Tag Archives: West Riding Asylum

Attending the insane

L0027370 Claybury Asylum, Woodford, Essex: a dormitory. Photograph by

In the day-to-day running of the asylum, it was not the work of the laboratory that was most immediately evident, but that undertaken by asylum attendants and nurses. By the late 19th century, this was a job that was increasingly codified as efforts to institute proper training and qualification began.

In 1890, the Medico-Psychological Association (MPA) recommended that attendants did two years training in an asylum; the following year saw the introduction of the Certificate in Attendance and Nursing upon Insane Persons. This official qualification was complemented by other developments such as the introduction of the MPA’s Handbook for the Instruction of Attendants on the Insane. The Handbook’s contents ranged from an overview of legal matters concerning insanity, to the importance of setting a good example for patients, to best practice in matters such as bathing and ward ventilation.

Non-restraint and asylum care

In both the Handbook and elsewhere, the issue of restraint was paramount as asylums were required to carefully record any instances of patient restraint in a central register. There was a sense that the disappearance of mechanical restraint (such as straitjackets) increased the potential for injuries, as attendants struggled to subdue patients or manually convey them to seclusion in an excited state. Florence Hale Abbot, writing in The American Journal of Nursing, suggested that in many cases being manually restrained by an attendant made a patient more excitable than they might be when mechanical means were used.

Ellen Dwyer, examining American asylums in her book Homes for the Mad, argues that such problems tended to occur on male rather than female wards, citing ‘general patient-staff tensions [which] were exacerbated by male attendants’ need to defend their masculinity’ (p.181). This was also hinted at in the MPA’s Handbook which cautioned: ‘Inexperienced attendants often think it a weak thing to get assistance, and pride themselves on managing a troublesome patient without aid from others. This is a grave mistake.’ (p.112).

Nurses at Claybury Asylum, Essex, 1890s. © Wellcome Library, London

Nurses at Claybury Asylum, Essex, 1890s. © Wellcome Library, London

This sense of gendered attendant experiences was evident in moves towards the formal qualification of staff and worries about mistreatment. Some commentators laid much of the blame for violence at the feet of male attendants. The Nursing Record & Hospital World noted that abuse was usually ‘brought to notice first from the men’s wards, where there [were] men attendants’, whilst the Male Nurses’ Temperance Cooperation (yes, there was such an organisation) lambasted the ‘drunken male attendant [who was] a greater terror to [the] inmates than his insane patients’. Though female nurses were said to have a more calming influence on male wards, it was difficult to do away with male attendants entirely. Geertje Boschma, writing on Dutch asylums, says that men remained necessary due to their greater strength, for example. The usefulness of male attendants had been earlier recognised by the 1839 Select Committee investigating Hereford Asylum, who criticised the scarcity of male staff, and noted that male patients tended to fight amongst themselves as a result of the lack of supervision.

Detecting injury

Alongside the issue of restraint, a related point of concern was how attendants were to identify injuries sustained by patients. Many handbooks set out the symptoms that might indicate fracture, for example. The MPA’s Handbook instructed the attendant to report any complaints of pain or a ‘shrinking away’ from contact that suggested its presence, as well as any bruises or other abrasions noticed during dressing and bathing. Bathing had a double function as a means of maintaining basic hygiene and method of inspection. At admission the patient was:

… carefully undressed, and any bruises, marks, injuries, or eruptions on his person … looked for and noted. … When a Patient [was] very dirty, the Relieving Officer, Relative, or other person accompanying him to the Asylum, [was] to remain until he [had] been washed and cleansed with soap, as bruises [were] often concealed by dirt, and revealed by washing.[1]

Male patients being washed by attendants at Epsom's Long Grove Asylum, c.1930. © Wellcome Library, London

Male patients being washed by attendants at Epsom’s Long Grove Asylum, c.1930.
© Wellcome Library, London

Attendants might also be reminded of bathing regulations on the wards themselves. A wall-mounted sign at the West Riding Asylum reminded nurses that bathing was to be supervised by the Chief Female Officer and Chief Nurse, and that ‘Hip, Cold, Turkish, and all kinds of Special Baths [were] only to be given or allowed in accordance with special orders from a Medical Officer.’[2]

The concern that a Medical Officer provide permission for ‘Special Baths’ was mirrored in the advice that, if any injuries were suspected, a Medical Officer was to be called upon to provide a definitive diagnosis. This reflected the view that, for asylum attendants, ‘a little learning [was] a dangerous thing’ as one asylum Superintendent put it. By the time that the fifth edition of the MPA’s Handbook was published in 1908, it was criticised for its increasing focus on anatomy rather than psychiatry. For many commentators, then, there was a sense that  – despite the introduction of official certification and training – asylum staff remained if not morally, then intellectually, inferior.

