The Politics of Madness: The State, Insanity and Society in England (Studies in Social History of Medicine)

The Politics of Madness

The past three decades have seen a global change in policies for the mentally ill. One of the most visible signs of new approaches to the care of patients has been the closure of large institutions built during the nineteenth and twentieth centuries to house those diagnosed as suffering from insanity and mental illness. The place of care continues to figure prominently in continuing debates about the protection of society as well as the effective management of patients in the community. Many of these debates echo those conducted when the closed institutions were first built, during the wave of radical reform that led to the creation of an elaborate asylum system in the mid-nineteenth century. This study of the English lunatic asylum before 1914 is based on a careful examination of private as well as publicly funded institutions in the Victorian and Edwardian decades. The political concerns that gave rise to the new asylums and guided their development during the nineteenth and early twentieth centuries are explored with regard to the networks of relationships which influenced the passage of thousands of people to and from these places. In discussing the impact of class, migration, gender, households and ageing on committal to the asylum, Melling and Forsythe challenge many earlier claims with regard to contemporary perceptions of insanity and reiterate the importance of distinctive institutions as well as a wide range of historical actors in control of those seen as mad. Joseph Melling is a Reader in Medical History at the University of Exeter, UK. Bill Forsythe is the Emeritus Professor of the History of Social Policy at the University of Exeter, UK.

Routledge studies in the social history of medicine Edited by Joseph Melling University of Exeter and

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20 The Politics of Madness The state, insanity and society in England, 1845–1914 Joseph Melling and Bill Forsythe 21 The Risks of Medical Innovation Risk perception and assessment in historical context Edited by Thomas Schlich and Ulrich Tröhler Also available in Routledge studies in the social history of medicine series: Reassessing Foucault Power, medicine and the body Edited by Colin Jones and Roy Porter

The Politics of Madness The state, insanity and society in England, 1845–1914

Joseph Melling and Bill Forsythe

First published 2006 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Simultaneously published in the USA and Canada by Routledge 270 Madison Ave, New York, NY 10016 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2006 Joseph Melling and Bill Forsythe This edition published in the Taylor & Francis e-Library, 2006. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book has been requested ISBN10: 0-415-30174-2 (hbk) ISBN10: 0-203-33534-1 (ebk) ISBN13: 978-0-415-30174-9 (hbk) ISBN13: 978-0-203-33534-5 (ebk)

For Ross Leslie Sproule-Melling and Patricia and Nuala Forsythe and Robert Herd

Contents

List of illustrations Foreword Acknowledgements Notes on the text List of abbreviations 1 Introduction: the English asylum and its historians

xi xiv xv xvi xviii 1

2 The origins of the asylum

13

3 The asylum and the British state in the administration of pauper lunacy, 1845–1914

23

4 The ethos of treatment, care and management at the asylum, 1845–1914

46

5 Journey to the asylum: residence, distance and migration in admissions to the asylum, 1845–1914

75

6 Community, friends and family: asylum, lunatics and the social environment, 1845–1914

99

7 Reading the rules of domesticity: gender, insanity and the asylum, 1845–1914

125

8 Madness and the market: occupations, class and the asylum, 1845–1914

145

9 The patient experience of the pauper and private asylum

176

x Contents

10 From asylum inmate to outpatient: the remaking of the institutional landscape in the twentieth century, 1914–1990 Notes Bibliography Index

204 213 262 271

Illustrations

Figures 5.1 Devon County Asylum admissions: parish origins of patients, 1846–1855 5.2 Devon County Asylum admissions: parish origins of patients, 1856–1865 5.3 Devon County Asylum admissions: parish origins of patients, 1876–1885 5.4 Devon County Asylum admissions: parish origins of patients, 1896–1905 9.1 Exminster asylum, patients admitted, 1845–1914: length of stay and outcome of stay, by five-year averages

78 79 80 81 182

Tables 3.1 3.2 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8

Paupers and pauper lunatics in three Devon Unions, 1850–1885 Provision for pauper lunatics in three Devon Unions, 1850–1885 Attendant to inmate ratios at Exminster, 1870–1908 The initial diagnosis of those entering the Devon County Asylum, 1845–1880 The initial diagnosis of those entering the Devon County Asylum, 1881–1914 Exminster 1845–1914: female diagnoses on admission and outcome of stay Exminster 1845–1914: male diagnoses on admission and outcome of stay Exminster asylum, outcome of stay (summary from 4,000 residents), 1845–1914 Exminster asylum, 1880–1882 intake: diagnoses and outcomes Exminster asylum, 1845–1914: re-admissions (from 4,000 residents)

28 29 56 62 63 69 70 71 71 72

xii Illustrations 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 7.1

Exminster patients and non-patients: place of birth and residence in 1871 Exminster patients: migration and family structure by gender Exminster patients: family and household structures of patients, 1851–1881 Devon non-patients: family and household structures of non-patients, 1851–1881 Comparison of family and household structures of Exminster patients versus non-patients Exminster patients: family structure of patients, by gender Exminster patients: migration of patients and non-patients by family and household structures, 1851–1881 Wonford House asylum, 1855–1914: admissions by gender and county of origin Exminster patients and their near relatives, 1845–1914, by gender Exminster patients, admitted 1880–1882, and their near relatives Exminster patients, 1845–1914: outcome of asylum stay, by gender and marital status Exminster patients admitted 1880–1882: outcome of stay, by gender and marital status Exminster asylum, patient admissions, 1880–1882: outcome by gender and marital status Exminster patients admitted, 1880–1882: recorded duration of insanity, by gender and marital status Exminster patients admitted, 1880–1882: ‘other places’ where individuals were examined and certified prior to admission, by gender Wonford House asylum, patients admitted, 1855–1914: on whose authority sent, by gender Wonford House asylum, patients admitted, 1855–1914: county of origin by major counties Wonford House asylum, patients admitted, 1855–1914: duration of attack, by gender and marital status (duration by years and months) Wonford House asylum, patients admitted, 1855–1914: length of stay, by gender and marital status Wonford House asylum, patients admitted, 1855–1914: re-admissions, by gender and marital status Wonford House asylum, patients admitted, 1855–1914: outcome of stay, by gender and marital status Digby asylum, patients admitted, 1886–1895: pauper and private intake, by gender and marital status

83 83 85 86 87 88 90 95 102 103 105 106 106 108 110 117 118 119 120 121 122 137

Illustrations 7.2 7.3 7.4 7.5 7.6 7.7 8.1 8.2 8.3 8.4 9.1 9.2 9.3 9.4 9.5 9.6

Digby asylum, patients admitted, 1886–1895: outcome of stay, by pauper and private status Wonford House asylum, patients admitted, 1855–1914: length of stay, by gender and marital status Wonford House asylum, gentlewomen admitted, 1855–1914: whose authority sent (summary) Wonford House asylum, gentlewomen admitted, 1855–1914: outcome of stay, by age and marital status Moorhaven asylum, patients resident 1909 and admitted 1909–1913: length of stay, by gender Moorhaven asylum, patients resident 1909 and admitted 1909–1913: outcome of stay, by gender Exminster asylum, patients admitted, 1845–1914 (4,000 sample) by major occupations and gender Exminster asylum, female domestic servants admitted, 1845–1914: main diagnoses Wonford House asylum, male patients admitted, 1855–1914, by occupation Wonford House asylum, female patients admitted, 1855–1914, by selected occupations Exminster asylum, patient admissions, 1845–1914 (4,000 and 13,000) by length of stay Exminster asylum, patients admitted, 1880–1882: recorded causes of insanity, by gender Exminster asylum, patients admitted, 1880–1882: bodily condition on admission, by gender Exminster asylum, patients admitted, 1880–1882: elderly versus all patients Wonford House asylum, patients admitted, 1855–1914: recorded causes of insanity, by gender Exminster asylum, all patients admitted, 1845–1914 (13,000): summary of re-admissions versus admissions, by gender

xiii 137 138 139 140 141 141 155 161

168–9 170 179–80 181 184 187 196 203

Foreword

When the Society for the Social History of Medicine was established in 1969, many people still associated the study of medical history with a fairly traditional, ‘heroic’, view of the role played by medicine, and medical professionals, in the improvement of human well-being. However, these views were being challenged by historians and social scientists who believed that the role of medicine could only be evaluated properly if it was set within the broader context of social, economic, cultural and political change. The Society was designed, partly to reflect these views, and partly to provide a forum in which all those interested in the study of medical history could come together for conferences and meetings. Its fundamental aim was, and is, to promote research into all aspects of medical history, without regard to limitations of time or place. Since 1969, the Society has established itself as the premier academic society for the study of medical history in the United Kingdom, and as a major forum for medical historians around the world. It organises a lively and wide-ranging programme of academic conferences and meetings, with special events for postgraduate students. In 1988, it began to publish a journal, Social History of Medicine, which is now widely-regarded as one of the most important academic journals in the field. The journal publishes articles on all aspects of medical history by new and established authors from a wide range of disciplinary backgrounds and many different countries. The Society decided to launch a dedicated book series, Studies in the Social History of Medicine, in 1989. The series was designed, initially, to provide a more high-profile outlet for papers which had been presented at one of its many thematically-organised conferences, but many of the volumes which have been published in the series originated outside the Society altogether. In more recent years, the Society has expanded the scope of the series by including conventional monographs. This represents a very exciting milestone in the development of the series, and bears witness to the continuing vitality of the social history of medicine and the role played by the Society within this. Bernard Harris

Acknowledgements

This book began as a scholarly journey more than a decade ago and we have incurred many debts on the way. The initial project was generously funded by the Wellcome Trust and we received unflagging support from the Secretaries of the History of Medicine Panel, David Allen, John Malin and Tony Woods, as well as Helen Hawkins who handled administrative and financial matters with great dexterity. Later research was funded in part by the University of Exeter’s Research Fund and the Centre for Medical History when Joseph Melling served as its first director in 1997–2003. Our researchers, Richard Adair, Richard McLain, Anne Stobart and particularly Robert Turner made a substantial contribution to the research published here, and we gratefully acknowledge their efforts. The Information Technology Services group at our university provided valuable expertise, and, more particularly, the late Rob Ashmore and Y.S. Zhang. Margery Rowe, John Draisey and the staff of the Devon Record Office provided the archival access and support to many of the records used in this study and we also thank Julia Shepherd and Lesley Hall at the Wellcome Library in London. Among the many academic colleagues who inspired and assisted us, we owe particular thanks to Jonathan Andrews, Jonathan Barry, Peter Bartlett, Michael Clark, Anne Crowther, Pamela Dale, Anne Digby, Mark Jackson, Hilary Marland, Pamela Michael, the late Roy Porter, Cath Quinn, Helen Rogers, Andrew Scull, Len Smith, Akihito Suzuki, Charles Webster and David Wright. We must record our deepest appreciation of the tireless efforts of the editors of the present series, Anne Borsay and Bernard Harris, who supported our initial proposal to Routledge. Each read the manuscript and made numerous corrections and suggestions, Bernard providing us with meticulous and invaluable guidance in an exemplary demonstration of editorial standards. The preparation of the manuscript was undertaken by Christi Hetzler, who demonstrated great professionalism in working with various drafts. Our colleagues at the Centre, Mary Carter and Claire Keyte, undertook many onerous tasks in the dispatch of the text. We should make the obvious disclaimer that the errors that remain belong to us alone. Finally, we would thank those members of our families to whom this book is dedicated. University of Exeter May 2005

Notes on the text

We have noted the principal archival and printed primary sources used for the text. The research was designed to combine a close reading of a range of institutional sources with a detailed quantitative analysis of four asylums in Devon during the Victorian and Edwardian decades. The first period of research was funded by the Wellcome Trust and largely devoted to a detailed search of archival sources connected to the Devon County Pauper Lunatic Asylum which opened at Exminster in 1845 and which recorded more than 13,000 admissions in the period to 1914. A basic analysis of all 13,000 patient admissions was undertaken by Joseph Melling, Bill Forsythe and Richard Adair with assistance from Robert Turner. From this comprehensive record a large sample of 4,000 admissions was compiled for more detailed study, including the main social and personal characteristics of the patients who entered the Exminster asylum. In addition, a further analysis was made by Joseph Melling and Robert Turner of all patients admitted to the asylum in the years 1880–1882 inclusive, as a basis for a systematic comparison of Devon asylum patients with the individuals recorded in enumerators’ reports for the 1881 Devon census collected in a machine-readable form by the Mormon Church and edited by the University of Essex. Information on Exminster patients was drawn from four principal sources. First, we examined the Certificates of Insanity and Magistrates’ Committal Orders which were legally required before the admission of any individual to an asylum or licensed premises after the lunacy legislation of 1845. In addition we consulted the Admissions Registers and related papers which were maintained at all such institutions in these years. Third, details of the social background and patient career of asylum inmates were gathered from the substantial case books, including a separate set of chronic case books, preserved at the Devon Record Office. Years were sampled for individual biographies, though all patients entering and departing in 1880–1882 were examined. Fourth, we examined the Minutes of the Visiting Justices who were responsible for the governance and general management of the Victorian pauper asylum, including the Annual Reports prepared by the medical superintendent and his staff for the Justices and the Quarter Sessions that appointed them. The administration of the Devon

Notes on the text xvii County Asylum was further investigated through an analysis of selected records of the Lunacy Commission, whose records were deposited in the Public Record Office (now National Archives) at Kew, London. To extend our evaluation of the Devon asylum’s relationship with the Poor Law, research was undertaken on four major Poor Law areas or ‘Unions’ in the period 1845–1914. A further research exercise, directed by Melling and undertaken with the assistance of Robert Turner, Anne Stobart and Richard McLain, involved an examination of all patient admissions to the Wonford House asylum between 1855 and 1914. The available details for all patients entering this smaller, privately funded and fee-paying institution were entered in a new database. Analysis was also undertaken of a number of patient case books, more particularly for the years 1880–1882 when further use was made of the 1881 Devon census to identify the social background and destination of those who were admitted to Wonford House. The third phase of the research, undertaken by Melling with the assistance of Turner, involved a detailed examination of patients entering Devon’s two Borough asylums: the Exeter asylum opened at Digby’s Field in 1886, and the Plymouth borough asylum established at Moorhaven in 1891. Only the first decade of patient admissions was available for the pauper and private patients at Digby asylum and relatively few records survived for Moorhaven, with only patient lists for 1909 and admissions for 1909–1913 available. From these limited sources we were able to compile data sets by which a comparison with the Devon asylum and Wonford House asylum was undertaken. Microsoft Access was the main tool for analysis of patient records, in addition to such statistical packages as RBase, SPSS, Excel and a variety of more specialist programs used and adapted by Robert Turner. Our analysis of the parish returns was undertaken using the Arcview software for GIS designed by ESRI.

Abbreviations

The major unpublished archives, principally located in the Devon Record Office (DRO), are cited with the following abbreviations in the text, following an initial full reference of the archival reference in each of the chapters that follow.

Glossary of sources and their abbreviated form of citation AG Mins AR BG Mins DQS Mins EAC EAR ECB MAR OG Mins PSMG Mins STG Mins TEFP VJP Mins WHAC WHAR WHCB

Axminster Poor Law Guardians’ Minute Books Annual Report of the Devon County Pauper Lunatic Asylum Barnstaple Poor Law Guardians’ Minute Books Devon County Quarter Sessions’ Minute Books Exminster Admissions Certificates, 1845–1914 Exminster Admissions Register Exminster case books Plymouth Borough Asylum, Moorhaven, admission registers Okehampton Poor Law Guardians’ Minute Books Plympton St Mary Poor Law Guardians’ Minute Books St Thomas Poor Law Guardians’ Minute Books Trewman’s Exeter Flying Post Devon County Pauper Lunatic Asylum Minute Books of the Visiting Justices Wonford House asylum, Admissions Certificates Wonford House asylum, Admission Registers of Patients Wonford House asylum, patient case book

Other abbreviations used LC Mins NA PP

Minute Books of the Lunacy Commission held in the National Archives National Archives British Parliamentary Papers

1

Introduction The English asylum and its historians

This book is concerned with the growth of asylum care for those certified as insane in Victorian and Edwardian England. The rise in the numbers of people admitted to specialist institutions during the nineteenth and twentieth centuries has been the subject of vigorous debate in the past four decades. The purpose of our study is to examine these arguments in the light of recent scholarship and original evidence drawn primarily from Devon in the period 1845–1914. There has been a broad agreement that the nineteenth century saw a remarkable rise in insane people known to the British state, growing from two or three persons in every 10,000 in England and Wales identified as lunatics in the early nineteenth century to about 13 per 10,000 by the time the Lunacy Act of 1845 was passed, and perhaps 30 per 10,000 at the time that a new Lunacy Act came into force in 1890. The growth in the numbers of the known insane was widely discussed by eminent and well-informed contemporaries such as Henry Maudsley and remained the subject of searching discussion at the Lunacy Commission, which had been established in 1845 to oversee the provision of asylum accommodation. While population generally increased by about 80 per cent between the seminal legislation of 1845 and 1890, the numbers of certified insane quadrupled.1 It is true, as Andrew Scull has pointed out, that the rate of admissions to asylums per head of the population grew less dramatically than did the total numbers of those certified in the five decades after 1845, though the steep incline in those institutionalised remains a striking feature of the period.2 To understand the origins and trend of this increase we need to consider the pattern of provision made for the insane in the eighteenth century. When Herman T. appeared to have become insane and decamped to Sparked Downs in 1723, he presented the Overseers of the Poor in the parish of Cheriton Fitzpaine with a problem that was to occupy them for some time. Herman was brought to his home village, shaved and cleansed. He was ministered to by physicians and eventually sent to a doctor in a neighbouring village who charged the overseers the substantial sum of £14 for curing him of ‘a mallancholy disorder’. Meanwhile his wife and child were maintained on outdoor relief.3 A century-and-a-half later, in 1880,

2

Introduction

Sarah L. was observed sitting on the churchyard steps of the same village. She was highly excited and suddenly rushed into the public house to drink beer, making use of ‘extremely bad language’ as she did so. Her uncle Samuel Langworthy informed Dr Rundle, the Poor Law medical officer, that she had been out all night on the Monday, running about the fields, and the village policeman confirmed that one or two young men had been preparing to take advantage of her until she drew a knife ‘and they vanished’.4 The Reverend Arundell and the Relieving Officer of the Poor Law committed Sarah to the County Asylum. Sarah’s complex personal history is indicated by the fact that this was her seventh visit since being first certified at the age of 17 in 1870. Discharged as recovered after each visit to the asylum, she made her ninth and final journey in 1885. Herman T. and Sarah L. both outraged the public sensibilities of the inhabitants of a quiet Devon village, though the terms on which their madness was addressed varied significantly. By the Victorian era, the site of specialist treatment of pauper lunacy had shifted from the parish community to a new type of institution known as a Pauper Lunatic Asylum. The consequence of this growth of specialist facilities for the insane was the creation of a large population of inmates held for different periods in total institutional asylums, their numbers rising relentlessly throughout the nineteenth and early twentieth centuries. It is the location of these new lunatic asylums within the expanding commercial world of capitalist production that has become such a focus for debate amongst historians of insanity. In his fundamental contribution to the study of madness in western societies, Michel Foucault was not primarily concerned with the physical fabric of asylum care or the growth of a complex machinery of medical science. Foucault was interested in the ways in which laws of nature, scientific rules or ‘games of truth’ were formed and in how the human subject was constituted and constituted himself or herself.5 Foucault intended to provide a dark narrative of the European Enlightenment as the triumph of unforgiving Reason embodied in the spread of scientific surveillance, though his primary concern was with the role of psychiatry and other scientific discourses in providing modern society with a memory – not only of disciplinary boundaries within institutions but of the disciplinary boundaries of knowledge including the science of psychiatry.6 Whereas the melancholy of Herman T. was a private affair made public by the physical apprehension and cleansing of the body, the key passage in the certification of Sarah L. was her reported revelation to the certifying physician that she had ‘informed me that she ought to go again to an Asylum’.7 The integration of the idea of the asylum as the necessary destination of the mad and the wayward had been absorbed by the public mind and into the memory of those who required treatment. Such a reading of the contemporary record may vindicate Foucault’s emphasis on the growth of moral restraint in bourgeois society, the chains of the madhouse replaced by the bonds of self-discipline. We could understand an appeal to the humanity of the subject as an appeal to the subjection of the

Introduction 3 self by rational individuals. A new and more specialised system of penal, medical and moral regulation was introduced during the later eighteenth and nineteenth centuries as the pursuit of new theories of treatment ensured that specialist knowledge should be employed to observe and direct the restoration of the individual to an understanding of their obligations. The clinic, asylum and reformatory were born as the new rational order associated with the bourgeois modernisation of society was expanded.8 Human beings were scrutinised and rules for their functioning were devised. New versions of normality were provided by medical science and absorbed into the body of society. Even in a remote village, the boundaries of subjective experience and personal confession had been drawn more tightly by the fixing of the asylum on the county horizon. Numerous writers have challenged and refined the account of the rise of the asylum provided by Foucault. Critics have noted the ambiguities which remain in Foucault’s account of knowledge, power and the capacity for resistance.9 Not only does his genealogical narrative of the confinement of the mad in early modern Europe include some extravagant historical inaccuracies, but his concern with the high politics of knowledge and the architecture of institutional power reduces the cast of historical players to a few seminal figures and obscures the complex world of institutional conventions and community preferences.10 The place of the asylum in an institutional world that Foucault presents as an integrated penal–medical complex has been the subject of meticulous research which heavily qualifies many of his assumptions.11 A very different account of the rise of modernity was provided in the writing of Elias and those who drew on his work. In such versions of the civilising process, social institutions are built by communities which learned through historical experience how to devise solutions to common risks.12 This perspective has informed the careful analysis of Poor Law provision by demographers and family historians such as Richard Smith where the micro-politics of welfare provision are examined in some detail.13 Indeed, versions of the family–community model of welfare demand have been elaborated in asylum studies by a number of social historians and historical geographers.14 Historians of insanity have recently emphasised not only the positive communal responses to such problems as poverty, crime and insanity, but the distinctive chronology of institutional reform in each state and the complex interplay between commercial and public provision.15 Whereas Foucault drew out the genealogy of distinct forms of discourse and the pursuit of knowledge in the making of subjective experience, recent accounts of the commercialisation of European societies during the seventeenth and eighteenth centuries have portrayed an empire of the senses in which bodily desires as well as intellectual curiosities were satisfied through a marketplace for the new and the fashionable.16 Novelty was the rage. Cities such as London became a theatre for the display of scientific marvels, traded across the floors of fashionable premises.17 Roy Porter provided a vivid

4

Introduction

Hogarthian portrait of an age in which quacks jostled with plausible pillpushers, madhouse keepers and sober preachers, pressing their attentions on the affluent and promising the restoration of reason to those lost in darkness.18 Not only is Porter deeply sceptical of Foucault’s claim that a grand wave of confinement swept Europe during the seventeenth and eighteenth centuries, but his social history of mental disorders stands in sharp contrast to the cerebral sketch of the overpowering will to knowledge which marked the age of Bentham and de Sade in Foucault’s account.19 Rather than stressing sharp discontinuities in the evolution of institutional care, recent research has tended to emphasise the positive contribution of private madhouses in the eighteenth century and the continued diversity of market provision in what is widely seen as a mixed economy of commercial, charitable and state provision in this period.20 Where many welfare historians have traced the emergence of institutional care primarily in the response of communities to particular problems and hazards, Porter’s work has reminded us of the presence of commercial as well as compassionate impulses in the English treatment of madness from Restoration to Regency. Closer to the spirit of Foucault’s intellectual assault on the pretensions of psychiatry was Andrew Scull’s formidable interpretation of the rise of the asylum during the long nineteenth century.21 Scull has consistently provided a critical reading of Foucault whilst retaining a profoundly sceptical view of the asylum project and the scientific pretensions of contemporary psychiatrists.22 Scull shares with Foucault an understanding of bourgeois modernisation as the building of a rational institutional order in which the deranged and the disruptive were marginalised by committal to the care of scientific specialists, though he uncovers the foundations of such institutions in the expanding market relations of the eighteenth century. Whereas Porter places the mad doctors of the eighteenth century within a circus of private vices, public virtues and moral treatments, Scull ties the growth of the new psychiatry to the professional advancement of intellectual entrepreneurs within the commercialised labour markets of the long nineteenth century. Both scholars acknowledge the strengthening demand for medical services in a growing service economy, though Scull locates the increasing use of the new asylums in the labour markets of the Victorian decades, as families surrendered responsibility for their relatives to the state psychiatrists. The asylum was, for Scull, located in the landscape of industrialising Britain where the commercialisation of economic life and labour relations weakened many traditional ties and strained the resources of communities which could not cope with the growing numbers of social casualties. The upheaval which followed the commercial and consumer revolutions of the eighteenth century provided the new asylums with their key function in absorbing those individuals who could not function effectively within the new market environment. The purpose of the new asylums was to model social behaviour around the norms of rational bourgeois expectations. Damaged human capital was repaired and worthless labour was warehoused

Introduction 5 in the corridors of buildings which quickly became museums filled with lifeless artefacts of humanity.23 This model of explanation, which draws on Marx and Weber as well as Foucault for much of its chronology of modernisation and the emergence of a rational bourgeois order, has drawn many criticisms over the past two decades. Scholars have often objected to the caustic criticisms which Scull has levelled against the professional ambitions of the psychiatric profession and their role in merely warehousing the mad.24 While Scull and Walton shared a number of conclusions on the care of the insane, recent critics have often contrasted Scull’s emphasis on the role of the asylum in catering for those marginalised by class society with Walton’s comments on the scope for family preferences and support in the decisions on dispatch to the asylum and retrieval of members from thence.25 Others have noted the importance of the Poor Law to the workings of the lunacy legislation, rather than the power of the asylum psychiatrist, in the administration of the pauper lunatics.26 Not only are lunacy historians increasingly aware of the complex demographic and kinship relations which formed the context of Poor Law provision for insanity in the nineteenth and twentieth centuries, they are more inclined to view the mixed economy of care as the product of a set of contractual and bargaining relationships where commercial calculations were only one feature of a continuing process of institutional negotiation. There is more agreement with Scull’s claim that those who used the pauper asylums of the nineteenth century were indeed the poorest groups of society and that the Poor Law authorities made every effort to ensure that the institutions catered for those without resources to pay for their own treatment.27 The present study is designed as a critical reappraisal of current debates on the history of insanity in England during the long nineteenth century, using the Devon experience to explore the limits of existing scholarship. We aim through this case study to examine the making of the new County Asylums which became a universal mandatory provision after 1845 and to consider the rules which governed the movement of the insane into and from these institutions until 1914. We share Foucault’s view that the institution must be placed within a context in which rules of behaviour are being laid down for society and articulated by agencies such as the Poor Law. Insanity was an act of transgression against rules which were both legal and social. Herman T. was not given the space for his own version of events to be recorded before his body was cleansed and his mind restored. Sarah L. was observed not merely to have transgressed the boundaries of the respectable by wild behaviour which threatened sexual scandal and physical violence, but her obscenities were noted and her confession of insanity recorded in the legal instrument which returned her to the asylum. On arrival at the asylum there would be an intimate examination of her body and her state of mind to ascertain the precipitation of her madness for the record. The methods offered by Foucault give us only a limited resource for

6

Introduction

understanding the complex social environment in which insanity was apprehended or the intricate institutional politics which defined access to treatment during the nineteenth century. As noted earlier, numerous writers have cast serious doubt on the narrative chronology suggested by Foucault and the exaggerated place accorded to the psychiatrist in the process of confinement. The main argument presented in our own study is that not only Foucault but many historians of insanity have overstated the degree to which asylums represented modern bourgeois values in which individual accountability was secured by rational direction. In contrast to the argument presented by Scull, we suggest that the County Asylum as well as the Poor Law remained a locus for social conflict throughout the nineteenth century and that the control of the asylum was contested for much of this period. Rather than the asylum simply imposing a dominant or hegemonic model of treatment on distinctive localities, we suggest that the identities of class, gender and ethnicity (or race) were negotiated via the rules of the asylum and that a variety of groups were involved in the disposal and retrieval of the pauper lunatic. We will argue that the functions and the meanings of the asylum were determined by the engagement between these different parties rather than prescribed in the structures of the institution itself. In this study we understand institutions to be a set of rules and collective practices which regulate the behaviour of people in society. The regulations governing both pauperism and insanity were underpinned by provisions made for the relief of the individuals who qualified for support. The functions that these rules perform clearly depend not only on the tasks defined by the state in legislation but also by the ways in which people understood and used the law, as well as the resources offered to those who came within the meaning of the regulations. We suggest that in Devon the social leadership of the landed gentry proved a significant theme in the promotion of the asylum as a monument to a patriarchal vision of moral regulation in which religious figures played a significant part. During the course of the period, the Poor Law itself was transformed and with it the relationship between the central state and local government that was registered in the changing routes of accountability for the asylum. The final section of the book develops these arguments in relation to the politics of community, class and gender in Victorian England before we turn to consider treatment inside the asylum and the process of discharge and departure. Our discussion suggests that the asylum occupied an important role not only in drawing the rules of normal behaviour in relation to domesticity, class and community, but also figured in the wider network of institutional life that defined the relationship between the citizen and the state in the later nineteenth and early twentieth centuries. We argue that, like the Poor Law system which had figured so prominently in its development, the asylum model had exhausted its potential for innovation long before the 1890 lunacy legislation placed it within a legal

Introduction

7

framework that prescribed more rigorously the terms on which treatment could be imposed on individuals. The classical chronology of insanity treatment offered by Foucault which was outlined above can be easily disrupted by a closer analysis of the complex institutional and state politics which accompanied asylum administration during the nineteenth century. The procedures by which the insane were identified, classified and counted in and out of the public asylum were part of an intellectual labour by which fields of knowledge were created and the sheep distinguished from the goats, their specific nature being entered as the scientific ‘facts’ faithfully recorded by Lunacy Commission statisticians, compilers of Select Committee appendices and commentators generally.28 There were also fields of what we might term private knowledge by which different groups restricted the dissemination of that which might be known or deployed in a strategic way, so that what was stated in one place might be withheld in another. Such disclosures might not merely distinguish what was privately known from what was publicly acknowledged, but different institutions might structure and classify information in ways which conformed to rules that were not shared by other agencies. The ‘pauper’ status of those sent to the Devon asylum deserves close attention. Returning to Cheriton Fitzpaine in the period when Sarah L. and many other domestic servants were readily admitted to the County Asylum as lunatics, we find females who appeared to have access to significant resources being certified. One such individual was a farmer’s wife detained for a week in the Crediton Union workhouse before being dispatched as a pauper lunatic to the asylum.29 At the same time, the unmarried Emma P. and Mary Ann V. (the latter the daughter of a farmer), were living with their families in Cheriton when the census enumerator called at their homes in 1881 and classified them as ‘imbeciles’.30 In other Unions the enumerators described the domestic circumstances of numerous ‘lunatics’ who were resident at home, even as heads of their households, rather than committed to the care of others.31 There clearly remained a variety of ways in which people believed to be mentally impaired or insane might be represented or portrayed. The provisions made for their care depended on the micro-politics of the immediate household or community as well as the practices of Poor Law physicians or census enumerators. The following chapters will argue that the entry of an individual into a category of medical infirmity and the selection of a person for different kinds of institutional care were the outcome not only of the creation of scientific fields of knowledge, mapped out by professionals serving the demands of the imperial state, but also the result of a range of assumptions and perceptions by different lay actors. The state’s growing concern with the experience of family life and childhood and the condition of family life certainly provided an impetus to debate and reform that largely excluded consideration of the adult institution. As local government assumed control of these asylums in the closing years of the century, the lay authority of the magistracy was

8

Introduction

steadily weakened and the status of the medical professionals probably increased as the connections with the Poor Law diminished. There were few challenges to the principle of the larger, central public asylum and its mode of treatment before 1914, though it is important to note the continuing role of voluntary initiatives in this world of limited horizons. What is also apparent is that the disclosure of relevant details and the decision of professionals and state servants to know and register the existence of different forms of insanity depended on the specific politics of state institutions as well as the way in which families, communities and other agencies mobilised to support a particular course of action. In the following chapters, we suggest that it was the interplay between different groups of actors which determined the functions of the asylum as much as the unfolding logic of scientific discourse, and that the committal of the insane to public asylums can be understood not only in terms of the triumph of rationality but rather as one of the most visible structures in which a doctrine of public utility was contested by a vision of compassionate responsibility. The fusion of the principles usually associated with Philosophical Radicalism with a commitment of care for those incapable of free agency (including the poor insane), produced a peculiar kind of political narrative which could be celebrated as a moralised political economy that enabled the ineffective to be protected by the law. In developing this analysis of the provision made for the poor insane, we draw most of our evidence from a specific asylum in the South West of England. We argue throughout the book that Devon provides excellent sources for an assessment of asylum provision in England and Wales, for at least three reasons. First, these institutions were developed as a comprehensive solution to the perceived problem of insanity across England and Wales and were linked to the national Poor Law of 1834, sharing a common legislative and administrative framework. Recent research has also underlined the distinctive legal and administrative system which regulated pauper lunacy in Scotland and Ireland during the nineteenth century, where the provisions of the Poor Law differed markedly from the requirements of the English legislation.32 The voluntary initiatives which were so important to the growth of subscription asylums and facilities for those deemed mentally defective in England and Wales were even more significant to Scottish development, whilst the distinctive ethnic and political conflicts of Ireland ensured that the relations between the state and civil society were reflected in the pattern of insanity provisions.33 The peculiar status of the majority religions in Scotland and Ireland, as well as their distinctive pattern of Poor Law provision, was registered in the separate evolution of lunacy legislation within the United Kingdom during the nineteenth century. These variations indicate the impact of the specific politics of insanity reform which enclosed the passage of state legislation during this period. The relationship between ‘local’ populations and the central government remained a major theme of asylum administration throughout the period we discuss. Within England

Introduction 9 and Wales, the control of the Poor Law, asylum administration and other state agencies remained a matter of contention. A second rationale for a detailed analysis of south-west England is that the region formed part of a British economy undergoing economic and social changes which have figured prominently in discussions of the institutional treatment of insanity in the decades of mass migration, industrialisation and urban change. A common criticism of individual asylum studies is that they provide us with detailed descriptions of the internal dynamics of the institutions and the therapeutic regimes within them, but offer fewer insights into the wider political, social and cultural context in which insanity itself was apprehended and addressed by contemporaries.34 In depicting the peculiar social and political geography of the South West, we are seeking to locate the workings of a distinctive county institution within the chronology of the wider economy and society of Victorian Britain. During the course of the nineteenth century, Devon moved from being one of the largest, most populous and prosperous areas of Britain to a remote and peripheral segment of the capitalist economy in which new industrial investment was largely driven by the state’s naval production at Plymouth within the developing political order of the greater imperial state of this period.35 Our third reason for the intensive study of institutional provision within south-west England is the opportunity provided for a close examination of political and cultural history of institutional provision. The governance of the English asylum was shaped not only by the system of administration dictated by the English Poor Law but by the intended and unintended consequences of preferences and struggles pursued by different social groups. For the construction and maintenance of the asylum indicated that the cultural expectations and political assumptions involved in the specialised care of the insane differed in important respects from those which guided the architects and enforcers of the Victorian Poor Law. The asylums were not established to ‘test’ the needs of the insane in the ways that the workhouse was designed to monitor the destitution of those seeking relief, nor were those certified as lunatics maintained in conditions of institutional hardship to ensure their lesser eligibility than those maintained by their families. These distinctions between workhouse and asylum care continued to be fought over in the political struggles between and within social classes in the middle decades of the nineteenth century. In later decades, struggles around the direction and management of the asylum, which we have termed the ‘politics of madness’, moved from the magistracy to local government. Reform of county government in the 1880s was undertaken at a time when Poor Law provision for those termed lunatics, idiots and imbeciles also came under closer scrutiny and when the legal requirements governing private asylums emerged as an issue of vigorous debate. The chapters are arranged in a way that should enable the reader to trace the journey of the patients alongside the institutional pathways which led to

10

Introduction

and from the asylum, within a larger landscape of economic and social power. Chapter 2 outlines the legislation that formed the national context in which English and Welsh asylums were built and inhabited during the Victorian decades. It is possible to trace a relationship between this intellectual and political context and the therapeutic regimes devised for the institutional treatment of lunacy. Historians of psychiatry have long debated the significance and decline of moral treatment as an institutional therapy which rejected the use of mechanical restraints and emphasised the appeal to the individual’s sense of moral as well as rational order.36 There is general agreement that moral treatment sank beneath the flood of chronic admissions to the new asylums during the mid-century decades and the move of psychiatrists such as Maudsley to a sombre hereditarian outlook.37 Even the dedicated advocates of moral treatment within the asylum, such as John Charles Bucknill of the Devon asylum, later treated the asylum model with some scepticism.38 Read within a social context where moral treatment had often figured in the promotion of a specific ideology of social obligations, the subsequent emergence of ideas of biological inadequacy, scientific grading and national efficiency appear to have accorded the asylum a rather different role within the political economy of progress as the receptacles for the unfit. The terms of this later discourse of segregation, as well as the platforms on which it was conducted, drew attention away from the moral authority of lay people within the localities and focused instead on the engagement between scientific expertise and the central state. Nor had the county and borough institutions provided a dynamic model for innovative policy-making. Asylums had succeeded only too well in their purpose of attracting substantial numbers of certified inmates but, despite reasonably high cure rates, they had failed to overcome the popular anxieties that assisted the passage of the 1890 lunacy legislation. It was not until the First World War that a major reappraisal was possible. Subsequent chapters address the role of the Poor Law in the administration of lunacy legislation and the governance of the English asylum, as well as the standards of care offered to patients within the management system devised for such institutions in the later nineteenth and early twentieth centuries. We note that social interests mobilised behind the foundation of an asylum varied across the different regions, though the pattern of support established in Devon appears to have held for a number of other counties across England.39 The leadership of pro-reform aristocrats and landowners together with the clergy and other moral campaigners was able to overcome the resistance of the farmers and other rate-payers who feared the imposition of heavy Poor Law rates to support grand new mansions to house the insane.40 In such instances the promotion of the asylum as a monument to what has been termed the ‘Beau Ideal’ of the English historical landscape would lend support to those scholars who have emphasised the role of the gentry in the making of the Poor Law and other social reforms.41 The slow relaxation of aristocratic control evident in Devon and some other counties

Introduction

11

during the nineteenth century provides an insight into English politics which contrasts with the prevailing orthodoxy on the pervasive importance of Radical ideas in political rhetoric found in recent studies of the nineteenth century.42 Our concern is to emphasise the rather different continuities of non-Radical values and the success with which the forces of tradition were able to capture the terrain of reform for their own visions of the moral society. The chapters that follow our discussion of the legal and institutional framework of asylum care deal with the physical environment and social circumstances associated with the identification, certification, committal and discharge of insane individuals in this period. We consider the impact of migration, family and community ties, gender relations and class membership on the pattern of admissions, residence and release detected in the institutional sources examined. In contrast to some recent interpretations of asylum care, our assessment of economic and social change in Devon indicates that mass migration, urbanisation and the disruption of family households did not appear to have had a profound direct impact on asylum admissions in the Victorian and Edwardian decades. Differences in household, family and community ties can be clearly detected in the admissions recorded at private as well as public asylums in Devon at this time, though it seems more plausible to understand the patient’s world in terms of a complex web of intricate connections where age, marital condition, household status, gender and class all figured in the journeys made to and from these asylums. Females appeared in rough proportion to their presence in the larger population, while unmarried and married people in their middle years made up the bulk of those admitted to the asylum. Unmarried long-stay patients and the elderly constituted a growing presence within these institutions by the end of the century. While class has figured less prominently in recent discussions of the social and cultural history of insanity than the role of gender and family ties, our study reconsiders the emphasis placed on occupation, income and class in the earlier work of Scull. An analysis of the occupational profile and social status of those entering the public as well as the private asylum in these decades indicates the considerable diversity in the personal and family backgrounds of patients, as well as the contribution of these institutions themselves to contemporary classification in regard to social status and personal reputation. The final chapters of the text return to the question of the patient experience of institutional care in the Victorian and Edwardian decades. Retrieving the individual and collective encounters which people had with the asylum is a task fraught with difficulties, not least because the great bulk of surviving testimonies come to us from professional and personal witnesses whose transient perceptions were selectively translated into documentary evidence. Between the standard requirements of the legal instruments and the mass of specific personal detail found in certificates and medical case notes, it is possible to detect some consistencies in reportage which enables

12

Introduction

historians to trace an echo of the voices of witnesses and, more rarely, those of patients themselves. Our analysis points to the continuing importance of social and cultural criteria in the assessment of the origins and extent of insanity after the certification of the individual, in the medical portraits compiled during their residence in the asylum and at the time of their release. The distinctive ways in which pauper and private patients were portrayed by the institutions charged with their care reveals both the obvious and more subtle ways in which the disordered mind was understood by those who surrounded the individuals certified in these years.

