Tag Archives: mental health history

Surgery in the asylum II: The craniectomy controversy

In January 1895, The Strand Magazine published another instalment in its ‘Stories from the Diary of a Doctor’ series. The tales were written in a semi-fictional tone, ‘in collaboration with a medical man of large experience’ – ‘[m]any [were] founded on fact’. They presented a romantic vision of the doctor as saviour, accompanied by illustrations that echoed other Strand series such as Sherlock Holmes. January’s ‘Diary of a Doctor: Creating a Mind’, relates the situation of a titled family whose male head has been taken ill after an injury. The attending doctor, frequently present in the family’s castle, is there when the young male heir, Cyril, is brought to visit his grandfather on his sickbed.

Strand_Magazine_1891Two and a half years old, the boy is described as beautiful – almost angelic – yet the doctor relates that ‘one glance was enough to tell me that … the mind in that poor little casket was a sealed book. The beautiful boy was looking at no one: he was gazing straight out of the window…’ The grandfather is less poetic: “That boy’s an idiot,” said the Squire – “he’s a beautiful idiot – he’s no heir for me – don’t mention him again.” ‘Idiocy’ was a common term at this time used to refer to a condition present from an early age that made a person incapable of managing their own affairs; it was typically deemed incurable, and covered a range of conditions that are now generally referred to as learning difficulties.

The doctor, his curiosity aroused, examines the child and draws the family’s attention to

“how small his head is in proportion to the rest of his frame. That smallness is at the root of the mischief. The little fellow is suffering from premature ossification of the cranial bones. In short, his brain is imprisoned behind those hard bones and cannot grow. The bones I refer to should at his tender age, be open, to allow proper expansion of the growing brain.”

A little while later, he notes: “An idea has occurred to me – it is a daring one … I propose to open the casket where the child’s mind is now tightly bound up, and so to give the brain a chance of expansion.”

V0030048 Brain of someone described as an "idiot". Process print.

Brain of someone described as an ‘idiot’. © Wellcome Images

The parents of the child consent, and the operation is carried out. Lasting one and a half hours, the procedure is deemed a success. The tale ends triumphantly, with young Cyril like any ‘normal child’ by his third birthday, and presented to his grandfather (now recovered from his illness) with a dramatic flourish, eventually living in the castle and – presumably – a potential heir once more.

Whilst ‘Creating a Mind’ relied on fictional tropes for its effect, it raised very real concerns. T. Telford-Smith, Superintendent of the Royal Albert Asylum, described it as ‘a tale which I fear has given rise to exaggerated hopes in the minds of the parents of many idiot children’, suggesting that several had pursued the possibility of surgery after reading the piece. The procedure in question – craniectomy – involved removing bone from the skull to increase the space available for the brain. Telford-Smith estimated that over 200 such operations had been performed in Britain, America, and France since 1890. It was not something to be taken lightly, he emphasised, and was certainly not the miraculous cure that The Strand made it out to be. Similar concerns were voiced by G.E. Shuttleworth, who thought that craniectomy had ‘almost passed from the domain of science to the region of romance’ as a consequence of ‘Creating a Mind’.

This is not to say that medical practitioners deplored the operation completely. Telford-Smith had known it performed on several children who had been admitted to the Royal Albert. Relating the case of a six-year-old boy who had never spoken and often knocked his head violently against the wall – a practice that the parents found ‘most distressing’ – he said that the parents could see only limited difference after three procedures were performed in 1895. The child remained speechless, yet his parents said they would submit him to the operation again knowing the results, as his restlessness had decreased markedly and the head-knocking had ceased. The case was presented by Telford-Smith in direct response to ‘Creating a Mind’ – despite the slight improvements in the child, he said, ‘A mind has not been created’. His account, though, emphasised the need to look at each case individually, weighing up the risks and possible outcome. He also noted the need for dedicated education and training after surgery, reminding readers that a physical procedure was no substitute for love and attention.

Surgery on the brain (or that aims to affect the brain) is a highly emotive issue, especially when performed on children as in these cases. The Strand episode is an interesting example in which a popular representation of psychosurgery was positive – so much so that several doctors were moved to respond to it. ‘Creating a Mind’ sits in contrast to tales like Heart and Science (mentioned in this post) that portrayed surgery on the brain as a Gothic nightmare. It’s a reminder, then, that discussions about psychosurgery often extended beyond the asylum walls and that opinions on the matter were rarely straightforward: for some parents of the 1890s, a novel medical procedure such as craniectomy may have been perceived as a means of ‘cure’ for their children.

Further reading

L.T. Meade and Clifford Halifax, ‘Stories from the Diary of a Doctor: Creating a Mind’, The Strand Magazine (Jan. 1895).

G.E. Shuttleworth, ‘The Surgical Treatment of Idiocy‘, Journal of Mental Science (Jan. 1896).

T. Telford-Smith, ‘Craniectomy for Idiocy, with Notes of a Case‘, Journal of Mental Science (Jul. 1897).

T. Telford-Smith, ‘Craniectomy, with the After-History of Two Cases‘, Journal of Mental Science (Jan. 1896).

David Wright and Anne Digby (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (London: Routledge, 1996).

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