[1] West Yorkshire Archive Service. SRH C85/1/16/3 Regulations and Orders. Relating to the Male Department (1909).

[2] West Yorkshire Archive Service SRH C85/1/16/2 Bathroom regulations. Relating to the Female Department (1874).

Further reading

Anon., ‘Nursing Echoes’, The Nursing Record & Hospital World 27 (17 Aug. 1901).

Anon., ‘Reflections from a Board Room Mirror’, The Nursing Record & Hospital World 14 (20 Apr. 1895).

F.H. Abbot, ‘Feeding and the Use of Restraint in Caring for the Insane’, The American Journal of Nursing 4 (Oct. and Nov. 1903).

W. Bevan Lewis, ‘On the Formation of Character: An address to the nursing staff at the Retreat, York, delivered November 1st, 1906’, Journal of Mental Science 53 (Jan. 1907).

G. Boschma, ‘The Gender Specific Role of Male Nurses in Dutch Asylums: 1890–1910’, International History of Nursing Journal 4 (Summer 1999).

N. Brimblecombe, ‘Asylum Nursing as a Career in the United Kingdom, 1890–1910’, Journal of Advanced Nursing 55 (Sept. 2006).

J. Crammer, Asylum History: Buckinghamshire County Pauper Lunatic Asylum – St. John’s (London: Gaskell, Royal College of Physicians, 1990).

E. Dwyer, Homes for the Mad: Life inside Two Nineteenth-Century Asylums (New Brunswick, NJ: Rutgers University Press, 1987).

L. Monk, ‘Working in the Asylum: Attendants to the Insane’, Health and History 11 (2009).

P. Nolan, A History of Mental Health Nursing (London: Chapman & Hall, 1993).

The Royal Medico-Psychological Association, Handbook for the Instruction of Attendants on the Insane (Boston: Cupples, Upham and Co., 1886 [first published 1885]).

J. Sheehan, ‘The Role and Rewards of Asylum Attendants in Victorian England’, International History of Nursing Journal 3 (Summer 1998).

L.D. Smith, ‘Behind Closed Doors; Lunatic Asylum Keepers, 1800–60’, Social History of Medicine 1 (Dec. 1988).

D. Wright, ‘The Dregs of Society? Occupational Patterns of Male Asylum Attendants in Victorian England’, International History of Nursing Journal 1 (Summer 1996).

Post-mortems in the asylum and issues of consent

Our last post explored why post-mortems were considered essential to the scientific study of mental illness in the 19th century, with the procedure establishing cause of death and gathering pathological information that could be correlated with clinical notes taken during life. How was consent for post-mortems obtained, though, and how much input did patients’ friends and families have on the practice?

Seeking consent

That the bodies of asylum patients were considered important repositories of knowledge can be seen in the efforts made by asylum doctors to secure them for post-mortem examination. Eric Engstrom, investigating German psychiatric clinics, describes how ‘valuable neuropathological specimens’ were offered free beds in order to obtain access to their bodies after death. In Britain, there were appeals during the 1870s for post-mortems to be made a universal, automatic practice within medical institutions. Despite the support of prominent alienist Sir James Crichton-Browne and others, efforts to institute ‘carte blanche post-mortems’ were rejected in 1877, though this did not mean that all asylums followed the same protocol with regard to the procedure. Jonathan Andrews summarises: ‘At some asylums post-mortems had become de rigueur, formal consent not even being sought. At a minority, prior consent was procured from patients while living. Whereas a few sought written consent using purpose-specific pro-forma, others relied merely on verbal consent’.

L0000838 Section of the brain, 19th century.

At the West Riding Asylum in Yorkshire, the intent to perform a post-mortem was made clear on the notice of admission sent to relatives: ‘In case of death the usual post-mortem examination will be made in order to certify correctly the cause of death. Relatives in any case objecting to this course are requested to communicate immediately upon receipt of this notice, personally, with the Medical Superintendent.’ It is impossible to know how many families responded – or indeed were able to respond, depending on literacy levels – to this specific advice. Towards the end of the 19th century it is clear that some relatives were voicing their objection to post-mortem. Casebooks kept during the patient’s life might be annotated ‘Post mortem objected to’, or alternatively ‘No objection to P.M.’

Sample of a post-mortem book, 1899. © WYAS, Wakefield.

Sample of a post-mortem book, 1899. © WYAS, C85/1132.