2

The origins of the asylum

The purpose of this chapter is to provide an outline of the history of the four institutions which will feature as the main case studies for the remainder of the book. These institutions were all governed by legislation passed during the period we are discussing and it is worth briefly recalling the statutory obligations laid upon them. Before 1845, the acknowledged places of confinement for lunatics were private licensed houses, charitable and subscription hospitals, in individual dwellings or in those County Asylums which were established under enabling legislation of 1808.1 This early statutory provision was followed by four major periods of reform from 1845 until 1890. The legislation of 1845 provided a new framework for the provision and administration of institutions designed to confine the lunatic. The two acts passed in that year established a central body responsible for the regulation of asylums and licensed houses in the shape of the Lunacy Commission. Its first and highly influential chairman was Lord Shaftesbury who had played a prominent part in the passage of these reforms. The Commissioners were responsible for the inspection of all such institutions. The legislation also required every county and borough authority to provide asylums for the reception of pauper lunatics. These institutions were to be governed by Boards of Visitors composed of Magistrates appointed by the Quarter Sessions which assembled each quarter to administer justice and oversee local governance. The legislation also provided for the certification and committal of individuals to the pauper lunatic asylum. An individual was first certified as insane by a licensed medical doctor and the order to commit such a person to the asylum was issued by a Magistrate or alternatively by an officiating clergyman together with a Relieving Officer of the Poor Law for the Union in which the person resided.2 These features of Poor Law administration form an important part of our later discussion of the asylum, the Relieving Officer being the senior official in the service of the Guardians who were responsible for the implementation of the Poor Law in each district. The next phase of reform arrived in 1853 when measures were passed consolidating the earlier legislation and strengthening the power of the Home Secretary and his agents, the Lunacy Commission, in regard to the private (non-pauper) asylums and licensed hospitals. The second statute of

14

The origins of the asylum

that year strengthened the power of the Lunacy Commission in regard to the building and governance of the pauper lunatic asylum.3 Fresh legislation in 1862 changed the requirements on the local Poor Law Unions to dispatch their lunatic inmates to the pauper asylum. The new act allowed chronic lunatics considered harmless and unlikely to improve to be held in workhouse infirmary wards which met the standards required and approved by the Lunacy Commission.4 The original Poor Law Act of 1834 had said little about pauper lunatic provisions in workhouses, referring only to the limited period (14 days) during which a lunatic might be held.5 The safeguards introduced under the legislation of 1845–1862 did not prevent the growth of a public campaign led by ‘The Alleged Lunatic’s Friend Society’ and other groups concerned to limit the scope for false certification and imprisonment. Shaftesbury argued vigorously against the introduction of any restrictions on the powers of the Commissioners, Visitors and practitioners who administered the asylum system he had helped to introduce. There was no significant lunacy legislation between 1862 and 1890 but, in 1890, an Act of Parliament was in force which stemmed from widespread concerns about the corruption and falsely based certificates of people by their relatives. The Lunacy Act of 1890 provided a formidable response to the complaints and fears of abuse in the form of a detailed statute with 342 sections.6 In Part One of the 1890 legislation, the procedures for the issuing and use of different kinds of orders were laid out. The second part of the act dealt with the care and treatment of the certified, provided for the rights to visits, freedom from restraints, discharge date procedures, appeals against a refusal to grant discharge and so forth. The significance of contemporary concerns over the property of affluent lunatics was indicated in the later parts of the legislation which increased the power of the Lord Chancellor’s Office, and the Lunacy Commission itself, to monitor all places where the insane were housed. There was indeed a specific court jurisdiction to oversee administration of the property of affluent lunatics, which fell to the Lord Chancellor, who appointed Masters of Lunacy, judges to hear cases in relation to those served by Visitors in Lunacy who investigated such cases and reported to the Masters of Lunacy. The primary concern of this book will be with the Devon County Asylum which was built in Exminster near Exeter and which was the pauper lunatic asylum for Devon. It was opened in 1845 and by 1914 it recorded well over 13,000 admissions. This was by far the largest institution of its kind in south-west England and the great majority of people who were admitted to an asylum in Devon were inmates of Exminster. There were two other pauper lunatic asylums erected in the later nineteenth century which were designed to serve the boroughs of Exeter and Plymouth. As we discuss in Chapter 3, these asylums were opened following a long and determined campaign by the Lunacy Commission in part because of overcrowding at Exminister and in part because the Lunacy Commission was determined to compel these boroughs to build their own provisions. The Exeter Asylum

The origins of the asylum 15 was established at Digby’s Field just outside the borough in 1886, after many years of discussion and debate. The larger city of Plymouth did not build its own asylum until Moorhaven was opened in 1891. The fourth institution which we discuss at different points in the text is a major private asylum sited near Exeter and which was eventually known by its location from 1869, namely the Wonford House Asylum. This institution long pre-dated the pauper asylums, being founded as a voluntary charitable asylum at the end of the eighteenth century in the parish of St Thomas on the edge of Exeter in 1801 and for many years known as Bowhill House and subsequently St Thomas Hospital. Whereas the Devon County Pauper Asylum saw 13,000 inmates pass through its gates between 1845 and 1914, this was because the population of Plymouth and Exeter were very much smaller than that of Devon, whilst the numbers of affluent people sent to private asylums were also small in comparison to those of pauper lunatics. These other institutions were both smaller in size and served small populations. The Wonford House Asylum admitted less than 2,000 people on a private fee-paying basis. Digby admitted about 750 people in the first decade of opening. Moorhaven in its first two decades admitted well under 2,000 people to its premises.7 The Devon County Asylum dominates the story of institutional provision for pauper lunatics in the Victorian and Edwardian periods and we will now briefly examine its origins. The Exminster asylum opened its gates a few weeks before the passage of the 1845 Lunacy Acts.8 The county was one of a small number to agree on the construction of an asylum before the legislation was passed. The Devon County Pauper Asylum was located in the village of Exminster, four miles from the county town of Exeter. In the early formative decades of its life, it was governed by a Committee of Visitors. The Visitors were Justices of the Peace directly appointed by, and answerable to, the County Quarter Sessions each year. Whilst the 15 Devon Magistrates who comprised this body could decide on most administrative matters at their monthly Visitors’ gatherings, the Quarter Sessions resolved on major questions such as applications for approval of new building projects to the central Lunacy Commission. It was not until 1888, more than four decades after Exminster opened its doors, that County Councils were created and given the responsibility of managing such places. It is worth recalling the extent to which the new County Pauper Lunatic Asylum dominated the treatment of the pauper insane for much of the nineteenth century in Devon, and its influence as a model for institutional treatment beyond its own walls. From 1845 until 1914 the Devon asylum provided residence and treatment for the overwhelming majority of people certified as pauper lunatics within the county. Although the legislation of 1845 had envisaged the provision of borough as well as county facilities through England and Wales, many boroughs showed themselves remarkably resistant to the directions of the Lunacy Commission and preferred to make

16

The origins of the asylum

contracts with the Shire County rather than incur the expense of building their own asylums. The private establishments licensed by the Quarter Sessions and the hospitals registered for the insane included Plympton House near Plymouth, housing 32 pauper lunatics in 1847. The only other registered hospital in Devon to receive a significant number of Poor Law clients was Bowhill House. Whilst this charitable foundation accepted a number of paupers along with fee-paying residents in its early years, the institution subsequently moved to cater primarily for ‘gentlemen’ and ‘gentlewomen’ and was relocated in the village of Wonford in 1869, becoming known as Wonford House.9 The other major amenity in Devon, which specialised in dealing with the category of ‘idiots’ and ‘imbeciles’ (as distinct from ‘lunatics’) was the Western Counties Asylum for Idiots, a subscription institution opened in 1869 and dedicated to the training of children certified educable within those categories.10 It is worth noting that imbeciles were distinguished from idiots in that the latter were seen to be very profoundly defective of cognitive thinking abilty or brain function, imbeciles somewhat less so. Indeed Bucknill and Tuke in their dictionary published in 1858 specifically described idiocy as a complete lack of intellectual faculties (quoting Esquirol) often from birth (quoting Pritchard) whilst imbecility they described as ‘a minor degree of mental deficiency’ at worst not diminished to idiocy but at best leaving the person able to show affection, hold conversations, make jokes, in other words imbeciles had a markedly low capacity to reason, idiots had never had this.11 Many of the figures who were prominent in the campaign to establish a County Asylum under the enabling legislation of 1808 and 1828 were also leading patrons of various voluntary and charitable bodies established during the early nineteenth century. The tenth and eleventh Earls of Devon were high Tories, the dominant figures at the Devon Quarter Sessions from 1830 until 1888.12 These two aristocrats were remarkably active promoters of voluntary and state amenities for the infirm, as well as being actively involved in national projects of institutional innovation.13 They led a powerful group of Devon Tories promoting the asylum project against stubborn parish resistance from Poor Law authorities and the rate-payers they represented. The tenth and eleventh earls were prominent advocates of social reform whilst adhering closely to a traditional Christian vision of service, obligation and charity. Indeed it is possible to exaggerate the contemporary impact of political economic principles so influential in the 1830s and overlook the parallel significance of this Tory evangelical reform movement and their common concern to educate and regulate the poor in citizenship. Indeed the influence and connections of the Courtenays as Earls of Devon stretched far beyond political leadership in the county. The family was strongly aligned with the politics and personality of Anthony Ashley Cooper, Lord Shaftesbury, who chaired the national Lunacy Commission for four decades, and whose family seat was in next-door Dorset.14 The future eleventh Earl of Devon served as Secretary (1850–1859) and then President

The origins of the asylum 17 of the Poor Law Board itself from 1867–1868. It is worth noting that Tory evangelicalism embraced a diversity of views on both moral issues and political economy. The struggles within Devon reflected the serious regard in which the principles of political economy were held even by many Tories alongside the conflicts which beset the contacts between the Powderham set and their adversaries in Okehampton.15 This commitment to protective legislation amongst the Tory elite at county and national levels became apparent in the Courtenays’ strong support for the Reverend William Palmer’s project to launch a Devon asylum with the support of his fellow Magistrates. Strong opposition met the original proposal at the 1830 Quarter Sessions, where organised ratepayers protested at the burdens which would be imposed on those ‘least able to bear it, the tenantry and small freeholder’.16 The parish of St Thomas itself (where the Courtenays lived and were to organise the St Thomas Board of Guardians) joined 30 others in protesting at the unwarranted exercise of power by the magistracy ‘which the Yeomanry will not justify’.17 In the face of determined hostility from the mass of cultivators in the county, the project faded until the passage of the New Poor Law in 1834, which spurred Reverend Palmer to assert that the fresh legislation made it illegal to detain dangerous lunatics within the workhouse over lengthy periods of time.18 Palmer’s appeal was answered by a counter-blast from a clear ideological opponent to the Tory patriarchal vision. Calmady Pollexfen Hamlyn was Chairman of Okehampton Board of Guardians and a leading Malthusian, free-market Liberal Magistrate who claimed as much moral concern as anyone else for the well-being of the insane, but who was as anxious for ‘another class’ who ‘still retained their senses but were struggling against the most depressed circumstances’.19 His concern was that scarce resources would be expended in ever-increasing amounts on lunatics whilst the class of industrious deserving poor whom he called ‘yeomen’ struggled to pay their rates often in very adverse circumstances. Hamlyn failed to attract the support of Lord Ebrington and the Whig patricians who supported the asylum project, including the possible conversion of a military barracks into a facility for the insane.20 Here was illustrated the fact that within classical free-market liberal principles of the times there was a tradition emphasised by Ebrington of restorative intervention or rescue. This is illustrated in the original vision of specialist workhouse provisions in the mid-1830s and by extensive prison reform projects at the same time aimed in part at the rehabilitation of prisoners. The Courtenays proceeded to mobilise a powerful cabal of Tory landowners in the new St Thomas Union formed by the Poor Law.21 The tenth Earl, Lord William Reginald Courtenay, prepared his campaign at a meeting in North Devon in early October 1836 before inviting the Assistant Commissioner of the Poor, W.S. Gilbert, to address a meeting in Exeter. Courtenay presented the assembled Guardians of all the Devon Unions with a stark choice of dedicating a wing of their Union workhouses

18

The origins of the asylum

as a specialist asylum facility for dangerous lunatics or approve a central County Pauper Asylum.22 This announcement clearly weakened the resistance to the county project in view of the inevitable expenditure which would be required for workhouse incarceration of lunatics, and Gilbert completed the case for the Asylum by suggesting that a curative institution would prove economical in the longer term by securing the return of the individual to productive labour.23 The case for relying on the commercial trade in asylum accommodation was expressed by Plympton St Mary Union, where the wellknown and later notorious private-licensed premises at Plympton House were situated.24 This and further meetings sought to restrain resistance by promising to limit the cost of the project and submitting the asylum ‘ultimately to the control’ of the rate-payers.25 Many rural Guardians elected under the legislation of 1834 were staunch defenders of the ‘yeoman’ interest against what was perceived as the grand projects of the patrician aristocracy and their retinue, which local rate-payers would have to fund. In promoting their schemes the Courtenays sought to shift the onus of responsibility on to their critics by proclaiming the failure to build a new asylum to be a ‘stigma on the county’.26 Unable to mobilise the rural Guardians, the asylum advocates used the Quarter Sessions to approve the scheme in 1840, urging the doubters that Parliament was about to introduce compulsory legislation to provide facilities ‘for this unfortunate class of person’.27 The Courtenays sold the land at Exminster for the new County Asylum and the architect Charles Fowler visited Bethlem and various provincial asylums as well as Pentonville Prison before completing his designs for the new institution.28 The foundation ceremony provided an occasion for aristocratic ritual presided over by the ‘leading families both of the county and city’, at which the Provincial Grand Lodge recited prayers that ‘the Grand Architect of the Universe grant a blessing on this foundation stone’.29 Before the stone was set the worst fears of the rate-payers had been realised in the escalation of project costs from £10,000 to more than £30,000 and by April 1845 it was apparent that the final expenditure would approach £60,000 before the doors were opened.30 The spiralling costs helped to poison the relationship between the county Magistrates who controlled the Visiting Committees of the Asylum and the Guardians who supplied the pauper lunatics entering the elaborate gateway which stood at the end of the long drive to the central block. The circumstances surrounding the establishment of the asylum are strong evidence of the paternalistic framework through which the Courtenays and other Devon grandees viewed the project. These saw pauper lunatics as part of society who would learn deference, gratitude and propriety if given charitable provision of orderly, stratified, kindly institutional care. The arrival of John Charles Bucknill at the Devon County Asylum was to contribute a personality to the struggle between the Visitors and the Poor Law who ensured that the sins of the local Guardians were given a full airing in the scientific press as well as in correspondence with the Lunacy Commis-

The origins of the asylum 19 31

sioners. The everyday management of the Exminster establishment and the medical regime created within its walls was the responsibility of the medical superintendent and his staff. Bucknill enjoyed a growing reputation both as an advocate of moral treatment and a defender of the professional status of the asylum psychiatrist, although his staff formed a modest complement in the 1850s. Appointed as a young man in 1844, Bucknill carved out a public reputation as founder and editor of the Asylum Journal of Mental Science from 1854, and in 1858 he published with Daniel Hack Tuke the influential Manual of Psychological Medicine, which famously advised the student of insanity that he ‘will not go far wrong if he regards insanity as a disease of the brain’.32 In 1862, Bucknill left Devon for the prestigious post of Visitor in Lunacy in the Lord Chancellor’s office, responsible for the protection of the propertied insane rather than the pauper lunatics who were the wards of the Poor Law.33 Bucknill’s aetiology of lunacy was essentially that it was a presentation of constitutional and pathological disorder. The origins of insanity lay in organic disease and therefore the existence of ‘any pathological state in the organ of the mind will interrupt the functions of that organ and produce a greater or lesser amount of disease of mind, that is of insanity’.34 Bucknill followed the pioneers of new moral psychiatric treatments including William Browne, James Conolly and Robert Gardiner Hill in rejecting mechanical restraint and a regime based on ‘fear of the lash, fear of the bond’.35 Removing the ‘brand of shame and degradation’ left by physical restraints, Bucknill sought to appeal to the power of the individual’s will to overcome their madness and recover their reason.36 This echoes Foucault’s celebrated discussion of Pinel’s breaking of the chains of the asylum and Tuke’s abolition of restrictive gags, replacing them with the interior mental regulation of moral self-discipline.37 It is also apparent that the practical application of moral treatment in most Victorian asylums consisted of directing the inmates towards regular physical labour and duties which were arranged along a graded scale of personal responsibilities, thereby rehabilitating those whom Walton describes as ‘the deviant, dissolute and depressed’.38 Bucknill was concerned with the relationship of class and the segregation of lunacy provision in Victorian society. He pronounced himself firmly opposed to the admission of middle-class fee-paying patients into the county pauper asylums and also argued, in views which echoed other observers on the plight of the respectable poor, that the independent poor who formed that ‘struggling and suffering class intervening between wealth and pauperism’ should be the subject of charitable effort in subscription hospitals and licensed houses rather than mixed with the broad mass of pauper lunatics.39 The ‘middling’ lunatic might therefore be catered for by voluntary, charitable endeavours whilst the public asylum catered for the broader mass of labouring poor. The superintendent also resisted the admission of children into the asylum at Exminster, arguing that the facilities did not permit the separation of the young and the adult.

20

The origins of the asylum

A more careful reading of the sources would suggest that both the rhetoric and the institutional politics of insanity treatment performed a more complex role in nineteenth-century England than these familiar extracts would allow. The therapy offered by the Devon asylum under Bucknill combined a wide range of traditional treatments with a humanist approach to the individual. Bleeding, blistering, bathing, puncturing were deployed along with liberal doses of narcotics to the excited and the violent. Records of bowel movements as well as head temperatures were recorded in the case notes which charted the patient’s progress in the asylum. If moral treatment suited the early years of optimistic reform, the continuing disappointment of Bucknill and others that post-mortems did not reveal the seat of brain disease led even the advocates of moral treatment to demand greater rigour in scientific enquiry. In a passage which foreshadowed the devastating attacks made by Maudsley on his predecessors in British psychiatry, Bucknill and Tuke complained that ‘no term has of late been more profusely and empirically employed, and none has been less understood than the moral treatment of insanity . . . if the English physician looks to the writing of his countrymen . . . he finds little more than vague generalities.’40 Because of his belief in the constitutional origin of insanity, Bucknill never shared the enthusiasms of some of his contemporaries for any huge therapeutic results of a ‘moral management’ regime of firm rationality, kindly consideration and dignified institutional milieu. His major concern was with humane treatment. Nonetheless he did believe that such a regime would act as a soothing influence on extreme feelings and behaviours in part because lunatics and imbeciles would be less frightened and stressed than if cruelly or neglectfully treated and that by repetition some permanent ameliorations could be achieved, particularly if such treatment was continued after return to the community. For this reason the asylum role of being a beacon and example of good practice was particularly important. Despite a deepening pessimism about the efficacy of asylum treatments, Bucknill retained a humanist approach to psychiatry and expressed an ‘extraordinary abhorrence’ at the contemporary claims for the inherent superiority of some races over others, warning of the oppressive implications of such arguments.41 If Bucknill’s philosophical inclinations were divided between an aspiration to scientific rigour and an inclination towards a humanist view of therapy, so also did his professional practice vary between absolute pronouncements on the segregation of the insane and the acceptance of a tiny number of fee-paying patients before 1850, as well as a handful of criminal lunatics during the 1850s.42 The tensions which emerge in the medical practices of leading psychiatrists such as Bucknill were exposed even more vividly in the institutional politics which marked the early development of the County Asylum. Central to the public administration of lunacy in the nineteenth century was the institution of the Poor Law.43 As noted earlier (pp. 1–2), whereas the parish overseers acted to redeem Herman T. and dispatch him to a physician

The origins of the asylum 21 specialising in the cure of melancholy, a Relieving Officer was involved in the committal of Sarah L. to the care of the public asylum psychiatrist. In each case the Poor Law served as the legal vehicle for the dispatch of the insane. After 1834, the workhouse medical officer was appointed to fulfil multiple duties within the Union and could play a key role in the initial examination of an individual within the workhouse infirmary and in advising the Relieving Officer and Board of Guardians on the threat posed and the best course of treatment available.44 More frequently, the putative lunatic was examined at the house of a District medical officer or other physician (and/or the family home) before an initial decision on certification was taken.45 It was the responsibility of the parish Overseer to report any incident and the formal duty of the Relieving Officer to arrange for the conveyance of the certified individual to the workhouse or the County Asylum. To increase the incentives on Guardians to utilise the asylum, the state introduced in 1874 a mandatory grant of four shillings per week towards the cost of pauper maintenance in the asylum in order to reduce somewhat the marked differential in expenditure between asylum and workhouse residence.46 This system placed the officers and contracted employees of the Poor Law in a formidable position to effect or obstruct the enforcement of the lunacy legislation of the period. Even more important to the definition of the policy of each Union was the outlook of the Board of Guardians and their predisposition towards the county institution. From his earliest days, Bucknill, in common with some other asylum superintendents, blamed the low recovery rates and high death rates recorded within their institutions on the Poor Law authorities who dispatched what were seen as hopeless incurables to the care of the new institutions. The contempt which he frequently expressed for the medical officers who usually issued the certificates of insanity and often served as workhouse infirmary officers contrasted sharply with his ready defence of the untrained Exminster attendants who were to be accused of gross misconduct shortly after his departure from the establishment.47 The sustained invective against local physicians which eventually attracted the attention of the Lunacy Commissioners in London cannot be completely explained as the product of an irascible ego but requires the kind of attention to moral environment which Bucknill himself would have appreciated. For Bucknill’s strictures were levelled not only against the delinquent officials of the Poor Law but also the families and communities which housed the insane within their midst. In such instances, the alert publicist was ready to harness the machinery of the Poor Law Commission to uncover instances of gross abuse, which he pressed courts to punish at the Assizes where relatives appeared. Such moralised campaigns formed part of an intense struggle for the discovery and control of the insane during the middle decades of the nineteenth century, in which the advocates of the County Asylum fought to establish its hegemony within the field of madness, although we must not discount or

22

The origins of the asylum

trivialise the outrage of leaders of the campaign to establish the new asylums at what they saw as abuse of lunatics in the community and their determination that dignified care should be offered to these people. Its success was at best limited, for a variety of reasons which we explore in the chapters that follow. This can in part be explained by the failures of moral treatment which earlier writers have documented, although we argue that such therapeutic regimes should themselves be understood within a wider nexus of power, class and gender relations in which the Victorian asylum functioned. The statements of prominent psychiatrists such as Bucknill were framed to appeal to different audiences who influenced or witnessed the legal regulation of pauper insanity. Working with a limited staff who were poorly paid and trained, medical superintendents occupied a bridge between the world of the affluent magistracy and the recipient of Poor Law relief. The benign vision of moral treatment offered the leaders of these institutions a philosophical canopy under which the stigmatised lunatic and the asylum doctor might shelter. Ambitious and fearless advocates of the asylum professional such as Bucknill were able to promote close ties with county society where the landed gentry endorsed Shaftesbury’s crusade for public care of the insane, strengthening the hand of the superintendents in their dealings with the Poor Law administrators. Even this alliance of forces was a transient coalition which was driven by the competing claims for central control, local accountability and professional autonomy that figured in asylum affairs from the early years of the Lunacy Commission. The following chapters chart the contests and struggles which defined the limits of English asylum administration in the Victorian and Edwardian decades, examining in depth the development of the famous Devon institution. Our emphasis is upon the role of the asylum not only as a reference point for the boundaries of acceptable behaviour but also as an institution for the disposal of those for whom other forms of provision had failed. The transactions which led to the admission and the discharge of the individual from the County Asylum involved not only the Poor Law authorities and the magistracy but a wide range of other agents who claimed some knowledge of the situation in which a lunatic had been identified. We argue that the asylum can be understood as a corridor between civil society and the state along which different groups met to negotiate the terms on which insanity might be agreed. In this light we now wish to explore the micro-politics of the Poor Law and the specific family strategies which surrounded the dispatch to and from the asylum, though we locate these relations within a changing world of class, gender and inter-generational relations in nineteenth-century England before examining, finally, the patient experience of both the asylum and life more generally.

3

The asylum and the British state in the administration of pauper lunacy, 1845–1914

This chapter examines the role of the Poor Law, the Lunacy Commission and other government agencies in the origins and development of the Devon asylum from the middle decades of the nineteenth century until the outbreak of war in 1914. These agencies were vitally important to the growth and progress of the Victorian asylum. We consider salient themes in the scholarly literature on the subject and examine in some depth the relationships between the Exminster asylum and these bodies during the period as a whole. The scholarship on asylums has been heavily influenced by Foucault’s work on ‘total institutions’ and the scholarship of Andrew Scull discussed earlier.1 One feature of the asylum which Scull stressed was the extent to which the rate-funded asylums of the nineteenth century catered for the poorest sections of society, with the admission of non-paupers to such places remaining ‘exceedingly rare’. Even those relatives who were prepared to countenance the stigma associated with the admission of their family members to the pauper lunatic asylum would, in Scull’s view, have discovered that the Poor Law authorities were ‘a formidable barrier to overcome’.2 For the Poor Law Guardians well knew that the significant costs of asylum care of a pauper lunatic would fall on them at once and could be a burden to them for decades to come. From the point of view of the lunatics themselves of course the term ‘pauper’ had very particular legalistic stigmatising connotations that a person had made the passage from independent member of the community to dependent on poor relief, and although, as we shall later show, this boundary was more fluid in reality, nevertheless to be denoted a pauper remained a formidable barrier to have crossed. A more detailed examination of the role of the officers of the Poor Law in the administration of Victorian lunacy has been recently provided by Peter Bartlett, who has argued that the officers of the Poor Law and the Boards of Guardians established under the 1834 Poor Law were key figures in the administration of pauper lunacy. Bartlett notes the declining influence of the Magistrates as compared with their role under the old Poor Law, though often figuring as ex-officio members of the new Boards of Guardians. He also stresses their important role as Visitors in the governance of the new asylums. Finally, Bartlett contrasts the robust influence of the Poor Law

24

The administration of pauper lunacy, 1845–1914

authorities in lunacy matters with the weaker influence of the Lunacy Commission.3 This last point is partly supported by Nicholas Hervey’s research on the Lunacy Commission which emphasises the conciliatory and occasionally weak approach of the Commissioners when confronted by intransigent local elites, although Hervey does acknowledge the significant role of the Commission in creating and expanding the role of government as inspectors of local asylums and defenders of standards of care.4 Mellett similarly emphasised the limitations of the Lunacy Commission in the mid-Victorian period.5 The Lunacy Commission as well as the medical superintendents emerge from such accounts as less authoritative and more dependent than they were portrayed in earlier studies offered by scholars such as Scull.6 There is little doubt that Bartlett is correct to emphasise the significance of the Poor Law in shaping the growth of the asylum and the implementation of lunacy legislation, although Bartlett asserted that the Poor Law and the asylums in given areas were in essence ‘administered by the same people’.7 It is perfectly true that although there was some overlap (both the Courtenays, for example, being prominent members of Devon Quarter Sessions, Exminster Board of Visitors and St Thomas Board of Guardians) there were many members who were not common to other bodies. The Boards of Guardians were in the main elected by the rate-payers, whilst the Boards of Visitors were selected by Quarter Sessions Magistrates from their own members, and the medical superintendent of the asylum and all officers there were salaried employees of the Board of Visitors. Each group had their own agenda and were often in tension or indeed conflict with one another. Furthermore, our own research suggests that there were and remained divisions among the ranks of the Guardians themselves and that these differences resulted in different Poor Law Unions adopting quite distinctive policies in respect of the admission of lunatics to the asylum, even within a single county such as Devon. The influence of the Poor Law may also be more clearly understood within the chronology of administrative and legislative change during the period we consider. There is no doubt, as Bartlett argued, in the years following the passage of the Lunacy Acts of 1845 the local Guardians were able to exercise considerable influence over the dispatch of pauper lunatics to the asylum. By the 1870s there appears to have been rather less room for local initiatives and preferences to be expressed and greater pressure from central authorities for a standard approach. Such pressure did not always result in a uniform approach to legislation across Devon, and diverse practices persisted in some of the Unions. In regard to the Lunacy Commission, we also provide an alternative perspective to that provided by Hervey, Bartlett and others. Our reading of the sources indicates that the Lunacy Commission exerted an important and growing influence in the management of local asylums, more particularly from the 1860s. The administration of these institutions was also affected by the reorganisation of local government and the creation of County Councils

The administration of pauper lunacy, 1845–1914 25 in 1888, quickly followed by the important lunacy legislation of 1890.8 At that point the effective governance of the asylum passed to the County Council though the influence of the Magistrates can still be traced in the Visitors who administered the affairs of the asylum on behalf of the Council. In contrast to Bartlett and Hervey, we view the early years of the Devon asylum as ones in which the medical superintendent, the magistracy, the Poor Law Guardians and the Lunacy Commission all exercised a degree of influence on the administration of this new institution. By the time Bucknill left the asylum in 1862, the clash between the powers of the Lunacy Commission and the autonomy of its superintendent reflected the growing influence of the external regulators which increased in subsequent years. This interpretation is developed in the remainder of the chapter. We first consider the ways in which the Poor Law administered its lunatics in the nineteenth century, with reference to four important Unions within the county. In the second part of the chapter we discuss the changing role of the Lunacy Commission and in particular the impact of its inspections on the Exminster institution. One important element in the changes secured in the later nineteenth century was the emergence of the County Council noted earlier. The New Poor Law was introduced in 1834. In the county of Devon this involved grouping almost 500 parishes and half-a-million people into 20 new ‘Unions’ under their own Boards of Guardians, most elected by the rate-payers and responsible for the building and administration of a Union workhouse.9 Exeter and Plymouth retained their own traditional, ancient Corporations of the Poor responsible for the relief of paupers in the workhouse and out-of-doors. These two bodies were not involved in the planning and building of the County Asylum and their rate-payers did not contribute to its upkeep. Consequently the Corporations paid a higher levy when they reached a contractual agreement to place their own pauper lunatics at Exminster. The Poor Law authorities were closely involved in the discussions and debates which ultimately led to the foundation of a County Asylum in Devon. The implementation of the Poor Law was itself the occasion of controversy and conflict in many parts of the county, including resistance on the part of local groups to the construction of workhouses.10 By 1840, the victory of the new Poor Law was secure across most of the county, though the administration of the workhouse in Exeter was one point of contention which remained.11 By comparison the introduction of the lunacy reforms of the 1840s appears to have provoked little popular protest.12 The reformers of 1834 envisaged the creation of specialist workhouses to deal with different groups of paupers, once the key problem of the ablebodied pauper on outdoor relief had been resolved. In practice the general workhouse holding a diverse population of inmates became the fundamental institution of the new regime. Guardians were left to fashion specialist services and buildings within this structure to meet the particular needs of

26

The administration of pauper lunacy, 1845–1914

children, the sick and the elderly, and those classified as pauper lunatics.13 One of the most significant groups to remain in the workhouse long after the building of the County Asylums was the class of ‘idiot and imbecile’ paupers, widely used as household labour in the workhouse, even though the Guardians had no strict legal right to detain the 9,000 individual idiots and imbeciles to be found there in 1847.14 In 1862 an act was passed as a result of overcrowding of lunatic asylums. In the words of the clarifying circular of the Poor Law Board: the crowded state of some of the County Asylums may render it expedient that when proper accommodation is provided in the workhouse for cases of imbecile and harmless chronic lunatics . . . they should be removed from the asylum to the workhouse . . . to make room for acute cases in which the treatment provided in the Lunatic Asylum is more important and necessary.15 In Devon the accommodation of pauper lunatics within the workhouse created a number of tensions during the nineteenth century, as a variety of local officials sought to manage the provision made for them.16 The central personality was the Union Relieving Officer who dealt with all applications and reports from workhouse master, parish overseers of the poor, community or family, and he remained a powerful figure in the lives of Victorian paupers. Even though the majority of those sent to the Devon asylum may not have been in receipt of long-term relief from the Union, they necessarily encountered the Relieving Officer as the first (and effective) gatekeeper of the County Asylum. The provisions for care appeared deceptively simple: before the 1890 act, a committal order to the county pauper asylum could be signed either by an individual Magistrate or by a Relieving Officer together with a clergyman, and the signature must be supported by a certificate of lunacy completed by a recognised physician, surgeon or apothecary.17 After 1890, the situation was tightened so that a committal order might only be signed by a Magistrate still to be accompanied by a certificate of lunacy signed by one physician. Before and after the 1890 legislation, the Relieving Officer of the Union played a critical role in the process of institutionalising the pauper lunatic, as Peter Bartlett has pointed out.18 Not only did the Relieving Officer make the decision as to whether an individual should be referred to the District Medical Officer, but he also made the original application to the Magistrate and was responsible for conveying the certified lunatic to the County Asylum. It is equally clear that the workhouse itself was a vital clearing house for the identification and disposal of a fair number of pauper lunatics in the later Victorian era. The original 1834 Poor Law stipulation on the removal of dangerous lunatics within 14 days appears to have been widely interpreted by Guardians as a right to retain numerous individuals in workhouses (rather than asylums). The statutory right of detention awaited the

The administration of pauper lunacy, 1845–1914 27 19

passage of an 1862 act. In this procedure the workhouse’s medical officer also played a key role.20 Under the 1845 legislation the Relieving Officer was empowered to call a local physician or surgeon, a Poor Law medical officer from 1853, to examine and if necessary certify the individual as a lunatic. The Order for the committal of the individual to an asylum was only issued by a Magistrate, or on the signature of both a local clergyman and the Relieving Officer. Many of the Magistrates also served as Poor Law Guardians, such as the St Thomas notable, Samuel Trehawke Kekewich. Only a certain number of those certified as pauper lunatics were inmates of the workhouse prior to certification, though the Relieving Officer’s responsibility for conveying the individual to the asylum often entailed their dispatch from the place of certification. The family would often accompany the individual and in the case of a female, the Relieving Officer’s wife or another responsible woman would be present. This resulted from the strong belief at the time that female lunatics as well as prisoners should be kept separate from male custodians to protect them from abuse as a matter of propriety. Relations between the first medical superintendent and the officers of the Poor Law Unions were often strained, Bucknill expressing some contempt for those ‘medical gentlemen of the Union’, who dispatched terminally ill people to his institution.21 These poorly paid doctors were frequently under some pressure from families and others and if they transgressed procedures they were liable to find that the Guardians refused to pay their fees.22 Only in 1874 did the government introduce a mandatory grant to subsidise the cost of asylum care, though the different rates for the care of those sent by Devon’s Corporations of the Poor (and other contractors) who did not contribute to the county rates was preserved.23 Even then, there still remained a significant differential (of between three and four shillings per week) in the cost of asylum care for those boroughs, such as Exeter and Plymouth, which remained outside Devon county jurisdiction and had not contributed to the building costs of the asylum.24 During the years when the County Asylum became overcrowded, it was common for the Visitors to request the withdrawal of inmates who were not Devon inhabitants and to refuse to renew contracts with the important boroughs such as Exeter and Plymouth. These Visitors were drawn from the Quarter Sessions and offered Devon’s established elite of county Magistrates a new opportunity for the exercise of institutional power which renewed their traditional role as arbiters of the Old Poor Law.25 Although the group around the Courtenays and their supporters was very influential in founding and governing the asylum and dominated the Poor Law Guardians in the large Union of St Thomas, in other areas of Devon rather different groups and ideas prevailed. These variations help to explain the contrasts which emerge in the attitudes, behaviour and policies adopted by the different Unions in distinctive areas of the county with regard to the problem of pauper lunacy.

28

The administration of pauper lunacy, 1845–1914

These contrasts can be clearly seen in a comparison of the three county Unions of St Thomas, Axminster and Okehampton in the earlier period and in a survey of the activities of the distinctive Union of Plympton St Mary (near Plymouth) in the later period. The St Thomas Union was large both in physical space and population, comprising 49 parishes and 47,099 people in 1841 (rising to 48,241 by 1881), and forming a great ring around the city of Exeter, with the St Thomas workhouse standing on the western side of the River Exe within sight of Exeter Cathedral. Axminster Union was, by contrast, a collection of 17 remote rural parishes and having a population of 20,583 in 1841 (falling to 18,769 by 1881). Okehampton was similar in size of population to Axminster (having 20,844 people in 1836 rising to 22,000 in 1871) but comprised 28 parishes and encompassed a large part of north Dartmoor. Not only were the three Unions rather different in their size and composition, but they also had varying proportions of both paupers and pauper lunatics in their populations. As Table 3.1 indicates, Axminster possessed the largest percentage of paupers but a relatively low number of this group were classified as lunatics. At the other end of the scale, St Thomas held the smallest percentage of paupers in its population but by far the highest proportion of these compared to the other two were labelled as insane.26 The three Unions also pursued quite distinctive policies in regard to how their pauper lunatics should be distributed between the County Asylum, the workhouse and those kept on outdoor relief in what may be termed ‘the community’. The treatment of pauper lunatics varied immensely in Exminster from what was the case in the Devon workhouses. Until 1862 they would have been held in the same conditions as any other inmates and at most would have been confined to the infirmary, or punished if recalcitrant or highly distressed and agitated. After 1862 some workhouses in Devon such as that at Exeter were given powers to establish special infirmaries to hold some lunatics under the law of that year, but in most workhouses lunatics were merely treated as members of the inmate population with no Table 3.1 Paupers and pauper lunatics in three Devon Unions, 1850–1885 Union

Paupers (as % of pop.)

% Paupers insane

Axminster Okehampton St Thomas

7.7 6.6 5.8

3.0 4.4 5.2

Sources: Return of Number of Paupers and Able-Bodied Paupers in Receipt of Relief in Unions in England, 1850, 1860, 1870 and 1874, Parliamentary Papers (PP) 1876, LXIII (C138a), pp. 35–37; Return of Number of Paupers and Able-Bodied Paupers in Receipt of Relief and Sums Expended in Unions of England, 1875–76, PP 1877, LXXI (337) pp. 45–46. Twenty-fifth Annual Report of Lunacy Commission PP 1871, XXVI (C351), p. 97; Twenty-eighth Annual Report of Lunacy Commission, PP 1874, XXVII (C284) p. 95; Thirtieth Annual Report of Lunacy Commission PP 1876, XXXIII (C403), p. 95.

The administration of pauper lunacy, 1845–1914 29 specialist provision at all. The St Thomas Union used Exminster far more than did the other two Unions, sending more than two-thirds of their pauper lunatics to the County Asylum in this period.27 Indeed, between 1845 and 1884 the St Thomas Union sent more than six times as many admissions to the County Asylum than its counterpart in Axminster, though its population was little more than twice as large. The contrasting policies adopted in regard to the use of the workhouse and the asylum are clear from Table 3.2, which indicates that Axminster’s Guardians retained a quarter of their pauper lunatics in the workhouse whilst their counterparts in Okehampton made less use of the workhouse for pauper lunatics and allowed almost half of those identified as lunatics to remain with relatives and friends. It is noticeable that St Thomas made somewhat greater use of private madhouses and licensed hospitals than either of its neighbours. Despite this, the numbers of those sent from St Thomas to private institutions overall remained small and appears to have reflected the general aspiration of the St Thomas Guardians to provide specialist care for their lunatics as Exminster became more congested. In Devon, the Courtenays clearly established a leading role in county affairs, expressing their ultra-Tory views and a powerful sense of traditional obligation based on hierarchy and reciprocity, cemented by a sense of Christian duty of obligation and charity.28 Their influence was continued in the work of trusted allies such as Samuel Trehawke Kekewich, who emerged as a commanding personality in the conduct of the New Poor Law and the asylum.29 Their enemies were also well organised. In attacking the county elite for their extravagance with rate-payers’ funds and their alleged abuse of power, their critics portrayed themselves as the spokesmen of the honest, oppressed yeomen of Devon.30 An important example can be found in Axminster, where the farming interest was led by a retired admiral rather than the grandees who graced the St Thomas meetings. Such groups were much less enthusiastic than the aristocratic entourage when the asylum

Table 3.2 Provision for pauper lunatics in three Devon Unions, 1850–1885 Union

Asylums (%)

Hospitals/ licensed houses (%)

Workhouse (%)

Out-relief (%)

Axminster Okehampton St Thomas

52.1 48.8 67.4

0.9 0.8 2.8

25.3 8.9 13.0

21.7 41.5 16.8

Sources: Eighteenth Annual Report of Lunacy Commission PP 1864, XXIII (389), pp. 112–113; Twenty-fifth Annual Report of Lunacy Commission PP 1871, XXVI (C351), p. 203; Twenty-eighth Annual Report of Lunacy Commission PP 1874, XXVII (C284), p. 85; Thirtieth Annual Report of Lunacy Commission PP 1876, XXXIII (C403), pp. 100–101; Thirty-fourth Annual Report of Lunacy Commission PP 1880, XXIX (C321), pp. 141–143.

