of the Committee of Visitors stated that ‘A post-mortem examination [would] be made of the body of every Patient dying in the Asylum, and a searching inquiry … instituted as to the cause of any bruise or injury found upon a body’. As well as establishing the immediate cause of death, then, the asylum post-mortem acted as a check on asylum care. In examining the state of the body at death – post-mortem books might remind the doctor to note things such as bedsores, fractures, or if the body was emaciated – the procedure mirrored the admission exam in which the patient was bathed and checked for physical injuries. Sometimes the post-mortem revealed injuries that had been overlooked during life (such as a broken bone), and in this way could be conceived of as a deterrent to any attendants who were tempted to use violence towards patients.

Brain dissection, seen from above. © Wellcome Library, London.

Brain dissection, seen from above. © Wellcome Library, London.

Secondly, the post-mortem was a means of gathering evidence about the pathology of mental illness. Unusual appearances within the skull itself – adhesions of the membranes to the surface of the brain, blood clots, or wasting away of the brain substance – were recorded and tabulated in order to establish any patterns. Francis O. Simpson’s The Pathological Statistics of Insanity (1900) collected together a staggering amount of post-mortem data, organised by type of mental affliction so that the reader could chart the appearances found in the brains of melancholic, maniacal, or epileptic patients. Post-mortem record books might have an index added by recording doctors, where one could look up all instances of ‘adhesion’ or ‘haemorrhage’ in order to identify any similarities between the cases.

Thirdly, such data could be matched up with the clinical information kept on a patient during their lifetime. That post-mortem books often allowed the practitioner to note the ‘Form of mental disorder at admission’ and ‘Form of mental disorder at death’ suggests that mental illness wasn’t necessarily viewed as a static condition, but also – as Gayle Davies notes in ‘The Cruel Madness of Love’ – that the post-mortem could sometimes lead to a ‘re-diagnosis at death’. Conversely, the post-mortem often confirmed the suspicions of the doctor about the root of a patient’s problem, with a tumour or other anomaly found in the region of the brain that corresponded to a motor disorder exhibited during life.

Asylum museums were often smaller versions of those like the Royal Free Hospital's, above. © Wellcome Library, London.

Asylum museums were often smaller versions of those like the Royal Free Hospital’s, above. © Wellcome Library, London.

Lastly, this focus on the physical fabric of the insane body as a site of knowledge about mental illness led to many body parts being preserved for asylum museums. These on-site museums were used for teaching purposes as well as forming a permanent ‘catalogue’ of brain anomalies. Some specimens might be ‘put aside for hardening for general purposes’ – likely for students to examine or practice their dissection skills upon – or even sent to a researcher at another asylum for study (a brain from a patient at the West Riding Asylum who died in the early 1870s was sent to fellow alienist John Batty Tuke to examine). Towards the end of the century, bacteriological research also began to draw upon the fabric of the body, with  a researcher in 1895 ‘[inoculating] slices of sterilized potato … with blood from [a] spleen … [A] pure cultivation of typhoid bacilli resulted’. The post-mortem was, then, bound up with several other practices evolving at the time, and was a site where doctors honed their pathological skills as well as accounted for the basic facts of death.

Within all this, it often seems that the patients themselves are worryingly absent. What were the rules governing consent for post-mortems? Did families know what precisely a post-mortem entailed? Did they voice their objections to the asylum doctor? These are questions I’ll be turning to in our next post. In the meantime, for a fuller discussion of all of these issues you might like to take a look at a special issue of History of Psychiatry journal, ‘Lunacy’s last rites: dying insane in Britain, c.1629–1939’.

Stop, look, and listen

It’s been a busy few weeks here with exam marking, thesis writing, and all manner of things in between (including being interviewed by some students making a documentary about the history of psychosurgery – we’ll keep you posted). As a consequence, the blog has felt a little neglected, but we’ve put together a list of some great reading, viewing, and listening for you over the next couple of weeks that should make up for it!

Read

New issues of History of the Human Sciences and History of Psychiatry journals. The former includes a brilliant piece by Felix Schirmann on ‘Badness, Madness, and the Brain’ in the late 19th century and a free-to-all article by Chris Millard on self-harm in 20th-century psychiatry. In History of Psychiatry, Torbjørn Alm and Brita Elvevåg explore ergotism in Norway, and there is a timely consideration (after recent criticisms by the British Psychological Society) of classification in the DSM by Massimiliano Aragona, as well as – ahem – a piece on bone disease and insanity by Jennifer Wallis.

Understandings of ergotism are examined in the latest History of Psychiatry. © Wellcome Library, London.

Understandings of ergotism are examined in the latest issue of History of Psychiatry.
© Wellcome Library, London.

Whether or not you’re attending this year’s very exciting iCHSTM conference (International Congress of History of Science, Technology and Medicine)  in Manchester, the iCHSTM 2013 blog is definitely worth keeping an eye on, with posts so far on the science of selecting soldiers in WWII, to autopsies and asbestos.

Also on the blogs, check out this excellent post by Lisa Smith on ‘The Moon and Epilepsy in the Eighteenth Century’ over at The Sloane Letters Blog.

Watch

For those of you based in London, there’s still time to catch some of the seminars in KCL’s History of Health and Medicine series. This Wednesday promises a fascinating talk by Julie Anderson and Carole Reeves on ‘Imaging the Abnormal Body’, and the final seminar on 5 June welcomes Carin Berkowitz and David Hay to speak on ‘Educating the Body – Eye, hand, and imagination in (bio)medical education’. The seminars are free and open to all, starting at 6pm.

Pauline Norris promises an interesting take on the humble lettuce. © Efraim Lev/Zohar Amar.

Pauline Norris promises an interesting take on the humble lettuce.
© Efraim Lev/Zohar Amar.

And if you’re looking for some intellectual stimulation this Friday, I’m intrigued by Pauline Norris’s seminar as part of the Institute of Historical Research’s History of Gardens and Landscapes History seminar series: ‘The Lettuce Connection: The Ancient Egyptian Cultivation of Lettuce, the God Min and Aphrodisiacs‘. The seminar starts at 5.30pm at Senate House, and is free to attend.

Next week, also at the IHR, Roberta Bivins will be speaking on ‘Domesticating Medicine: Medical Technologies and the Home‘. Again, the seminar is free to attend, with a 5.30pm start.

On 10 June the annual Freud Memorial Lecture will take place at London’s Freud Museum. This year, it’s given by Allen Frances, who asks ‘How well does Freud’s work stand the test of time?’ For more details, including how to book, see the Museum’s website.

Listen

Today sees the first episode of a ten-part series by BBC Radio 4, ‘Disability: A New History‘ presented by Peter White. Examining the history of disability in the 18th and 19th centuries, the series will cover everything from ‘the only dwarf in Liverpool’ (today’s episode) to the facial disfigurements caused by diseases such as smallpox. It promises to be a fascinating set of programmes, with contributions from several key historians in the field, that I’m really looking forward to listening to.

© Wellcome Library, London.

© Wellcome Library, London.

Over on BBC Radio 3, a recent programme examined the cultural history of syphilis, a disease that frequently raises its head here on asylumscience. You can listen to the programme here.

I think that’s enough to keep you busy for the next week or so – and we’ll be back with our normal blog service in two weeks time!