Determining the specifics of post-mortem

Post-mortem records show that some families had very specific ideas about where the boundaries lay, and Andrews notes that this might be particularly evident if families belonged to a religious denomination that emphasised resurrection. Even amongst people without such beliefs, though, the idea of a post-mortem was – and is – a difficult one to deal with. In Speaking for the Dead, the authors relate the case of a mother whose son was killed in a road accident. Two years after his cremation, she and her family discovered that her son’s brain had been removed, and that his body had thus not been intact at his cremation. “It was my son’s heart and brain that made him what he was,” she said, and this is a feeling that crosses many cultures – of the brain as intimately bound up with the self.

There is a sense of this in several 19th-century records too. Often the ‘[h]ead [was] not permitted to be examined’, though there were some exceptions in which the head only was specified, possibly if the potential value of the exam to the wider study of mental illness had been emphasised by the doctor. Usually, the thorax was the part viewed by the family as an acceptable area of investigation, with records noting ‘Chest only examined’, or ‘Thorax only permitted to be examined’.

From J.M. Beattie, Post-Mortem Methods, 1915. © Wellcome Library, London.

From J.M. Beattie, Post-Mortem Methods, 1915.
© Wellcome Library, London.

There were also moves towards making death a less harrowing experience for patients’ families, with separate chapels set up apart from the mortuary. Reporting on the arrangements at Claybury Asylum, the British Medical Journal reported:

‘Our representative was much struck by the care taken to save the feelings of the friends of the dead. There is a cheerfully-furnished waiting-room for their special use; when they wish to take their last look at the departed the coffin is wheeled into the central hall where there is no trace of anything unpleasantly suggestive.’

Whilst asylum staff were keen to examine the bodies of deceased patients, then, there was increasing awareness that friends and families had a place in decisions about post-mortem practices, even if this was a time at which consent procedures were still being elaborated.

Further reading

J. Andrews (ed.), History of Psychiatry 23 (Mar. 2012) – Special issue: ‘Lunacy’s last rites: dying insane in Britain, c.1629-1939′.

S.  Ferber and S. Wilde (eds.), The Body Divided: Human Beings and Human ‘Material’ in Modern Medical History (Farnham: Ashgate, 2011).

E.T. Hurren, Dying for Victorian Medicine: English Anatomy and its Trade in the Dead Poor (Basingstoke: Palgrave Macmillan, 2011).

R. Richardson, Death, Dissection and the Destitute (London: Phoenix, 2001).

M. Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America (Princeton: Princeton University Press, 2002).

(Anti)Vivisection and the Asylum

As previous articles on this blog have highlighted, animals occasionally played an important part in asylum research in the nineteenth century. Their behaviours could be observed as part of the growing programme of comparative psychology, and they could be used to study the physiological or psychological effects of new drugs. They were also crucial in the development of cerebral localisation theory, being the experimental subjects of various stimulation and ablation procedures which aimed to locate different mental functions in distinct regions of the brain cortex. Tests on dogs, cats, monkeys, rabbits, etc, were a surrogate for human experimentation, and the results of animal studies were transferred to an understanding of the human brain.

David Ferrier. © Wellcome Images.

David Ferrier, a Scottish physician who began his animal research in the laboratory of the West Riding Lunatic Asylum in 1873, became the leader of cerebral localisation studies in Britain. His ideas were quickly accepted by most of the scientific community, but they were still highly contentious, and Ferrier, at the front of this programme, became the focus of various criticisms. His evidence was critiqued, and his work was attacked on its principles too. Cerebral localisation was not just reductive of empirical explanation, but reductive of the human soul. His “new phrenology,” as it was termed by its critics, was seen by some as an attempt to remove God from an understanding of the human mind.

In 1875, Frances Power Cobbe wrote that “the prevalent materialistic belief that the secrets of the Mind can be best explored in matter, undoubtedly account in no small matter for the vehemence of the new pursuit of original physiological investigations.” Cobbe, who founded the Victoria Street Society and was the single most influential figure of the anti-vivisection movement in Britain, saw experimental brain studies as unquestionably linked with materialism and the rise of animal experimentation. She believed in an independent, God-given mind, which the new cerebral localisation reduced to simple reflexive machinery. In the most macabre fashion, experimenters showed that volitional acts were not reliant on a conscious, immaterial mind: cats clawed and macaques kicked simply by stimulating a small region of the animals’ brain.

Frances Power Cobbe. © Wellcome Images.