30

The administration of pauper lunacy, 1845–1914

project was first discussed in 1836, arguing that the great landowners should contribute at least half the cost of the new institution.31 In the early years this resistance proved effective enough to stifle the initiative in favour of a county institution, but within a few years the Quarter Sessions carried not only the vote in support of an asylum but carried Axminster in favour of it. The complaints of the east Devon Union were largely confined in subsequent years to periodic protests at the cost of the asylum as the Guardians administered their own accounts on a fragile fiscal basis, allowing expenditure to be incurred in advance of rate income, thus reinforcing the view that their rate-payers could ill-afford the maintenance of their paupers at Exminster.32 If Axminster’s Guardians were passively resistant, those in Okehampton were frankly hostile. Led by three upper-middle-class families, rather than the coterie of aristocrats and clerics on the St Thomas Board or undistinguished notables in Axminster, the Okehampton leaders possessed the political and social confidence to run their own affairs and maintain tight control over the economic and political life of the area.33 Their leader, Calmady Pollexfen Hamlyn, espoused a Malthusian version of free-trade liberalism and social responsibility which recognised economic prosperity as the only true road to progress and social justice. A prominent free-market liberal, in close touch with the leading Devon liberal Lord Ebrington, he pressed for open meetings of the Quarter Sessions, even to the extent of opposing Ebrington’s sympathy for the asylum project as part of his opposition to what he saw as secretive, inefficient, elitist Tory domination of the local political agenda.34 Hamlyn again presented himself as the tireless advocate of both the ‘honest and independent Yeomanry of Devon’ and also the honest industrious labourer, whose interests were best served by the strict enforcement of the principle of less eligibility enshrined in the 1834 Poor Law.35 It should of course also be borne in mind that the cost of maintenance in the asylum ran at around ten shillings per week throughout the period 1845–1900, whilst the cost of workhouse care ran at around half that amount. This rigorous endorsement of the classical liberal principles of the New Poor Law should be viewed in a context of bitter social protest against its introduction in north Dartmoor, with military and police reinforcements needed to protect the new Relieving Officers and the Okehampton Guardians themselves during the 1836 unrest.36 Any sign of opposition was dealt with most severely. It is hardly surprising that the Okehampton Guardians responded to the Courtenays’ asylum campaign of 1836 by appealing to the Poor Law Commission to take a view before local Guardians were asked to support any project.37 The regime at the Okehampton workhouse towards both sane and insane alike was exemplary in its imposition of less eligibility principles on the inmates, particularly in the treatment of workhouse children. In April 1846 a distraught mother made detailed allegations of the harsh treatment of her two idiot children, which the

The administration of pauper lunacy, 1845–1914 31 Guardians dealt with by immediately dispatching the children to Exminster, referring the complaint to the Poor Law Commission, and then dismissing the allegations when they were referred back by the London authorities.38 Six months later they were demanding the return of the two children to the workhouse because of the expense of maintaining them at the asylum.39 Catastrophic circumstances surrounded the death of 16 workhouse children in 1848, for which a respected Exeter physician attributed at least partial blame to the crude sewage system operating at the workhouse infirmary.40 Matters came to a head when Lord Courtenay served as Secretary to the Poor Law Board in London in 1851, when the incident of the child paupers was condemned, and complaints recurred in the 1860s when it was alleged that the workhouse infirmary in Okehampton supplied drinking water in buckets used for defecation and even that a violent idiot had been given charge of the infirmary.41 It may have been to avoid such vigorous criticism that the Okehampton Guardians resolved to leave an extraordinarily high proportion of lunatics outside the workhouse. While they were more punctilious than their Axminster counterparts in identifying pauper lunatics, they were clearly intent on enforcing the Poor Law according to the lights of the individualistic rhetoric expressed in the 1834 Royal Commission on the Poor Laws, as well as resisting the influence of Devon’s Tory elite. It is clear that the driving local political force behind the asylum in its early years were the Tory grandees, the Courtenay family and their associates. But this is not to discount the fact that many of the Guardians of the Poor were also members of the Committee of Visitors and this is not inconsistent with the fact that the principles of 1834 included a vision of specialist workhouses offering specialist provision to their inmates. Indeed the workhouse for the St Thomas Union did make specialist provision available to inmates. Thus there was an ideal of selective restorative intervention within the New Poor Law, particularly in regard to the deserving poor, alongside the notions of less eligibility and workhouse deterrence of the able-bodied poor for which it is so well known. While the County Asylum was easily the dominant provider of care and maintenance to the lunatics dispatched by the Relieving Officers of the different Poor Law Unions, it is worth noting that private institutions also offered residential places to pauper lunatics. Mrs Spicer’s house was used by the St Thomas and Axminster authorities, though the former refused to pay her bill after an adverse report was presented to them in 1838, with her licence to trade in lunacy revoked at the 1842 Quarter Sessions.42 Axminster terminated her services somewhat later and then briefly considered sending some of their lunatics to the ‘cheerless and filthy’ Plympton House, though this plan was soon abandoned.43 Alternative arrangements proved so expensive that the St Thomas Board resolved with some relief in 1845 to remove all their pauper lunatics into the asylum.44 Axminster’s greater reluctance to make use of Exminster may have been influenced by their straitened finances

32

The administration of pauper lunacy, 1845–1914

in the 1860s.45 A rare flash of enthusiasm for Exminster was seen when the Axminster Guardians discovered one of their paupers lodged in a more expensive asylum elsewhere and the individual was rapidly transferred to the Devon County Pauper Lunatic Asylum.46 The limited numbers of pauper lunatics declared by Axminster may indicate that some individuals who could have been certified and committed to the asylum were retained in the workhouse. On the same principle of parsimony, Okehampton also at times relied on the services of Plympton House in the 1830s, though this establishment was roundly condemned by the Lunacy Commissioners subsequently for its ‘damp, cheerless and filthy’ accommodation, some inmates being left in chains in outhouses.47 Refusing to follow the bidding of the Lunacy Commission and remove its pauper lunatics to the Devon County Asylum, Okehampton resorted to the distant Belle Vue establishment and remained vigilant in resisting any increase in charges made by that institution.48 Having reluctantly eventually followed the direction of the Commissioners in dispatching ‘idiots and persons of unsound mind’ to Bucknill’s care at Exminster, they soon retrieved them and relations between Okehampton and the Asylum remained cold and aloof.49 The inclination of the Guardians at the Union to leave lunatics in their own homes also alarmed the central Poor Law Board, who stressed the difficulties of maintaining violent lunatics outside the specialist institutions created for their care.50 The contrast with St Thomas could not have been greater since the latter resisted a proposal from the Local Government Board (which had in 1871 assumed responsibility for the Poor Law) in 1885 that the chronically insane be returned to the workhouse, arguing that this would result in inadequate provision. Under renewed pressure, the Guardians turned to the well-known and distinguished Fisherton House to house their chronic cases, even at increased rates, rather than accommodate them in the workhouse.51 In similar circumstances, the Axminster Board of Guardians reverted to uncertificated accommodation, provoking the wrath of the Lunacy Commissioners in the process.52 Such evidence as that we have surveyed above suggests that the policies of the different Unions within Devon continued to differ strongly in the approach which the Guardians pursued in regard to both the Poor Law of 1834 and the Lunacy Act of 1845. The influence of political allegiances as well as the mobilisation of rate-payers’ interests was more visible in the early, formative years when the asylum project was the source of controversy within the county. Yet the distinctive preferences established in these years appear to have remained in the first four decades of Exminster’s existence when different Unions continued to pursue a distinctive approach to the admission and maintenance of those certified as lunatics. In contrast to the troubled relations between the asylum and the Guardians of Okehampton and Axminster, the St Thomas Union was commended by the Poor Law Board.53 St Thomas not only retained a large number of Relieving Officers but employed them in a diligent exercise of pro-asylum policies.

The administration of pauper lunacy, 1845–1914 33 In the later decades of the nineteenth century the distinctive role of Unions such as St Thomas and its capacity to influence the progress of asylum care in the county diminished. In part this reflected the increasing regulation of local Poor Law authorities by central government and, in 1888, the responsibility for the supervision of the asylum passed to the new County Council. The growing influence of central state regulation can be detected in the increasing uniformity of Poor Law Unions in their approach to the administration of pauper lunacy. Such a trend may be found not only in the central and east Devon Unions but also in Unions such as Plympton St Mary which bordered the booming naval town of Plymouth. The Union comprised parishes which bordered on this growing metropolis as well as more rural districts with much more stable population. The Guardians of the Union offer an interesting contrast with the three Unions discussed earlier in that there was a distinctive military presence evident by the 1880s as well as a range of agrarian notables and yeoman representatives alongside small trades and business agents. The importance of a small group of Relieving Officers in the completion of admission certificates is also apparent, as well as a handful of medical men signing the certificates of insanity.54 The Lunacy Commission expressed periodic concern that any lunatic, more particularly those who presented a danger to themselves or the public, should be removed to an approved asylum as soon as possible. Inmates of the workhouse who were considered dangerous were generally perceived by the Poor Law Board (Local Government Board from 1871) to be suitable candidates for treatment in an asylum. The Guardians of Unions such as Plympton St Mary were aware that the risks posed by dangerous pauper lunatics included the threat that they would be severely censured if there were incidents involving certified lunatics not dispatched to the asylum. The evidence suggests that in Plympton the Guardians were ready to dispatch those labelled as ‘dangerous’ on entry to the workhouse relatively quickly, though others were only subsequently identified as dangerous lunatics after a period of residence at the workhouse.55 The identification of danger appears to have depended on incidents such as an attack on a member of staff or threatening other inmates as upon any medical examination.56 In the 1870s there appears to have been a surprising level of tolerance towards some forms of aggressive and disobedient behaviour, possibly as the Exminster asylum was rapidly filling beyond capacity and was anxious not to encourage admissions from workhouses. Edward L. was depicted by the Plympton medical officer as having in the past six years ‘frequently threatened the lives of other inmates of the Workhouse’ and kept them ‘in a continued state of fear’. The Master added that ‘he scales the walls & runs away, returning in a state of unconsciousness through drink’. This ended when Edward was committed to the asylum as part of a general clearance of awkward inmates. He was discharged from Exminster 21 years later, ‘not improved’, his eventual fate being unknown.57 William M. arrived at Exminster in 1870, being nearly blind with general paralysis, but he was

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sent there after having many times threatened to kill ‘the man in charge of the room where he sleeps’, which was likely to be another workhouse inmate.58 The Plympton authorities similarly accepted Martha H.’s repeated attacks of mania over three years and her habit of ‘singing all sorts of nonsense’, including replies to any questions put to her, but she went too far by jumping from a window and found herself on the road to Exminster.59 In other circumstances much less remarkable behaviour seems to have provoked an early dispatch of the offending individual to the County Asylum. Although some very elderly patients were described as dangerous apparently as a rationale for their dispatch to Exminster, it is hard to avoid the conclusion that they were merely disruptive to the perceived good order of the workhouse. Susan G. was sent at the age of 88 after ‘continually quarrelling and talking incoherently using bad & obscene language’.60 Whether the prospective patients were anxious to leave the workhouse or the authorities to dispose of them, a number of individuals who were credited with extravagant acts of violence against attendants or plots to blow up the workhouse were not found to be threatening personalities when installed at the County Asylum.61 In particular the workhouse regime was based on a notion of reciprocal rationality, that an inmate would know at least what the rules of the place required and would make a calculative choice either to obey or disobey them. For calculative disobedience, expulsion, punishment (reduced diet) or police proceedings would be used; to secure obedience, incentives and instruction would be imposed. It was those inmates whom workhouse staff viewed as not amenable to reason, who were susceptible to extreme and repetitive behavioural outbursts, or who could not comprehend instructions, that were most likely to be consigned to the asylum as the institution most appropriate for such people. It is the case that particular kinds of behaviour were consistently ruled out of court at the workhouse and seen as a basis for early dispatch to Exminster. Three forms of bad behaviour were never tolerated for long: arson, attempted suicide and outrageous immorality. The display of dirty physical habits was liable to qualify for a passage to Exminster. When Henry W. showed an unnerving habit of getting out of bed at three in the morning and lighting a fire, he qualified for a place at the County Asylum.62 Similarly, Emma S.’s threats to commit suicide were taken seriously when in 1899 she informed the workhouse staff that she was about to ‘destroy the Gas fittings to Cause an Explosion’, which brought her quickly to Exminster.63 Here again the asylum staff found her not to be dangerous, which may be a tribute to her tenacity in wanting to get away from the workhouse rather than the sagacity of the authorities. The prospect of a suicidal inmate was one which the Plympton Guardians and officials took very seriously on most occasions, perhaps as much because of the resources involved in the careful supervision and treatment of such inmates as from concern at the scandal of a workhouse death. Amongst the entrants from Plympton classified as suicidal on entry to Exminster, the

The administration of pauper lunacy, 1845–1914 35 length of the single stay in the workhouse was only a quarter of the period resident by the non-suicidal admissions (162 compared to 650 days). The actual numbers of Plympton Workhouse entrants who were identified as suicidal when coming to the asylum was fairly limited (15 of 88 or 17 per cent), with the ratio falling noticeably after 1890 from 22 per cent to 14 per cent of admissions. Once again there is also a significant variation in the gender experience of reported suicidal intentions with one in 3.5 females sent on to Exminster classed as suicidal compared with one in 12.5 males. As with the incidence of violence in the Plympton Workhouse, the alleged threat of suicide could be seized on by the authorities as a trigger for dispatch to the Devon asylum. So, when the elderly Mary D., who had delusions of a pension from the Queen, ‘took off her garters & tied them together & said she would strangle herself’, she was sent away.64 By way of contrast, Jane D. was held for months after she first tried to cut her throat, and only after an elaborate suicide attempt by hanging was she finally sent on the same journey.65 This tardiness in removal appears to have been rare, with inmates removed when suicide was seriously threatened, even shortly after childbirth. The assumption appears to have been made that suicidal inmates could not be effectively housed at the workhouse. Even where patients were not thought to be actively seeking to do violence to others or themselves, the fact that their behaviour could pose a threat to health and order was sometimes sufficient for their committal to the asylum. William Henry E., for example, was quite blind and insisted on wandering about ‘in dangerous places’.66 Various inmates would resort to banging their head against doors, placing their hands in the chimney fire and so forth.67 A particular problem for the Union authorities was the predicament of seriously incapable idiot children and imbeciles of all ages. They were not welcomed at Starcross Idiots Asylum which was primarily for boys and where a capacity for education or training was required, and the Exminster physicians recognised even in the earliest days that the County Asylum could provide no specialist care or hope of cure. Thus, Alice C., a teenage inmate, was described on her arrival at the County Asylum as ‘perfectly lost to all reason’, constantly ‘picking out the cinders from the fire grate, and placing them in her bosom’, but had proved too difficult to be looked after in the workhouse.68 Other and older individuals were perceived as more culpable in their behaviour and inclinations. Mischief rather than mental confusion was a term found in the descriptions provided in the certificates of the relevant medical officers at Plympton. Thus Eliza H. was portrayed as ‘destructive to bedding, very idle & quarrelsome, . . . restless & full of mischief being insensible to persuasion & kindness’.69 Before casually dismissing this testimony from the Matron of the Workhouse (and wife of its Master), we should recall that workhouses could possess as much claim to moral treatment in the decades of chronic overcrowding and rising pessimistic neo-Darwinian sentiments as asylums such as Exminster. Even so, good order was paramount

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and noisiness or inappropriate singing from inmates such as Elizabeth B. proved fatal to her prospects of continued residence when these were coupled with night-time ravings.70 Indeed, good behaviour at night was more important than in the day, and any tendency to walk about in the night or get into the beds of other inmates was not tolerated for long. The use of opiates sometimes preceded the decision to transfer to Exminster, but one test was quietness in the hours of sleep and the degree of mischievous intent imputed to the individual.71 Refusal to work (Charles George J.) or rejecting workhouse clothes (Fanny W.), or inclinations to leave the workhouse infirmary without his clothes (Archibald H.) all qualified as reasons for dispatch.72 In numerous other cases the epithet employed to justify the transportation of the Plympton pauper to the county institution was that of ‘dirty habits’, which appeared to stretch from a blunt description of physical incontinence to an implication of indecent conduct. Nor does there seem to have been growing tolerance of such lapses over time. Albert George H. was sent up from Plympton in 1904 with otherwise trivial symptoms of insanity such as vacant expression, but with the telling phrase added that he had been ‘dirty in personal habits during detention’.73 Similarly, Robert McQ. was said to be lately much more noisy, difficult to manage and refusing to stay in bed at night, but the fact that he was also ‘very dirty in his habits’ tipped the scales against his remaining at Plympton.74 These examples again suggest a belief that the inmate was repetitive in their behaviour and lacked the capacity to receive and act on instructions also wanted for reason and therefore was unsuitable for an institution whose regime was predicated on predictable compliance with regulations and calculative decision-making. Despite this, the comparative high cost of asylum care would have led to a reluctance among workhouse personnel to send paupers on to Exminster. This would have been reinforced by the Guardians and Relieving Officers whose attention was always on issues of resource allocation. A significant number of borderline cases were actually treated within the Plympton Workhouse itself. There certainly is evidence that a number of people became institutionally selected at Plympton, in the sense that they were identified as returnees to the workhouse or community and eligible for dispatch to the asylum if they surfaced again. Once an individual became recognised as an old Exminster hand, it appears that he or she was much more readily returned to the asylum on appearing at the door of the workhouse, regardless of the symptoms displayed. Maria J. was quickly sent on to Exminster in 1884, though the rationale was simply that ‘she is continually talking of all sorts of unreasonable things, is very excited, and last night searching the floor for an imaginary sovereign she said she had lost’.75 Similarly, John M. had been in Exminster five times previously when he was sent there again in 1905, though his only symptom of insanity was that he ‘sits absolutely silent and shows no sign of intelligence’.76 When Mary B.H. arrived at the workhouse pregnant in 1905, having suffered from mental

The administration of pauper lunacy, 1845–1914 37 strain in her previous delivery, she was sent up to Exminster before displaying any remarkable symptoms.77 These people were typecast as Exminster candidates and quickly went on to the asylum. There seems little doubt that the workhouse infirmary continued to function not merely as an alternative to Exminster for hopeless and chronic cases in the late Victorian and Edwardian years but apparently as a viable form of asylum and recovery for a limited number of individuals. The same institution also served as a place of residence for natives of Plympton returning to their home area from the Devon asylum. In all, there were 22 occasions between 1867 and 1914 where the workhouse admitted paupers directly from Exminster. The first half of the period, up to 1890, saw seven such events, while the second half saw 15, with a burst around 1908–1909. This may be broadly indicative of a closer tie-in of the various institutions dealing with pauper lunacy over time. These returnees divide almost exactly into two groups; 10 who were moved on to the community or elsewhere within a month, and 11 who remained at the workhouse for more than a year. Five of these longer-stay returnees went back to Exminster again, more particularly in the period 1904–1914.78 It is worth noting that although certified as lunatic, many of those manifesting distress, inappropriateness of behaviour or extreme emotion were poor, isolated and/or aged, and might have been discharged because the asylum felt that it had done as much as it could for the cure or relief of their actual lunacy and therefore returned them, particularly bearing in mind the high cost of asylum care to the Poor Law Guardians. The pattern seems to have been that the longer-term residents of the workhouse who had come back from the asylum would stay for many years, with only two returning to their own community. The prospects for the short-stay returnees were much brighter. Of the 11 who left the workhouse within a month of return, one (William R.) absconded on the first day in 1869.79 Most were taken out by members of their family or at their own request.80 Others were discharged by the Guardians or Relieving Officer and only one made his way back to Exminster.81 This suggests that about half of those who were discharged back to the workhouse had fair prospects of release back into their families and communities and the workhouse may have functioned as a place where a trial assessment of the discharged lunatic could be made. Our evidence also indicates that a paradoxical consequence of the 1890 legislation was to encourage a more elaborate examination and verification of workhouse inmates. Facilities were also extended to enable such examinations to take place. This enabled the Union to hold difficult cases and gave scope for their release from custody without dispatch to the asylum. Noah P., a labourer of Plympton St Maurice, arrived on a three-day detention order in November 1904, and was immediately placed in the padded room for two examinations by Dr Prance (medical officer). Prance eventually concluded that he could ‘find no trace of mental affliction which would authorize his being removed to Exminster Asylum’, and Noah was removed

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two days later by his wife.82 He returned the following year under another three-day order and remained for ten days before leaving on his own request, with the physician’s permission.83 In these cases we may also be registering the break up of the close nexus between Relieving Officers and medical officers in the Union as the old stagers, Pearce, Scott and Ellery, retired and the new guard adopted different views on the mental condition of the entrants. September 1908 saw a further disagreement when the new medical officer, Dr Stamp, admitted a labourer, Thomas K. On the previous day the Magistrate, Crews, had examined Thomas ‘with a view to having a summary reception order for Exminster Asylum signed’, but this was rejected by Dr Stamp and Thomas discharged himself four days later and never returned to the workhouse.84 There may have been a new assertiveness amongst the Poor Law medical officers which had been absent in the earlier generations, but we also see the unexpected frictions emerge in the Edwardian years that were almost absent earlier. The Devon experience appears to confirm the conclusions of recent scholarship on the importance of the Poor Law in the whole process of lunacy administration. Not only was the workhouse used as an important transit point for a fair number who journeyed to Exminster from the Union, but it also functioned as an alternative locus of treatment and detention for those who went to the County Asylum after a period of time, who returned from the asylum to their communities, or who never entered the gates of the Devon asylum in their lives. Second, we found that the social composition of those identified as lunatics was extremely varied and included journalists, blacksmiths, clerks and labourers as well as the elderly, teenage idiots, pregnant women and alcoholics. Vagrants, wanderers and those without connections in the district formed only a small proportion of the total coming to Plympton as suspected lunatics: a majority of those who went to Exminster appear to have had no other dealings with the Union workhouse than as an administrative channel to the County Asylum. This weakens the commonplace assumption that those entering the Victorian asylum were invariably gathered from the poorest sections of society and most desperate families, and also challenges the idea that the asylum was necessarily a dumping ground for social undesirables. The Lunacy Act of 1890 emerges as an important watershed in the development of lunacy treatment at Plympton. Greater rigour was required in the examination and classification of suspected lunatics and the extended vocabulary of medical terms being used appears to have had greatest impact on that group of people covered by the generic phrase ‘idiot or imbecile’ before 1890. Before 1890 the criteria for deciding if a lunatic went to Exminster appear to have been the propensity to violence (against others or oneself), usefulness, or disruptiveness within the workhouse. Availability of space at the asylum and the degree of family and friendship support for the individual were also factors. After 1890, both Magistrates and physicians were compelled to be more precise in their reasoning for committal and, at the

The administration of pauper lunacy, 1845–1914 39 same time, there was a perceptible decline of the close intra-Union relationships between officers and medical men which had characterised the earlier decades. We have also registered a clear pattern of family consultation in the later years and when relatives or friends appeared, it is noticeable that even deeply distressed individuals were frequently released to their kin on request. After the early decades of diversity and innovation, the different Poor Law Unions did comply more closely with the requirements for the use of the asylum, but our evidence also indicates that, while the vigilance of the Lunacy Commission and the Poor Law authorities increased noticeably in the later years, especially in regard to the physical standards in which pauper lunatics were kept, there was still considerable scope for the Guardians to tailor the regulations to meet their own needs and preferences. Indeed, the dexterity of the Plympton Guardians in dealing with the problem of the dangerous lunatic shows that they were capable of discriminating between those who were genuinely a menace to themselves and others and those who were troublesome and who could be identified as a danger in order to secure their passage to the asylum. The Plympton example also indicates that the legislation of 1890 was an important watershed, but again offered opportunities for more deliberation on the medical condition of the individual and perhaps greater space for hesitation in their certification. The close nexus of Poor Law medical officers and other officials suggests that the Guardians and officials were able to defend their interests even within the tighter system of legislative control and administrative regulation that prevailed in the later years of our period. Having considered the impact of Poor Law Unions on the disposal of pauper lunatics in Devon, we will now consider the actual impact of the Lunacy Commission on the asylum in the decades after 1845. It is worth recalling that the numbers of people held in pauper lunacy asylums were rising steadily throughout our period and, indeed, the proportion of insane paupers nationally grew rapidly from one in 100 paupers in 1842 to one in eight paupers by 1910.85 The main instrument of regulation exercised by the Lunacy Commissioners was the annual visit to the County Asylum and the publication of their report in parliamentary papers. The duties of the Commissioners were certainly onerous, for not only had they to visit the occupants of the County Asylums each year but also 750 workhouses, 144 private licensed establishments, 13 hospitals, 20 gaols and private houses where lunatics were kept.86 One theme in the deliberations of the Commission was their hostility to private asylums and to the mechanical restraints which were popularly associated with them. Whereas Bucknill’s contacts with Poor Law Unions were often strained, the early years of the relationship between Exminster asylum and the Lunacy Commission displayed a good deal of reciprocal trust and respect. Bucknill was seen as promoting those ‘habits of industry, propriety and order’ to cultivate the self-control essential to the recovery of the individual’s humanity

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and the withdrawal of surveillance.87 Indeed the Commission gave united and public support, helping him to ride out a storm of local protest over his placement of 40 female patients in a rented seaside villa at Exmouth as a therapeutic venture which was singled out for praise in the Commission’s Annual Reports.88 Bucknill’s skills as a publicist undoubtedly helped him to promote both his own and the Commission’s interests in his press and official reports. For example, they greatly assisted each other with the exposure, by Bucknill in the Journal of Mental Science and by the Lunacy Commissioners in their annual reports, of atrocious cases of neglect and maltreatment within isolated family households in Devon, thereby raising popular anxieties about the secret imprisonment and gross maltreatment of lunatics.89 In conflict with Poor Law Guardians, he sought the support of the Commission, advising them of abuses in various Unions. Even as the asylum began to experience overcrowding in the 1850s, he continued to receive praise in the reports of the Commission.90 At the end of the 1850s, however, there were signs of deterioration in the previously cordial connection. For example, Bucknill criticised the recruitment of non-specialists to the Commission and opposed moves to introduce tighter surveillance of medical practice at the County Asylums. He responded in cavalier fashion to complaints of the Lunacy Commission that certification procedures were not always strictly followed at Exminster.91 By 1861 the Commissioners were covertly writing to the Secretary of State about the ‘want of general rules’ at Exminster and Bucknill’s firm refusal to comply with general regulation.92 When Commissioners visiting the Devon asylum found the registration books in a chaotic state (contrary to the requirements of 1853 legislation), the Visitors were privately admonished by the Commission for the blatant falsification of dates by their Asylum Clerk in the returns required by law.93 Before Bucknill finally departed to become Visitor in Lunacy in the Lord Chancellor’s Office in 1862, the Lunacy Commission had shifted from their previous policy of unqualified endorsement of the Exminster model, even if their alliance with Bucknill in opposition to private madhouses and workhouse care for lunatics hardly faltered. One of the bonds between Bucknill and the Commission was their conviction that they were faced with lethargy, hostility and hesitancy from the central Poor Law Board when aberrant or truculent behaviour occurred on the part of Unions.94 This is closely in line with Hervey’s comments on the relationship between the Lunacy Commission and Poor Law Board in the mid-nineteenth century. However, in regard to Exminster, the Commissioners’ criticisms of neglect and abuse of workhouse lunatics became public and vocal after Bucknill left and the grounds for these were made much stronger by the transparent problems caused by overcrowding under Bucknill’s successor.95 Relations between the new superintendent, Symes Saunders, and the Lunacy Commission quickly soured. A radical overhaul of the Devon asylum

The administration of pauper lunacy, 1845–1914 41 was demanded and the Commissioners prosecuted its Clerk as early as 1863 for failing to make adequate statistical returns and upbraided its Visitors a year later for failing to implement reforms.96 Thereafter criticisms followed in a steady stream as the care regime was criticised and its staff described as overworked, with the result that cases of patient abuse figured prominently in the reports of annual visitations in the late 1860s.97 Financial and sexual scandal threatened as the corrupt practices of the Asylum Clerk (who also served as the Steward) were exposed in 1869 and the position of Saunders himself seems to have been in some doubt as the Chair of the committee of Magistrate Visitors who governed the Asylum resigned in 1870.98 The dismissal of the Steward and numerous attendants, and the subsequent announcement of the extent of the fraud, brought unwelcome public attention to the asylum as the Lunacy Commission added its disquiet to the chorus of criticisms the Visitors faced in this period.99 Whilst public attention was in part secured by the Commission’s vociferous demands for improvements in both standards of care and administration at the Devon asylum, the disorders were also symptomatic of the rapid and uncontrolled growth of the inmate population in its early years, including the acceptance of profitable contracts for accommodating the borough inmates at higher rates. Having promoted the image of Exminster as a model for therapeutic innovation during the Bucknill era, the Commissioners turned to cite the Devon asylum as an example of mismanagement and failure in many annual reports which publicised failings in the Saunders years. A key point in Bartlett’s interpretation is his conclusion that the Lunacy Commissioners deferred to the Poor Law Board in their dealings with the local Guardians. The Devon evidence suggests that it was relatively common for local Unions to resist the guidance offered by the Poor Law and Local Government Boards, as when the Axminster Guardians virtually refused to dispatch workhouse lunatics to the asylum when Lunacy Commissioners recommended their removal.100 The workhouse medical officers were frequently opposed to the transfer of their charges to the County Asylum, whilst the Guardians of Barnstaple and Axminster expressed considerable scepticism when asked to improve workhouse amenities in the mid-1880s.101 The Poor Law authorities at Okehampton continued to be criticised by the Commission in the 1890s, and as late as 1910, for their poor facilities and neglect of pauper lunatics, but the Local Government Board was loathe to press the point.102 We make a particular point about the Poor Law Unions here. Social provision was highly local in character, despite the aim of legislation of the mid- and late nineteenth century to standardise it. Thus the local prisons were often deeply resistant to the standardising legislation of 1835 and 1865, whilst local opposition to health and sanitation legislation was fierce and prolonged. The Lunacy Commission had few powers of compulsion over local Guardians or the central Poor Law regulator, and functioned within a strict demarcation of spheres of authority between Central Boards and

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Commissions. The evidence indicates that the problem lay not so much in a timid approach by the Lunacy Commissioners to matters of interdepartmental concern with the Poor Law regulator, but rather in the reluctance of an apathetic and often hostile central Poor Law authority to enforce a stringent policy on individual Unions when the Lunacy Commission had drawn such matters to the attention of the regulator.103 The London Commissioners were swift to manipulate adverse publicity, official censure and even administrative procedures to secure reforms and institutional innovation. A common Lunacy Commission tactic was publicly to praise the Devon County Asylum once the Visitors agreed to do its bidding. This was also apparent in their long conflict with Plymouth and Exeter in regard to their reluctance to build their own asylums. We have traced the long and ultimately successful campaign by the Lunacy Commission to compel both boroughs to build their own asylums, displaying great skill in manoeuvring this outcome.104 The Lunacy Commission appears to have taken the lead in successfully pressing for specialist institutions for the insane, even though there was a growing recognition that ‘chronic’ and ‘harmless’ cases might be safely left within a wellprovided workhouse ward under the 1862 Act. The passing of the Local Government Act in 1888 and the Lunacy Act of 1890, however, changed the terms of central–local relations in respect of the administration of pauper lunacy, but the new era again provided the Lunacy Commission with opportunities to exploit institutional crises and secure further reforms within the Devon County Asylum. The relations between the Exminster asylum and the Lunacy Commission were never again to return to the cordiality of the early Bucknill era in the period following the scandal over the asylum steward. Saunders commented contemptuously on the hostility to him after one visit to the asylum in 1890 when two Lunacy Commissioners departed, leaving behind them a ‘caustic and choleric report’.105 The annual reports for the 1890s presented a bleak account of overcrowding, suicides and abuse at Exminster.106 These problems remained despite the opening of the two new borough asylums within the county.107 Perhaps the most difficult period of all had passed by the 1890s. In the mid-1880s, Exminster faced its darkest years of overcrowding and poor morale which preceded the transfer of local government responsibility for the institution from the County Quarter Sessions to the new County Council established under the Local Government Act of 1888. In strictly legal terms the responsibility now lay with a different body, though it is worth recalling that three-quarters of the Asylum Visitors appointed by the new County Council were Justices of the County as well as elected Councillors, and the dominant figures on the Visitors Sub-Committee (E.A. Sanders, Trehawke Kekewich and Lord Clifford) held both roles.108 The chair of new committee (E.A. Sanders) was also leading the powerful Finance Committee, to which the Asylum Visitors were increasingly answerable.109 The passage of the 1888 Local Government Act and the 1890 Lunacy Act

The administration of pauper lunacy, 1845–1914 43 also marked the renewal of external criticism of Saunders and the asylum by the Lunacy Commission who recommended improvements in the presentation of accounts and patient records at the institution.110 The County Council’s auditors supported such moves to improve the accountability of the asylum, which was now subject to the scrutiny of the Council’s Finance Committee.111 Irregularities in arrangements for building work at the asylum in the mid-1890s and the intervention of Local Government Board officials precipitated a final crisis which effectively removed the autonomy of both Saunders and the Asylum Visitors. The immediate occasion of this was the County Council’s effort to raise a major new loan in 1895 to finance asylum extensions and the failure of subsequent expenditure to meet estimates found to be imperfect.112 The Finance Committee extracted contractors’ estimates with some difficulty from the Asylum Committee as further omissions came to light.113 Amidst legal actions and mounting criticisms within the County Council itself, the Chair of the Asylum Committee was replaced as leader of the Finance Committee.114 In 1899 events culminated in fresh estimates for a new asylum at a projected cost of more than £45,500 as the Local Government Board thundered about instances ‘of gross carelessness in keeping the Asylum accounts’.115 The Council’s Finance Committee protested that the asylum authorities had failed to comply with the requirements of the 1888 legislation and effectively brought the Visitors under its control by imposing the County Clerk on the Asylum Committee.116 The reason for the demise of the autonomous government of the Devon asylum can be traced not only to the incompetence in preparing estimates of major building projects but also a series of damaging legal actions brought by individuals and rural district councils against the Visitors, seriously calling into question their judgement.117 A final contribution to the mounting sense of mismanagement within the asylum came in the renewed friction between the authorities and the Lunacy Commission, as the latter pressed the Visitors and superintendent to frame new rules for the asylum following incidents of violence against patients and apparent breaches of the 1890 act.118 One aspect of these difficult relations was the refusal of the Commissioners to approve plans for Saunders’ new residence unless it were connected by corridor to the main building.119 As overcrowding worsened, the Asylum Visitors urgently sought space for their inmates in other institutions, even asking Plymouth to offer beds in its new asylum at Moorhaven at premium rates.120 The Visitors were reduced to pleading with the Lunacy Commission as the County Architect, Harbottle, travelled to London in efforts to persuade them to approve fresh building plans.121 It was in these circumstances that the Visitors finally decided in 1898 to retire Saunders in favour of ‘a younger and more active man’.122 The new superintendent, Dr Arthur Davis, devoted his time to developing a more effective management of the institution, but by 1905 the problems of overcrowding, injuries to patients and incidents of violence surfaced

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The administration of pauper lunacy, 1845–1914

again.123 These efforts were rewarded with some praise in Lunacy Commission reports, though there were also expressions of serious concern at patient deaths in the asylum.124 One case arose where Davis, having criticised the standards at Kingsbridge Workhouse, was forced to account for the violent death of a Kingsbridge inmate at the asylum.125 The Exminster superintendent himself called for legislation to secure the accommodation of ‘quiet and harmless’ patients within workhouses with an increase of staff to oversee them.126 In terms of the literature we have discussed earlier, a number of points can be made. First, this chapter confirms the emphasis which Bartlett places both on the law, and on the Poor Law in particular, in shaping the lives of those certified as lunatics. However, we also find that the workings of the Poor Law and of the magistracy were more complex and varied than his model would suggest, and that there were spatial as well as temporal variations in the policies adopted in regard to the pauper lunatic within the single county of Devon. The Devon evidence shows that the Magistrates continued to exercise a significant influence in the affairs of the Poor Law as well as the asylum itself until the final quarter of the nineteenth century when local government was finally reformed. Nor is it clear that the influence and autonomy of the superintendent was incompatible with the active role of the Poor Law in the administration of lunacy. For it was in the early days that Bucknill, by securing the support of key groups of Magistrates, was able to stand against the more resistant of the Guardians and even to withstand some of the pressures which emanated from the Lunacy Commission in his final years at Exminster. The question of the effectiveness of the Lunacy Commission has also been raised in the works of Hervey and of Bartlett. However, both have argued that the Lunacy Commission was of limited effectiveness in challenging local interest groups and Bartlett in particular has made a strong argument that the most formidable local grouping in Rutland and Leicestershire was the Poor Law Guardians who controlled who went into the asylum and often sat on the Committees of Visitors which governed the asylums. Certainly we accept that in regard to tackling local abuse the Lunacy Commission offered no quick fix and had to proceed, often for years, by careful negotiation and diplomacy. It is clear that it was reluctant to use what power it did have to compel where no actual abuse of patients was concerned and, although its long-range concern did not change, diplomatic considerations, powerful local interest groups and sheer workloads meant that it could be decades before it could show success with a given problem. In contrast to both these authors, we find that the influence of the Lunacy Commission over the longer term was substantial in pressing both Exeter and Plymouth to build their own asylums, leaving them little alternative by the 1880s than to comply with the strategy outlined by the Commissioners from its early years. Doubtless the two boroughs were responding to other considerations, although in the case of Plymouth it is difficult to avoid the conclusion that

The administration of pauper lunacy, 1845–1914 45 they only grudgingly and resentfully acted to set up Moorhaven. Exeter was more positive and saw an opportunity to offer private care to lunatics whose families could pay for this; thus, a significant private population with their own conditions and regime quickly came into being there. Overall, the relationship between the Lunacy Commissioners and Exminster moved from one of high praise during the early Bucknill era to concern and ultimately public condemnation in the Saunders period. The consequence was that Exminster’s performance was constantly monitored and omissions were drawn to public attention. Their reports would appear in local newspapers which became critical of non-compliance and were formally discussed by the Committee of Visitors and, after 1888, the County Council. Considerable local concern would be expressed if abuse was alleged and there is no doubt that such local newspapers as Trewman’s Exeter Flying Post took a prominent role in publicising criticism made by inspectors of the Lunacy Commission. In regard to the Poor Law Guardians who had such an influential role in pauper lunacy, the powers of the Lunacy Commission were necessarily more limited since the Poor Law was the responsibility of the Local Government Board. Their role was largely confined to inspections and to public criticism of poor standards where these were discovered by their visiting staff. An incident in the end of our period from Barnstaple indicates the limits of the powers of the Commission as well as the uneven way in which the important legislation of 1890 was implemented in local areas. The Lunacy Commissioner visiting Barnstaple in 1898 was astonished to find that in only one in eight cases were the rigorous procedures to test the evidence of lunacy prior to certification followed, and 13 years later Justices in the same Union were signing sheaves of blank certificates for later completion by Relieving Officers without any attempt at examination of the individuals to be confined at the asylum.127 Such incidents suggest that the Local Government Board was hardly an active and vigilant body in seeking out failures of its local Guardians to enforce the law in regard to pauper lunacy. These failures echo some of the earlier problems which arose in different Unions when the Lunacy Commission reported difficulties to the Poor Law Board with limited results. Our final conclusion is that the magistracy, which had been responsible for the administration of pauper lunacy in the Quarter Sessions, gave way after 1888 to an elaborate system of County Council committee governance. This new body had a significant impact on the management of the asylum.