Following a period of petitioning and canvassing, anti-vivisection protestors led by Cobbe succeeded in prompting a Royal Commission into vivisection in 1875. In the House of Commons, the MP James Maden Holt argued that Ferrier’s experiments manifested “a refinement of cruelty which renders the operator… quite unfit to be trusted with the care of an animal, much less of a human being.” He pointed out that “[w]hen it comes to the knowledge of the public that these are the practices of a medical man who has free access to the lunatic asylums of the West Riding, public indignation will know no bounds.” Anti-vivisection campaigners voiced the concern that allowing animal testing was a slippery slope that might eventually lead to human experimentation in asylums or other medical institutions. They had reason to worry. Across the Atlantic, an Ohio physician named Roberts Bartholow had already replicated Ferrier’s electrical stimulations on Mary Rafferty, a young cancer patient under his care at the city’s Medical College.

In 1876, Parliament passed the Cruelty to Animals Act (which lasted for 110 years). Under the Act, vivisection could continue, but only for original, useful purposes, with a license from the Home Secretary. Anti-vivisection campaigners saw the Act as a concession to the scientific lobby, and so whilst trying to alter the Act, they also sought to prosecute individuals under the new laws in place. Their main target was Ferrier. In a well-documented session of the 1881 International Medical Congress in London, Ferrier had presented a monkey which had its left motor cortex removed, leaving it with no voluntary control of its right-sided limbs. He was then summoned to court for operating on animals without an appropriate license, though the case was soon thrown out when it was revealed that Ferrier’s assistant had actually conducted all the experiments, and was in possession of a full license. Cobbe’s prosecution failed, and the scientific community breathed a collective sigh of relief. Anti-vivisection campaigners turned to reflect on their movement, and to repeat to their audiences the potential tragedies that lurked in a country that did not seriously resist animal experimentation. The incidence of such operations would undoubtedly continue to rise, and scientists would push the boundaries of decency further. Indeed, in a society openly tolerant of testing on animals, surely it was only a matter of time before scientists turned to other humans as their test material?

Front cover of Heart and Science. © Andrew Gasson.

Ferrier, localization and vivisection became topics for several prominent novels of the time. In Heart and Science (1883), written in response to Ferrier’s 1881 trial, Wilkie Collins tried to “drag the scientific English Savage from his shelter behind the medical interests of humanity.” H.G. Wells’ The Island of Dr. Moreau (1896), showed how vivisected animals, which jabber and are kept in conditions similar to asylum patients (at least in the imagination of the public), eventually turn on their tormentor. And in Dracula (1897), Bram Stoker drew attention to the way modern psychology construed humans as automata devoid of a soul. Dr. Seward, an asylum superintendent in the novel, wrote that had he “the secret of one such mind – did I hold the key to the fancy of even one lunatic – I might advance my own branch of science to a pitch compared with which Burdon-Sanderson’s physiology or Ferrier’s brain knowledge would be as nothing.” Asylum patients were perfect material for experimental investigations.

As Richard French has shown, anti-vivisectionism in the nineteenth century was part of a broader public movement against the creeping power of scientific and medical authority, alongside other crusades like the early anti-vaccination campaigns or protests against the Contagious Diseases Acts. The worry of potentially being experimented upon like vivisected animals also had a resonance with criticisms of asylums, which were remote, foreboding and obscure institutions, whose working practices were mostly misunderstood and often dreaded. Alienism – the profession of treating the insane – was as foreign to most men and women as were the grotesque experimental practices of Dr Moreau. Through Ferrier, and his work at the West Riding, vivisection and asylums became well associated, in the scientific community, and the public mind too.

Further Reading

R.D. French, Antivivisection and Medical Science in Victorian Society (Princeton: Princeton University Press, 1975).

S.L. Star, Regions of the Mind: Brain Research and the Quest for Scientific Certainty (Stanford: Stanford University Press, 1989).

A. Stiles, Popular Fiction and Brain Science in the Late Nineteenth Century (Cambridge: Cambridge University Press, 2012).

The Ophthalmoscope: Viewing The Living Brain

Continuing the theme of medical technologies in the asylum, I’d like to turn to another, much more common instrument, but one whose role in psychiatric study is less well-known: the ophthalmoscope.

The ophthalmoscope in use, 1872. © Wellcome Images.

Created and described by Helmholtz in 1851, the ophthalmoscope was an instrument that allowed one to see into the back of the eye, revealing specific retinal conditions in diagnoses such as leukaemia, syphilis and diabetes. In particular it revealed the optic disc, the point at which the optic nerve reaches the eye from the brain, thus giving privileged access to the condition of the cerebral matter and the state of circulation in the brain. Short of opening up the skull, this was the only means to view any part of the brain in a living patient; and given that asylum doctors in the nineteenth century were committed to a somatic view of mental illness, and were looking for the physical (cerebral) causes of insanity, this was a useful tool. Yet a conservative medical profession in Britain was often resistant to new instruments replacing the experience and acumen of trained physicians, believing that such experimental, laboratory methods could never supplant the use of unaided  senses in the clinic. There were thus initially few British adherents, with Thomas Clifford Allbutt (1836-1925) complaining in 1871 that he could ‘count upon the fingers of one hand’ the number of physicians working with the ophthalmoscope in England.