4

The ethos of treatment, care and management at the asylum, 1845–1914

In March 1881 the Guardians of Exeter’s Corporation of the Poor gathered at a Special Court session to watch J.B. Parker’s exhibition of a Revolving Bed designed for the treatment of lunatics. Parker explained the value of the device in changing the position of the patient and ‘also in restraining violent lunatics by means of a network of cord’. On being placed under such restraint the lunatic ‘might be mesmerised and that from 80 to 90 per cent might be cured by such means’. The Guardians were sufficiently impressed to appoint a small committee to offer Parker an opportunity to prove his assertion of the curative powers of mesmerism. This interest was expressed long after mechanical restraints had been discredited and 20 years after the Exeter authorities had been sternly advised by the national Lunacy Commissioners in 1861 of the dangers of engaging in such experiments without the approval and guidance of physicians.1 The Guardians’ readiness to open their door to such medical entrepreneurs is to be explained in part by the formidable pressures on them to deal with pauper lunatics throughout Devon. As the asylums built in the 1840s had filled to overflowing by the early 1880s, the Lunacy Commissioners pressed boroughs such as Exeter and Plymouth to provide their own amenities.2 Having no automatic right of access to the County Asylum, Exeter’s Guardians were making use of Dr Finch’s establishment at Fisherton House, where 87 Exeter paupers were being held in early 1882.3 By the 1880s Exminster had become the target of severe criticism from the Lunacy Commission, its superintendent, George Saunders complaining bitterly of the way he was treated by the London Commissioners and those who visited his institution during these years. At the close of the decade it was clear that overcrowding at Exminster was reaching crisis proportions and the breakdown in relations between the asylum and the London authorities was to overshadow the attempts of the institution to expand in the following years.4 To understand the precarious position into which both Exeter and the Devon Asylum had fallen by the closing decades of the nineteenth century, we need to return to the opening of the institution and the promise of psychiatric treatment held out by Bucknill’s generation. Much has been written about the rise and fall of moral treatment in Victorian psychiatry, it being

The ethos of treatment, care and management 47 frequently argued that the optimism of moral treatment years gave way to a profound pessimism and a growing acknowledgement of hereditarian ideas in the 1860s and 1870s, which offered a rather different legitimation of the custodial role of the asylum psychiatrist than had prevailed in earlier years.5 There appears little doubt that, by the late nineteenth century, spilling over into the Edwardian era, there was a pronounced mood of fear and pessimism in regard to inmates of lunatic asylums in Britain as the hopeful vision of moral management had been replaced by a bleak Neo-Darwinian pessimistic belief that lunacy and mental defectiveness, like pauperism and recidivist criminality, were inherited and incurable. The Lunacy Commission starkly reported the demise of the earlier optimism about the potential of asylums to cure, commenting in 1901: Now the asylums are congested with aged, infirm and broken down persons and vacancies for acute cases are difficult to secure . . . resources are largely monopolised by the class to which we have referred, many of whom do not need its costly appliances, and are not benefited by its hospital equipment, and they crowd out those who are urgently in need of both.6 Such statements may be contrasted with the optimistic vision of the early years of asylum building after 1845, though the contrast between the years when Bucknill was in residence at Exminster and the later period is more often stated than demonstrated. Charlotte Mackenzie has recently investigated Bucknill’s career and argues that we can understand his development in terms of a shift from an advocate of institutional care to being a sceptic of asylum provision.7 Such arguments would support a view that there was indeed a growing mood of scepticism about the possibilities of institutional treatment. In this chapter we consider in more depth the therapeutic regime which Bucknill and his successors developed within the Devon institution. We will argue that even in the ‘optimistic’ years of his tenure at Exminster there were significant tensions between his aspirations as a leading authority capable of curing the insane, and the difficulties of managing a large and rapidly expanding institution. While Bucknill was anxious to emphasise the originality of his work at Exminster and the success of his practice, rather than acknowledging the difficulties which he experienced as an asylum superintendent, the evidence suggests that he was increasingly overwhelmed by the weight of admissions and the tedium of both administration and of physical care of large numbers of individuals who flooded through the doors of the Devon Asylum. The experience of Bucknill also indicates that a forceful superintendent with powerful patrons found that he struggled to maintain freedom of action against the central state in the form of the Lunacy Commission, as well as local and central Poor Law authorities. By the time Bucknill departed in the early 1860s, there are clear signs that the grip of

48

The ethos of treatment, care and management

central government was tightening as the drive towards standardised provision and open accountability gained momentum. In developing an argument that the therapy offered to inmates at the Devon asylum was influenced by a range of institutional, political and social factors as well as the leadership provided by the medical staff, we consider first Bucknill’s ideas and his policies at Exminster. We then examine the pattern of admissions and in particular the age profile of those entering the institution and the prospects for recovery which are recorded over the whole of the period considered. Finally, we consider the appointment and conditions of service experienced by those assistant medical officers and the attendants who were primarily and most directly responsible for the care of the residents in the Victorian and Edwardian years. Dr John Charles Bucknill was a relatively young man on his arrival as the first medical superintendent at Exminster but quickly established a reputation as an advocate of the moral, humane treatment of lunatics whose illnesses, he argued, could usually be traced to organic brain disorders. At its heart, the theory of moral treatment espoused the ideal of the superior moral influence of the superintendent and an ideal of shared living, including communal exercise, purposeful occupation, creative recreation and such pursuits as gardening within the asylum grounds, which would enable individuals to regain their reason.8 While Bucknill is often seen as one of the most prominent advocates of moral treatment within the new County Asylums, implementing the ideas developed by John Connolly at Hanwell or Robert Gardiner Hill at Lincoln, he was also a staunch critic of what he perceived as the lax use of the terminology and understanding of ‘moral treatment’ in the mid-Victorian years. Indeed, his early and sustained emphasis on the organic, constitutional origins of insanity may be seen as foreshadowing Maudsley’s later hereditarian views on the insane. President of the Association of Medical Officers of Asylums and Hospitals for the Insane in 1860, Bucknill became editor of the Journal of Mental Science and later of the journal Brain. Rejecting the use of mechanical restraints and physical force as an instrument of control, Bucknill published in 1858 with Daniel Hack Tuke of the famous York Retreat family, A Manual of Psychological Medicine. This became one of the leading texts on the diagnosis and treatment of insanity in the later nineteenth century. A familiar figure in cases where the McNaughten Rules of 1843 concerning criminal responsibility were at issue, Bucknill departed from Exminster to take up the position of a Lord Chancellor’s Visitor in Lunacy and was knighted in 1894, three years before his death.9 Bucknill believed that the origins of insanity were organic and could be traced to the condition of the brain. He wrote in A Manual of Psychological Medicine that: Not a thrill of sensation can occur, not a flashing thought or a passing feeling can take place, without changes in the living organism; much

The ethos of treatment, care and management 49 less can diseased sensation, thought, or feeling occur, without such changes.10 As Brizendine has noted, Bucknill viewed mental disease as arising from ‘physical lesions’ even if such physical signs could not be detected by the present state of scientific observation and post mortem study.11 Bucknill saw the treatment of the insane in terms of three ‘intentions’ or therapeutic strategies. The first was the hygienic, which involved removing the individual from the environment in which their disease had been caused and developed, placing them in humane surroundings where they could receive proper care and attention. The second approach was the moral one, which was not limited to the celebrated regime of moral treatment developed from the late eighteenth century in institutions such as York’s Retreat.12 For Bucknill, a moral approach meant placing the individual in a rational, safe and sanitary condition where physiological improvement as well as improved morale was possible. Andrew Scull has emphasised that moral treatment did not exclude the use of other therapeutic weapons by the alienists of the Victorian years.13 The third element in Bucknill’s proposed treatment of the insane was the medicinal one, which involved the administration of the most appropriate remedies available, including the use of drugs, including tartrate of antinomy, calomel, opium, sulphuric ether and other opiates. The aim of these medicinal treatments was to ameliorate the physical disorders of the body, reduce or remove the pathological condition of the brain, and to treat any urgent or dangerous symptoms.14 Thereafter the orderly routine of the asylum and the ministrations of its physicians and attendants would achieve favourable improvements in the behaviour and condition of the individual.15 In writing The Manual, Bucknill drew on his experience of more than two thousand cases of insanity of which he had direct experience at Exminster, and he attaches a number of cameos of case histories from the asylum which exemplified different kinds of insanity. In his period at Exminster, Bucknill applied and developed his own highly individual therapeutic strategy based on an appeal not to ‘the lowest and basest of the motives of human action . . . fear of the lash, fear of the bond’ but by inculcating the ‘higher motives’ which could only be developed when the use of mechanical restraint was removed ‘absolutely and forever’.16 Bucknill saw the task of the superintendent caring for the insane as a responsibility to promote ‘the power of the will’ because ‘insanity must . . . be defined as a condition of the mind in which a false action or conception or judgement, a defective power of will or an uncontrollable violence of the emotion and instincts have separately or conjointly been produced by disease’.17 Bucknill continued to express his view of the asylum as the appropriate environment in which individuals could regain their self-control and he appears to have pursued these goals in his period at the Devon Asylum.18 The evidence also indicates that the Devon Asylum witnessed a rapid influx of cases which must have made individual treatment extremely difficult to

50

The ethos of treatment, care and management

sustain. The surviving case registers show that he was less able to undertake the detailed discussion of individual patients as his time at Exminster advanced. There is little sign that the diagnosis and treatment of insanity altered significantly in his Exminster years. We now consider the pattern of admissions, diagnosis, treatment and discharge at the Devon Asylum. On 22 July 1845, the first male pauper lunatics were admitted to the asylum at Exminster, followed six days later by the first cohort of females and, by 5 August, there were 20 men and 33 women held in the asylum. Within a decade the asylum was housing almost 500 inmates, and by the early 1880s the numbers approached 1,000, a peak of 1,300 inmates being registered in 1907.19 The design of the new asylum was of a semi-circular, two-storeyed building from the perimeter of which semi-circle radiated out eight ‘galleries’, each 150 feet long with dormitories, single sleeping rooms and day rooms in each gallery. At the centre of the space enclosed by the semi-circle was the administrative block with the great entrance modelled on that of Pentonville Prison.20 Between 1856 and 1858, a new detached ‘women’s block’ was constructed followed by expansion on the male side.21 Indeed it is worth noting that throughout our period male and female inmates at Exminster were kept separate day and night, except when under direct supervision of staff and staff were not permitted access to inmates of the opposite gender unless accompanied by a member of the same gender as the inmate in question. It is notable that pressure on female beds was frequently greater than that recorded for male dormitories in our period. Bucknill was practical in his management of Exminster. It is obvious that he did not see himself as a purist moral manager and he was impatient of the looseness with which the term ‘moral treatment’ was bandied about. He freely acknowledged that high staff–patient ratios, overcrowding, untrained staff and a host of other pressures made any such achievement impossible. From the early days he recognised the importance of recruiting competent attendants upon whose shoulders the burdens of everyday care would rest. While he insisted on high standards being achieved in the care of asylum inmates, he was realistic enough to recognise that the work of the attendant was ‘so very disagreeable and onerous that it is astonishing to me that we meet with such good men who are willing to undertake it’.22 The working conditions of the attendants are discussed later in this chapter. The medical regime was the responsibility of the superintendent and his immediate assistants. On arrival at his new institution, Bucknill provided the sole medical attention to the lunatics until the addition of an assistant medical officer in 1848. His staff included a female housekeeper, ten male and 14 female resident attendants. Other officers included a steward, clerk to the Visitors and chaplain. There was also a significant group of domestic staff. The first assistant medical officer who served under Bucknill was Dr Parsey, who left to become superintendent of Warwick asylum in 1852. Four assistants followed, including Dr Symes Saunders who eventually succeeded him as superintendent in 1862. While mechanical restraints were

The ethos of treatment, care and management 51 prohibited, seclusion rooms were used to restrain patients where deemed necessary. Bucknill claimed that visitors to the Exminster asylum were astounded to find apparently ‘normal’ people undertaking useful work and suggested that even the ‘idiots’ housed at the institution were susceptible to praise and blame, being ‘easily taught to be cleanly and orderly and their comfort and happiness are much increased’.23 Amusements and diversions for the inmates were provided in the form of regular reading classes, the playing of musical instruments and strolls within the grounds during the summer months, with Dr Saunders, the attendants and more capable patients taking the lead in these activities.24 We can gain only a limited insight into the quality of care and treatment provided by Bucknill personally during his time as superintendent at the Devon County Asylum since some of the patient case books are missing for the key years in which he was employed. The evidence gained from the certificates, admission notes and case files which survive for the early period indicates that Bucknill would, as superintendent, usually examine the individual admitted within hours of their arrival, or certainly within a day or more of their appearance. Fairly detailed notes were prepared of the physical and mental condition of the person admitted, including information clearly drawn from the certificates of insanity prepared by the Poor Law medical officers and magistrates, outside the institution. Bucknill frequently expressed some impatience, if not contempt, with the quality of the diagnosis offered in these documents and appears to have arrived at his own diagnosis after a fairly careful inspection of the person before him. The admission notes almost invariably provided the first episode in the patient careers which were laid out in the case books carefully maintained for inspection by the Lunacy Commissioners. Our evidence suggests that the early months and years saw regular entries and commentary by the superintendent and his colleagues, diminishing clearly when the inmate had become an established resident with lower prospects of recovery. In many instances the long-term resident was examined once or twice a year with the solitary comment attached, ‘No change’. Later in our period these individuals were often reallocated to ‘Chronic’ case books and apparently viewed as having few prospects of leaving the institution. The length, style and content of the admission registers, and more particularly the case notes which survive from the early period, suggest that the detailed, florid discussion of individual patients which characterised the first years of Bucknill’s tenure were much less in evidence as his career as Exminster superintendent drew to a close. Indeed, as noted earlier, the general management of patient records at the asylum was sharply criticised by the Lunacy Commissioners within 15 years of Exminster opening its doors.25 By the time of his departure in 1862, it appears that Bucknill’s medical care of the Exminster inmates had been adversely affected by the volume and diversity of people arriving at the asylum gates, and perhaps by the grinding cares of running a large institution where he remained

52

The ethos of treatment, care and management

personally responsible for the direction of the attendants as well as organising domestic arrangements. In his approach to the care of those placed in Exminster, Bucknill appears to have broadly followed the ‘intentions’ laid out in his textbook of 1858, to provide a hygienic environment for all and to dispense a range of medicinal treatments including the widespread use of purgatives, emetics, opiates and alcohol, often in liberal quantities. As we earlier observed, although Bucknill was convinced of the necessity for humanity and the capacity for amelioration of symptomology inherent in moral management theory, he essentially saw the causes of insanity as constitutional brain disorder. In contrast to many of his contemporaries, Bucknill did not have a private practice for the treatment of the insane at Exminster. His was also a conventional Victorian view of intricate class stratification and exact class differentiation. ‘Middle-class’ patients should not, in his view, be admitted into county pauper lunatic asylums. He argued that those with moderate means, ‘the struggling and suffering class intervening between wealth and pauperism’, should seek treatment in charitable and voluntary asylums, or in private licensed houses away from paupers.26 Bucknill also retained a traditional view of the role of men and women, dismissing women’s rights campaigns as ‘a repulsive novelty of female manhood’, while quoting with some approval Milton’s vision of a valorous and contemplative male complementing the graceful and beautiful female.27 The Exminster superintendent subscribed to the view that women were more intensely driven by emotion than instrumental males and suggested that ‘religious and moral principles alone give strength to the female mind. When these are weakened or removed by disease, the subterranean fires become active and the crater gives forth smoke and flame.’28 The dangers of feminine passions were a hazard to be guarded against. Less conventionally, however, he rejected the notions of racial domination and superiority which underpinned much contemporary discussion of colonial expansion. Such attitudes towards race could only lead to ‘the extraordinary abhorrence’ of dominance, oppression and conflict.29 The practical model for the treatment of the insane developed at Exminster included innovations in cottage care for some inmates, drawing on the Gheel experiment in Belgium.30 Improving cases were periodically boarded out in the village of Exminster, usually with an employee of the asylum. Such initiatives also served to relieve the growing pressure on asylum space by moving out, as ‘a temporary expedient’, some of those with reasonable prospects of improvement or recovery. Women who were ‘suffering from low spirits or delusions’ were placed in such accommodation and engaged in household work under the supervision of an asylum attendant.31 The practice was still in evidence in 1878, and by 1890 small numbers continued to be boarded out and dispersed to a wider area around the asylum.32 In other instances Bucknill permitted individuals such as Elizabeth W. to visit her mother regularly, even though she had expressed murderous hatred for another family member, and the superintendent was satisfied that such cases

The ethos of treatment, care and management 53 could be trusted with some freedom not only within the grounds of the asylum but outside its boundaries.33 Bucknill’s confidence in the benefits of contacts with the wider world was clearly a theme of his management of Exminster, which appears to have grown in later years into a conviction that alternatives to asylum care could yield results that institutions could not achieve.34 A more ambitious experiment in placing lunatics within the larger society of Devon came when he embarked on the scheme of housing a select number of female lunatics in a seaside villa at Exmouth in the summer of 1856. The origins of the venture can be found in the pressures created by the arrival in Exminster of 50 female pauper lunatics from Plymouth Corporation of the Poor. In renting a villa at Exmouth, Bucknill saw an opportunity to do more than relieve overcrowding at the asylum and selected females who were ‘clean and quiet’ for dispatch under the care of Dr Saunders.35 Throughout his career, Bucknill emphasised the public hostility which was expressed not only towards the insane but also the institutions which cared for them and, in engaging on the therapeutic excursion in Exmouth, he appears to have been keen to confront ‘the ignorance and the prejudices which still exist in the public mind with regard to the insane’, and to cultivate a more sympathetic attitude towards those he cared for.36 The superintendent also believed that the ‘hygienic and moral influence’ needed for an improvement in the condition of lunatics, which he discussed in his published work, could be found in the air of the coastal resort. A final motive which Bucknill may have had in pressing forward with this innovative policy was the undoubted benefits accruing to himself and his institution from the support gained among the Lunacy Commissioners and his professional colleagues who learned of the experiment in the pages of the Journal of Mental Science.37 This support proved invaluable when the Exminster staff encountered the wrath of an alarmed community in Exmouth, who petitioned the Secretary of State on their fear of ‘painful scenes’ and possible violence at the hands of the strangers.38 Commended by the Lunacy Commission in their advice to the Secretary of State, Bucknill and Saunders were able to soothe the concerns of the Exmouth property-owners and local school owner in the course of 1856–1857 and to show that the women dispatched there had not offended public decency.39 In these circumstances Bucknill remained convinced of the therapeutic benefits of the initiative and decided to increase the numbers housed at the Exmouth villa to more than 40 in summer 1857. He argued that there was no remedy he should recommend more highly to ‘the sufferers from mental disease than residence at the seaside’.40 The Lunacy Commissioners again advertised the virtues of the scheme to other institutions.41 On the opening of a new wing for females in Exminster during 1858, the villa at Exmouth was finally surrendered and the women withdrawn to the asylum, without any attempt to renew the experiment in later years. In his last years at the Devon asylum, there are clear indications from the

54

The ethos of treatment, care and management

surviving case books that Bucknill’s willingness or capacity to devote time to detailed entries on individual patients had been seriously curtailed and was a source of concern among the Lunacy Commissioners.42 Bucknill left Exminster in 1862 and he was succeeded by his deputy, Dr Symes Saunders, who in his turn was succeeded in 1898 by Dr Davis, who had been first medical superintendent of Plymouth’s asylum, opened in 1891 at Moorhaven. During the period 1862–1914, there were a number of clear developments. It was apparent even in Bucknill’s period that the influx of an increasing number of individuals, some of whom had languished in workhouses or in domestic homes for many years with only minimal care and attention, presented formidable problems for those seeking to offer effective treatment. This problem of large numbers and intense pressure on available space within the asylum was to remain one of the most important and problematic features of the Exminster experience in the decades which followed Bucknill’s departure. The Lunacy Commission in London became deeply concerned that the rapid growth in the population of the asylums threatened the relationships between inmates and staff at these institutions. The relatively high ratio of 15 inmates to one attendant in the Bucknill years was accepted, though from his final years we can detect a marked deterioration in relations between the asylum and the Commissioners.43 The most notable contrast, as we say later, was with the ratio in the early twentieth century of one-to-nine. The care and treatment provided at Exminster was overshadowed by the relentless expansion in the physical size of the institution, as well as the numbers who entered it. By 1875 there were over 600, with much greater numbers of females in evidence, and in 1890 there were over 900 patients resident at the institution.44 Less than 20 years later, the figure had climbed to an extraordinary 1,344 (755 being female) or more than three times the number for which the asylum was originally designed. One consequence was that the asylum cemetery was filled to excess.45 New building proceeded continuously throughout the later nineteenth and early twentieth centuries, the Lunacy Commissioners even urging Devon County Council to contemplate the construction of a new asylum in 1893–1894.46 Instead it was decided to provide additional accommodation for patients and nursing staff, while overcrowding remained acute enough for the County Council to purchase another extensive tract of land as female patients were dispatched to Dorset County Asylum due to lack of space.47 Regardless of periodic assurances that the expansion programme had been completed, extensive additions continued to be undertaken in the years before 1914 as Exminster was forced to ask Devonport to remove all of its patients from the asylum.48 In addition to the laying down of new buildings, the infrastructure of the institution was enlarged and developed in these years as the demand for water and sewage waste increased, provoking bitter disputes with its neighbours.49 By the end of the century there was fresh controversy as the rural district council in St Thomas undertook a legal battle to prevent the asylum dis-

The ethos of treatment, care and management 55 charging its sewage into the public sewer.50 There was also considerable expenditure on electricity and gas facilities. This growth in the physical fabric of the institution took place in response to a relentless flow of people through the asylum, periodic crises of overcrowding and difficult living conditions, forcing the Visitors and the County Council to answer to the Lunacy Commission for the problems which were plainly visible in their inspections. One of the most significant issues raised in such reports was that of staff–patient ratios and the quality of care which was offered to the residents of the asylum. It is difficult to overstate the importance of the role of the asylum attendants who were responsible for the daily care and physical management of the inmates during our period. Contacts with qualified medical staff were infrequent, even rare, for the majority of residents who had remained in the institution beyond two or three years. For the least hopeful, chronic cases, there was usually little prospect of release except when the pressures on space and resources compelled the Lunacy Commissioners, Visiting Magistrates, or possibly the families of the individuals to dispatch them back to the workhouses or to other places in order to free space for new arrivals as the institution expanded almost relentlessly in our period. The attendants have not received the kind of detailed research which historians have devoted to the senior medical figures of the period, and their pivotal role in the lives of the Victorian lunatic deserves some serious consideration. The first indicator of daily environment and quality of working life for staff as well as inmates within the asylum is the ratio of staff to residents which varied over our period, falling in the 1870s, fluctuating in the 1880s but improving in the later Victorian and Edwardian decades. Drawing on the annual reports of Exminster provided in the Lunacy Commission’s publications, Table 4.1 offers a rough estimate of the pattern of staff ratios in this period.51 When the ratio of inmates to staff increased, the Lunacy Commission pressed the Visitors to employ more attendants, expressing their dismay in 1890, for example, that almost 1,000 patients were under the care of only eight night attendants.52 In 1892 the Lunacy Commission reported bitterly on what it saw as a preventable suicide, adding that the year before ‘we had to reflect upon a case of suicide on the female side of the Asylum when we pointed out that we had regarded its staff as being too weak’, adding in somewhat exaggerated terms that such an inefficient staff, we venture to assert boldly, is not to be found in any other asylum in England, and it is to our mind incomprehensible that any superintendent with such a manifestly weak staff should have allowed it to be reduced by the removal of one person from every ward to do cook’s duties, which every attendant has a right to expect done for him.53

25 29 34 34 35 44 58 69 83?b

1870 1875 1880 1884 1888 1893 1898 1903 1908

415 425 486 497 501 586 641 686 750

Number of female patients 16.6 14.6 14.2 14.6 14.3 13.3 11.1 9.9 9.0b

Ratio of attendants to inmatesa

Notes a On day of inspection. b No attendant figures provided. Ratios calculated by the Commissioner reporting.

Number of female day attendantsa

Year of inspection report

Table 4.1 Attendant to inmate ratios at Exminster, 1870–1908

15 18 21 24 24 36 41 52 64?b

Number of male day attendantsa 270 260 296 327 359 424 462 532 573b

Number of male patientsa

18.0 14.4 14.1 13.6 15.0 11.7 11.3 10.2 9.0b

Ratio of attendants to inmatesa

The ethos of treatment, care and management 57 The evidence suggests that the growth in the numbers housed at Exminster ran ahead of the staff, and more particularly the male attendants at some periods in the nineteenth century, provided to care for them. It is apparent from such comments that the Commissioners considered Exminster to be far removed from the praise for what they had seen as a shining example of progressive practice during Bucknill’s early years at the Devon institution. The result was considerable difficulty in the lives of the staff as well as the patients at the Devon County Asylum, which were compounded by poor conditions of pay and work. Not only were there periodic crises at the institution, but also a prolonged problem of attracting and retaining staff. The conditions of service were poor even in Bucknill’s day. He expressed his concern that attendants became fatigued with the hard work of asylum duties, noting that the occupation was a ‘very onerous and tiring’ one and that females often departed for the lighter burden of domestic employment.54 The management regime established at Exminster was that of firm, even military, discipline where the attendants were expected to conform to rigorous standards of behaviour and usually take up residence in or near the grounds of the institution. Advertising in the local press for attendants, Bucknill was particularly inclined to employ former soldiers who had completed a brief period of service, ‘long enough to have acquired discipline and not to have learned the tricks of an old soldier’.55 The results satisfied the superintendent, proud of his complement of men who were (in his words), ‘a good lot, intelligent, amiable and cheerful’.56 Bucknill’s fondness for military men may have also arisen from his well-known enthusiasm for the Volunteer movement in Devon. Those who were recruited to the service of the asylum faced conditions and remuneration which were hardly better than the armed forces. The working day of the attendant began at 6.30 a.m. and did not finish until 7.30 p.m. with only one rest day per fortnight.57 This punishing schedule was a cause of concern at the Lunacy Commission, where the risk of rapid staff turnover and loss of sustained contact with patients was discussed along with the low wages paid. Even at the end of the nineteenth century, wages remained modest for attendants, males receiving substantially higher rewards for their work than their female equivalents. In 1903 the Head Male Attendant earned £124 per year while the Head Nurse received only £71. Their subordinates fared much worse, with male night attendants earning £36 to £45 a year and females £25–£27.58 Male agricultural workers in Devon earned 15 shillings per week in 1892 and almost 17 shillings per week in 1900, amounting to £39–£43.40. This indicates that attendants earned no more than the substantial number of agricultural labourers whom they supervised as patients.59 The monetary incentives to remain in asylum service were hardly great even in the pre-1914 years, when the lower-grade medical staff began to organise for collective bargaining, although wages did improve somewhat. Other inducements could be found in the customary and ex-gratia benefits

58

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which such employees could receive in the service of an institution such as Exminster. The asylum provided apartments within its grounds for unmarried attendants, while married employees were often given a cottage, though by 1900 the increased numbers of attendants meant that many of these cottages were located some miles from the institution and the occupants required to walk considerable distances for their early morning duties.60 Another benefit provided on a discretionary basis was that of medical attendance including admittance to the Devon and Exeter Hospital to which the Visitors subscribed.61 For those who remained in long and loyal service to the asylum, there was also the prospect of a non-contributory pension, decided in individual cases by the Visitors. The prospects for increased pay and superannuation depended largely on promotion. These appointments appear to have been usually made on the grounds of seniority rather than by qualification or professional examination, though at the end of the nineteenth century there was greater effort made to provide lectures and some training, with 29 male and 20 female attendants holding the Certificate of the Medico Psychological Association by 1903.62 The evidence of staffing at Exminster nevertheless suggests that many attendants did in fact remain for a considerable period. In 1880, for example, 36 of the total of 61 attendants had been there over two years, although onefifth of the female attendants had completed less than a year of service compared to only one in 20 males. At the end of that decade, the turnover of female attendants remained a problem, half being in employment for less than two years.63 There was also a core of attendants who did remain for considerably longer periods, influenced perhaps by the prospect of a superannuation payment. In 1906 almost three in ten attendants had served for more than five years.64 Some of the senior attendants could show substantial periods of service. In 1912 the chief female attendant retired after 36 years’ service to be replaced by her deputy, who had been at Exminster for 24 years and was in turn succeeded by another senior attendant who claimed 16 years of employment.65 Senior male attendants retired after similar periods of service. Another significant figure in the management of the institution, and the employer of numerous female inmates, was the housekeeper, Mrs Quick, leaving in 1891 after more than 20 years of service at Exminster.66 Although the asylum provided various benefits to its staff, any employee caught transgressing the rules of the institution was subjected to firm discipline. Night attendants discovered sleeping were liable to be dismissed, with ‘tell tale’ clocks used to punch the tickets which these employees carried with them around the wards and dormitories of the institution. After the departure of Bucknill, there arose a crisis in staff relations when Saunders reported to the Visitors that regular thefts of asylum property were taking place and that the steward was the ringleader of a cabal of attendants who displayed a ‘great spirit of insubordination’ and were responsible for the brutal treatment of some inmates.67 Saunders himself did not escape criticism on this occasion.68

The ethos of treatment, care and management 59 In seeking to establish a firm moral tone among the staff and to provide the kind of ‘hygienic and moral’ environment to which Bucknill aspired, the attendants remained the subject of rigorous discipline long after the departure of its first superintendent. In 1902 it was reported that one of the nurses was pregnant to a male attendant and Dr Davis told the Visitors that these long-serving employees ‘as is customary in such cases’ had been dismissed. In a later incident where a nurse had given birth to a daughter, the Visitors heard that the child ‘has been removed’ and the putative father was called to appear before them to ‘state his case’.69 In this late period another two attendants were denied promotion where they were held to be responsible for incidents such as the escape of a patient.70 One context in which to understand the enforcement of a stern discipline at the Devon asylum is the clear deterioration in staff relations before the First World War when complaints about ‘stinking’ food were harshly criticised by Dr Davis, who asked for the support of the Visitors in placing ‘a rigid check on unfounded complaints’, and the dismissal of a leading complainant.71 The increased activity of the attendants’ trade union in this period cannot be divorced from the determination of the medical staff to assert their authority within the asylum.72 The senior staff responsible for the management of the attendants were recruited from further afield and also travelled further in search of career advancement. The salaries given to the leading medical and pastoral staff were not generous. The chaplain earned £210 in 1863 rising to £300 in 1903. Dr Saunders, as medical superintendent, received £500 in the year after Bucknill departed, but by 1903 Dr Davis was in receipt of an annual salary of £850. The improvements in remuneration were not simply a testament to the competence and persuasive powers of the superintendents but reflected also the increasing difficulty of attracting senior medical personnel to the Devon Asylum. This is particularly noticeable in the turnover of assistant medical officers after Bucknill’s departure. Nine individuals succeeded each other as assistant medical officer under Dr Saunders between 1862 and 1884, when the post of second assistant officer was created. Pressures on these staff remained strong enough for a third assistant to be established in 1900 and a fourth in 1911. In the first 11 years of the new century, more than 20 doctors passed through the asylum, many remaining a year or less, with the Visitors continuously advertising for replacements. Davis resorted to visiting the deans of London medical schools to recruit likely candidates.73 By 1913 he was empowered by his Visiting Committee to offer appointments in person to suitable individuals, with decisions approved after the event.74 One incentive provided to those remaining was the prospect of early promotion as senior colleagues departed and an improvement in the somewhat meagre salaries offered to the junior medical staff. When Dr Fortune resigned in 1908, Dr Eager assumed his duties while the Visitors filled his own post by promoting the junior assistant, only to find within a month that this doctor’s resignation forced them to advertise for a

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replacement.75 The bleak professional lives of the asylum’s medical officers may be contrasted with the scholarly accounts which have emphasised the self aggrandisement of Victorian psychiatrists and academic claims of unremitting medical imperialism. The inducements offered to the medical staff did little to prevent the remarkable turnover of colleagues after the Bucknill era had passed. Occasionally, physicians broke under the strain of arduous and demanding work which the growth in patient numbers clearly presented to the hard-pressed medical staff, one fleeing the institution at night and without notice.76 Others sought to confront the superintendent and Visitors, with clear signs of defiance and conflict, as when Dr Davies reported in 1899 that Dr Clapp refused to surrender his keys to the clerk and continued to occupy his bedroom. The doctor was ordered from the asylum by the Visitors.77 More violent disputes led to ugly incidents which again testified to the strains and poor morale of the senior staff in these years.78 Whereas the medical superintendent was fairly well remunerated, being housed in a substantial residence at the asylum, his assistants found their positions so demanding that, by the early twentieth century, the Visitors were forced to rely on locum assistants to fulfil the duties of the medical personnel. So desperate did the situation become that the Devon Visitors agreed to the appointment of a female as the fourth medical officer in 1911 after stubbornly refusing to interview a woman who was the only candidate for the post some years before.79 Dr Enid Walters remained in post only a few months before leaving for a better-paid position at a sanatorium.80 The quality and temper of staff morale at the Asylum had inevitable consequences for the care and treatment of its inmates during these decades. Bucknill himself had recognised that the staff as well as the inmates of the Asylum were liable to be viewed with deep suspicion by their contemporaries, noting that ‘the public extends its unreasonable antipathy to the insane to all those who are connected with insanity; even to those who wrestle with the great evil and, to the best of their ability, hold it down’.81 Those who were employed in the treatment of the insane were, according to Bucknill, likely to be influenced if not infected by this ‘morbid atmosphere of thought and feeling, a perpetual Walpurgis night of lurid delusion’.82 Whatever the validity of Bucknill’s vivid description of popular attitudes, there is little sign of abuse of inmates until scandal erupted over Saunders’ direction of attendants in the late 1860s. The evidence suggests that the final as well as the early years of Saunders’ tenure were marked by increased reports of the abuse of patients at the Devon Asylum. In 1896 an assistant medical officer reported a female attendant for the brutal treatment of a patient and three years later another attendant was fined and dismissed following an attack on a patient.83 On some occasions these assaults followed a brutal attack by the patient on an attendant, as when one male attendant was dismissed by Dr Davis in 1902 for the ‘uncontrollable manner’ in which he retaliated.84

The ethos of treatment, care and management 61 Towards the end of the nineteenth century, the Lunacy Commission again became concerned about the abuse of patients by some attendants at Exminster, as reported in their annual publications and in their correspondence with the County Council.85 Another source of criticism can be found in the local press which provided a commentary on the Commissioners’ Reports. As early as 1871 Trewman’s Exeter Flying Post took up the call of the Commission for the dismissal of an attendant, having originally been an active supporter of the asylum project. The newspaper concluded that ‘several grave matters had again to be brought under the notice of the committee, previous warnings in relation to them having been entirely neglected’. They advised their readers that the staffing levels and conditions at the County Asylum had proved ‘totally inadequate’.86 Where the annual inspections by the Lunacy Commission found fearful patients who bore the signs of attack or abuse, then the Commission were severely critical, frequently demanding the prosecution of offending staff and calling for an improvement in staffing levels.87 We now turn to considering the pattern of diagnosis, admission and discharge, including the length of stay of people at the asylum. Initially, we consider the whole period from the foundation of the asylum in 1845 to the outbreak of war in 1914. It is very difficult to assess the impact of treatment on the individuals for whom it was designed in this period, given the brevity and uneven quality of case notes for the majority of those admitted. The historian of the asylum must rely on the numbers admitted, length of stay and reason for discharge to gain some understanding of the rates of recovery among those who entered the institution. The diagnosis used to admit the individual was made by one Poor Law medical officer, who was required prior to commitment and certification to state the facts indicating insanity on the certificate, observed by himself and by others. The admission registers appear to have copied many of these details, and even in Bucknill’s time there appears to be a reasonable concurrence between the initial diagnosis entered in the admission registers and the subsequent description of symptoms in the much more elaborate case books. Taking the diagnoses entered in the asylum admission registers and with details clearly drawn from the original certificates of insanity, we can indicate some of the main categories used to identify insanity in the period. The use of the terms to diagnose insanity do appear to have varied between males and females, and to have changed over the period as a whole. We have therefore divided the period into two parts, distinguishing the diagnoses used up to 1880 from the terms used from 1881 until 1914. Tables 4.2 and 4.3 give the results of our analysis: A comparison of the two tables indicates some of the similarities and variations in the diagnosis of female and male insanity in the periods considered as well as the changing application of prefixes such as ‘acute’ and ‘chronic’ over the two earlier and later years. The evidence from the admission registers indicates that women as well as men were most likely to be

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Table 4.2 The initial diagnosis of those entering the Devon County Asylum, 1845–1880 Diagnosis

Female (%)

Male (%)

None Unclear Acute dementia Acute mania Acute melancholia Acute mania Chronic dementia Chronic mania Chronic melancholia Chronic mania Delusions Dementia Del tremens Epileptic mania Epileptic Epileptic insanity General paralysis Idiocy Imbecile mania Imbecility Manic depression Melancholia Monomania Mania No symptoms insanity Puerperal melancholy Puerperal mania Puerperal insanity Religious mania Senile dementia Senile melancholy Senile mania Unknown Weak-minded

11 (1.2) 7 (0.8) 1 (0.1) 5 (0.5) 5 (0.5) 20 (2.2) 0 (0.0) 30 (3.3) 0 (0.0) 16 (1.7) 0 (0.0) 115 (12.5) 0 (0.0) 2 (0.2) 1 (0.1) 7 (0.8) 15 (1.6) 21 (2.3) 9 (1.0) 15 (1.6) 0 (0.0) 264 (28.7) 6 (0.7) 339 (36.9) 2 (0.2) 1 (0.1) 12 (1.3) 0 (0.0) 1 (0.1) 12 (1.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 919 (100.0)

10 (1.2) 10 (1.2) 1 (0.1) 4 (0.5) 2 (0.2) 21 (2.5) 0 (0.0) 12 (1.4) 0 (0.0) 14 (1.6) 0 (0.0) 115 (13.5) 2 (0.2) 1 (0.1) 0 (0.0) 6 (0.7) 99 (11.6) 31 (3.6) 13 (1.5) 32 (3.8) 1 (0.1) 152 (17.8) 7 (0.8) 302 (35.4) 8 (0.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 9 (1.1) 0 (0.0) 1 (0.1) 0 (0.0) 0 (0.0) 853 (100.0)

diagnosed as suffering from mania on their entry to the asylum. More than 30 per cent of females and slightly fewer males were diagnosed as suffering from ‘mania’ in our sample of 4,000 from the total 13,000 admissions over the period as a whole, while 5 per cent of each sex were said to be ‘acute’ maniacs and another 4 per cent of each were termed ‘chronic’ maniacs. The sample of 4,000 was weighted to reflect the sex ratio of Exminster admis-

The ethos of treatment, care and management 63 Table 4.3 The initial diagnosis of those entering the Devon County Asylum, 1881–1914 Diagnosis

Female (%)

Male (%)

None Unclear Acute dementia Acute mania Acute melancholia Acute mania Chronic dementia Chronic mania Chronic melancholia Chronic mania Delusions Dementia Del tremens Epileptic mania Epileptic Epileptic insanity General paralysis Idiocy Imbecile mania Imbecility Manic depression Melancholia Monomania Mania No symptoms insanity Puerperal melancholy Puerperal mania Puerperal insanity Religious mania Senile dementia Senile melancholy Senile mania Unknown Weak-minded

, 11 (0.9) , 1 (0.1) , 1 (0.1) , 73 (6.1) , 60 (5.0) , 7 (0.6) , 5 (0.4) , 60 (5.0) , 6 (0.5) , 11 (0.9) , 88 (7.4) , 133 (11.2) , 0 (0.0) , 0 (0.0) , 0 (0.0) , 4 (0.3) , 7 (0.6) , 11 (0.9) , 0 (0.0) , 35 (2.9) , 0 (0.0) , 223 (18.7) , 0 (0.0) , 298 (25.0) , 3 (0.3) , 0 (0.0) , 3 (0.3) , 20 (1.7) , 1 (0.1) , 66 (5.5) , 10 (0.8) , 17 (1.4) , 28 (2.3) , 10 (0.8) 1,192 (100.0)

, 12 (1.2) , 5 (0.5) , 0 (0.0) , 56 (5.4) , 35 (3.4) , 7 (0.7) , 3 (0.3) , 42 (4.0) , 8 (0.8) , 6 (0.6) , 94 (9.0) , 172 (16.5) , 0 (0.0) , 0 (0.0) , 0 (0.0) , 5 (0.5) , 41 (3.9) , 25 (2.4) , 0 (0.0) , 42 (4.0) , 0 (0.0) , 142 (13.7) , 0 (0.0) , 234 (22.5) , 5 (0.5) , 0 (0.0) , 0 (0.0) , 0 (0.0) , 2 (0.2) , 45 (4.3) , 10 (1.0) , 12 (1.2) , 19 (1.8) , 18 (1.7) 1,040 (100.0)

sions recorded in the decades between 1845 and 1914. Almost 700 males (from our sample of 1,900 men) and rather more than 700 females (from some 2,100 in the sample) were classified as suffering from mania on their entry to the Devon asylum. The next most familiar category was melancholia, which was the diagnosis found among almost one quarter (23 per cent) of female admissions but only one in six males were given this simple

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diagnosis, women being also found to be more commonly ‘acute’ melancholics than men.88 The third largest group was ‘dementia’ which accounted for about 15 per cent of male admissions and 12 per cent females, with another 3 per cent of men and 4 per cent of women identified as suffering from ‘senile dementia’. Thus we can say that these three categories accounted for more than three-quarters of female admissions and almost three-quarters of male entrants. Those identified as idiots, imbeciles or weak-minded accounted for almost 8 per cent of males and 5 per cent of females entering the Devon Asylum. The only other significant categories were those of general paralysis and that of delusional insanity. General paralysis was the condition found in more than 7 per cent of men and 1 per cent of women, while ‘delusions’ were said to have caused the insanity of 5 per cent of male and 4 per cent of female admissions. The first point of difference is that females were more likely than males to be diagnosed as melancholic in both periods. The proportion of women certified simply as melancholic falls from about 29 per cent to less than 19 per cent between our earlier (pre-1881) and later periods, though it is noticeable that the number of ‘acute’ melancholics among females increased to 5 per cent. Male melancholics fell from 18 per cent to 14 per cent in the same periods (acute melancholics accounting for less than 4 per cent of the later total). Those diagnosed with mania were also a larger proportion of females than males in both periods, though the number of simple maniacs falls from well over one-third of females before 1881 to onequarter in the later years, while the ‘acutes’ rose more than ten-fold to 6 per cent. A similar proportion of males were diagnosed with mania in the earlier decades (more than one-third to under one-quarter at the later time) though the diagnosis of acute mania did not increase as noticeably among males (doubling). It is interesting that a higher number of males than females were diagnosed with dementia both before and after 1880, though the gap between the sexes in this regard widened in the later years. The use of ‘melancholia’ as a diagnostic term diminished in the later period, though the use of ‘acute melancholia’ increased. Whereas ‘delusional insanity’ was virtually unknown to the admission register before the 1880s, by the end of our period it claimed a significant proportion of those diagnosed. The most intriguing diagnosis for males in these decades was that of ‘general paralysis’ which is usually understood to refer to the general paralysis of the insane associated with syphilis infection, leading to brain disease and symptoms of chronic trembling. The diagnosis of the condition became more precise in the last two decades of the nineteenth century, and with the Wasserman test, developed in the early twentieth century. It was frequently thought to prevail among men and women in the port cities where opportunities for prostitution were greater.89 Yet the evidence from the Exminster asylum does not readily conform to this model of scientific and medical understanding. In the period 1845 until 1880 there were almost

The ethos of treatment, care and management 65 100 males and 15 females diagnosed as suffering from general paralysis, which represented almost one-eighth of male admissions in these years and was the fourth most frequent diagnosis. The later period is rather different, with considerably less than half the number of males diagnosed as suffering from general paralysis than in the earlier years and less than half the females given as sufferers. The most likely explanation for this drop in numbers appears to be that the use of the term became more restricted and was used more precisely after 1880. About one in five diagnosed with general paralysis came from Plymouth before 1881 and one in three among the smaller cohort for the later years up until the opening of Moorhaven in 1891. The case books which survive for the asylum include considerable detail for many individuals who entered the County Asylum, notably in Bucknill’s early years and for periods during Saunders’ and Davis’ tenure as superintendent. These notes indicate that the testimony of family members and Poor Law officers, as well as the details found in the original documents of certification, were frequently included in the medical case books maintained in the asylum. These details included the initial diagnosis of the individual and, despite the frequent and severe criticisms made by Bucknill of Poor Law medical officers, there are few signs of direct criticism of these diagnoses in the case books which remain. From the early days, the Exminster case books provide a detailed portrait of many of those admitted, with details drawn from relatives and others as well as official documents. One way in which the facts of insanity are presented is as an inability to appreciate the social and personal circumstances in which a patient lived prior to admission. In the case of men this was often portrayed as a failure or inability to behave in a respectable and responsible way in public and in their duties as employees, husbands or fathers and as members of their communities. For females there was more often a greater emphasis upon the completion of domestic, household and family responsibilities which the individual had failed to undertake in a consistent or responsible way. While there was a greater use of the medical prefixes of ‘acute’ and ‘chronic’, along with ‘senile dementia’, ‘delusions’ and ‘general paralysis’ in what appears to be more precise and consistent medical classification in the later years of our study, there is little compelling evidence that the therapeutic portraits of the inmates or the regime in which they lived at Exminster changed radically before 1914. This would confirm the impression that in contrast to its very distinguished reputation in the Bucknill years, the asylum was an undistinguished institution with few intellectual resources or pioneering initiatives in the treatment of its patients before 1914. The way in which the asylum staff responded to the individuals they cared for clearly depended on the nature and severity of the symptoms which the individual presented, ranging from serious epilepsy to crippling melancholy, though in the case of violent individuals the staff resorted to a range of opiates as well as the use of seclusion rooms to manage the

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behaviour of the individual and protect the staff and other patients. For those individuals able to work, the men were set to labouring and the women to domestic tasks around the asylum estate which were seen as important steps towards the recovery of both reason and responsibility. An orderly routine of work and recreation was part of the asylum regime which rehabilitated the individual and enabled them to regain their proper social role. The case notes clearly indicate that the individual received the greatest attention in the first few months of their residence when their characteristics and views were noted in some detail, and the longer-stay individuals did not receive the same degree of attention, and their twice-yearly meeting with the medical staff was often accompanied by the single comment, ‘no change’ or ‘the same’. After remaining in the institution for some years, many of these longer-stay patients were transferred to a ‘Chronic’ case book, their status being clearly distinguished from other individuals. The outcomes of residence at Exminster for those who were admitted were inevitably complex and varied in individual cases, but we do detect some broad trends both in the initial diagnosis and in the pattern of discharge and death within the institution in the period we are considering. There were significant variations in the experience of men and women. These include initial diagnosis, length of stay and pattern of release from the institution. There was also some difference over time, particularly as the simple diagnoses of ‘mania’, ‘melancholia’ and ‘dementia’ (which remained the most common throughout the period) were refined or extended by the addition of ‘acute’, ‘chronic’ and ‘senile’. In later years the term ‘delusions’ or ‘delusional insanity’ also emerged to claim a significant proportion of admissions. Some earlier research, such as that of Elaine Showalter noted elsewhere, suggested that the diagnosis of males and females could be most readily distinguished by the prevalence of the category of ‘melancholia’ among women. One way in which the impact of admission to Exminster and residence at the County Asylum can be measured is in terms of the different outcomes for the individuals concerned. An analysis of 4,000 women and men admitted in this period indicates that the male and female experience of the asylum varied in this respect. Females formed the larger group among our large sample of 4,000 admissions for the whole period, comprising more than 2,000. Among those for whom we have detailed information, almost 900 (well over two-fifths of the total) died in the asylum. Approximately 56 per cent were discharged, most of them as recovered (850 or two-fifths of the total), while much lesser numbers left as ‘relieved’ (one in 12) or ‘not improved’ (one in 20). Among the 1,800 male admissions, more than half ended their life in the asylum. A little over one-third of the total left recovered, while one in 15 departed ‘relieved’ and one in 18 as ‘not improved’. Women were rather more likely, therefore, to leave the institution as recovered or ‘relieved’ than men, who were clearly more prone to die in the asylum or to leave ‘not improved’.

The ethos of treatment, care and management 67 The reasons for the different outcomes of asylum life on the women and men who went there are not always easy to discern. Some clues can be found in the relationship of initial diagnosis to outcomes. Women formed a substantially greater proportion of the total in our sample, but male deaths led in a number of categories. The greater number of male deaths were primarily to be found among the larger numbers diagnosed as suffering ‘general paralysis’ (about 100 versus 16 females), those identified as suffering idiocy, imbecility and weak-mindedness (well over 100 compared to less than 70 women), and ‘dementia’ or ‘senile dementia’ (more than 250 versus 218 women). Women who died in Exminster were mainly those who had been diagnosed as suffering from mania or its acute and chronic forms, as well as dementia (including senile dementia), and melancholia. Those women dying in the asylum were more likely than men to have been diagnosed as melancholic or as suffering from mania. The greater preponderance of men identified as suffering dementia (though not senile dementia) may appear strange since we know that those females who remained in the asylum often lived for many years before dying; modern medical experience is that substantial numbers of elderly females and, to a lesser degree males, suffer from progressive dementia and become residents of mental health facilities. The diagnosis of dementia in the Victorian and Edwardian decades covered a much larger group of patients admitted to the asylum. In terms of the age profiles of patients with different kinds of diagnoses, a detailed examination of the total male and female intake for 1880–1882 who died in the asylum reveals some significant contrasts among the men and women who entered the Devon Asylum. Considering men first, we find the diagnosis of dementia is applied to a substantial number of male entrants, 16 being identified simply as ‘dementia’ cases, eight having dementia with epilepsy, seven with dementia with general paralysis, five with senile dementia. The largest single group among the 112 men who entered Exminster in 1880–1882 and who died were 34 men who were diagnosed as suffering from ‘general paralysis’. A total of 15 of the male deaths were among those identified as imbeciles or idiots, four of the ‘imbeciles’ also having epilepsy. There were only 20 ‘mania’ cases among the males who died, six of them being associated with ‘general paralysis’ and a further three or four being acute, chronic or senile. Those identified as melancholic constituted less than 20 of the recorded deaths among the male intake. There were important differences in the age profile of the different groups. Among the men seen as ‘general paralysis’ sufferers, only two were older than 50, 16 being younger than 40 and another 16 in their forties when they died. Idiocy and imbecility were also associated with younger males, 13 being younger than 40 and only two older. The presence of epilepsy was also a condition of younger males, being associated with ‘dementia’ as well as ‘imbecility’ in the intake, four supposed dementia sufferers in their twenties also being diagnosed epileptics and only two older

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than this. Mania was evenly distributed, five men being younger and five older than 40, another three men younger than 40 being acute or chronic and another six younger men being diagnosed as having mania with general paralysis. Among those men in the intake who died, dementia and melancholia diagnoses were both mainly attached to men in later life. Of the 18 men diagnosed simply with ‘dementia’, 13 were over 50 and the five suffering ‘senile dementia’ were older than 68. Only one male with melancholia was younger than 40 and nine in their forties or fifties, with another ten older than 60 (one having ‘senile melancholia’). In terms of the outcomes of those admitted to the asylum, we have found that a substantial proportion of the intake left the institution either ‘recovered’ or ‘relieved’. For the 1880–1882 intake we examined in more depth, we found that of 276 females and 262 males who entered in those years, a higher proportion of women left as recovered (102 versus 84) or relieved (36 versus 25). More than half of the men who entered died in the institution as compared to slightly more than two-fifths of the women. The rate of recovery was similar between the sexes, more than four-fifths of males and females who recovered left the asylum within a year of their arrival and most of the remainder departed within three years of their admission. One in eight of the female entrants left as ‘relieved’ compared to less than one in ten of the males who arrived in the years 1880–1882. More females than males also left within a year of their admission. Among the limited number of people discharged as ‘not improved’, almost two-thirds were female, though the men discharged without improvement were largely sent away within a year of arrival or held for a considerable time before discharge. Most females who were discharged ‘not improved’ left after more than a year in Exminster, but within five years of arrival. The pattern of deaths between the sexes also varies.90 More men died and the largest proportion of them (almost twofifths, or 38 per cent) expired within a year of their arrival and well over half within 1,000 days. Less than one-quarter were very long-stay residents of more than 5,000 days. The females who died in the asylum survived considerably longer, little more than one-quarter dying within the first year and less than two-fifths within 1,000 days. The largest group (more than a third of those dying) remained at Exminster between one and 5,000 days and another sizeable group remained for considerably longer (the longest for more than 47 years). The figures clearly show that those men and women who were diagnosed with mania had a stronger prospect of leaving the asylum recovered than those diagnosed with dementia, though almost as many females who entered in 1880–1882 with mania were to die there as to leave recovered. A rather higher proportion of those women and men diagnosed with melancholy left as recovered or relieved, especially among the females where almost twice as many left recovered or relieved than died. A more detailed examination of those who entered in 1880–1882 confirms this general picture for the whole period.

The ethos of treatment, care and management 69 Table 4.4 Exminster 1845–1914: female diagnoses on admission and outcome of stay Diagnosis

Died (%)

Not improved (%)

Recovered (%)

Relieved (%)

None Unclear Acute dementia Acute mania Acute melancholia Acute mania Chronic dementia Chronic mania Chronic melancholia Chronic mania Delusions Dementia Del tremens Epileptic mania Epileptic Epileptic insanity General paralysis Idiocy Imbecile mania Imbecility Manic depression Melancholia Monomania Mania No symptoms insanity Puerperal melancholy Puerperal mania Puerperal insanity Religious mania Senile dementia Senile melancholy Senile mania Unknown Weak-minded

7 (0.8) 0 (0.0) 9 (1.1) 1 (0.6) 2 (0.2) 0 (0.0) 5 (0.6) 1 (0.6) 0 (0.0) 0 (0.0) 2 (0.2) 0 (0.0) 21 (2.4) 4 (3.6) 41 (4.8) 11 (6.7) 14 (1.6) 5 (4.5) 38 (4.5) 6 (3.6) 3 (0.3) 1 (0.9) 20 (2.4) 2 (1.2) 4 (0.4) 0 (0.0) 1 (0.1) 0 (0.0) 52 (5.8) 8 (7.1) 20 (2.4) 4 (2.4) 4 (0.4) 0 (0.0) 1 (0.1) 1 (0.6) 19 (2.1) 3 (2.7) 4 (0.5) 1 (0.6) 36 (4.0) 5 (4.5) 37 (4.4) 6 (3.6) 158 (17.7) 23 (20.5) 49 (5.8) 15 (9.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.1) 0 (0.0) 1 (0.1) 0 (0.0) 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) 6 (0.7) 2 (1.8) 1 (0.1) 1 (0.6) 16 (1.8) 2 (1.8) 1 (0.1) 3 (1.8) 22 (2.5) 5 (4.5) 2 (0.2) 1 (0.6) 8 (0.9) 0 (0.0) 1 (0.1) 0 (0.0) 31 (3.5) 6 (5.4) 8 (0.9) 4 (2.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 149 (16.7) 17 (15.2) 259 (30.5) 50 (30.3) 2 (0.2) 0 (0.0) 3 (0.4) 0 (0.0) 242 (27.1) 25 (22.3) 303 (35.6) 44 (26.7) 0 (0.0) 0 (0.0) 2 (0.2) 1 (0.6) 0 (0.0) 0 (0.0) 1 (0.1) 0 (0.0) 4 (0.4) 0 (0.0) 10 (1.2) 1 (0.6) 1 (0.1) 0 (0.0) 15 (1.8) 4 (2.4) 1 (0.1) 0 (0.0) 1 (0.1) 0 (0.0) 60 (6.7) 5 (4.5) 7 (0.8) 4 (2.4) 9 (1.0) 0 (0.0) 0 (0.0) 1 (0.6) 11 (1.2) 0 (0.0) 2 (0.2) 3 (1.8) 3 (0.3) 1 (0.9) 2 (0.2) 0 (0.0) 5 (0.6) 0 (0.0) 4 (0.5) 0 (0.0) 893 (100.0) 112 (100.0) 850 (100.0) 165 (100.0)

Unknown (%)

2 (2.4) 0 (0.0) 0 (0.0) 1 (1.2) 2 (2.4) 1 (1.2) 0 (0.0) 6 (7.3) 0 (0.0) 0 (0.0) 4 (4.9) 3 (3.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.2) 0 (0.0) 2 (2.4) 0 (0.0) 1 (1.2) 0 (0.0) 12 (14.6) 1 (1.2) 20 (24.4) 1 (1.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (2.4) 0 (0.0) 1 (1.2) 22 (26.8) 0 (0.0) 82 (100.0)

The 1880–1882 intake figures reveal that the highest numbers of male deaths were to be found among those diagnosed with dementia and general paralysis, while the greatest prospects of recovery were to be seen among those diagnosed with mania and melancholia. Idiots and imbeciles rarely recovered or left the institution alive. Among females there was

70

The ethos of treatment, care and management

Table 4.5 Exminster 1845–1914: male diagnoses on admission and outcome of stay Diagnosis

Died (%)

Not improved (%)

Recovered (%)

Relieved (%)

None Unclear Acute dementia Acute mania Acute melancholia Acute mania Chronic dementia Chronic mania Chronic melancholia Chronic mania Delusions Dementia Del tremens Epileptic mania Epileptic Epileptic insanity General paralysis Idiocy Imbecile mania Imbecility Manic depression Melancholia Monomania Mania No symptoms insanity Puerperal melancholy Puerperal mania Puerperal insanity Religious mania Senile dementia Senile melancholy Senile mania Unknown Weak-minded

7 (0.8) 2 (1.8) 8 (1.3) 2 (1.5) 8 (0.9) 0 (0.0) 5 (0.8) 1 (0.7) 0 (0.0) 0 (0.0) 1 (0.2) 0 (0.0) 23 (2.5) 2 (1.8) 30 (4.7) 3 (2.2) 15 (1.6) 1 (0.9) 17 (2.7) 2 (1.5) 5 (0.5) 1 (0.9) 20 (3.1) 1 (0.7) 2 (0.2) 1 (0.9) 0 (0.0) 0 (0.0) 29 (3.1) 3 (2.6) 10 (1.6) 13 (9.5) 5 (0.5) 0 (0.0) 2 (0.3) 1 (0.7) 5 (0.5) 2 (1.8) 8 (1.3) 3 (2.2) 41 (4.4) 4 (3.5) 32 (5.0) 14 (10.2) 211 (22.6) 22 (19.3) 35 (5.5) 17 (12.4) 0 (0.0) 0 (0.0) 2 (0.3) 0 (0.0) 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 9 (1.0) 1 (0.9) 0 (0.0) 0 (0.0) 102 (10.9) 8 (7.0) 20 (3.1) 9 (6.6) 42 (4.5) 9 (7.9) 4 (0.6) 1 (0.7) 10 (1.1) 0 (0.0) 3 (0.5) 0 (0.0) 46 (4.9) 9 (7.9) 8 (1.3) 8 (5.8) 1 (0.1) 0 (0.0) 0 (0.0) 0 (0.0) 101 (10.8) 9 (7.9) 144 (22.6) 28 (20.4) 5 (0.5) 0 (0.0) 2 (0.3) 0 (0.0) 192 (20.6) 35 (30.7) 265 (41.6) 26 (19.0) 1 (0.1) 0 (0.0) 7 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (0.3) 0 (0.0) 46 (4.9) 1 (0.9) 2 (0.3) 4 (2.9) 9 (1.0) 0 (0.0) 1 (0.2) 0 (0.0) 7 (0.8) 1 (0.9) 4 (0.6) 1 (0.7) 3 (0.3) 0 (0.0) 0 (0.0) 0 (0.0) 6 (0.6) 3 (2.6) 5 (0.8) 3 (2.2) 932 (100.0) 114 (100.0) 637 (100.0) 137 (100.0)

Unknown (%)

1 (1.7) 1 (1.7) 0 (0.0) 2 (3.3) 1 (1.7) 0 (0.0) 0 (0.0) 1 (1.7) 0 (0.0) 0 (0.0) 3 (5.0) 2 (3.3) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.7) 1 (1.7) 0 (0.0) 0 (0.0) 3 (5.0) 0 (0.0) 10 (16.7) 0 (0.0) 15 (25.0) 1 (1.7) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.7) 0 (0.0) 0 (0.0) 16 (26.7) 1 (1.7) 60 (100.0)

again a fair prospect of recovery for those diagnosed as suffering from mania and melancholy, though much less so for females seen as idiots and imbeciles. The variation in death rates can be largely attributed to the higher proportion of deaths among those identified as suffering general paralysis and idiocy among males coming to Exminster. There is no consistent evid-

The ethos of treatment, care and management 71 Table 4.6 Exminster asylum, outcome of stay (summary from 4,000 residents), 1845–1914 Diagnosis

Died

No Recovered improvement

Relieved

Unknown

No symptoms of insanity

Male Mania Melancholy Dementia GPI

268 130 259 102

43 10 24 8

339 164 38 20

47 31 21 9

– 11 4 1

– – – –

Female Mania 334 Melancholy 176 Dementia 222 GPI 16

36 22 28 2

363 299 59 1

36 58 19 3

23 14 5 –

4 – – –

ence of variations of length of stay among those diagnosed with mania and melancholia or between men and women diagnosed with these conditions, though our earlier comments on the typical age profile of individuals with the different diagnoses (dementia diagnosis being more common for older patients, and general paralysis of the insane and epilepsy being largely associated with younger males and – to a lesser degree – females), are relevant here. A final point worth noting with regard to outcomes is the incidence of readmissions among those coming to the Devon asylum, some individuals being re-admitted a number of times. Among the whole 13,000 admissions Table 4.7 Exminster asylum, 1880–1882 intake: diagnoses and outcomes Diagnosis

Died

No improvement

Recovered

Relieved

Male Mania Melancholy Dementia GPI Idiots and imbeciles

23 20 36 35 15

4 3 2 1 0

46 26 5 8 1

8 9 0 5 2

Female Mania Melancholy Dementia GPI Idiots and imbeciles

42 29 31 1 9

6 5 2 0 3

53 38 5 0 2

11 17 3 1 0

72

The ethos of treatment, care and management

recorded in our period, as many as 17 per cent of female and 15 per cent of male entrants were re-admissions. The chronological pattern of readmissions is apparent in the 4,000 sample. Female re-admissions peaked in the 1870s and 1890s at more than 200 per decade, but this was not significantly out of trend with the general post-1860 era. The lesser numbers of men being re-admitted are noticeable throughout the period, and even at their peak in the post-1900 period there are less than 200 per decade readmitted. This may reflect in part the greater propensity of males to die in the asylum and more quickly than females noted above. An analysis of our large sample of 4,000 admissions reveals a pattern of re-admissions indicated within Table 4.8. The evidence suggests that both wives and husbands were rather more likely to figure as re-admissions than were spinsters and bachelors taking into account the overall distributions of the sexes in our period. Widowers were noticeably less likely to be re-admitted than were widows. We may conclude that unmarried people were less likely to be re-admitted because a higher proportion were detained in the asylum and became longer-stay patients, though the differences between the marital groups were marginal rather than dramatic. There are perhaps four main conclusions to be reached on the ethos of care and treatment at Exminster in the period covered by this chapter. The first is that the asylum expanded in both physical size and in population of inmates almost relentlessly over the whole period, and this inevitably had a significant impact on the resources of the staff and the care which they were able to provide for those who were admitted. Our evidence makes it clear that the institution became overcrowded at various points, attracting the critical attention of the Lunacy Commission. Medical staff who were in charge of the diagnosis and ‘medicinal’ treatment described by Bucknill were clearly hard-pressed to deal with the enormous growth in numbers and variety of individuals even in the closing years of Bucknill’s own tenure at the institution. At various times in Saunders’ period as superintendent, the Table 4.8 Exminster asylum, 1845–1914: re-admissions (from 4,000 residents) Married

Unmarried

Widowed

Male All admissions % of total Re-admissions % of total

866 46.6 104 48.8

853 45.9 91 42.3

138 7.4 18 3.6

Female All admissions % of total Re-admissions % of total

820 39.1 112 40.7

959 45.7 127 46.2

318 15.2 36 13

The ethos of treatment, care and management 73 asylum appears to have slipped into what can only be described as crisis. Second, one important consequence of these difficulties was that the Devon Asylum moved from being seen as a prime exemplar of the virtues of effective management and treatment which the Lunacy Commission wished to promote, to being an object of concern, criticism and vigilant inspection by the closing years of the century. There can be no doubt that Bucknill’s prominence and his continuous publication of the virtues of his approach at Exminster played a major role in securing the high fame of the institution and its founding superintendent in the earlier period, and this contrasts with the later and much weaker reputation of Saunders. Finally, it is also worth emphasising that the attendants remained primarily responsible for the care of inmates, and their conditions of work and wages continued to be poor throughout much of this period. Third, the evidence suggests that the diagnosis given to individuals prior to admission was usually incorporated in the asylum admission registers and even the case books which detail the condition of the patients. We later look in detail at the reasons why individuals came to the attention of the certifying physicians with reference to family and social circumstances. Here we would observe that, although there is little clear sign that the medical staff employed technical or scientific terms which were very different from those of the physicians who certified the individuals prior to their arrival, it is noticeable that there were often detailed accounts of the early behaviour and attitudes of the individuals under consideration, which tended to give way to more sparse notes as their careers at the asylum continued and the pressures on the medical staff increased. These asylum records do indicate that there were significant variations in the way that people were diagnosed and that different diagnostic groups had a distinctive experience of the asylum in terms of the outcome of their stay at the institution. In particular, those seen as suffering from mania tended to be younger on average than individuals who were diagnosed as melancholic and particularly as demented. The melancholia and mania cases also had better prospects of leaving the asylum as recovered or relieved while those suffering (it appeared) from general paralysis and from imbecility or idiocy generally had a poorer chance of leaving Exminster alive. Finally, there are also variations in the experience of men and women which we can underline. Various scholars have noted that females were more likely to be characterised as suffering from melancholy than males and the returns from Exminster confirm this point, though it is evident that ‘mania’ was the most common diagnosis for women as it was for men, and also that the prospects for leaving the asylum recovered or relieved was strong for those identified as melancholic and particularly for females. Since males accounted for a large majority of those diagnosed with general paralysis or as idiots and imbeciles, their higher death rate is apparent (though demented males were also a sizeable proportion of the men taken into the asylum). Not only did women tend to leave the asylum recovered rather more quickly

74

The ethos of treatment, care and management

than men, but they also survived the institution rather better than did their male counterparts when they did remain for longer periods. These factors help to explain the patterns of residence at the institution as well as the higher numbers of women who can be found in the institution at various points in the period we have surveyed.

5

Journey to the asylum Residence, distance and migration in admissions to the asylum, 1845–1914

One of the most important themes in discussions of the history of insanity concerns the impact of economic and social change on the committal of individuals to institutional care during the nineteenth and twentieth centuries. The influence of industrialisation as well as the demographic crises of crop failures, famine and population pressure have figured in a number of important studies of insanity in the Victorian decades, drawing to some extent on research into family structure during the transformation of Britain into a modern industrial society. In the past two decades, much research in the social history of madness has drawn attention to the importance of family relations in the decisions made to admit and discharge individuals from the lunatic asylum.1 Much of this fresh research has criticised Scull’s celebrated argument that the capitalist transformation of British society led to a growing reluctance on the part of families to tolerate unproductive and awkward members as the family household responded to the competitive market pressures of the new commercial age.2 John Walton had offered an early critique of this model, stressing both the capacity and willingness of working-class households to retain family members in tight-knit communities such as the Lancashire textiles districts around Manchester, which were contrasted with looser kinship and communal connections found in urban centres with substantial numbers of migrant workers, such as Liverpool.3 It is only fair to note that both Scull and Walton were sensitive to the limits of their evidence and the ideological terms in which urban and rural madness was perceived, while broadly acknowledging that the capitalist transformation of the British economy, including the increase in long-distance migration, tended to weaken family and community ties.4 In a recent critical commentary on this scholarship, Wright has restated the case for identifying socio-demographic characteristics of patients, including the dislocation of family ties caused by migration, as the appropriate direction for comparative research on insanity and asylum confinement.5 A second related, but rather less well noted, theme in writing on the social history of lunacy is the discussion of the impact of distance on admissions to the lunatic asylum during the nineteenth and twentieth centuries.

76

Journey to the asylum

Contemporary commentators on the lunacy admissions in the Victorian decades often suggested that urban civilisation was an incubus of mental disorders.6 In recent years, historical geographers have used Foucault’s analysis of intellectual and institutional power to adapt such contemporary studies as Edward Jarvis’ important analysis of the impact of distance on admissions to hospitals and lunatic asylums during the nineteenth century.7 Jarvis published his views in contemporary American medical journals, arguing that long distances significantly affected the likelihood of families and communities using medical facilities, including the asylum, and arguing for the location of smaller institutions closer to local and more remote settlements. Philo has provided a detailed analysis of the Jarvis ‘law’ of distance in his broader assessment of the growth of the English asylum system, as well as a detailed account of the Three Counties Asylum in Bedfordshire in the mid-nineteenth century. His research suggests that the distinctive class system of English society led to the violation of the Jarvis ‘law’ as wealthy lunatics were dispatched to more remote private institutions while hard-pressed boroughs also sought to place their charges in cheaper accommodation at some distance away. In explaining the reasons for the lesser importance of distance in admissions to lunatic asylums, Philo argues that the ‘territorial structures’ of English class society and conflicts among rival propertied groups help to account for the muted impact of physical space as compared to North America.8 This chapter examines the pattern of admissions to lunatic asylums in Devon during the Victorian decades and investigates the significance of distance and of migration in admissions to the institutions which catered for pauper and private lunatics at this time. We consider first some of the salient features of admissions and distance among those coming to the asylum before considering in more depth the patterns of migration and family connections among those who entered the Victorian asylum during the nineteenth century. It is worth noting that there were important variations in the physical, economic and social structure of Devon when compared to such industrialised regions as Lancashire or densely urbanised counties such as Middlesex as part of the London conurbation. A large number of Devon’s inhabitants continued to be employed in agriculture in the 1850s, relatively few working in modern manufacturing industries compared to older handicraft trades and the wide range of personal and other services recorded in the contemporary census returns.9 More detailed consideration of the occupational and class profile of the county is undertaken in Chapter 8. Most of the present chapter is devoted to an examination of broader changes in the pattern of migration and physical settlement in our period. It would be misleading to assume that Devon was unaffected by major demographic changes in the second half of the nineteenth century, or that the large city of Plymouth and large towns such as Exeter were atypical of the changes which affected urban centres in the later nineteenth century.10 The county saw a considerable degree of migration by both males and

Journey to the asylum 77 females between 1845 and 1914, including the growth of cities, towns and coastal resorts in the later Victorian years. We argue in this chapter that the physical distance between place of residence or apprehension and the appropriate institution did influence the calculations made by contemporaries in regard to the committal of people to different asylums, though we would stress the importance of a range of personal, family and institutional considerations which affected decisions which were made as to where an individual might be sent. Our interpretation is less concerned with the curative or punitive functions of the Victorian and Edwardian asylum than with the various ways in which the asylum became the locus for the exercise of power by different groups of social and institutional actors. We also consider the consequences of such struggles for the admission, treatment and discharge of patients to the asylum. An adequate understanding of decisions to commit an individual to an asylum should include an examination not only of the family households in different areas but also the ways in which the kinship groups and communities addressed and related to the Poor Law officials in these districts. Questions of distance and space figured in contemporary perceptions of the asylum as well as influencing decisions made with regard to committal and release of individuals. The distances travelled by Victorian lunatics to the asylum were measured out not only by families concerned with the utility of the new county institutions, but also by the administrative agencies responsible for their disposal. These communal and administrative preferences, which may be characterised as ‘local knowledge’, figured alongside the expression of family loyalties and calculations of economic costs and benefits in the decisions reached on the certification and committal of an individual.11 We have noted elsewhere that the admission of children and young persons to the workhouse and the pauper asylum in Victorian and Edwardian England reveals a complicated range of preferences and decisions in regard to the institutionalisation of those who were not usually identified and certified as lunatics in this period.12 The role of families and households in the certification, committal and discharge of asylum inmates is considered at greater length in the next chapter. Here we wish to consider the measurable impact which physical distance, family and community structures, and migration levels made on the decisions made to commit individuals to the County Asylum. The evidence indicates that those who were sent to the asylum were mostly the more settled individuals who were long established in their parishes, rather than recent immigrants or those who had experienced higher levels of migration. To assess the impact of distance on admissions to the Devon County Asylum we compiled detailed statistics on the parishes of those who were sent to Exminster in the period 1845–1914. A comparison was made between the numbers entering that institution from these areas and the number which might reasonably be expected to arise from the populations of such areas. Parishes were graded into six bands arranged according to

78

Journey to the asylum

Figure 5.1 Devon County Asylum admissions: parish origins of patients, 1846–1855.

their propensity to send people to the asylum.13 We found that the majority of parishes displayed little variation from the average, though a significant number displayed lesser or greater propensity to send individuals, albeit there were also significant variations over time in these and other parishes.14 The maps which follow record the propensity of different parishes to send their members to the Devon asylum.

Journey to the asylum 79

Figure 5.2 Devon County Asylum admissions: parish origins of patients, 1856–1865.

The results gathered from Exminster indicated that there was a strong and reasonably consistent connection between the physical distance of the parish to the Devon asylum and the scale of committal to the institution. The impact of distance appears most marked in the years following the foundation of Exminster asylum, when the St Thomas Union was particularly prominent amongst those committing lunatics, and again from 1881

80

Journey to the asylum

Figure 5.3 Devon County Asylum admissions: parish origins of patients, 1876–1885.

onwards when St Thomas was responsible for fewer cases being dispatched to the asylum.15 The evidence does not, therefore, easily support the view that such an asylum will gradually extend its reach to more remote areas over time. Explaining the reasons for more distant parishes to send fewer of their members to the County Asylum is not an easy task. It seems likely that a number of factors influenced the numbers sent from a parish to the County

Journey to the asylum 81

Figure 5.4 Devon County Asylum admissions: parish origins of patients, 1896–1905.

Asylum. We attempted to measure the impact of such factors as the physical size of the parish area, the size of population in the parish, the density of settlement, and the rates of population growth or decline, as well as the influence of distance. The results suggest that most of these factors were of limited significance in the patterns of admissions. No clear and consistent relationship could be

82

Journey to the asylum

detected between the physical area of Devon parishes and their propensity to send residents to Exminster.16 The figures do indicate that the most populous parishes of the county sent a higher proportion of their number to Exminster in the early decades (though not in the first decade after its foundation), but from the 1870s this characteristic is less marked.17 By dividing the parishes into three simple groups according to population size, it is possible to detect some variation in the experience of small (less than 1,000 people), middling (1,000 to 10,000) and large (more than 10,000) parishes. In the first three decades after 1845 the smallest parishes were clearly underrepresented among those admitted to Exminster, though this pattern weakened after 1875 before again becoming a feature of admissions from the late 1890s until 1905. The middling parishes were better represented in admissions and their parishioners increased noticeably among those entering the asylum after 1875, diminishing in proportion only at the very end of the period. The Devon parishes with the largest populations, more surprisingly, were prominently represented amongst asylum patients only in the earliest years. From 1875 we can trace a clear negative association, after excluding the effect of the absence of pauper lunatics from Plymouth and Exeter.18 It is worth recalling that the Devon Asylum was located, as were many county institutions, near to the large county town of Exeter and within 40 miles of Plymouth.19 The lesser numbers sent from the more populous places in the county cannot be easily explained in a simple distance–effect model. Turning to the density of population within the different parishes, we found that there was little consistent relationship between density and admissions, though at the end of the period a stronger connection appears to have emerged in this regard, after many years when both the least and most densely populated parishes were under-represented in the asylum.20 The rate of population growth is another important feature of the demographic history of Devon which appeared likely to have affected the capacity of individuals, families and communities to respond to the appearance of insanity among its members. Parishes were divided into those recording significant increases or decreases of population around the decennial census points.21 Neither the parishes growing most rapidly nor those suffering the most dramatic loss of population appear to be strongly associated with high Devon Asylum admissions for most of the period, with the exception of the decade 1875–1884 when greater numbers came to Exminster from parishes which experienced a population decline.22 Further investigation into the impact of migration on the rate of admission to the County Asylum was undertaken by comparing the parish of origin of almost 500 Exminster inmates with the wider population in the later nineteenth century.23 We found that Devon females were rather more migratory than males, living beyond their parish of birth in larger numbers, which may be explained in terms of the labour market for domestic service and the need for women seeking a husband to travel greater distances prior to, or following, marriage. Those admitted to Exminster were more likely to

Journey to the asylum 83 Table 5.1 Exminster patients and non-patients: place of birth and residence in 1871 Parish

Union

■N (%)

N (%) Non-patients Male Female Total Patients Male Female Total

Devon

■N (%)

Outside Devon

■N (%)

5,881 (46.5) 6,198 (40.8) 12,079 (43.4)

2,673 (21.1) 3,298 (21.7) 5,971 (21.5)

2,582 (20.4) 3,535 (23.3) 6,117 (22.0)

1,519 (12.0) 2,150 (14.2) 3,669 (13.2)

0,129 (58.6) 0,116 (43.6) 0,245 (50.4)

0, 42 (19.1) 0, 61 (22.9) 0,103 (21.2)

0,32 (14.6) 0,57 (21.4) 0,89 (18.3)

0,17 (7.7) 0,32 (12.0) 0,49 (10.1)

reside in their original parish of birth and less likely to be found living outside the Union and the county. Among the patients, females were again more mobile than males and more likely to be found residing away from their place of birth. Almost 60 per cent of men admitted to Exminster were living in their parish of birth, compared to less than half of non-patients. Less than one-tenth of Exminster entrants appear to have originated outside the county of Devon. Any explanation of the lower rates of migration found among those admitted to the Devon asylum would have to encompass the key role of Poor Law institutions in the procedures of admission, as well as the impact of marital status on those committed to Exminster. An analysis of pauper lunatics resident in the workhouses of five Devon Unions in the 1871 census Table 5.2 Exminster patients: migration and family structure by gender Category

Born in parish

Born outside Devon

■(%) Patients N

Patients N (%)

Non-patients N (%)

Male 3 2, 4, 5

31 (62) 14 (53.8)

17 (30.4) 13 (65)

6 (12) 1 (3.9)

5 (8.9) 1 (5)

Female 3 2, 4, 5

15 (35.7) 11 (50)

19 (53.9) 6 (27.3)

7 (16.7) 1 (4.6)

8 (15.1) 5 (22.7)

Total

71

55

15

Non-patients N (%)

15

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter. Note The non-patient group was selected as for Table 5.1.

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suggests that more than 90 per cent of workhouse lunatics were born in the parish or relevant Union, compared with about 70 per cent of those admitted to the Devon Asylum. One clue to the heavy preponderance of parish residents within the workhouse lies in the large numbers of ‘idiots’ or ‘imbeciles’ who were placed in the Union workhouse.24 Such evidence indicates that those individuals identified to the census authorities as lunatics and, more especially, idiots and imbeciles were even more firmly tied to their parish of birth than people committed to the County Asylum. In considering the family households of the individuals admitted to the Devon Asylum over the period 1851–1881, a comparison can be made between those entering Exminster with the non-patient population (excluding servants, lodgers, boarders and visitors as well as other ‘marginal’ groups).25 After the elimination of the above marginal groups from the patient cohort, the remaining asylum inmates were distributed by household types indicated in Tables 5.3–5.5. The results show some remarkable differences between patient and nonpatient households, as well as important similarities. Almost two-thirds of patients came from what demographers usually term ‘simple households’, a couple living with or without children, compared to rather more (nearly 72 per cent) of non-patients. We can conclude that a large majority of both patients and non-patients were characteristically found living in simple family households during this period. Much more striking contrasts appear when we consider other household types. Solitary householders were almost unknown amongst the admissions to Exminster and such households were twelve times as common among the base non-patient sample compared with the patients. The absence of such individuals at the asylum presents an interesting problem for our study. It might appear that membership of a larger family group was almost essential to being institutionalised as insane and perhaps even to being identified as mad.26 People living on their own may have exhibited symptoms of insanity which went unnoticed or were met with indifference.27 On the other hand it may be that individuals who were subsequently identified as candidates for the County Asylum were unlikely to be able to maintain themselves in their own household.28 The fact that so few solitary householders emerged in Devon asylum entry registers would indicate that kinship, Poor Law and possibly other factors served to support the solitary householder and prevent their ready admission to the county institution.29 Whatever the explanation, insanity may have been (to appropriate the title of Scull’s major survey text) the most solitary of afflictions but it was clearly not the affliction of the most solitary householders in Victorian society. Important differences between the domestic arrangements of patients and non-patients also emerge when we surveyed extended and multiple households. Combining these two categories, we find that some 27 per cent of patients came from these households, compared with only 15 per cent of non-patients. Considered in more detail, we find that the majority of these

Journey to the asylum 85 Table 5.3 Exminster patients: family and household structures of patients, 1851–1881 Classa

1851 N

1881 N

Total N (%)

1a 1b Total

– – –

– 1 1

– 1 1 (0.7)

2a 2b 2c Total

3 1 – 4

4 2 – 6

7 3 – 10 (7.1)

3a 3b 3c 3d Total

7 21 4 1 33

12 37 6 4 59

19 58 10 5 92 (65.3)

4a 4b 4c 4d Total

3 2 3 2 10

5 6 3 3 17

8 8 6 5 27 (19.2)

5a 5b 5c 5d 5e Total

2 2 – – 1 5

3 3 – – – 6

5 5 – – 1 11 (7.8)

6a Total

–

–

52

89

– 141 (100)

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter. Notes a Explanation of categories: Tables 5.3 and 5.4 1: Solitary households. 1a: Widowed person, with/without servants, lodgers, boarders or visitors. 1b: Unmarried person, with/without servants, lodgers, boarders or visitors. 2: Non-family households, no conjugal family unit. 2a: Co-resident siblings. 2b: Other co-resident relatives. 2c: No family relation given in source. 3: Simple households. 3a: Married without offspring. 3b: Married with offspring. 3c: Widower with offspring. 3d: Widow with offspring.

4: Extended households, conjugal family unit plus kin. 4a: With kin upwards from head (e.g. mother). 4b: With kin downwards from head (e.g. grandson). 4c: With kin sideways from head (e.g. sister). 4d: Combinations of the above or others. 5: Multiple households, more than one conjugal family unit. 5a: With secondary unit upwards from head. 5b: With secondary unit downwards from head. 5c: With secondary unit sideways from head, parental generation present. 5d: With secondary unit sideways from head, parental generation not present 5e: Combinations of the above or others. 6a: Unclassifiable.

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Table 5.4 Devon non-patients: family and household structures of non-patients, 1851–1881 Classa

1851 N

1a 1b Total

5 3 8

9 10 19

14 13 27 (8.4)

2a 2b 2c Total

3 1 – 4

6 3 – 9

9 4 – 13 (4.1)

3a 3b 3c 3d Total

11 55 2 12 80

28 99 7 15 149

39 154 9 27 229 (71.6)

4a 4b 4c 4d Total

10 1 1 3 15

14 3 7 2 26

24 4 8 5 41 (12.8)

5a 5b 5c 5d 5e Total

– 3 – – – 3

– 4 – – – 4

– 7 – – – 7 (2.2)

6a

2

1

3 (0.9)

112

208

320 (100)

Total

1881 N

Total N (%)

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter. Note a See note to Table 5.3 for explanations of categories.

extended and multiple patient households possessed an extension or secondary unit going downwards in age from the head of household (17 cases), or upwards from the head (14 cases), rather than extending sideways to siblings and in-laws from the household head (11 cases). The implication is that most of the extended members were dependants on the heads of households rather than contributing significant income to the domestic economy.30 The question remains whether these larger households had been actually altered, i.e. extended, in response to individual crisis and perceived illness, perhaps contracting in size once the insanity of a relative passed. Examina-

Journey to the asylum 87 Table 5.5 Comparison of family and household structure of Exminster patients versus non-patients Categories 1 2 3 4 5 Totals

Patients N (%)

Non-patients N (%)

1 (0.7) 10 (7.1) 92 (65.3) 27 (19.2) 11 (7.8)

27 (8.4) 13 (4.1) 229 (71.6) 41 (12.8) 7 (2.2)

141 (100)

320 (100)

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter.

tion of those patients living as the extended part of such households in 1881 reveals interesting clues in a handful of cases. In four of the ten cases for which detail exists, there are grounds for believing that the patient may have moved after the census. Mary B. was unmarried and recorded as living with her (also unmarried) sister in Crediton, but moved before her confinement when she was reported as having ‘been living with friends’ despite having at least one other sister living elsewhere in the town.31 Her case may be contrasted with those of Emma P. and Eliza B. who moved away from more distant kin to live with members of their nuclear family (Eliza’s husband and Emma’s parents).32 Other individuals were found in the households of more distant relatives. In the case of males, this could well be explained by the inability or reluctance of their parents to deal with violent or disruptive behaviour. Isaac Q. was reported to have been insane for 12 months and living in his sister’s household when he arrived at Exminster.33 These findings do not, in themselves, damage the argument made by Scull that poor families in the Victorian era were increasingly reluctant to engage in longer-term care of their disruptive and dependent members. The evidence from Devon indicates that the structure of the household also influenced the likelihood of admissions, with the more complex households possessing rather more remote relatives appearing more prominently in admissions to the County Asylum. We should be careful before reaching the conclusion that it was the more distant relations who were more vulnerable to certification and committal. In only 12 of the 38 extended or multiple households it was the extended members who were consigned to Exminster.34 In only five instances did the patient belong to an older generation, whilst two-thirds of the individuals dispatched to the asylum were core family members.35 Those peripheral members – including the elderly – of the extended and multiple households sent to Exminster were a decided minority of the individuals who came from such backgrounds. One of the functions of the extended and multiple family may have been to accommodate relatives who were perceived as insane, either as an alternative to institutional care or prior to their being dispatched to institutions, but this

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would suggest a positive effort to absorb the consequences of difficult behaviour rather than an anxiety by families to place their members in the hands of the Poor Law. Having suggested the limitations of the existing literature in explaining the demographic behaviour that we find in Devon, there remains the problem of how we might begin to resolve the puzzle of migration, family structure and lunacy in the Victorian decades. Earlier research undertaken on the Exminster inmates reveals the importance of factors such as gender, age and marital status in determining the pattern of admissions. The next section explores some possible relationships between these characteristics and the demographic experience of the insane. There has been considerable discussion of the role played by gender and marital status in the identification of Victorian lunacy, to which we have already alluded and will discuss further in Chapter 7.36 Devon females displayed greater mobility than males in our period, possibly in response to the peculiar demands of contemporary labour and marriage markets. We might expect there may be some differences in the households to which females belonged in consequence of their apparently greater need to search out employment and betrothal opportunities. The most salient features of our (rather limited) evidence on this point would appear to show that there was no significant difference between the sexes in the most important group, i.e. those living in simple households. There were greater differences in the pattern of residence in extended and the more fragmented, less common, households. Women patients are less likely to be found in the extended household but more frequently in non-familial households – those lacking a complete conjugal family unit, as Table 5.6 indicates. Looking more closely at these groups, we found that females in nonfamilial households fall into two distinct clusters: four were unmarried and living with their sisters, and three headed their households and lived with grandchildren or nieces. Almost half of the male patients from extended households (eight out of 17) headed their households, nearly always living with nieces, nephews or grandchildren as well as spouses or children. Six more males of the total 17 made up all or part of the extension to the household.37 This appears to indicate that both males and females amongst future Table 5.6 Exminster patients: family structure of patients, by gender Category

Male N (%)

Female N (%)

1 2 3 4 5

0 (0) 3 (4.0) 50 (65.8) 17 (22.4) 6 (7.9)

1 (1.5) 7 (10.8) 42 (64.6) 10 (15.4) 5 (7.7)

Total

76 (100)

65 (100)

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter.