Sir Thomas Clifford Allbutt. © National Portrait Gallery, London.

[There was a strong rumour, still perpetuated today, that Allbutt was the model for Dr. Lydgate in George Eliot’s Middlemarch (first published in serialised form between 1871 and 1872). This is probably wrong, though Eliot did visit Allbutt in September 1868, and wrote that he was a ‘good, clever, graceful man, enough to enable one to be cheerful under the horrible smoke of ugly Leeds’!]

Allbutt, the main proponent of ophthalmoscopy in nineteenth century Britain, was a physician and lecturer at the Leeds General Infirmary, and conducted some of his work at the nearby West Riding Lunatic Asylum (some patients under his care would occasionally make the same journey too). In his classic monograph On the Use of the Ophthalmoscope in Diseases of the Nervous System and of the Kidneys (1871), Allbutt included an appendix of two hundred and fourteen cases of insanity he had observed with an ophthalmoscope at the asylum. He found changes in the eye in a large proportion of those diagnosed with old or organic cases of brain disease. The usefulness of the ophthalmoscope in the asylum was clear to him, as he argued it would help remove ‘the metaphysical or transcendental habit of thought’ and bring a ‘more vigorous and more philosophical mode of investigation’ to disorders of the brain.

Images of optic neuritis taken from Allbutt’s 1871 book.

Allbutt’s work was continued at the asylum by Charles Aldridge, a young doctor who investigated blood supply in the brain using the ophthalmoscope, a tool which he said was ‘able to diagnose obscure cerebral affections through its instrumentality’. It had long been thought that blood flow, particularly an increased level leading to cerebral inflammation, was at the root of many instances of mental disease. As late as 1879, Bucknill and Tuke still argued that it ‘is most probable that inflammation is not the condition of insanity, but is the exciting cause of a secondary pathological state upon which the symptoms of insanity immediately depend’. The frequency with which inflammation, clots and congestion were found in post-mortem asylum cases was evidence of this.

Physiological experiments had shown that blood flow – and the nutrients, oxygen, and poisons it might contain – was crucial to normal cerebral functioning, and thus provided a route for doctors to describe and explain various mental conditions. In three papers in the 1870s, Aldridge presented his observations of cases of epilepsy, general paralysis and dementia using the ophthalmoscope. He concurred with Allbutt that general paralytics displayed atrophy of the optic disc, and further claimed that one could estimate how long the disease had existed by the relative amount of atrophy. Epilepsy, he found, was concurrent with a state of ‘passive hyperaemia’, whereby blood flow away from the brain was impeded, creating cerebral pressure. By contrast, dementia, whose sufferers were characterised by paleness of the optic disc, probably had its origin in a state of anaemia of the brain. The ophthalmoscope seemed to offer the possibility of diagnosis in all types of insanity.

However, whilst the ophthalmoscope did eventually become a popular instrument amongst general medical clinicians – and those dealing with disorders of the eye or nervous system in particular – it never really took hold in asylum practice. It could be used in the diagnosis of general paralysis, but this was a disease which could be more easily confirmed through other symptoms. And in other forms of insanity the ophthalmoscope was less reliable, as there was no constant causal relationship between lesions in the brain and observations of the eye. Instead, doctors would have to rely on other diagnostic criteria, and wait for the mortuary to make any specific claims about the state of the brain. The ophthalmoscope in the asylum is  illustrative of the way in which the potential uses and limits of new medical technologies are tested, and also of the way nineteenth-century asylum doctors followed a variety of leads in their attempts to link mental diseases with specific physical causes.

Further Reading

C. Aldridge, ‘The Opthalmoscope in Mental and Cerebral Diseases’, ‘Opthalmoscopic observations in general paralysis, after the administration of certain toxic agents’, ‘Ophthalmoscopic observations in acute dementia’, West Riding Lunatic Asylum Medical Reports, 1-4 (1871-1874).

T.C. Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of the Kidneys (London/New York: Macmillan & Co., 1871).

C. Lawrence, ‘Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain 1850-1914′, Journal of Contemporary History, 20 (1985).

G. Rosen, The Specialization of Medicine, with particular reference to ophthalmology (New York: Froben Press, 1944).

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).

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

Bones, breaking strain, and the insane body in 19th-century asylum practice

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.

Further reading

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