Journey to the asylum 89 Exminster patients were found in each of the distinct familial patterns and we do not find dramatic differences on grounds of gender. More significant is the divergence between the sexes in numbers employed in service or resident in institutions immediately prior to admission at the Devon Asylum. This group comprised just over 17 per cent of males who were overwhelmingly to be found in workhouses, but almost 31 per cent of females who were divided evenly between service, lodgings and institutions.38 When we recall that women were also more likely to reside in more fragmented non-familial households, usually consisting of only two or three siblings or as aunts and nieces, there emerges a clear disparity in the domestic circumstances of a significant proportion of females on the verge of their journey to Exminster in these years. Variations in household residence patterns of patients appear to have been a function of age and marital status as well as gender. As we have seen, there were virtually no solitary householders admitted to the asylum, though older patients did exhibit different household characteristics from younger admissions and were more liable to be members of extended households as they grew older.39 Thus 70 per cent of patients aged 45 or less belonged to simple households, whilst only 60 per cent of older individuals did so. This compares with 14 per cent of the younger group being attached to extended households, while almost twice that number of the older group (26 per cent) belonged to such households.40 The evidence is consistent with the trend of older kinsfolk joining simple households of their children or siblings in later life, rather than living as solitaries as might be more common among the base population as a whole. The degree to which a propensity to symptoms of insanity actually precipitated such a move, or whether membership of the extended family functioned merely to identify and report such behaviour, remains unclear. Marital status was likewise an important distinguishing feature amongst the patients in our sample. Amongst the 157 patients for whom the information is available, well over half (57 per cent) were married at committal, more than one-third (34 per cent) were single and less than onetenth were widowed. Almost two-thirds (63 per cent) of the sub-group of servants, boarders, lodgers and visitors entering the asylum were also unmarried.41 Excluding this sub-group, we find that over one-quarter (26 per cent) of the patients emanating from simple households were single, and mostly younger than 30. Single people were also a significant proportion of the patients coming from extended households (26 per cent), multiple households (36 per cent) and households lacking a conjugal family unit (67 per cent).42 In this last case, the single patients appear to have co-resided as unmarried siblings and were somewhat older than patients in other categories.43 While we have suggested that many ‘core’ members of households found their way to Exminster in our period, it is also evident that these included a sizeable sprinkling of unmarried people. These characteristics would suggest that not only were patients (and more

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particularly male lunatics) less migratory than the base population, but were also more closely associated with extended and multiple families. We find that within the patient group, those living in wider kin-linked households displayed most clearly the characteristic lack of migration over their lifetime. Comparing those admissions who formed part of the simple nuclear family with or without resident children (category three), against patients from extended, multiple, and our second category (those without any current spouse-to-spouse or parent-to-child links), we find few differences between the two groups in respect of those born in their current parish of residence. More than twice as many patients from simple households, however, were born outside the county of Devon.44 This is shown in Table 5.7. This bias towards lower rates of mobility among the Exminster intake is even more apparent when we come to those patients who formed the ‘extended’ part of an extended or multiple household. This may be expected since those born outside Devon would have weaker family connections within the county. There are also interesting gender variations in these respects. Male patients from simple households were actually more likely to have been born in their current parish of residence than those from the other categories. Women display a very different pattern, with little more than one-third of female patients in simple households having been born in their parish compared with half of women in other households. As against this we can see that both men and women in simple households were markedly more likely to have originated outside Devon than those in more complex households. This would fit our earlier finding that members of more extended families are more likely to have been native Devonians than those in simple households. The real puzzle is that males in simple households were even more likely to be residing in their birth parish than those in more complex Table 5.7 Exminster patients: migration of patients and non-patients by family and household structures, 1851–1881 Category

3 2, 4, 5 Total

Born in parish

Born outside Devon

Patients N (%)

Non-patients N (%)

46 (50) 25 (52.1) 71

36 (34.8) 19 (45.2) 55

■ (%) Patients N 13 (14.1) 2 (6.3) 15

Non-patients N (%) 13 (11.6) 2 (6.3) 15

Source: Devon Census Enumerators Books 1851–91, West Country Studies Library, Exeter. Note The non-patients are a sample selected on the basis of similar age and sex as the patient group and are not the individuals from the sample of non-patient households.

Journey to the asylum 91 families. There is a greater contrast between the experience of males and females in simple households than appears to have been the case for males who had different household arrangements at this period. Significantly higher numbers of men were born in the parish of residence. Only a limited part of this contrast can be explained in terms of greater long-distance (i.e. out-county) migration of females since only marginally more simple household females came from outside Devon. A much higher proportion of women at Exminster originated within the county and came to live in the parish of residence, on similar lines to non-patients, whilst remarkably high numbers of male admissions were local men living in simple households – presumably as breadwinners in most cases. Here may lie an important clue as to the relationship between gender, household structure and institutionalisation. For local men in such circumstances may well have been visible to the Poor Law and other local authorities in a way that solitaries were probably not. The solitaries were also less likely to depend on their kin to maintain them or to report their condition and need of institutional care. At the same time we might expect any cessation of the main source of family (wage) income to provide the Poor Law authorities with the kind of impetus to intervene, which would have been less urgent where more extended family support existed. Poor Law officials might also have responded rather less decisively to the evidence of females displaying comparable levels of insane behaviour. The disproportionately large number of single people admitted to the Devon asylum in these decades should be seen alongside the evidence that so few appear to have been living on their own when admitted to Exminster. It is difficult to establish the contemporary value or sentimental worth placed on an unmarried person living within a family household, though we may speculate that they could expect rather more support than those living on their own and less personal attention than married individuals. The patterns emerging from the evidence we have presented more tangibly suggest that the migration, gender, marital status, family background and complexity of household arrangements all contributed to the social environment in which individuals were constructed as lunatics. Less clear is the precise relationship between marital status, place of residence and admission to the Devon asylum, though there appear to be good grounds for supposing that both social and institutional factors played a significant role in the identification of the insane. To gain further purchase on the notion of institutional visibility, we measured the distance between the parish of residence of the person admitted to the asylum and the administrative centre of the Union – where the Poor Law workhouse almost invariably stood. The results from this exercise were suggestive rather than conclusive. We detected a mild effect indicating that those parishes furthest from the locus of Poor Law administration were less likely to be represented at Exminster than those closer to the workhouse.45 Together with the earlier findings on size and density of population,

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such figures indicate the possible importance of institutional reach and visibility in the different unions. It is possible that individuals living in substantial settlements enjoyed greater access to the workhouse authorities, and were more visible to them, than their counterparts living either in remote villages or in large towns and cities. Stability in the size of population and rate of population growth may also have assisted the officers of the Poor Law to undertake the surveillance of the pauper host. These structural characteristics provide one material context in which to understand the workings of lunacy administration in these years. Our regression results capture, at best, a limited part of the explanation for the uneven representation of parishes in the asylum registers.46 These trends suggest at least the possibility that administrative practices and policy preferences may have influenced the admission of pauper lunatics in the Victorian decades. There is only limited scope for reconstructing the complicated arrangements made for the disposal of pauper lunatics in the various Poor Law unions from the published Reports of the Lunacy Commission, though we do gain some insight into the total numbers of pauper lunatics at different points in our period and the distribution of known lunatics among different kinds of institutions.47 Assessing the numbers held in various places at the time of the Reports for the census years 1871–1901 reveals interesting variations in the use made of the asylum at Exminster by different unions, and also changes in the intensity of use made by the same Boards of Guardians over time.48 We found broad similarities between the propensity to send (which we measured by establishing a statistical likelihood versus incidence of admission or ‘z-scores’) for those numbers in each parish and the admissions to Exminster from the various Devon Unions in the period 1871–1901. The figures suggest that it was not merely, or even primarily, the price advantage of using alternative facilities to the asylum which shaped patterns of use, but also factors such as the periodic overcrowding of Exminster and the pressures exerted by the Lunacy Commission which influenced admission patterns in these decades.49 There appears to have been something of a boom in the use made of registered hospitals and licensed houses (i.e. private madhouses) during the 1870s and 1880s, until the opening of the Exeter Borough Asylum in 1886 greatly reduced the use of these establishments in Devon. During their heyday, the bulk of pauper inmates arriving at these establishments came from the boroughs of Barnstaple, Exeter, Plymouth and Tiverton, which had no direct right of access to overcrowded Exminster.50 Substantial numbers of lunatics also continued to be housed within workhouses across Devon throughout this period, along with numerous individuals who were recorded in Lunacy Commission reports as lunatics but who resided in no formal institution.51 The slow decline in the use of workhouse wards for registered lunatics was mirrored in the steady reduction of those who were cared for by ‘relatives and friends’ in the Devon County Unions (but not the urban centres) during the late Victorian period.52 Table

Journey to the asylum 93 3.2 in Chapter 3 gives some indication of the dispersal of recognised lunatics between Unions and different kinds of facilities. These additional numbers of lunatics provide further insights into the geographical distribution of known lunatics in Victorian Devon and the institutional practices of those responsible for implementing the legislation of 1845 and 1890.53 They appear to confirm both the significance of variations between the different Poor Law areas of the county and some other trends which we have identified in these decades.54 St Thomas emerges from the records as a strong client of the Devon Asylum, during the early years and again in 1871–1901, though it is more accurate to see this Union as prominent rather than outstanding in its contribution of admissions. Newton Abbot is a fairly heavy user of asylums but is noticeable as a low-score district when its large population is taken into account. Honiton, on the other hand, was not particularly distinguished as a dispatcher of people to Exminster but scores consistently highly for recorded lunatics within the Union area. Whilst Exeter and Plymouth’s provisions appear clearly determined by the erratic policy swings of their own boroughs in correspondence with both the County Asylum and the Lunacy Commission, it is interesting that Barnstaple is a consistent user of asylums but records low numbers of lunatics throughout its Union in these years, whilst the borough of Tiverton is not distinctive in this regard. There was a surprising reliance on workhouses in Plymouth and Exeter, as well as the Newton Abbot and St Thomas Unions. The bulk of workhouse lunatics were found here. When relatives and friends are excluded from the calculations, differences between Unions diminished, though St Thomas’ predilection for asylum care, Barnstaple’s use of workhouse wards, Honiton’s reliance on non-institutional arrangements, and Newton Abbot’s limited numbers of recognised insane are confirmed in most of the years selected. We can detect both common trends and continued diversity in these figures on recorded lunacy in late-Victorian Devon. There was a general move away from private madhouses and towards County and Borough Asylums after the overcrowding crises of the 1870s–1880s set the scene for the building of the latter at Exeter and Plymouth. Numbers of lunatics in the workhouse also increased slightly in the years of Exminster’s overcrowding, and it is only in the late 1880s and early 1890s that we can see the beginnings of a significant reduction in recorded cases of the insane held in workhouses. A sizable number of individual lunatics continued to be housed in ‘the community’, though the custom of private establishments collapsed in the 1890s.55 The figures reveal a more complex range of preferences and incentives than the familiar explanation that the reluctance of urban boroughs to pay the fees charged by the County Asylum had a powerful influence on the distanceeffect within counties such as Devon.56 Various scholars have noted the possible presence of an urban–rural divide in admissions to such institutions and our exclusion of the two major cities may disguise some of these contrasts.57 Our results also suggest that

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the most populous parishes and the settlements with the greatest density of population were not consistently associated with high admissions to Exminster asylum.58 There are numerous contrasts between independent boroughs and county Unions, though it is difficult to match this to any consistent divide between urbanised parishes and those with primarily rural hinterlands across Devon as a whole in this period. Philo highlighted the conflicts between county notables and economising burghers in his account of how the distance–decay pattern was disrupted in the three counties of eastern England during the mid-century years. Viewing the Devon experience from the longer perspective of 1845–1914, we can see a rather different and more complicated story emerging from the sources. There were certainly periodic conflicts between grandee Magistrates and their social inferiors on the subject of the Exminster asylum, as noted in Chapters 2 and 3. The close proximity of the landed elite to the asylum and their dominant presence amongst the magistracy which governed Exminster by Quarter Sessions was underwritten by a political nexus with the chair of the Lunacy Commission, which preserved the autonomy of the Guardians against undue interference by the central bureaucracy. We have attempted to assess the impact of these developments in Devon by introducing a ‘Union effect’ into our calculations, comparing the influence on a parish belonging to the pro-asylum Union of St Thomas with a more remote and politically obscure Union (Kingsbridge). Since St Thomas was the Union in which Exminster stood, we might also expect the distance effect to be greatest in the years when their Guardians were most closely associated with support for the asylum. The results indicate the strength of the ‘Union effect’ in the two decades following the opening of Exminster. The positive influence of St Thomas appears as strong as the measurable distance effect, whilst membership of Kingsbridge Union had no significant impact on the propensity of parishes to send pauper lunatics to the asylum until the decade after 1865 (when there was a clear negative association). The positive impact of St Thomas fades very quickly in the 1860s and remains insignificant for most of the nineteenth century, with a slight ‘ripple’ apparent after 1890, possibly as a result of the increasing pressure the Lunacy Commission placed on Poor Law authorities to improve workhouse facilities for their lunatics, prompting another wave of Exminster admissions.59 The personal and family circumstances in which pauper lunatics were admitted to and discharged from the Victorian and Edwardian asylum remain obscure, though may best be understood in the context of both larger social change and the peculiar responses to the evidence of insanity and recovery documented by contemporary witnesses.60 There is much less research available on the impact of distance on the private asylum in these years.61 A comparison of the public or pauper asylum and the world of private institutions will cast further light on the significance of distance, migration and household structures in the use made of the Victorian and Edwardian asylum. Since these private institutions were

Journey to the asylum 95 generally smaller than the pauper asylums, catering for more affluent individuals with resources to pay fees, it seems reasonable to assume that their clients exercised greater choice over their accommodation than could pauper clients, and would be drawn from more varied localities as well as a range of social groups. Wonford House recorded approximately 900 female and 800 male admissions in the period 1855–1914. We have some idea of the previous addresses of more than four-fifths of these individuals, though their precise geographical and social origins are frequently unclear or ambiguous. We have summarised the geographical details and the results are given in Table 5.8. There is a heavy preponderance of admissions to Wonford House from the South West of England, with more than two-thirds of males and females with known previous addresses arriving from a place in Devon. More than four-fifths of people with known addresses came from the wider region extending to Dorset and Cornwall, with less than 5 per cent arising from London. Examining the Devon addresses in more detail, easily the largest concentration of admissions comes from Exeter (more than 40 of each sex clearly living in Exeter prior to admission). Comparatively, Plymouth is much less important, with less than 20 females and only ten males coming from the city, with a tiny number coming from Devonport and East Stonehouse. Taken together, the major coastal resorts of south, east and north Devon together provided well over 100 admissions, equally between the Table 5.8 Wonford House asylum, 1855–1914: admissions by gender and county of origin County

N

Male Devon Somerset Cornwall Dorset London Bristol Bath Total

437 76.27 68 55 9.60 8.5 18 3.14 2.8 15 2.62 2.3 26 4.54 4 22 3.84 3.4 0 0.00 0.00 573 100.00 89.1

Total for whom address known 643 Total male admission 790 Total as % of male admission 72.5

%

% known origin

County

N

Female Devon Somerset Cornwall Dorset London Bristol Bath Total

503 76.3 58 8.8 31 4.7 19 2.9 32 4.9 14 2.1 2 0.3 659 100

Total for whom address known 721 Total female admission 892 Total as % of female admission 73.9

%

% known origin 69.8 8 4.3 2.6 4.4 1.9 0.28 91.4

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sexes, in our period. The only other significant contributors were the market towns of Devon, including Tiverton, Barnstaple and Bideford.62 The conclusion appears to be that this substantial private institution was catering primarily for people with some private resources in Devon, and more particularly in Exeter, with significant numbers within Devon arriving from the coastal resorts, though it is noticeable that this asylum which clearly served the south-western English counties attracted relatively few from Plymouth as well as counties beyond the region. The evidence from Exeter and Plymouth borough asylums is too scanty and their foundation was too late in our period to make any substantial analysis. In regard to Digby’s Asylum, opened in 1886 to serve Devon’s county town, it is apparent that Exeter was easily the main user, accounting for almost half the male admissions and well over half the female admissions. The next main client was London County Council which claimed almost one-quarter of female admissions and more than 15 per cent of male entrants. Within Devon the boroughs of Tiverton and Barnstaple were together responsible for about 15 per cent of those admitted followed by Somerset at about 9 per cent. The evidence we have surveyed indicates that distance exerted a complex influence over admissions to these institutions in the Victorian and Edwardian years. Philo is justified in emphasising the significant role that social and political actors, including the Poor Law authorities, played in the admission of people to the pauper asylum in these years. We have considered the residence of those admitted to the pauper and private asylums as well as a variety of demographic and migration characteristics of those coming to the County Asylum in this period. The evidence suggests that parish of residence and its distance from Exminster affected the pattern of admissions, along with factors such as the size of settlement and proximity to the Poor Law workhouse. There also appears to have been a change over time in that, in the early years, those parishes which were closest to the asylum, most obviously St Thomas itself, provided the largest numbers of admissions, while the smaller and more remote parishes which possessed smaller populations and lower density of population sent more individuals by the 1870s. In the late 1880s the importance of distance appears to have increased once again, though here again the middle-sized parishes and settlements figured more readily than the larger towns and cities within the county. The key intermediary in this relationship between demographic settlement and asylum admission was the Poor Law and a variety of agents who established some relationship to the statutory authorities responsible for certification and committal. Historical studies of the institutionalisation of the insane have drawn on demographic sources and methods to elucidate the influences on admissions. Conceptions of welfare institutions in the early modern period have been profoundly influenced by the wide-ranging reassessment of the role of the family and kinship in the care of the dependant. The balance of responsibilities between the family household and the wider community remains a

Journey to the asylum 97 63

matter of intense interest and debate. As historians of the asylum move the area of debate from the discourse of psychiatrists and their institutional practices to the wider social and demographic environment in which the asylum flourished, fresh issues have emerged in the exploration of the social origins of the individuals who became inmates of these places. There are also interesting continuities between the pioneering research of scholars such as Scull and Walton and the concerns of both demographic and recent asylum historians. Debates continue to revolve around the impact of modernisation, the growth of capitalism, the spread of commercialised consumption, and the impact of industrialisation on the functions and integrity of the family household. Walton was responding to the challenge of Anderson’s seminal study of Lancashire as well as the arguments of Scull in framing his model of migration patterns and family strategies. Whilst differing in the emphasis they place on such factors as the impact of urbanisation, the arguments of Walton and Scull combine to suggest that the onset of long-distance migration and the spread of commercialised centres of trade combined with the introduction of the new asylums to weaken family tolerance of awkward dependants. The corrosive forces of commercialisation were successfully resisted where working-class families could develop networks of support amongst kinfolk and community which enabled the tighter-knit textile manufacturing centres, for example, to devise a collective response to insanity and to discriminate in their use of the new asylums according to the demands of the particular moment. Our research on individuals admitted to the Devon lunatic asylum in the period 1845–1895 provides limited support for the interesting models developed by Walton, Scull and Philo. Although the county experienced deindustrialisation of some areas and escaped the intense urbanisation of Lancashire, the second half of the century did see a shift of population from rural to urban and coastal settlements. Many rural communities witnessed an enormous loss of people to the booming centre of Plymouth and flourishing coastal areas such as Torbay. The data on migration lend little weight to the view that commercialisation, urbanisation and long-distance movement served to fragment families and can be directly linked to those travelling to the County Asylum. About half of Exminster’s patients in 1871 were living in their birth parish compared to little more than two-fifths of non-patients. It was apparently from the deeply rooted, physically less mobile and more socially entrenched families that the bulk of the Exminster patients came. Most lunatics originated in family households which were characteristic of those experienced by the broad mass of the county population. In this sense, they appear to represent the mainstream of Devon society rather than those wandering the urban centres in search of social connection. Our evidence provides little support for the view that the people who filled the wards of the Victorian lunatic asylum were the dispersed wandering perdus of contemporary myth. Indeed, Exminster patients appear to have been more closely tied to

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extended households and kinship networks than many in the wider population who lived in solitary households and nuclear families. In sharp contrast to Walton’s findings on Lancashire, longer distance migration was associated with lower levels of admission to Exminster. These findings do not necessarily destroy the demographic model offered by Walton and Scull, any more than they contradict the view that families play a significant role in the whole process of institutionalisation. What is questionable is whether we may draw on one well-known industrial region to sustain a model of growing commercialisation, industrialisation and high migration rates with the rising tide in asylum admissions. Our evidence points to the need for a reassessment of the assumption that there was a predominant pattern of admissions which can be attributed to a clear chronology of economic, demographic and social change. A more plausible explanation may be derived from a model which identifies important shifts in the economic and social structure as a context in which to examine the relationships that bound the insane to the asylum as well as the interplay of political and institutional forces that can be detected in the choices made by different social actors in these years. The patterns of admission found in Devon suggest the possibility that low levels of mobility and strong family ties were associated with high incidence of lunacy, and insanity itself may have contributed to the inability of such families to participate in the migration patterns that accompanied commercialisation and modernisation.64 The evidence points to a subtle and complex process of transformation and adaptation in these years, in which propensity to use the Poor Law and the lunatic asylum figured as one strategic response. The forces of economic and social change appear to have been mediated by distinctive family relationships within particular communities and by the institutional structures established to regulate pauper lunacy in this period. Our research indicates that factors such as gender, marital status and household seniority were significant in the social and institutional construction of madness during the second half of the nineteenth century. The journey to the asylum was directed not merely by the broad market, class and ideological dynamics traced in some accounts, but also by a complex interplay between local kinship or community ties and the evolving institutions of the Poor Law which demarcated the boundaries of social regulation in their lives. In Devon at least it appears that it was the stable rural communities rather than the shifting mass of outcast city-dwellers who provided the mass of the admissions to the pauper asylum as well as the private asylum.

6

Community, friends and family Asylum, lunatics and the social environment, 1845–1914

There has been considerable debate about the role of families and kinship in the admission and discharge of pauper lunatics to and from asylums during the nineteenth century. Scholars have investigated the capacity of relatives to negotiate with Poor Law officials and medical staff in regard to the delivery of individuals to such institutions. In a recent study of the Norfolk asylum, Steven Cherry has argued that such claims have been frequently overstated.1 Janet Saunders has also raised the question of whether the Victorian asylum functioned as a place of ‘last rather than first resort’, where the strength of family ties and location of relatives was a key determinant of admission.2 John Walton argued that it was not only family bonds but particular types of behaviour (such as attempted suicide) which were more likely to secure asylum admission. This point is borne out by the Plympton experience. It seems likely that many of the families who appeared at the Plympton workhouse had been struggling for some time with stressful behaviour. This is quite apart from the behaviour exhibited in families which were suffering grievous stress which we discuss later.3 The factors which would decide the destination of the pauper lunatic were therefore complex and we can be confident that arrival at the gates of Exminster was only the end of a long, often winding road for the people concerned. Earlier discussions of discourses in relation to power have been succeeded by more detailed consideration of the processes of disposal and management and, in particular, by consideration of the families and communities from which the pauper lunatic was taken.4 This has brought us closer to the suffering and loss which occurred than the older debates in which the pauper lunatic figured as a somewhat abstract object of conjecture. In this chapter we want to excavate further some of that suffering and loss from a group of around 13,000 pauper lunatics, who were sent to Devon County Pauper Lunatic Asylum between 1845 and 1914, and we shall also make reference to the families and communities of these people. We do this in order to add further historical information to understanding of this subject which deeply affected large numbers of people. However, we also believe that this is important because the extreme suffering which we will try to describe

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resonates with all eras in which new policies are being implemented with regard to mental disturbance. There were of course opportunities for contacts between families and friends for pauper lunatics at Exminster. Visiting was relatively unrestricted until 1909 when sheer numbers led to a system of visiting times and days. At that time the superintendent declared that ‘the applications for visiting the patients have become so numerous of late that there is scarcely a day in the week or a Sunday without several coming in’.5 However, this did not necessarily mean, of course, that all patients were receiving visitors. For one thing many of them had no families and for another it was expensive and timeconsuming to travel from distant parts of Devon even when the railways came. As the Lunacy Commissioner observed in 1901: ‘this county, being very large and the patients’ friends having to come from long distances, we felt that the suggestion of some patients that on certain days in the month the railway companies should be asked to issue cheap tickets was worthy of consideration.’6 Visits were often stressed and fraught occasions for both inmate and visitor. For example the inmate might feel ambivalent about seeing the relative or friend in such surroundings and, in addition, there might be strong feelings of resentment. Thus Mary S. on one day ‘expresses a strong desire to see her husband’ but, because he had placed their child with a woman with whom she suspected him of having been unfaithful, on another occasion ‘speaks in an angry and bitter way against her husband’. Others became distressed or ‘excited’ when a spouse, son or daughter visited. Visits between some turned into bitter recriminations and exchanges of abuse. Others directly blamed their families for the fact that they were in the asylum: ‘shortly after Mary S.’s report her relatives came to see her, but she refused to see them, was very angry and indignant accusing them of conspiring to keep her in here.’ Sometimes inmates felt most ambivalent towards their relatives: ‘Mary G. occasionally speaks very angrily of her husband and his putting her in an asylum; at other times is very low spirited and desponding, thinking he must be dead.’7 Furthermore pauper lunatics could write to whom they wished, although in the period under review those letters were censored. There was intense anxiety among some friends and family about how well treated a pauper lunatic was by the asylum. Charlotte Mackenzie found similar examples among the families of those who went to Ticehurst.8 Mistreatment and cruelty were part of the community folklore about the treatment of lunacy and the claims the new asylum made of regulated, accountable and kindly treatment were out of kilter with what local people had heard of the madhouses and attics of the past. These claims were by no means therefore universally believed, and the Visitors had to deal with complaints of ill treatment from families and friends even though these might appear to have no foundation. In 1879 the Visitors’ Clerk read a letter from the Board of Guardians of the Bideford Union . . . that Grace C., a patient, had, through her mother, complained to them that

Community, friends and family 101 Grace had been ill treated by the attendants. The Committee saw the Patient and heard her statement and examined the ward attendants and the Head Attendant and they have every reason for believing that the Patient has been kindly treated – that she is sometimes very violent and attacks those around her.9 On occasion, as has been made clear, there was abuse of pauper lunatics and prosecution and dismissal of attendants. In 1899, for example, Dr Davis, the superintendent, dismissed a nurse summarily for punching a female patient on the chest and in 1902 a male attendant was dismissed on the spot for an ‘uncontrollable’ attack on a provocative patient.10 There was also fear as to what other pauper lunatics might do, and this was especially distressing to families and friends who well knew that the asylum contained some criminal lunatics and were convinced of the truth of all the stereotypes about them. On occasion these fears proved well grounded when control and surveillance systems failed. For example, on 7 March 1905, using the lid of a commode, a pauper lunatic attacked another patient sleeping in a next door room with no apparent build up or motive. The attacker ‘was not considered by us to be homicidal, but . . . restless at night and . . . taciturn in manner’.11 The victim died as a result and it transpired that the attacker believed that the victim was his hated mother: he was sent to Broadmoor. But the general environment was distressing to all involved, with pauper lunatics experiencing agonies of mental disorder; and highly distressing to frail or vulnerable people. Bucknill’s case notes reveal tragic suffering and distress among the thousands of pauper lunatics who were brought to Exminster. A farmer was ‘greatly agitated; says that men, spirits and demons are pursuing him and attempting to kill and poison him; that demons in the shape of little terrier dogs are eating his flesh.’ Case number 1,691 was a farmer’s daughter, aged 44, deserted by her lover: she was ‘greatly depressed; says her body and soul are lost and that she should be burned alive; that she sees hell flames . . . constantly moans and shouts aloud.’ Case 1,658 was ‘a married woman aged 57 . . . said she was under the terrible power of witches, who whispered into her ear that her family were to be burned. She believed all her family to be dead even though she saw them about her.’ Case number 555 ‘asks everybody why he is not killed and begs them to kill him, shouting all night long; tears his clothes, destroys his bedding, scribbles on the walls and doors . . . very destructive and violent, wets and dirties his bed, miscalls persons, fancying that he has seen everyone before.’12 One of the most obvious ways in which we can assess the relationships of the people who entered the Devon County Asylum is by examining their marital status and the role of the family and other figures in their admission to (and discharge from) the institution. Taking the large sample of 4,000 individuals from the whole intake (which comprised some 6,859 females and 6,140 males), we find that among the 2,113 females there were more

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than 800 wives, some 959 unmarried females and more than 300 widows, the marital status of the remainder being unknown. Among the 1,900 or so males entering Exminster, there were some 867 married men, 853 bachelors and 138 widowers.The figures indicate that, while a similar proportion of the males entering the asylum were married and unmarried, a significantly greater number of the female intake were unmarried. There was also a noticeably greater number of widows entering than widowers, which is likely to be explained in part by the greater life expectancy of females. The nearest relations of those admitted to the asylum are usually given in the documents brought to the institution on the entry of the individual and entered into the registers of the asylum. We found that about one-fifth of each sex did not have their relationship to a family member or other kin given on these documents, or it has been lost. For the remainder, the most common family relationships identified were those of wife, husband and father. Mothers were identified as the closest relative among one-tenth of the males and about one-twelfth of the females entering the institution, though sisters were more commonly seen in the documentation for women coming to Exminster. The figures are given in Table 6.1. The unmarried of each sex formed a substantial part of the intake over the whole period, and the character of their admission papers differed in some respects. For they were much more likely than the married to have no near relatives identified in the admission documents – more than 200 bachelors Table 6.1 Exminster patients and their near relatives, 1845–1914, by gender Males’ intake relatives Not given or unknown Brother Daughter Father Mother Sister Wife Other relatives Total

0, – (%) 0,375 (20.0) 0,103 (5.5) 0, 35 (1.9) 0,324 (17.3) 0,180 (9.6) 0,124 (6.6) 0,662 (35.3) 0, 75 (4.0) 1,878 (100.0)

Females’ intake relatives Not given or unknown Brother Daughter Father (including ‘father and others’) Husband (including ‘husband and others’) Mother Sister (including ‘sister and others’) Other relatives Total

0,424 (20.3) 0,119 (5.7) 0, 74 (3.5) 0,304 (14.5) 0,661 (31.6) 0,173 (8.3) 0,237 (11.3) 0,100 (4.8) 2,092 (100.0)

Community, friends and family 103 and more than 250 spinsters having no near relatives given out of the totals indicated in Table 6.1. Among the 959 unmarried women and 853 unmarried men we find that fathers were much more prominent as a nearest relative than for the sample as a whole, appearing in this role in more than one-third (34 per cent) of bachelors’ records and more than one-quarter (28 per cent) of spinsters’ documents. Mothers were rather less in evidence, accounting for less than one-fifth of unmarried males (19 per cent) and even less where their unmarried daughters were admitted (16 per cent of spinsters). Sisters were much more likely to appear when spinsters entered than when unmarried brothers were admitted to Exminster, though the numbers were not as great as those of parents. Our evidence for the whole of the 1880–1882 intake confirms the strong impression that, for married people, their spouse was almost invariably the nearest relative given on their admission to the asylum, and for the unmarried the father is identified in about two-fifths of the records as the nearest relative followed by mother, the brothers of unmarried males and sisters of unmarried females being the next significant relative identified. Widowed entrants tended to give their children or (in the case of widows) their sisters. Table 6.2 Exminster patients, admitted 1880–1882, and their near relatives

Male intake Not given or unknown Brother Daughter Father Mother Sister Son Wife Total Female intake Not given or unknown Brother Daughter Father (including ‘father and others’) Husband (including ‘husband and others’) Mother Sister (including ‘sister and others’) Son Total

Married (%)

Unmarried (%)

Widowed (%)

4 (3.1) 1 (0.8) 0 (0.0) 1 (0.8) 2 (1.5) 0 (0.0) 0 (0.0) 123 (93.9) 131 (100.0)

7 (8.1) 16 (18.6) 0 (0.0) 33 (38.4) 24 (27.9) 6 (7.0) 0 (0.0) 0 (0.0) 86 (100.0)

2 (9.5) 2 (9.5) 5 (23.8) 0 (0.0) 3 (14.3) 2 (9.5) 7 (33.3) 0 (0.0) 21 (100.0)

2 (2.0) 0 (0.0) 0 (0.0) 1 (1.0)

7 (5.9) 21 (17.8) 0 (0.0) 47 (39.8)

1 (2.5) 2 (5.0) 11 (27.5) 4 (10.0)

91 (92.9)

0 (0.0)

0 (0.0)

2 (2.0) 1 (1.0)

20 (16.9) 23 (19.5)

2 (5.0) 10 (25.0)

1 (1.0) 98 (100.0)

0 (0.0) 118 (100.0)

10 (25.0) 40 (100.0)

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What is apparent is that the bulk of those entering the asylum after census night in 1881 until the end of 1882 were members of well-defined family households. These results broadly confirm our analysis of the communal and domestic circumstances of the patients provided in Chapter 5. Considerably more than one-third were head of their household and another one in six were the wives of the householder. A similar proportion (15 per cent) were the sons or daughters of the householder and relatively few were unrelated to the head of household or identified as paupers, boarders or lodgers in the census returns for 1881.13 When compared to the small number of those who were found insane and wandering at large, noticeable differences can be detected. Two-thirds of the latter were male and less than one-third were married. All the women were single or had no marital status, and most of the males were single or widowers. The minority of married males had wives as their nearest relatives but most of the remainder gave no nearest relative or more remote relatives were identified. There was also a contrast between those found to be ‘wandering at large’ and the individuals who were ‘not under proper care and control’ under the terms of the 1854 Lunacy Act, the latter being rather closer in their character to the broader intake.14 There has been considerable discussion in recent years about the role of families and kinship groups in the discharge of individuals from the Victorian asylum, as well as their influence over the admission of people to these institutions. In assessing the journey of the individual to the pauper asylum, we need to take into account the role of the Poor Law (as we have emphasised in earlier chapters) and the role of local physicians as well as Guardians and Magistrates in the committal process. Similarly, we will examine in more detail below the policies of the medical staff and the Visiting Committee in regard to the discharge of inmates from the Devon institution. In regard to the departure of people from this establishment, it is worth noting that the returns for marital status suggest that the family relationships may have figured in the pattern of residence and discharge experienced by individuals at Exminster. Our evidence shows that there is a disparity in the experience of women and men who entered the asylum, with females having better prospects of departing recovered than males. This disparity is noticeable not only among the unmarried but rather more so among the married individuals who came to Exminster. Wives were significantly more likely to leave recovered (or relieved) than did married men in this period. There is no significant variation between the widowed of both sexes in this respect. The figures for 1880–1882 show rather similar patterns for the intake as a whole, though it is noticeable that, as measured by death rates, married men and women among the 1880–1882 intake fared rather worse than the large sample for the whole period (a higher proportion of each group dying and rather fewer being discharged recovered, though more married women left relieved), while the single men had lower death rates and higher recovery rates, though unmarried females had less prospect of leaving recovered

Community, friends and family 105 Table 6.3 Exminster patients, 1845–1914: outcome of asylum stay, by gender and marital status Marital status

Died (%)

Not improved (%)

Recovered (%)

Relieved (%)

Unknown (%)

Men Married Single Widowed 0 or uknown Total

418 (44.9) 38 (33.6) 321 (50.5) 64 (46.7) 23 (38.3) 429 (46.1) 65 (57.5) 255 (40.1) 60 (43.8) 35 (58.3) 70 (7.5) 8 (7.1) 48 (7.5) 10 (7.3) 1 (1.7) 14 (1.5) 2 (1.8) 12 (1.9) 3 (2.2) 1 (1.7) 931 (100.0) 113 (100.0) 636 (100.0) 137 (100.0) 60 (100.0)

Women Married Single Widowed 0 or unknown Total

299 (33.5) 37 (33.3) 413 (46.3) 54 (48.6) 170 (19.1) 19 (17.1) 10 (1.1) 1 (0.9) 892 (100.0) 111 (100.0)

379 (44.6) 79 (47.9) 22 (27.5) 364 (42.9) 67 (40.6) 52 (65.0) 104 (12.2) 19 (11.5) 5 (6.3) 2 (0.2) 0 (0.0) 1 (1.3) 849 (100.0) 165 (100.0) 80 (100.0)

Married (%) Single (%)

Widowed (%) Unknown (%)

Men Died Not improved Recovered Relieved Unknown Total

418 (48.4) 429 (50.8) 70 (51.1) 38 (4.4) 65 (7.7) 8 (5.8) 321 (37.2) 255 (30.2) 48 (35.0) 64 (7.4) 60 (7.1) 10 (7.3) 23 (2.7) 35 (4.1) 1 (0.7) 864 (100.0) 844 (100.0) 137 (100.0)

14 (43.8) 2 (6.3) 12 (37.5) 3 (9.4) 1 (3.1) 32 (100.0)

Women Died Not improved Recovered Relieved Unknown Total

300 (36.6) 413 (43.5) 170 (53.6) 37 (4.5) 54 (5.7) 19 (6.0) 379 (46.3) 364 (38.3) 104 (32.8) 80 (9.8) 67 (7.1) 19 (6.0) 23 (2.8) 52 (5.5) 5 (1.6) 819 (100.0) 950 (100.0) 317 (100.0)

10 (66.7) 2 (13.3) 2 (13.3) 0 (0.0) 1 (6.7) 15 (100.0)

and more of being discharged relieved or not improved. It should be noted that the term ‘recovered’ means that, in the view of the asylum, the insanity was cured by virtue of the treatment received. The term ‘relieved’ connoted the relief of symptoms of insanity without the belief that the insanity had been cured. Those relieved were therefore presumed to be more vulnerable to the return of insanity at some future date than those seen as recovered. The evidence is suggestive rather than conclusive in regard to the impact of marital and family relationships on the patterns of discharge. The figures indicate that the asylum continued to discharge a substantial proportion of both the married and the unmarried as recovered or relieved in these

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Table 6.4 Exminster patients admitted 1880–1882: outcome of stay, by gender and marital status Marital status

Died (%)

Not improved (%)

Recovered (%)

Relieved (%)

Unknown (%)

Males Married Single Widowed 0 or unknown Total

75 (56.0) 4 (40.0) 43 (32.1) 4 (40.0) 12 (9.0) 2 (20.0) 4 (3.0) 0 (0.0) 134 (100.0) 10 (100.0)

42 (50.0) 10 (40.0) 33 (39.3) 11 (44.0) 7 (8.3) 3 (12.0) 2 (2.4) 1 (4.0) 84 (100.0) 25 (100.0)

2 (33.3) 1 (16.7) 2 (33.3) 1 (1.0) 6 (100.0)

Females Married Single Widowed 0 or unknown Total

42 (36.5) 2 (11.8) 53 (46.1) 12 (70.6) 20 (17.4) 2 (11.8) 0 (0.0) 1 (5.9) 115 (100.0) 17 (100.0)

42 (41.2) 16 (44.4) 48 (47.1) 14 (38.9) 12 (11.8) 6 (16.7) 0 (0.0) 0 (0.0) 102 (100.0) 36 (100.0)

1 (16.7) 4 (66.7) 1 (16.7) 0 (0.0) 6 (100.0)

periods. Over the whole period, the greater number in each marital group died in the asylum with the exception of married women, where a substantially greater number left recovered than expired within the walls of the institution. Even among those entering in 1880–1882, who appear to have fared worse in terms of survival than those entering over the longer period, Table 6.5 Exminster asylum, patient admissions, 1880–1882: outcome by gender and marital status Married (%)

Single (%)

Widowed (%)

Unknown (%)

Men Died Not improved Recovered Relieved Unknown Total

75 (56.4) 4 (3.0) 42 (31.6) 10 (7.5) 2 (1.5) 133 (100.0)

43 (46.7) 4 (4.3) 33 (35.9) 11 (12.0) 1 (1.1) 92 (100.0)

12 (46.2) 2 (7.7) 7 (26.9) 3 (11.5) 2 (7.7) 26 (100.0)

4 (50.0) 0 (0.0) 2 (25.0) 1 (12.5) 1 (12.5) 8 (100.0)

Women Died Not improved Recovered Relieved Unknown Total

42 (41.2) 2 (2.0) 42 (41.2) 16 (15.7) 0 (0.0) 102 (100.0)

53 (40.5) 12 (9.2) 48 (36.6) 14 (10.7) 4 (3.1) 131 (100.0)

20 (48.8) 2 (4.9) 12 (29.3) 6 (14.6) 1 (2.4) 41 (100.0)

0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (100.0)

Community, friends and family 107 we find that there were as many married women who recovered as died in the asylum. There are signs that the pressures of overcrowding became serious for periods in the 1880s and early 1890s when many of the 1880–1882 inmates would have been at Exminster. We would conclude that females fared considerably better in coping with the asylum than did their male counterparts. Husbands seemed to have been particularly illadapted to coping with institutional life although this was probably due in large part to their poor physical condition on admission. The evidence raises interesting questions about the capacity and possibly the willingness of female family members to care for married males as well as their unmarried female and male relatives. In their assessment of the administration of the asylum in the nineteenth and twentieth centuries, Bartlett and Wright argued that institutional and non-institutional forms of care served as an alternative to admission to the major pauper institutions and deserve greater attention and emphasis. They also stress the degree to which family members could influence the admission and discharge of individuals from these mainstream institutions. When seeking to assess the role of relatives and kinship groups in the pattern of admission of people to the Devon asylum (and similar places in Devon which we discuss later), we must refer to the role of the Poor Law authorities and the issues discussed in Chapter 2. In particular, the role of relatives in the certification and admission of family members to the pauper lunatic asylum was often (though not invariably) expressed through contacts with officers of the Poor Law Unions in the county. The influence of household, kinship and communal relationships also points to the question of the ability of relatives and friends to cope with the onset or persistence of signs of insanity among individuals in contemporary society. Any assessment of the prevalence of insanity before certification must be a speculative and limited exercise. We may glean some clues from the testimony of the legal documentation concerning the reported duration of ‘the attack’. Table 6.6 provides a summary of some evidence drawn from the Devon asylum. Those inmates who were admitted in 1880–1882 had the duration of their attack entered in the certification and admission documents. The figures indicate some variations in the experience of the married and unmarried people coming to the asylum. There are also differences in the pattern of residence of males and females at this time. A large majority of married men had been suffering insanity for a year or less, two-fifths of them being reported as having been ill for 30 days or less on certification. An even larger proportion of single males (45 per cent) were admitted after a perceived illness within 30 days. For married women the situation appears to have been different. Just over one-third of wives came to the asylum after a reported attack of less than a month. A larger number (44 per cent) entered after a reported illness of more than a month and up to a year. Very few married females came to Exminster with a history of more than a year since

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Table 6.6 Exminster patients admitted, 1880–1882: recorded duration of insanity, by gender and marital status Duration of attack (days)

Married (%)

Single (%)

Widowed (%)

Males 0–7 8–30 31–90 91–365 366–3,000 3,001–6,000 6,001+ Total

31 (23.0) 23 (17.0) 32 (23.7) 31 (23.0) 17 (12.6) 1 (0.7) 0 (0.0) 135 (100.0)

30 (31.9) 12 (12.8) 17 (18.1) 19 (20.2) 14 (14.9) 2 (2.1) 0 (0.0) 94 (100.0)

3 (11.5) 7 (26.9) 6 (23.1) 7 (26.9) 2 (7.7) 0 (0.0) 1 (3.8) 26 (100.0)

Females 0–7 8–30 31–90 91–365 366–3,000 3,001–6,000 6,001+ Total

18 (17.6) 24 (17.8) 17 (16.7) 27 (26.5) 16 (15.7) 0 (0.0) 0 (0.0) 102 (100.0)

35 (26.5) 24 (25.5) 30 (22.7) 22 (16.7) 16 (12.1) 4 (3.0) 1 (0.8) 132 (100.0)

9 (22.0) 9 (34.6) 8 (19.5) 12 (29.3) 3 (7.3) 0 (0.0) 0 (0.0) 41 (100.0)

the attack for which they were admitted. Single women remained outside the asylum for shorter periods after an attack of insanity. Three-quarters of all spinsters were admitted having suffered for three months or less. This compares with rather less than two-thirds (63 per cent) of bachelors arriving. Widows and widowers were admitted after rather longer periods outside the institution following the attack for which they were certified. The evidence on length of time since the attack of insanity suggests that wives were far more likely to remain outside the asylum for a significant period before their certification and admission than were unmarried women. Husbands were also rather slower to be admitted than bachelors, though the difference is much less significant and married men were noticeably more likely to be sent to Exminster within three months of an attack than married women. Family and kinship support for the married appears to be confirmed by such evidence, particularly the neglected role of husbands as carers for their partners and their greater capacity for dealing with the reported incidence of insanity. The certificates of women admitted to Exminster in 1880–1882 offer a vivid contrast in their experience of care ranging from numerous instances of desertion by husbands and shared destitution in the workhouse to cases where respectable working men struggled to cope with reported incidents of deep distress and domestic crisis.

Community, friends and family 109 The process of certification was only one stage on the road to the asylum. The arrangement of preliminary medical examination and the application for an order to commit an individual to such an institution devolved on to the officers of the Poor Law and the Magistrates responsible for enforcing the legislation of 1845. While the Poor Law Relieving Officers and Medical Officers played a key role in the administration of pauper lunacy, the circumstances in which their role was exercised could vary widely. The Poor Law workhouse was not universally used, for example, as a point for the medical examination and dispatch of individuals to the pauper asylum. The evidence for those admitted to Exminster in 1880–1882 provides some insight into the mechanics of certification and committal of an individual to the asylum. Among the 276 female admissions in these years, more than half (57 per cent) were examined in their home, less than one-fifth (17 per cent) were examined in the workhouse, virtually the same number in ‘other’ places and a mere 8 per cent in the physician’s home. Among 262 males, exactly half were seen by the physician in their own home, the same proportion examined (17 per cent) in the workhouse as for females, more than onequarter (27 per cent) elsewhere, and only one in 20 in the physician’s home. While a very similar proportion of men and women were examined in the workhouse, by the Poor Law workhouse medical officer, rather more females were certified in their own home. The character of diagnosis also varied according to the place of examination. Among those who were examined in the workhouse were a remarkably high proportion of women and men diagnosed with ‘dementia’ (more than one-quarter of the 78 individuals for whom details survive) and almost one-fifth (18 per cent of this group) were identified as suffering from imbecility. According to Bucknill and Tuke, the demented were individuals who had lost the power of reason and comprehension while the imbeciles had never possessed this ability.15 They were significantly over-represented among the workhouse constituency which came to the Devon Asylum and as compared to the larger intake to the institution. Females were usually examined and certified in their homes and in ‘various’ other places (including, it seems, family and neighbours’ houses), while greater numbers of males were examined and certified in public buildings, military and police establishments. The major locations are given in Table 6.7. The place of the Poor Law and the workhouse in the process of admission to the pauper lunatic asylum has been discussed in some detail elsewhere and needs little reiteration here.16 Evidence gleaned from the Plympton St Mary Union in Devon from 1867 to 1914 reveals a rich and diverse history of Poor Law administration in regard to pauper lunacy in these years, where a range of workhouse staff could figure in the documentation which accompanied an individual to the Devon Asylum.17 Relatively few individuals entered the Plympton workhouse as lunatics in the years 1871–1891. Admissions to Exminster indicate that there was a steady flow of 17 to 20 individuals per decade coming from the Plympton workhouse to

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Table 6.7 Exminster patients admitted, 1880–1882: ‘other places’ where individuals were examined and certified prior to admission, by gender Females (%)

Males (%)

Police premises Prison Public/administration buildings (inc court houses) Asylums (non-DCLA) Royal N hosp (Plymouth) Military premises Public houses/refreshment premises Various

4 (10) 1 (2.4) 7 (17)

8 (12.7) 1 (1.6) 18 (28.6)

6 (14.6) 0 (0) 0 (0) 2 (4.8) 21 (51)

13 (20) 5 (8) 1 (1.6) 3 (4.8) 14 (22)

Total

41

63

the asylum between 1867 and 1900, followed by a sharp upturn in 1900–1905. A slightly higher proportion of those leaving (as compared to entering the workhouse) in those years were dispatched to the asylum as lunatics, but the numbers remained very small in comparison with those leaving the workhouse at their own request or that of their mother, or even those dying in the workhouse.18 The evidence from Plympton of people sent to Exminster between 1867 and 1914 also confirms the impression gained from the Devon Asylum records that only a limited minority of individuals who entered the County Asylum were previously residents of the workhouse.19 The largest group of future Exminster inmates coming from the Plympton workhouse was transferred quickly and only a limited proportion of future residents at the Devon County Lunatic Asylum had been at the Union premises for more than a year. Such evidence must qualify the claim, frequently made at the time, that the Guardians of such Unions only sent the chronic and incurable cases from the workhouse to the asylums. Males were usually transferred quickly, whereas most of the really long-term workhouse pauper lunatics were women. The Plympton case confirms the returns gathered from the asylum in regard to the process of admission to the asylum, in that the local police often played a role in bringing a person to the attention of the authorities, particularly where males were outraging public decency or representing a threat to private householders. The attitude of Poor Law officers was also likely to be coloured by the reports received by those serving in the police force. The Plympton records suggest that when an individual was detained in this way the Relieving Officer of the Poor Law usually instigated a search to seek out close family or friends of the person concerned. Where such relatives were unwilling or unable to accept responsibility for the care of the individual, then the person was likely to remain in the workhouse for a period before being sent to Exminster if they were assessed as dangerous,

Community, friends and family 111 unmanageable or disordered. The Poor Law authorities were also compelled to consider the costs involved in the different options of care for those found to be disordered, including the residence of their pauper lunatics in various institutions and the burden of transporting and maintaining the individuals at Exminster. The Plympton Guardians were most concerned, for example, when one pauper was sent to Exminster from the Portsmouth Borough Asylum, to recover the costs of travel from the father of the lunatic.20 On other occasions the Guardians were willing to consider the use of private madhouses where costs and space were a consideration.21 Decisions in respect of the accommodation of lunatics may have been influenced to some degree by considerations of family access to those admitted. The impact of physical distance on the admission of individuals to the Devon asylum points to the importance of accessibility of the institution on the decision, reflected in the greater number of admissions arising from Poor Law Unions and parishes which were closer to Exminster than more remote areas of the county.22 A broader picture of the role of family relatives in the process of admission to the asylum can also be illustrated by individual cases from the records of Exminster. Any account of family connections and the treatment of family members in the mid-Victorian years is bound to be coloured by the furious controversies which erupted around specific instances of abuse and the scandals which were widely publicised by the different advocates and opponents of asylum care as a means of justifying or criticising the regime of these institutions. A number of Devon cases were already the subject of public debate before Bucknill’s arrival at Exminster, and his textbook with Daniel Tuke offered a series of cameos of Devon patients that illustrate the efficacy of his methods of intervention while superintendent. One celebrated case emerged in the 1830s when an Assistant Poor Law Commissioner discovered the condition of a Tiverton woman who had spent 28 years in a tiny room without fire or furniture. The same official reported the circumstances of a man who was found chained in the darkness of an outhouse where he had lingered for eight years.23 More notorious was the scandal of Charles L., son of a Lewtrenchard farmer, whose family was prosecuted and an uncle imprisoned in 1852 after evidence was presented by the Lunacy Commission concerning his imprisonment in a tiny wooden cage where he had remained in chains for nine years. Housed in the Exminster asylum he was subsequently described as a quiet and well-conducted inmate who was employed in the blacksmith’s shop.24 After his arrival, Bucknill also discovered and publicised instances of gross neglect and abuse of family members, such as Edward L. of Bratton Fleming.25 While the reported abuses of family members figured in the early publicity undertaken by the Lunacy Commission and asylum advocates such as Bucknill to promote the virtues of institutional care, there is also formidable evidence that relatives were expected to carry considerable burdens of personal care when individuals were vulnerable to attacks of insanity. The Poor

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Law Relieving Officers in the borough of Exeter heard in 1864 that Amelia H. had been attended in her reported lunacy by her mother until the latter had been paralysed and was unable to look after her daughter any longer, necessitating the admission of both to the Corporation workhouse.26 The attention of the authorities was often drawn to the plight of individuals only when their parents were ailing and no longer capable of taking care of them outside of the institutions designed for their residential care. Charlotte G.’s ‘violent and destructive’ behaviour became impossible when her aged father was unable to contain her within the family household, and in other instances it was the death of a parent or the vulnerability of a spouse to violence which alerted the Poor Law officers to the need for action.27 Married men as well as women who sought to cope with childbirth and with childhood illness were vulnerable to intense pressures which often resulted in reports of mental collapse.28 In some cases families could witness extreme conflict and violence for sustained periods before complaining to the authorities.29 If some families were reluctant to send their members to an institution that was many miles from their own homes and even from the Union workhouse, there remained the question of contact with their relatives once they had been sent to Exminster. There is also the larger question of the degree to which such institutions were able to establish contact for their inmates with the wider society in which the asylum was located. As noted earlier, Bucknill argued that his contemporaries retained a deep distaste not only for the insane but also for the places which were established to aid their recovery, and those who were employed within them.30 In contrast to Foucault’s view that asylums were just one of a range of institutions which were designed to intimidate urban populations, the asylums were frequently located in pastoral, rural areas. Here the prospect of recovery from the contemplation of pleasant views and amid the quiet healthy atmosphere was thought to be greater than in urban areas, being removed from ‘the hurry and restless movement, the keen competition and struggle, the growth and corresponding evils of large cities’ which, the Lunacy Commission considered to have been a source of ‘mental disorder in the population’.31 Yet it would be a mistake to assume that such institutions were completely sealed off from the wider environment in which they were established. One of the most obvious ways in which contact with the surrounding communities was maintained was in the form of the regular walks and excursions from the asylum into the local area, twice weekly, which involved as many as 600 patients by the 1890s.32 There were also varied amusements available in the form of dances, concerts and theatrical performances undertaken by local dignitaries, musicians and actors, attended by as many as 200 inmates in the 1870s.33 Christmas festivities were a high point in the social calendar of the institution, as in many other similar establishments, with the officers and attendants ranked in line to participate along with the residents and prominent individuals from Devon society.34 Staff and inmates formed a

Community, friends and family 113 chorus of minstrels to entertain local audiences.35 Another form of contact with the outside world was provided in the form of sports events, including matches with other asylums in the area such as Wonford House.36 Such orchestrated events were designed to display the good organisation of the institution as well as offering its inmates an opportunity for outside contacts. By the end of the period, the Devon Asylum was an established fixture within county society. As noted earlier, the responsibility for its governance had passed from the direct control of grandees such as the Courtenays to the County Council, though the latter were still under the influence of notable Devon families such as the Aclands, with Sir Thomas Dyke Acland figuring as a prominent chair of the County Council at the turn of the century. The intellectual and moral climate in which the institution had expanded was also a different one from that in which Bucknill had been appointed, with concerns about inherited disabilities playing a significant part in comments such as Dyke Acland’s sombre and pessimistic evidence to the Royal Commission on the Feeble Minded in 1908.37 The nature of ‘community’ and the social environment of Devon continued to be a significant context in which the asylum functioned in the later part of the period, though it would be mistaken to assume that there was an increasing tolerance of its residents in all areas of society. The scepticism which some observers expressed in regard to the inmates of the asylum should not obscure the importance of efforts by families, relatives and medical staff to secure the release of those who were seen to have recovered or even improved during their time at the institution. There has been considerable interest among historians of insanity in the process of discharge, or ‘casting out’, from these establishments, and it is clear that the release of an individual from Exminster was often preceded by considerable discussion with relatives as well as by the Visitors who remained responsible for approving the discharge of patients. The superintendents were often contacted by relatives and friends of the certified in a bid to secure their release, though Bucknill was quite clear that violent patients could not be returned to the community without danger to themselves and others.38 Such decisions were reviewed at the monthly meetings of the Visitors, the Magistrates frequently expressing their concern that those assuming responsibility for the care of a discharged inmate should vouch for the continued maintenance of the individual.39 Where the family and friends of an inmate were unable to persuade the superintendent and Visitors that they were capable of caring for the released person, then their request for discharge was refused, even where letters were received urging the release of the person committed. Reports were also received of the progress of individuals who had been discharged into the hands of relatives.40 In some instances the family relatives would journey to Exminster to address the Visitors gathered at their monthly meeting. For example, the sister of Henry C. asked for his release in 1852, explaining that

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he was ‘a farmer renting under Mr Luttrell’ and that ‘his friends are able to provide for him, that he is ill and that they wish to have him home’.41 Mary B.D.’s father pleaded with the Visitors to release Mary into his care since he ‘was a man of property and capable of taking care of his daughter and that he proposed to employ a person expressly for that purpose if she were discharged from the asylum’.42 Bucknill was even willing to contemplate the discharge of ‘idiots’ from his care where friends were ‘willing and capable of taking care of them’, but not in the absence of such evidence.43 In some cases the relatives seeking the release of a family member sought the support of Poor Law officers, while in other instances they struck a bargain with the Union Guardians to relinquish any claim for reimbursement of maintenance costs in return for agreeing to look after a discharged inmate.44 The discharge of a person from the asylum clearly depended not only on their capacity to demonstrate that they no longer posed a danger to themselves or others, but also that there were people willing to offer them shelter and some kind of support after their release. In common with other asylums, Exminster released pauper lunatics on a trial licence, usually of a month, but sometimes of six months, before release was finalised. Usually a money allowance of around seven shillings was made direct to the patient for the trial period and, in some instances, the Visitors awarded grants from their benevolent fund, formally established in 1879.45 Families and friends who failed, in the view of the Visitors, to provide for individuals released on licence found that their relatives were recalled. Maria C. was released (but not formally discharged) on six months’ trial in 1872 and initially was reported to be ‘quiet and so got on for some time at home’. She latterly became troublesome and talked improperly, precipitating her return to the asylum.46 Jesse H. was admitted in 1904 and though temporarily released in 1905, she was quickly returned in 1905 and not formally discharged until early 1911.47 In other cases the strain of caring for a released patient was too great.48 When friends rather than close relatives secured the release of one man in 1892, he immediately embarked on a violent campaign against his father and the rest of his family, forcing a police escort back to Exminster.49 In the passage of inmates from the asylum, the medical staff exercised a considerable, often fundamental, influence over the decision to discharge or release on licence. It was the superintendent who was expected to make the arrangements with local Poor Law officials as well as relatives, for the reception of individuals leaving the institution. When Mrs D. applied in 1870 for the discharge of her daughter, the Visitors requested Dr Saunders to communicate with the Barnstaple Guardians to make satisfactory arrangements which provided the basis for the discharge.50 While relatives could address the asylum superintendent and the Visitors directly, as they sought to secure the discharge or release on licence of family members, the evidence shows that the officials of the Poor Law were likely to be involved in many instances. On occasion the Visitors would only agree to the discharge of an inmate if the Poor Law officers confirmed arrangements for care had been

Community, friends and family 115 made, in one instance requiring these officials to ensure the care of a female released and also setting down the condition that she ‘be not placed in the workhouse’.51 Not only was the asylum superintendent a key figure in the release of inmates, but he also maintained contacts with the medical staff of the Poor Law and local physicians after the exit of a patient. A local medical officer wrote to Saunders in the early 1870s that one former patient retained ‘symptoms of mental derangement refusing to answer simple questions’, adding that her mother had been compelled to use physical force to get the woman to bed at night and up again in the morning.52 Where the superintendent could not trace relatives and was not prepared to recommend habitation in the workhouse, then alternatives were sought. Saunders advised the Visitors in 1868 that five inmates were without friends to care for them and they were ‘not cases for workhouses’.53 In such instances the asylum turned to the cottage model where attendants and artisans who worked at Exminster were asked to provide a limited board to small numbers of patients who were considered eligible for trial release. In considering the needs of their patients and their legal duty to offer treatment as well as accommodation for those placed under their control, the asylum superintendents were responding not only to the physical and emotional pressures of the institutions which they directed, but were necessarily sensitive to the social and political concerns of the communities from which these individuals arrived. Such concerns were registered in a variety of forms ranging from the formal meeting of the asylum Visitors to the more generalised commentaries found in contemporary press reports. The Devon Asylum made over 13,000 admissions in the period under consideration, of which more than one in six were re-admissions, females figuring more prominently in this regard than males. The role of relatives in re-admissions is difficult to establish given the sparse nature of the records, but a detailed examination of more than 500 admissions (including readmissions) in 1880–1882 indicates that almost half of the female intake were single and more than half the male intake were married. In 30 per cent of the women’s documents and a similar proportion of male entries, violence to self or others was mentioned as one of the facts indicating insanity, details usually being provided by relatives. However, violence was a particular feature in the certificates of married men and single women, though the violent conduct (or threatened conduct) of widows also figured. When we consider those who had previously been in the asylum or who were re-admitted within the 1880–1882 period, we find that single females comprised more than half of those re-admitted and married males considerably more than half of the men who were re-admitted. The nearest relations of those readmitted were almost invariably the spouses of the married intake, but among the single women it was brothers, sisters and fathers who figured most commonly, while for single men it was much more usual for fathers and mothers to figure as relatives. Among the married men who were readmitted, violence was a prominent feature in well over half of the group,

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though for single women violence is mentioned in less than half the cases and this is slightly less than the proportion of re-admitted wives whose certificates note violence as a factor in certification. The certificates frequently detailed the delusions, threats, fantasies and real hazards which were presented by the individual as they were seen to lapse into insanity, some of the most vivid and lurid accounts being provided by close relatives.54 By way of comparison it is worth glancing at the experience of the private asylum near Exeter known as St Thomas Hospital and, after 1869, Wonford House. Over the period 1855 to 1914 there were 1,682 admissions, of which just over half were females (the proportions being the same as the much larger Exminster intake in the period 1845–1914). Among the males were very slightly more husbands than bachelors and only 6 per cent widowers. Well over half the women who came to Wonford House were unmarried and less than one-third were married, more than one in ten being widowed. In terms of admission to this voluntary, fee-based institution, the Poor Law was unlikely to be involved and there was no statutory requirement that a magistrate should order the committal of the private individual, though certificates from two independent medical practitioners as well as the authority of a responsible relative or some other person with legal authority to order the committal of a lunatic were required. The major groups are identified in Table 6.8, accounting for between 70 per cent and 75 per cent of all admissions. The most prominent people who gave authority for the committal of an individual to Wonford House were primarily the spouse of the married admissions followed by senior males within the family, namely fathers and brothers. Mothers and sisters figured rather less prominently and there was a tail comprising a wide array of relatives who gave permission for the admission of the patient, in some instances with the support of the Commissioners in Lunacy. Although Wonford House was a substantial private fee-based institution it mainly served Devon and the South West with more than 90 per cent of the major county admissions coming from the region and 66–69 per cent of all admissions arising from the counties of Devon, Somerset, Cornwall and Dorset (excluding Bristol and Bath). The implication is that the residents were usually placed in an establishment which was within travelling distance of their home and relatives. The admissions to Wonford House provide an assessment of the duration of the attack as well as the supposed causes of insanity. In terms of years at the asylum, we can see that married men and women were more prominent among those who had suffered their first attack within the previous year or few years, while the unmarried are clearly reported to have had a longer history of attacks. The certificates make it clear that the great majority of the men and women who entered the asylum were said to have suffered for less than a year from the time of their first attack and a substantial majority were reported as having been insane for less than a month. There were some

Community, friends and family 117 Table 6.8 Wonford House Asylum, patients admitted, 1855–1914: on whose authority sent, by gender Male

N (%)

Female

N (%)

Wife Father Mother Brother Sister Son Daughter Brother-in-law Son-in-law Uncle Aunt Friend Solicitors JP Commissioners in lunacy Relatives and Commissioners in Lunacy

159 (27.23) 106 (18.15) 46 (7.88) 101 (17.29) 36 (6.16) 39 (6.68) 10 (1.71) 26 (4.45) 5 (0.86) 9 (1.54) 2 (0.34) 10 (1.71) 4 (0.68) 4 (0.68)

Husband Father Mother Brother Sister Son Daughter Brother-in-law Son-in-law Uncle Aunt Friend Solicitors JP Commissioners in Lunacy Relatives and Commissioners in Lunacy

175 (28.27) 89 (14.38) 49 (7.92) 112 (18.09) 62 (10.02) 24 (3.88) 15 (2.42) 17 (2.75) 1 (0.16) 10 (1.62) 10 (1.62) 15 (2.42) 1 (0.16) 2 (0.32)

Total % of total male admissions

584 (100.00)

Total % of total female admissions

619 (100.00)

13 (2.23) 14 (2.40)

73.9

12 (1.94) 25 (4.04)

69.4

variations between marital groups in that married men were less likely to be admitted within the first month after their attack as compared to single men, though these variations in admission disappear within six months of attack. Wives were also rather less likely to be admitted to the asylum within a brief time of their first attack, though the variations are modest. As we might expect, the widowed were admitted within a brief period of the reported onset of insanity. The domestic and communal circumstances which led to the admission of these individuals to Wonford House are inevitably difficult to disentangle from the records that survive, though we have noted that the social boundaries between the public and the private asylum were more porous than is often noticed. About 140 of the Wonford admissions (one in 12 of the total) were transferred to the asylum from other institutions in this period. Many of these were from private asylums in the south-west and farther afield. A total of 12 of those admitted had previously been at Plympton House near Ivybridge, and six arrived from a small private asylum at Taunton. Another

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Table 6.9 Wonford House asylum, patients admitted 1855–1914: county of origin, by major counties County (male)

N

% of % total County major admissions (female) counties

N

% of % total major admissions counties

Devon Somerset Cornwall Dorset London Bristol Bath Total % of male admissions Total male admissions

437 55 18 15 26 22 0 573

76.27 55.32 9.60 6.96 3.14 2.28 2.62 1.90 4.54 3.29 3.84 2.78 0.00 0.00 100.00 72.53

503 58 31 19 32 14 2 659

76.33 56.39 8.80 6.50 4.70 3.48 2.88 2.13 4.86 3.59 2.12 1.57 0.30 0.22 100.00 73.88

72.5 790

Devon Somerset Cornwall Dorset London Bristol Bath Total % of female admissions Total female admissions

73.9 892

fourteen came from private institutions in Bath, Bristol and Gloucester, four coming from Fox’s famous institution at Brislington (outside Bristol).55 There were also a small but significant group who were delivered from London, including five from Holloway’s Sanatorium in Surrey. A rather larger number came from institutions which were not obviously small private establishments and many of this group came from pauper lunatic institutions, whether they had paid fees or not. The most famous institution of all, Bethlem Hospital in London, provided at least seven admissions to Wonford House and another nine came from ‘hospitals’ including St Andrews of Northampton, where they had been resident. As many as 30 of the admissions were from ‘asylums’ which are recognisably pauper lunatic institutions, four coming from Exeter Borough Asylum, three from the Devon Asylum and another seven from Somerset and Bristol pauper asylums. The question of the social origins of the Exminster and Wonford residents and the social complexion of the institutions to which these individuals were admitted is discussed in greater depth in Chapter 8. We now consider the period during which people remained at Wonford during the later nineteenth and early twentieth centuries, and the influence of their family and communal relationships on their residence and discharge. The evidence of length of stay within Wonford indicates that almost half of married males left the asylum within six months of admission as compared to less than one-third of single men. A substantial majority of widowers remained in the asylum for less than three years. Almost half of all wives admitted were to remain less than six months in the institution, with little more than one-third of all married women remaining more than a year at Wonford. Less than one-third of spinsters were to depart within six months

Community, friends and family 119 Table 6.10 Wonford House Asylum, patients admitted, 1855–1914: duration of attack, by gender and marital status (duration by years and months)

Male Years 0–1y 1y–5y 5y–10y 10y–20y +20y Female Years 0–1y 1y–5y 5y–10y 10y–20y +20y Male Months 0–1m 1m–2m 2m–5m 5m–6m 6m–12m 12m–24m +24m Female Months 0–1m 1m–2m 2m–5m 5m–6m 6m–12m 12m–24m +24m

Single (%)

Married (%)

Widowed (%)

Unknown (%)

245 (71.01) 50 (14.49) 17 (4.93) 16 (4.64) 17 (4.93) 345 (100.00)

296 (78.93) 69 (18.40) 5 (1.33) 3 (0.80) 2 (0.53) 375 (100.00)

41 (87.23) 3 (6.38) 3 (6.38) 0 (0.00) 0.00 (0.00) 47 (100.00)

41 (87.23) 3 (6.38) 3 (6.38) 0 (0.00) 0 (0.00) 47 (100.00)

380 (76.92) 78 (15.79) 15 (3.04) 13 (2.63) 8 (1.62) 494 (100.00)

223 (81.09) 32 (11.64) 12 (4.36) 6 (2.18) 2 (0.73) 275 (100.00)

76 (76.77) 15 (15.15) 4 (4.04) 3 (3.03) 1 (1.01) 99 (100.00)

16 (84.21) 2 (10.53) 1 (5.26) 0 (0.00) 0 (0.00) 19 (100.00)

233 (67.73) 22 (6.40) 45 (13.08) 6 (1.74) 36 (10.47) 2 (0.58) 0 (0.00) 344 (100.00)

214 (58.63) 36 (9.86) 63 (17.26) 10 (2.74) 40 (10.96) 1 (0.27) 1 (0.27) 365 (100.00)

25 (53.19) 5 (10.64) 7 (14.89) 2 (4.26) 8 (17.02) 0 (0.00) 0 (0.00) 47 (100.00)

19 (67.86) 3 (10.71) 3 (10.71) 0 (0.00) 3 (10.71) 0 (0.00) 0 (0.00) 28 (100.00)

307 (62.15) 44 (8.91) 87 (17.61) 20 (4.05) 28 (5.67) 8 (1.62) 0 (0.00) 494 (100.00)

167 (60.51) 20 (7.25) 45 (16.30) 2 (0.72) 36 (13.04) 6 (2.17) 0 (0.00) 276 (100.00)

61 (61.62) 8 (8.08) 17 (17.17) 4 (4.04) 8 (8.08) 1 (1.01) 0 (0.00) 99 (100.00)

9 (47.37) 2 (10.53) 8 (42.11) 0 (0.00) 0 (0.00) 0 (0.00) 0 (0.00) 19 (100.00)

and the largest proportion of unmarried women left after six months and before three years had lapsed. More than one-fifth of spinsters remained at Wonford for three years or more as compared to only one in ten wives. This compares to about one-quarter of bachelors who stayed for more than three

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Table 6.11 Wonford House asylum, patients admitted, 1855–1914: length of stay, by gender and marital status Days

Single (%)

Married (%)

Widowed (%)

Male 1–89 90–179 180–364 365–1,094 1,095–2,999 3,000 or more Unknown Total

53 (15.50) 50 (14.62) 72 (21.05) 61 (17.84) 41 (11.99) 43 (12.57) 22 (6.43) 342 (100.00)

104 (28.73) 74 (20.44) 67 (18.51) 57 (15.75) 32 (8.84) 21 (5.80) 7 (1.93) 362 (100.00)

12 (26.09) 6 (13.04) 9 (19.57) 11 (23.91) 4 (8.70) 3 (6.52) 1 (2.17) 46 (100.00)

Female 1–89 90–179 180–364 365–1,094 1,095–2,999 3,000 or more Unknown Total

75 (15.21) 73 (14.81) 103 (20.89) 96 (19.47) 47 (9.53) 67 (13.59) 32 (6.49) 493 (100.00)

62 (22.46) 68 (24.64) 50 (18.12) 40 (14.49) 28 (10.14) 17 (6.16) 11 (3.99) 276 (100.00)

19 (19.19) 14 (14.14) 21 (21.21) 19 (19.19) 14 (14.14) 4 (4.04) 8 (8.08) 99 (100.00)

years, while only one in six husbands were detained for this longer period. Single women almost dominated the group of very-long-stay patients at this asylum, with unmarried men twice as prominent among long-stay inmates as husbands. There were a limited number of re-admissions at Wonford, which comprised (in total) almost 100 female re-admissions and 76 male re-admissions. The largest incidence of re-admission was among males and females readmitted twice. Marital status figured in re-admission: it was more common for wives to be re-admitted once and for husbands to be re-admitted twice. Single males were as likely to be admitted once or twice, though spinsters were noticeably more likely to be re-admitted twice than once, with half of the re-admissions among unmarried women being among those re-admitted twice (as compared to half of married women re-admissions who came back only once). The numbers for the widowed were small, though females were more prominent than males, with widows having a higher number of readmissions than men. There were a handful of multiple re-admittants, with one single woman and one married man returning six times or more. Table 6.12 indicates the outcomes of residence at the asylum in this period as a whole. The figures for males show that rates of recovery for bachelors, husbands and widowers were rather similar but that the last category were more likely to be discharged as relieved rather than recovered. Husbands died in almost as great a proportion as widowers (noticeably more

Community, friends and family 121 Table 6.12 Wonford House asylum, patients admitted, 1855–1914: re-admissions, by gender and marital status Number of Single (%) re-admissions Male 1 2 3 4 5 6 7 Female 1 2 3 4 5 6 7

Married (%)

Widowed (%) Unknown (%) Divorced

32 (42.11) 32 (42.11) 10 (13.16) 2 (2.63) 0 (0.00) 0 (0.00) 0 (0.00) 76 (100.00)

36 (36.36) 44 (44.44) 12 (12.12) 5 (5.05) 1 (1.01) 1 (1.01) 0 (0.00) 99 (100.00)

4 (40.00) 4 (40.00) 2 (20.00) 0 (0.00) 0 (0.00) 0 (0.00) 0 (0.00) 10 (100.00)

– 3 1 0 0 0 0

– – – – – – –

39 (39.39) 49 (49.49) 6 (6.06) 2 (2.02) 1 (1.01) 1 (1.01) 1 (1.01) 99 (100.00)

34 (47.22) 28 (38.89) 7 (9.72) 3 (4.17) 0 (0.00) 0 (0.00) 0 (0.00) 72 (100.00)

2 (11.11) 7 (38.89) 2 (11.11) 2 (11.11) 4 (22.22) 1 (5.56) 0 (0.00) 18 (100.00)

2 (50.00) 2 (50.00) 0 (0.00) 0 (0.00) 0 (0.00) 0 (0.00) 0 (0.00) 4 (100.00)

– – 1 – – – – 1

than their unmarried counterparts). The pattern of outcomes for females was rather different. Wives and widows appear to have had significantly greater prospects of leaving recovered than did spinsters, and as large a proportion of unmarried women as widows died at the institution. Wives were substantially more likely to depart relieved as well as recovered, and less than one in ten of married women expired in the asylum. One of the most important themes in the recent discussion of the history of institutional care for the insane during the nineteenth and twentieth centuries has been the role of the family in shaping the admission to the asylum, and the part that relatives played in the discharge of inmates and patients from these establishments. This chapter has been concerned with the role of relatives and communities in the admission, retention and discharge of those certified as insane during the later nineteenth and early twentieth centuries. We have examined both the pauper lunatic asylum of Devon and the substantial private institution which became known as Wonford House. We have been particularly concerned with the marital status of those admitted and the authority given by relatives and friends for the admission and discharge of their family members or associates in these years. The place of certification and the terms on which an individual was certified have also been considered where evidence exists. Our findings indicate that both gender and marital status were significant factors in

Females Recovered Relieved Not improved Died Not given

Males Recovered Relieved Not improved Died Not given

Outcome

135 107 51 90 113 496

95 67 51 73 60 346

27.22 21.57 10.28 18.15 22.78 100.00

27.46 19.36 14.74 21.10 17.34 100.00

Single % of singles in total

106 74 22 26 49 277

92 73 37 108 57 367

Married

38.27 26.71 7.94 9.39 17.69 100.00

25.07 19.89 10.08 29.43 15.53 100.00

% of married in total

38 19 8 18 16 99

11 13 3 15 5 47

Widowed

38.38 19.19 8.08 18.18 16.16 100.00

23.40 27.66 6.38 31.91 10.64 100.00

% of widowed in total

Table 6.13 Wonford House asylum, patients admitted, 1855–1914: outcome of stay, by gender and marital status

0 0 0 1 0 1

0 1 0 0 0 1

Divorced

2 8 4 2 5 21

9 8 5 5 0 27

Not given

Community, friends and family 123 determining the patterns of admission, length of stay and terms of discharge for both public and private institutions in this period. Those admitted to Exminster were disproportionately unmarried women and men and the experience of the unmarried also varied as between males and females. Any discussion of the incidence and social origins of insanity in these decades must confront the huge array of qualitative and quantitative evidence we have briefly summarised above. It has been noted that diagnoses were compiled not only from medical observations but from lay testimony and moral commentaries. We have suggested that the personal circumstances and the reported disorders of those individuals sent to the private as well as the public asylum had a significant bearing on the certification and committal of the insane. Our sources suggest that the unmarried were usually admitted within a shorter period of their first attack than their married counterparts. Husbands were also admitted rather sooner than wives. More surprisingly, we find that married men did not recover as quickly or in as great a number as married women and this confirms the pattern that men had greater difficulty surviving such institutions. Males were more likely to be detained wandering at large while females were more likely to be found not under proper care and control than males. Spouses figure as the nearest relatives of both pauper and private lunatics followed by male relatives and close siblings. Our evidence does indicate that relatives played a significant role in the certification and the discharge process, though perhaps more obviously and directly in the case of private patients.56 In the Exminster case in particular, the relatives were likely to negotiate with a range of officials and medical personnel and the influence of these groups over the admission and discharge of the inmates is documented on numerous occasions. This suggests that relatives had a significant influence on the progress of the individual through the institutional system in this period. Susan Burt in her perceptive recent account of Hampshire County Lunatic Asylum pointed particularly well to the role of family and friends in influencing officials towards admission and discharge, and in Devon we certainly found that this was also the case.57 However, superintendents continued to exercise a vital and usually decisive sway in advising Visitors in regard to the discharge of pauper inmates. Our conclusion is therefore that we need to appreciate the importance and the complexity of the role of families and relatives as well as other members of the community in terms of providing evidence and accounts of insanity and in offering support for those eligible to leave the institution, but the final decision usually lay outside their control. The allocation of female and male symptoms to separate private and public spheres of insanity is heavily qualified by the very similar bland terms in which most incidents of madness were addressed and treated. Even more striking is the range of witnesses called to contribute to the ‘facts indicating insanity’ in the process of certification, and the degree to which complex negotiations with the Poor Law indicated a measure of power exercised by

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the relatives, friends and neighbours of those who were candidates for institutional care.58 Such influence was exercised within a wider theatre of social power where ideals of domesticity figured in struggles for the social leadership of rural society. Later we consider the process of mental diagnosis within this institutional setting. A substantial number of the married as well as unmarried were said to have been insane for a short period before entry.59 Single people of both sexes were significantly younger and had also been insane much longer than the married admissions.60 The unmarried were more likely to have had a patient ‘history’ and to have been subject to attacks of insanity earlier in life.61 Where the unmarried fared significantly worse was in their prospects for release once they had remained in the asylum for two or three years. Their bodily health often remained good but they languished for years unclaimed.62 The window of opportunity through which unmarried patients could escape from the asylum was rather smaller and closed much more tightly after a substantial period of residence. Wives were rather older on average than spinsters and they often remained in Exminster for long periods but they also survived the institution rather better than married men and were less likely to return for treatment. Husbands may have been physically ill on arrival, but if they could survive they were reclaimed more quickly than wives and usually went home within the first two years. Single people of both sexes were accepted back if they demonstrated signs of early recovery, but the signs are that both the medical staff and the outside world lost interest in them if they became long-stay patients. The conclusions we reach in this chapter point to the continued importance of marital status and household arrangements, as well as gender and age in the pattern of admissions to the Victorian asylum. Family connections figured prominently in the documents which accompanied individuals to and from these places, though it is important to recall that the legal power to commit and discharge to pauper asylums lay with Magistrates and medical personnel rather than relatives or friends. In the private asylum the family could exercise rather greater control over the movement of people to and from the institution largely, if not wholly, because they usually provided resources for the maintenance of the person within the walls of the feepaying establishment in these decades. In addition, because they tended to have a higher social status than those placed at Exminster, they had greater power to influence the course of events.

7

Reading the rules of domesticity Gender, insanity and the asylum, 1845–1914

In autumn 1878 the Poor Law Guardians of Axminster in Devon received correspondence from their counterparts at Bodmin concerning the legal maintenance of a clergyman’s wife admitted to the Cornwall lunatic asylum. As the wife of a former curate of Membury parish, Anna M. had some claim to settlement in the Axminster Union. The Axminster Board moved quickly into action, seeking to contest settlement even though Anna’s sister wrote from Devizes offering to refund the cost of her maintenance in Bodmin, and later Devon, Asylum.1 Delicate but persistent enquiries were made to discover whether the Ms or the Archdeacon had paid their house rent in Membury, and only after satisfying itself did the Axminster Board decide not to oppose an order of settlement.2 The sister’s promise to reimburse most of the residential costs was duly honoured when Mrs M. entered the Devon Asylum at Exminster in early spring 1879, and the following year the clergyman himself entered the Axminster workhouse as a pauper.3 The circumstances of Mrs M.’s original diagnosis remain obscure, though it appears that her husband’s impecunious condition and her sister’s generosity were secondary to the determination of the Poor Law authorities in Devon and Cornwall to clarify her legal status and their obligation for maintenance.4 Rather different was the case of Reverend Henry T. who was certified as suffering from ‘general paralysis’ by a physician in April 1882, sent to Exminster as a pauper patient, dying within two months.5 These two cases involved the families of respectable clergymen in Devon during the late nineteenth century. They demonstrate not only the distinctive and complex circumstances in which individuals were admitted to the County Asylum, but also the importance of gender, marital status and dependence in negotiations with the Poor Law in regard to the admission of women who were considered to be insane. The case of Henry T. highlights the peculiarities of diagnosis which connected a clergyman with a diagnosis that was later narrowed to syphilitic infection. This chapter is concerned with the particular influence of gender in the diagnosis of people as insane and their admission to different asylums in Victorian Devon. The theme of social power remains central to our concern. Joan Scott has called on historians to examine social power ‘enacted on the field of gender’, and a number

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of important attempts have been made to investigate the peculiar role of gender in the diagnosis and treatment of mental illness.6 The nature of such social responsibilities was defined not only by the demands of work, community and kinship, which have often figured in accounts of insanity treatment, but also by contemporary political and cultural exchanges over the meaning and limits of domesticity.7 Contests over the provision of institutional care for the poor insane engaged the interests not only of those directly involved in the treatment of lunacy but also a variety of political actors who sought to promote a particular vision of domestic duties and social obligations. Feminist scholars who have examined the social and cultural history of insanity have often noted the degree to which contemporary physicians drew on a range of sources to confirm the significance of the female life cycle in the outbreak of insanity.8 It is possible to read parallels both in the pages of the Asylum Journal and in the surviving case notes on Bucknill’s female patients.9 Historians of insanity have, however, also stressed the limited part that psychiatric expertise played in the certification and institutionalisation of the mad during the nineteenth century. Much of the debate on the influence of gender on the making of the nineteenth-century insane has concerned the growing feminisation of madness and the domestication of the public asylum. Recent research has cast doubt on the earlier claims of scholars such as Elaine Showalter in regard to the importance of femininity in the intellectual and social construction of insanity in the Victorian years, most notably in the investigation undertaken by Busfield and others in respect of the statistical evidence for the representation of women in the admission registers of the asylum and the figures published by the Lunacy Commission.10 In her analysis of the institutional regimes devised by psychiatrists such as John Bucknill, Henry Maudsley and other prominent physicians, Showalter broke new ground in her exploration of the cultural context of medical practice and the literary conventions used by psychiatrists.11 These arguments about the feminisation of institutional care and the rehabilitation of disordered women in the virtues of domestic regularity contributed to important debates on the making of gender identities and the sexual division of social space in Victorian England.12 Subsequent empirical and conceptual research has called into question some of these claims, whilst feminist historians of science have more generally shifted attention away from patriarchal practices and towards women’s own contribution to a contested scientific discourse.13 Studies by Michael, Shepherd, Walsh, Wright and many others have provided detailed accounts of the gender profile of admissions to asylums in different parts of the United Kingdom during the nineteenth century.14 There has been rather less discussion of the methodology of cultural history developed by Showalter and other scholars, though careful textual analysis of institutional texts has been one of the most important contributions made by social historians of insanity.15 The narratives which made up the diagnosis and admission

Reading the rules of domesticity 127 documents of the Victorian insane were clearly the product of a range of cultural references and family preferences, rather than a distinct and consistent set of gender portraits taken from literary conventions, and there remains the indisputable evidence noted by Showalter and others that such places accumulated a growing population of females between 1845 and 1914, providing an institutional replica of the tidy house in which melancholy or manic women could be re-educated in the rules of domesticity. This chapter examines the influence of gender relations and gendered assumptions in the provision made for those certified as insane in south-west England during the nineteenth century. We are primarily concerned with admissions to the Devon Asylum, though comparisons are made with the fee-paying institution at Wonford House and the borough asylums of Plymouth and Exeter. The Devon Asylum recorded more than 13,000 entries between its foundation in 1845 and the outbreak of war in 1914, with an almost equal distribution of females (53 per cent) and males (47 per cent) during the period, closely reflecting the sexual profile of the Devon population at the time. There was a strong consistency in this pattern over the period as a whole.16 Women tended to be older (on average) when admitted to Exminster, partly reflecting their greater life expectancy.17 This more elderly profile of female admissions and the capacity of women to survive longer within the asylum explains a growing trend, noted by Showalter, for women to dominate the asylum population from the mid-Victorian years. By 1881 about two-thirds of the Exminster residents were female. One reason for this growing imbalance in the gender of the asylum population was the longevity of long-stay female inmates, including those reclassified as ‘chronic’ patients who were entered in special case books. Relatively few young patients came to the Devon Asylum, most women and men entering in mature adult life, and women clearly predominating amongst those who arrived aged 40 or more.18 The pattern for the other institutions in Devon was remarkably similar, with exactly the same ratio (53:47) evident in the 1,682 admissions to Wonford House in 1855–1914. Exeter Borough’s asylum at Digby had both pauper and private patient lists though the sex ratio was again similar, there being over 300 pauper females and rather fewer pauper males admitted in its first decade (1886–1896), a ratio of 54:46. There were slightly more females than males among the private, fee-paying admissions with almost 100 women entering in these early years, amounting to 56 per cent of the total.19 The limited evidence for Moorhaven asylum’s intake after 1892 suggests a similar profile, with a ratio of 56 females to every 44 males among the 358 patients resident in early 1909 and a similar profile among the pre-war intake. A substantial majority of these women and men were long-term residents of the asylum.20 These similarities suggest that the Victorian asylums in Devon were broadly representative of the gender balance of the county’s population and that this profile was fairly consistent across institutions and over different periods of time.

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There is now broad agreement among asylum historians that the increasing preponderance of women in the nineteenth-century asylum was the product of length of stay and longevity rather than of admissions practices, and that the majority of both sexes were released alive or dead within a few years of arrival.21 Female single stays at Exminster were for an average of five years compared to four years for males, though women who lived on until their death inside the institution survived for noticeably longer than men.22 In this regard, the experience of younger females contrasts markedly with more mature and elderly women. Both younger women and men showed a very high discharge rate: youthful females entered in smaller numbers and left more quickly than males.23 The length of stay increased with the age of those admitted and whilst the majority of mature or even aged people were released within a few years of their arrival, it is noticeable that the gap in period of stay between women and men widened in middle and later life.24 Marital status was also an important factor in our case, though there is again a marked divergence in experience between those who recovered and those who remained within the institution until death. Both the unmarried and the married who were discharged alive usually left within two years of entry, whilst the patient careers of those who remained until death were much more varied. Wives who eventually died had survived much longer than husbands, and spinsters usually lived on for even longer, as did bachelors who remained.25 One feature that is apparent in a consideration of gender is that both sexes overwhelmingly consisted of adults. They were usually members of fairly stable households and when insanity was suspected, they were likely to be examined in their own homes or nearby. Only a small proportion of those admitted to Exminster were found to be wandering at large. Those considered to be ‘beyond care and control’ were mostly, if paradoxically, in the care of relatives, friends or others known to them.26 It is interesting that most of the men wandering at large were married or widowed with wives or close relatives identified on their certificates, whilst none of the female wanderers were married. Those admitted as beyond care and control were even more tightly connected to their relatives and their households, though single women are much more apparent than unmarried men.27 Adolescents and teenagers formed less than 5 per cent of Exminster admissions, with males in a clear majority.28 These included young females like ‘idiotic’ Susan L. who arrived in 1871 aged 15 and was re-admitted the following year having displayed ‘erotic tendencies’ towards men. Whilst a wayward sexual appetite was noted, it was the threat of violence to her parents which figured more prominently in her re-entry.29 The vulnerability of young women considered idiots or ‘imbeciles’ periodically exercised the Lunacy Commission as well as the Poor Law authorities, even if they did not secure the institutionalisation of large numbers in the County Asylum. Women in adult life were much more noticeable in the corridors of the Devon Asylum. The age profile of male and female admissions varied more than their

Reading the rules of domesticity 129 marital status. Devon bachelors arrived at a younger age than did the spinsters, with almost three-quarters of unmarried males younger than 40. Husbands and widowers were also younger on entry than wives and widows. Whilst the unmarried were over-represented in the asylum, the widowed as well as the married were under-represented, and there was a slight increase in the proportion of spinsters and widows being admitted during the later years of the period. The significance of the marital relationship and the importance of household status in the lives of the insane is indicated by the identification of the nearest relative on their certificates. Spouses are overwhelmingly entered in the papers of the married and male family heads dominated in the committal of unmarried daughters as well as sons. Unmarried women and men were less likely than wives and husbands to have the next of kin identified, registering again weaker kinship ties amongst the unwed insane.30 Those coming to the asylum with few employment skills were also more likely to be unmarried and vice versa.31 This was most vividly apparent amongst those classified as idiots, imbeciles or weakminded.32 These appear in the asylum records as people previously perceived as capable of only rudimentary tasks. The growth in the numbers of those entering Exminster with no known employment status also strengthened the presence of the unmarried within the walls of the institution in the decades before 1914. It was also amongst single women that employment in domestic service was most evident.33 We discuss the diagnoses made in regard to male and female admissions in our chapters on ethos of treatment and the patient experience, though it is worth briefly noting here that female and male admissions to the Devon Asylum suggest that the symptoms exhibited by members of the two sexes were often described in similar, rather prosaic terms. Amongst those who entered the Devon Asylum, the most common diagnoses were mania, melancholia and dementia, which accounted for more than 60 per cent of the intake and the acute, chronic and senile forms of these diseases bringing the total to about three-quarters of the patients. Those classed as idiots, imbeciles or weak-minded accounted for well under one-tenth of the arrivals and though primarily male, this group included a significant proportion of females.34 The melancholic female is a familiar figure amongst the entrants, though the largest single diagnosis for both sexes was that of mania.35 A critical reading of the published and institutional documents created in the period suggests that the female life cycle was one among a number of scientific conventions that shaped the diagnosis of women and that the two sexes shared the basic terminology of insanity found in the certificates and admission registers. What emerges from the ‘facts’ of madness provided by others as well as the physician is the degree to which normality was defined in terms of relational capacities that the certified evidently were seen to lack. These social facts of insanity often read to the historian as a rather better predictor of the length of stay and survival rates than the medical diagnoses and assessments of physical health provided at the time. Physical

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examination of females admitted to almost all asylums included a standard report on the uterus, women’s menstrual and digestive functions, as well as life changes; the references to the feminine life cycle which did connect an organic condition in the body to mental disorder more often presented these as a ‘predisposing’ rather than immediate or ‘exciting’ cause of insanity. Childbirth and puerperal insanity figured in a number of cases. Case notes rarely include excursions into literary comparison which psychiatrists such as Bucknill were anxious to pursue in more erudite writings. Psychiatrists’ interests in the sexual allure of younger women which has figured so prominently in cultural histories of insanity, notably that of Showalter, and in later discussions of psycho-analysis, find only a limited echo in the documentation that has survived for the Devon institutions. The bulk of the certificates and case notes comprise a prosaic description of the ‘facts of insanity’ and simple comments on the behaviour of the patient. We have already suggested in our earlier chapter on treatment that gender differences appear to have figured in the curative regime of the asylum as well as the identification of mental disorders in contemporary society. Diagnoses accorded to those entering the County Asylum appear to have broadly matched the proportions of the two sexes entering the institutions, with the notable exceptions of ‘general paralysis’ and ‘idiocy’, which were largely associated with males, while life cycle changes were almost all considered with regard to females. Puerperal mania and insanity related to childbirth accounted for perhaps 3–4 per cent of Exminster admissions who were diagnosed in any clear way, though this is likely to be an underestimate of the true extent of birthrelated certifications. A close reading of the ‘supposed causes of insanity’ provided on the admission of female patients to the Exminster asylum detailed in Chapter 9 reveal numerous instances of women whose disorder was related to physical illness and household circumstances which may be attributable to child bearing.36 In the case of the fee-paying asylum at Wonford House, the number of females whose insanity was said to be due to childbirth and confinement probably accounted for 5–7 per cent of the total, a little more than the numbers where women were said to have mental disorders as a consequence of the menopause.37 Individual cases of insanity attributed to childbirth, such as that alleged in regard to Maria H., suggest the importance of childbirth in precipitating the certification process. She came to the asylum in 1847 having miscarried and then witnessed the birth of a friend’s baby. Her own death within three months of arriving at Exminster, aged 27, also suggests the possibility of an unknown medical infection.38 Sarah B. was an experienced midwife who, arriving pregnant in 1876, delivered herself of her premature baby late one night and told her attendants that the child ‘cried once or twice’ before dying.39 Sarah likewise survived only two months in the asylum. Susan D. was described as a school teacher and wife of a seaman, admitted in 1875 suffering from puerperal mania having undergone a difficult ‘instrumentated

Reading the rules of domesticity 131 40

labour’ three weeks before. Discharged recovered after six months, Mrs D. returned in 1882 as a widow living with her sister and without an occupation. She was suffering from acute mania with ‘want of submission to control’, though the cause of her insanity was again given as confinement. She departed again after treatment.41 The insanity of women entering their middle life was occasionally attributed to menopausal symptoms, and given the heavy representation of these female age groups, we might expect a significant discussion, though direct references to the change of life again appear relatively rarely in female certificates.42 Certifying physicians and asylum medical staff made sparing use of the term ‘hysteria’ in diagnosing and discussing asylum admissions, through a long period which is sometimes considered a time of major concern with female hysteria.43 Much more striking is the apparent disuse into which the basic term ‘lunacy’ began to fall in the later Victorian period. By the early 1880s the large majority of people admitted to Exminster were diagnosed as suffering from ‘unsound mind’ rather than as lunatics, with the latter accounting for about one-fifth of the intake.44 These accounts suggest that both the patient’s narrative and the translation of the facts indicating insanity into a legal transaction for the admission of an individual into the County Asylum depended upon a keen appreciation of the relational as well as physical or mental capacities of the person. The preference for the diagnosis of an ‘unsound mind’ over ‘lunacy’ and the sparsity of references to the biological origins of insanity reflect a real emphasis placed on the social environment by doctors and psychiatrists alike. The moral range as well as the scientific enquiry of the medical men was usually restricted to the immediate kinship and community network of the individual, again derived largely from those known to the patient. The apparent precision of the diagnosis of general paralysis illustrates something of the complex imagery of insanity during these years. Viewed from the asylum records, general paralysis was overwhelmingly a male complaint, while idiocy was primarily so.45 Many younger men came to the asylum exhibiting symptoms of what was understood to be paralysis. Charles West S. appeared in 1848 walking with a ‘gait very tottering like that of a drunken man and he is very apt to fall as he turns round’.46 The fact that a substantial number of admissions came from the naval districts of Plymouth and included numerous servicemen and maritime workers may indicate a strong link between the syphilitic infection and general paralysis of the insane (GPI).47 Closer examination of the admissions indicate an eruption of such diagnoses in the 1860s, reaching a peak in the late 1870s and early 1880s before declining steeply from the later 1880s just as more precise medical knowledge and interventions were becoming available.48 The cause of general paralysis in cases such as that of Reverend Henry T. was not given. There is good reason to believe that the term was widely used, along with dementia, to encompass a wide range of disorders rather than restricted to

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symptoms of syphilitic infection which were only poorly understood and unevenly diagnosed in the Victorian era. In many instances, the disease was attributed to physical injury or anxiety rather than moral intemperance.49 The apparent peak of GPI diagnoses during the years when Contagious Diseases legislation was in force indicates that the links between sexual infection, legal regulation and social purity campaigns were one context in which mental illness was understood, though the connections remained a matter of debate.50 More generally in relation to different kinds of sexual relationships, our analysis of the Exminster case notes revealed references to romantic attachments, disappointments in love and the melancholy of females abandoned by lovers, though it is important to note the instances where men as well as women figured in such accounts. The cases included Dan M., a widowed coal merchant from the seaside town of Ilfracombe admitted in 1891. His brother Samuel provided a ‘family history’ of his unrequited love for a local woman, squandering his fortune in searching for her after she left the area in the certainty that scriptural authority meant their union was blessed.51 Once at Exminster, he became something of a fixture, labouring hard in the mornings, spending his afternoons writing long letters on religious themes to his relatives and preaching at all hours to his fellow patients and visitors.52 Such cases indicate the difficulties inherent in uncovering the varied circumstances in which diagnoses were made and also how the procedure of certification varied by gender. Our chapters on therapy and on family relations considered how legal terms such as ‘care and control’ were used in distinctive ways when males and females were certified as insane in Devon. Violence within the home and the immediate neighbourhood was a familiar theme in the certification of both males and females but it assumed different forms. Attacks on fathers, brothers and wives, particularly by younger adult males, figured in the catalogue of violence that secured men a passage to Exminster if not to prison. Such a decision to certify a person rather than subject them to a criminal process would be made by a host of personnel in the locality at the time of the event in question – police, Poor Law medical staff, Relieving Officer, family representatives, local dignitaries and so forth.53 Women beyond control were more likely to be described as melancholic or manic and to pose different threats to the head of household. Wives in ‘the puerperal state’ who displayed a violent aversion to their husbands and children were liable to be certified, including Mary P. who frequently wandered at a riverside where her illegitimate baby had been found dead. She confessed to the certifying physician that she had thrown the child in the river, though it appears to have been her fear of harming the children of her subsequent marriage which led to her admission to Exminster Asylum.54 An awareness of the vital importance of the male breadwinner and the desperate circumstances facing her children led Emily B. to contemplate the murder of both husband and children since, in his absence, ‘the children would want’.55

Reading the rules of domesticity 133 References to domestic households and the economic circumstances of the family were often interwoven with discussions of female bodily illness and the life cycle, making a crisp analysis of the causes of insanity difficult. The admission documents and medical notes illuminate some of the complex domestic circumstances in which women and men, often with considerable resources and skills, were discovered to be insane. Women and men who could sustain a solitary household or migrate to other areas were less common in the admissions register than those living with others. Lunatics were very rarely found wandering abroad and those certified as not under proper control were usually beyond the care of someone well known to them.56 Such evidence shows that the asylum insane were to varying degrees connected to the community from whence they were dispatched and that their identification as insane depended on their relationships with those around them and the exhaustion of their resources as much as any dangerous behaviour which required specialist medical treatment. The question remains as to why the public asylum should have held an increasingly feminine population during these decades and what influence their relations with wider society had upon their stay within its walls. We need to understand not only the capacity of females to remain in the asylum, often for considerable periods of time, but the social circumstances and cultural assumptions that led to such large numbers of unmarried women and men being admitted in the first instance, and to the lesser propensity of such females to depart from the institution which frequently became their final home. The threads of domestic duty and household authority were overlaid with moral authority within the household, as is clear from numerous cases involving daughters and domestic servants. Sarah W. returned in a nervous state to her family home in 1872, having been unable to manage her duties as a housemaid, whilst Sarah S. was so distressed by the death of a child in her arms when employed as a domestic servant that she lapsed into despondency.57 Abusive behaviour by employers figured in the narrative of some young servants coming to the asylum, though transgression of moral boundaries by the female employee figured in more accounts.58 The authority of the employer, household and Poor Law authorities formed an impressive network of social and institutional power in which the domestic labour of women was secured. This became apparent to Mary Jane G. in 1869 when she lost her place as a servant at the age of 28 and left the family home after a row with her father. After sleeping rough in Powderham Woods (near Exminster village), she was found wading out into the sea at Teignmouth and taken into police custody.59 When Sarah R. was turned out of the family home by her father she was refused (she believed) access to the Union workhouse and only her appeal to local householders shamed the authorities into dealing with her. Since her case notes describe her ruminations on the love of young men and propensity to expose herself, it appears that the ire of the authorities was provoked by sexual indiscretions that outraged her family household and led to her (illegal) exclusion from the workhouse.60

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Whilst the moral economy of the domestic household provides the setting for many accounts of female insanity in this period, it is again significant how few women are portrayed as prostitutes, criminals or vagrants.61 It appears that the prisons, lock hospitals, Magdalene refuges and other institutions were used much more readily than the asylum in their cases. Catherine M. appears to have pressed for her own transference from Devon County Gaol to Exminster in 1860, suffering from venereal disease and apparently assuming that medical treatment of her physical complaint would be followed by early release. On discovering that she would serve her full prison term within the asylum she vented her indignation on fellow patients, only ceasing when her sentence was complete.62 The Devon Asylum did receive the recalcitrant and dangerous individuals who were difficult to contain within the incentives and punishments of the workhouse, though criminal lunatics were rarely found at the institution.63 Those prosecuted as vagrants were sent to prison and moved on unless the eruption of their insanity forced a transfer to Exminster.64 The greater capacity of women to survive initial institutionalisation and to remain in the asylum for significant periods of time is especially noticeable when we compare wives with husbands. Initial diagnoses offer few clues, as we have noted.65 Many husbands either recovered or died within 1,000 days of coming to Exminster which indicates the complex interplay of social and medical conditions. Since many of those sent to public asylums in the nineteenth century appear to have died from such physical ailments as tuberculosis or ‘fever’ rather than mental illnesses, it is possible that differences in bodily health contributed to the marked variation in death rates. It appears plausible to suppose that household members were cared for by partners and other relatives until their physical and mental deterioration led to a breakdown in their financial maintenance of the household or where the risk of violence posed by them was too great for the household to contain. Where the male head of a household was involved, the Poor Law authorities would be alerted and intervene to prevent the whole family falling into destitution. One explanation of the polar distribution of husbands’ survival rates might be that husbands were often admitted if physically so powerful as to be an unmistakable danger to those around them, or alternatively had been nursed by their spouses and families until their mental and physical condition had deteriorated to the point where their prospects of survival were poorer than single individuals. The reasons for the bodily health of those admitted, and evidence concerning the quality of care received from family relatives and in their own communities, are difficult to establish. A sample of the Exminster patients shows a large proportion of those registered as in good physical health on admission were to die inside the asylum, while surprisingly high numbers of those described as in poor condition were to be discharged recovered. Married men again appear to have weathered the asylum worse than either women or bachelors.66 Wives who came in poor health and spinsters in

Reading the rules of domesticity 135 better condition seem to have enjoyed the best prospects for departure.67 Many women appear to have taken the opportunity of asylum residence to recover their health and return to their pursuits. Thus Jane T.J. reappeared in a ‘very feeble state’ in 1873 having apparently escaped some years before. This farmer’s widow was described in an unflattering portrait as a ‘squalid vivacious female’, proceeding to make ‘herself quite at home’, begging resources and objecting to work of any description.68 Discharged as recovered in 1874 she returned at least once more before ending her travels at Exminster in 1884, where she remained until her death in 1901.69 It is accurate to portray the Devon Asylum population as increasingly dominated by females, though it is misleading to conclude that an increasing proportion of the intake was remaining for longer. The average length of stay for women appears to have fallen from the 1890s to 1914. This period also saw a surge in re-admissions of former patients.70 Married men formed a larger proportion of this group than did wives, even if the latter had remained for longer periods of treatment in their previous stay at Exminster. These husbands only returned to the asylum after a considerable period of time outside, whilst unmarried people reappeared after briefer spells in the world.71 Sarah L. was a servant with various relatives at Cheriton Fitzpaine who first arrived as an unmarried servant in 1870 and made her ninth and final visit to the asylum in 1885.72 The impact of the Devon Asylum on women admitted and their contribution to the ethos of the institution remain somewhat opaque. It is apparent that the institutional rules at county asylums provided a graduated scale of incentives and rewards for both female and male inmates. Whereas females could retrieve their reputation for rational behaviour by assiduous attention to the multitude of domestic tasks, males were steadily introduced to outdoor labouring and trusted tasks as a means of re-introducing them to their more public responsibilities.73 Recreational activity as well as dutiful labour was encouraged. William W. was encouraged to entertain the patients and attendants with his violin but when ‘lower than usual’ he did not care to touch it.74 So proficient was John S. in his display of card tricks and tumbling for the amusement of patients and attendants in 1872 that his physicians decided he was not insane.75 Even the formidable Bucknill was impressed by Mary S., who arrived in summer 1847 with puerperal mania expressing furious anger at her husband’s supposed infidelities. Despite the evidence of early recovery and a reconciliation with her husband, Mrs S. lapsed into excitement and was incapable of undertaking basic ironing at the asylum laundry. These lapses in domestic duties figured in her continued treatment but, by the beginning of 1848, the perplexed superintendent had enquired, probably of her relatives, and received further information that ‘ever since her marriage (14 years) she has lived in a state of constant [irritation] with her husband, & was always quarrelling with her neighbours’. The next month she demonstrated a more obliging manner by not being annoyed ‘when joked by

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other patients about her country (Ireland) or [displaying] quickness of temper’. Mary was set another round of household tasks and was judged by the asylum housemaid to be ‘quite incompetent to perform the most ordinary domestic duties’. In the absence of improvements and despite her habitual irritability and regular wrangles with her husband on visiting days, Bucknill had concluded by April that his patient’s only remaining ailment was ‘an ungovernable temper which she has possessed all her life’. With this comment she was then discharged.76 The psychiatrist was firmly in control of this particular narrative of puerperal disorder and ungovernable behaviour, though in reaching his conclusion the superintendent drew confirmation from family witnesses that the life-long ailment of unruly anger was a familiar trait. Such documents also confirm the impression of the admission papers that the capacity for forming relations, within the asylum as well as with the outside world, was a key element in their admission and discharge. Assumptions about gender were not peculiar or distinctive to the institutional regime but arose in part from a continuing conversation with the relatives and friends of women and men who were resident in the asylum. The case notes indicate that others who remained within the asylum did so in part because they also found the prospect of release intimidating and preferred the predictable routine of the asylum.77 These institutionalised, longer-stay residents were certainly a limited minority of the asylum population, but the diversity of patient experiences in these decades reveals that individuals were expected to show conformity to existing social norms in order to demonstrate their ‘sanity’ and that these norms were socially gendered. As we noted earlier, the central Lunacy Commission pressed the tradition-minded Corporations of the Poor in Exeter and Plymouth into building their own borough institutions within reach of their city boundaries.78 The Exeter Borough Pauper Lunatic Asylum opened in 1886 at Digby’s Field and that of Plymouth at Moorhaven in 1891. Table 7.1 indicates the pattern of admissions at Exeter’s Borough Asylum in its first decade of operation. The intake to the Digby asylum covered both a pauper and a private clientele with the latter being about one-quarter of the size of the pauper class. The marital status of the two groups shows some similarities and a few differences. A significant majority of pauper females were unmarried along with a bare majority of pauper males. Single females again predominated among the private stream though again there was a noticeably narrower gap between bachelors and husbands admitted on a private basis. The remarkable feature of the table is the high number of deaths, but also the discharge of large numbers of females and males as not improved in this period. Most people certified insane in Devon during the Victorian and Edwardian decades were admitted to Exminster. The other asylums only ever held a fraction of its intake, though they do offer important points of comparison. During the years 1855 to 1914 there were almost 1,700 admissions to the

Reading the rules of domesticity 137 Table 7.1 Digby Asylum, patients admitted, 1886–1895: pauper and private intake, by gender and marital status

Male Pauper Private Female Pauper Private

Single (%)

Married (%)

Widowed (%)

Unknown

125 (77.64) 36 (22.36) 161 (100.0)

98 (76.56) 30 (23.44) 128 (100.0)

13 (68.42) 6 (31.58) 19 (100.0)

15 0 15

159 (74.65) 54 (25.35) 213 (100.0)

84 (71.79) 33 (28.21) 117 (100.00)

57 (86.36) 9 (13.64) 66 (100.0)

7 0 7

Wonford House asylum. The proportions of males and females admitted were very similar to those recorded for the Devon County Pauper Lunatic Asylum. There are again significant variations in the marital status of the people admitted to this fee-paying institution which parallel the experience of the pauper asylums. Almost half of the Wonford males were married compared to less than one-third of the females. Well over half of the women arriving were unmarried as compared to a little more than two-fifths of the men, with almost twice as many widows as widowers in the institution.79 We noted in the chapter on family relatives that senior males within the sending household usually played an important role in the admission of married and unmarried individuals to Wonford House. Spouses were overwhelmingly responsible for giving authority in the entrance of married people of both sexes to Wonford. Most people admitted came from the larger region of the south-west of England, with a sizeable sprinkling from the southern counties beyond Dorset and further afield. The impression gained from an examination of male admissions to Table 7.2 Digby Asylum, patients admitted, 1886–1895: outcome of stay, by pauper and private status Died

Recovered Relieved

Not improved

Not insane

Tranfera

Unknown

Male Pauper 127 Private 26

42 16

6 8

67 13

3 3

3 8

0 0

Female Pauper 119 Private 29

60 26

11 15

108 10

0 1

5 8

3 0

Note a Transferred from pauper to private or private to pauper.

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Table 7.3 Wonford House Asylum, patients admitted, 1855–1914: length of stay, by gender and marital status Days

Single (%)

Married (%)

Widowed (%)

Male 1–89 90–179 180–364 365–1,094 1,095–2,999 3,000 or more Unknown Total

53 (15.50) 50 (14.62) 72 (21.05) 61 (17.84) 41 (11.99) 43 (12.57) 22 (6.43) 342 (100.00)

104 (28.73) 74 (20.44) 67 (18.51) 57 (15.75) 32 (8.84) 21 (5.80) 7 (1.93) 362 (100.00)

12 (26.09) 6 (13.04) 9 (19.57) 11 (23.91) 4 (8.70) 3 (6.52) 1 (2.17) 46 (100.00)

Female 1–89 90–179 180–364 365–1,094 1,095–2,999 3,000 or more Unknown Total

75 (15.21) 73 (14.81) 103 (20.89) 96 (19.47) 47 (9.53) 67 (13.59) 32 (6.49) 493 (100.00)

62 (22.46) 68 (24.64) 50 (18.12) 40 (14.49) 28 (10.14) 17 (6.16) 11 (3.99) 276 (100.00)

19 (19.19) 14 (14.14) 21 (21.21) 19 (19.19) 14 (14.14) 4 (4.04) 8 (8.08) 99 (100.00)

Wonford House is that a larger number of admissions were married and that almost half of these remained in the asylum for less than six months (a substantial majority left within three years), with unmarried men spending rather longer in the institution, less than one-third leaving within six months of their arrival. The figures for females are very similar, though fewer married women departed within three months and slightly more wives were discharged after three months but within six months. The proportions for the spinsters were almost the same as those recorded for bachelors. Our arguments on the relationship of class, status and gender in the patterns of admission to the Victorian asylum are vividly illustrated in the case of the ‘gentlewomen’ who entered the Wonford asylum. Over twothirds of all females given some occupational or social title at Wonford were given this title, well over half of them being unmarried and deriving no genteel status from their husbands. There was a significant contrast in the age of gentlewomen according to marital status, almost half being younger than 40. Two-thirds of married women given this title were older than 40. As the largest single group given a clear title at Wonford, it is noticeable that the married gentlewomen admitted were more likely to be discharged as recovered or relieved than were unmarried females, more than one-quarter of spinster gentlewomen dying in the asylum. In this respect the experience of gentlewomen was similar to that of female admissions more generally.

Reading the rules of domesticity 139 Table 7.4 Wonford House Asylum, gentlewomen admitted, 1855–1914: by whose authority sent (summary) Relationship Unknown/unclear Father Mother Brother Sister Husband Daughter Son Other male relative Other female relative Friend Clergyman, minister Justice of Peace Lunacy Commissioners Other Total

Single (%)

Married (%)

Widowed (%)

8 (5.06) 27 (17.09) 11 (6.96) 46 (29.11) 30 (18.99) 0 (0.00) 1 (0.63) 0 (0.00) 9 (5.70) 8 (5.06) 6 (3.80) 1 (0.63) 1 (0.63) 2 (1.27)

4 (6.15) 2 (3.08) 4 (6.15) 4 (6.15) 2 (3.08) 43 (66.15) 1 (1.54) 3 (4.62) 1 (1.54) 0 (0.00) 1 (1.54) 0 (0.00) 0 (0.00) 0 (0.00)

2 (6.25) 1 (3.13) 1 (3.13) 9 (28.13) 2 (6.25) 0 (0.00) 2 (6.25) 6 (18.75) 1 (3.13) 1 (3.13) 3 (9.38) 0 (0.00) 1 (3.13) 1 (3.13)

8 (5.06)

0 (0.00)

2 (6.25)

158 (100.00)

65 (100.00)

32 (100.00)

Table 7.5 indicates the outcome of residence for the Wonford gentlewomen by age and marital profile in our period. Such evidence strengthens the view that the genteel title was bestowed on females who cannot be easily distinguished from a broader intake in other respects. Detailed analysis of the histories of female educationalists at Wonford also suggests that women employed in such occupations did not display markedly different patterns of admission and progress than those found for the larger group of female patients. Having examined the passage of inmates into and out of the main Devon County Asylum and its borough equivalent in the county town of Exeter, at Digby’s Field, it is worth considering the experience of people who entered the institution which served the largest city in south-west England and provided the setting for a major military establishment in the form of the Plymouth Naval Dockyard. The city of Plymouth was made up of the three ‘towns’ of Plymouth, Devonport and Stonehouse, each with their own Poor Law Union. Plymouth has attracted considerable attention from social and maritime historians interested in its position as a dockyard town. The sources for the borough asylum permit only brief sketches of its certified residents, though some important glimpses of the relationship between committal and institutional care can be gleaned from Moorhaven’s records. In the years 1909–1913, almost 500 new admissions were recorded at Moorhaven, the majority again being women who came primarily from Plymouth (almost all from Plymouth and Devonport rather than Stonehouse).80

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Table 7.5 Wonford House Asylum, gentlewomen admitted, 1855–1914: outcome of stay, by age and marital status Outcome Died Recovered Relieved Not improved Unknown Total

Unmarried

Married

Widowed

Unknown

Total (%)

40 49 43 17 1

15 25 16 9 0

9 13 6 2 0

0 1 1 0 1

64 (25.8) 88 (35.5) 66 (26.6) 28 (11.3) 2 (0.8)

150

65

30

3

248 (100.0)

Among the 358 residents of the Plymouth Borough Asylum in early 1909 were an important clutch of early admissions amounting to more than 20 women and slightly fewer men who had arrived in the first months of Moorhaven’s existence. There were few private patients there at the beginning of 1909, though 20 were resident in 1909, there being twice as many private women as men. The longest residents included Oscar A., William C. and Frances L., each of whom was admitted in late 1891. They lived for about 30 years at the asylum before dying within its walls in the interwar period. While we would expect that both male and female admissions in the earliest period were likely to have been transferred from workhouses and other asylums, their certification already having been in force for some time, an analysis of admissions during the pre-war years provides a better insight into the impact of the asylum on the women and men who were sent there. Between 1909 and 1913, Moorhaven admitted 274 females and 192 males. More than half of the women admitted were to be discharged (including those recovered or relieved), while only one-third of the men left the asylum in this way. More than two-fifths of these males died compared to a little over one-quarter of the females.81 Among those entering in the pre-war years we may see that well over two-thirds of males and females remained at Moorhaven for less than five years and the rates of discharge were substantially better, though again there are important variations in the experience of the sexes. Almost half of the men in this later intake were not to survive as compared to less than onethird of the women, while a little less than half the females were discharged (most within five years it appears). While the extended length of stay was accompanied by death for a large number of men and women who were living in Moorhaven in 1909, the evidence both for 1909–1913 and particularly for men who were admitted to the asylum in 1913–1914, suggests that many of those who arrived at the institution were to die within a few years of arrival.82 Two-thirds of the men and more than half of the women resident in early 1909 remained in the institution for ten years or more and little more than one in eight of this group (as a whole) were to leave within five years.

Reading the rules of domesticity 141 Table 7.6 Moorhaven Asylum, patients resident 1909 and admitted 1909–1913: length of stay, by gender Length of stay (years)

1909 inmates

1909–1913 intake

■Males (%)

Male (%)

Females (%)

Females (%)

0–4.99 5–9.9 10 or more Longer staya

19 (12.03) 12 (7.59) 105 (66.46) 22 (13.92)

31 (15.50) 34 (17.00) 108 (54.00) 27 (13.50)

132 (69.11) 15 (7.85) 19 (9.95) 25 (13.09)

186 (68.63) 28 (10.33) 19 (7.01) 38 (14.02)

Total

158 (100.00)

200 (100.00)

191 (100.00)

271 (100.00)

Note a Those patients remaining in the asylum beyond 1913 whose date of discharge is unknown.

The evidence shows that there was a hard core of long-stay patients in residence at the Plymouth asylum by the pre-war years and their prospects for discharge appeared to have been bleak. Among this 1909 group of long-stay patients, both men and women were likely to remain within Moorhaven until death. This contrasts with the admissions recorded in the pre-war period, where it is striking that a majority of women admitted in 1909–1913 were later discharged, apparently as recovered or relieved, while only one in three men left the institution for this reason. Men in this latter group were much more likely than women to die within Moorhaven, which is again broadly consistent with the pattern found in the County Asylum over a longer period. A sustained comparison with the experience of private patients is precluded by the limited sources, though the evidence suggests that Moorhaven drew in a limited number of private patients in the 1890s and again in the Edwardian years. Among the small group of private patients resident in early 1909, a significant number were recorded as having been ‘removed’ Table 7.7 Moorhaven Asylum, patients resident 1909 and admitted 1909–1913: outcome of stay, by gender 1909 inmates Male (%) Discharged Recovered Removed Transferred Died Total

1909–1913 intake

Females (%)

■Males (%)

Females (%)

12 (9.45) 0 (0.00) 24 (18.90) 6 (4.72) 85 (66.93)

27 (17.31) 2 (1.28) 22 (14.10) 4 (2.56) 101 (64.74)

60 (35.93) 3 (1.80) 19 (11.38) 3 (1.80) 82 (49.10)

113 (47.88) 3 (1.27) 43 (18.22) 4 (1.69) 73 (30.93)

127 (100.00)

156 (100.00)

167 (100.00)

236 (100.00)

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rather than discharged, suggesting perhaps a withdrawal of these individuals rather than full recovery. The pattern of the new admissions of 1909–1913 differs clearly in that a significant majority of the private female patients and a slight majority of the males were discharged recovered. The later group of admissions also, perhaps obviously, went on to be shorter-stay patients than the veterans of 1909, with a substantial majority of both private female and male patients leaving within a year of their admission to Moorhaven.83 We began this chapter by discussing the peculiar experience of a rural clergyman who entered the Devon County Asylum for a brief period in the late 1870s with possible General Paralysis of the Insane. The chapter concluded with a discussion of an institution that was opened late in the nineteenth century to service an urban community which had long been associated with the spread of venereal disease and controversy over regulations of the prostitution market in a barrack town. Further reflection on the origins of such matters is beyond the scope of this book. What we have tried to draw out are the various characteristics of gender and sexuality which appear to have figured in the distinctive pattern of admissions, detention and discharge recorded in the Devon institutions in the second half of the nineteenth century and the early years of the twentieth. One of the most powerful themes in Victorian popular literature was the spectacle of the woman confined to a private cell in an attic or madhouse by dark conspirators. These concerns were publicly aired in the celebrated legal battles of Georgina Weldon in the 1880s and contributed to the introduction of the important Lunacy Act of 1890.84 The legal transactions that secured the passage of the many thousands of women and men to the public asylums of the period rarely involved private fortunes and scandals over the birthright of the well-born.85 These pauper institutions do figure on occasion in sensation novels but in comparison with the intense controversy over the workhouse ‘Bastilles’ failed to capture the political imagination of radical activists. Yet the experiences of Anna M., Henry T. and numerous others indicate that access to the county pauper lunatic asylum also depended on the completion of legal transactions by relatives and a complex process of calculation by the authorities as to the status and resources of the individuals concerned. The fact that a clergyman such as Henry T. was recorded in different places as a domestic gardener and pauper cautions us to the dangers of simply accepting titles associated with some of the men coming to these institutions as well as, more obviously, the bestowal of titles such as ‘gentlewoman’ on female patients. The Devon Asylum where Anna M. and Henry T. were treated during the late 1870s and early 1880s was an institution in transition. Individuals enumerated at Exminster in the census of 1881 were described as patients as well as lunatics, idiots or imbeciles. The majority of both men and women arriving at this time had been certified as suffering from an unsound mind rather than branded with the title of lunacy. The wards and corridors of the asylum were gradually silting up with longer-stay

Reading the rules of domesticity 143 patients, particularly women who survived the institution rather better than their male counterparts. There were two females for every male resident at the Devon institution by the 1880s. Similar patterns in the gender of admissions and survival are evident in the asylums at Exeter, Plymouth and the private institution at Wonford as were apparent in the County Asylum during our period. Much of the existing scholarly literature on the social and cultural history of insanity has been concerned with the scientific boundaries established by nineteenth-century psychiatry and the professional ambitions of its practitioners. Considerable attention has been devoted to the medical terms by which mental disorder was detected and classified, including the application of such celebrated diagnoses as that of female hysteria. Our research has suggested a greater fluidity and a more limited usage in the deployment of such terms, reflected in the large number of instances where certifying physicians disclaim any knowledge of or insight into the causes of the insanity which they described. We similarly find asylum medical staff relying upon commonplace language and even vague medical terminology in their descriptions of the patients. Since the majority of patients were diagnosed in rather broad terms, we have concluded that it is difficult to establish any sophisticated relationship between diagnosis and social environment. The chapter suggests four kinds of contrasts that may throw light on the peculiar role of gender in the detection and treatment of insanity during these decades. First, we have seen that marriage and marital status were key factors in distinguishing the experience of both sexes in their entrance and residence at the asylum, with the unmarried being over-represented and generally remaining for a longer period than their married counterparts. This was particularly true of younger females. The second distinctive feature the chapter has stressed is the contrasting experience of married men and women in their experience of both public and privately funded institutions. Contrary to what might be expected, married men were more likely to appear in the asylum, to have been ill for shorter periods, and to remain rather longer in many cases than were wives. Married and unmarried men were also more likely to die within the walls of the asylum than were women, most graphically in the case of the Moorhaven Asylum. Third, we have seen that there are significant differences in the pattern of admission, treatment and discharge as between the pauper and the private institutions for the insane in the Victorian and Edwardian decades. The private asylum at Wonford not only catered for a more socially affluent and elevated clientele, but also tended to read the gender character of its admissions in terms of male occupations and a set of status characteristics that are best exemplified in the category of ‘gentlewomen’. The equivalent term for men was very sparingly used. A parallel example is that of the female teacher, who was usually identified as a ‘governess’ rather than a school mistress and still less as the school teacher who figured much more prominently, governesses correspondingly less so, in the records of the Exminster and the Digby asylums.

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Finally, we have seen that it is difficult to discuss gender without considering not only marital status, class and age, but also without taking into account expectations of domestic duties and responsibilities which figured prominently in discussions of the lapses of female behaviour and reasonableness. We discuss these qualities at more length in our chapter on the ‘patient experience’, though it is worth noting that even the female life cycle was understood by Bucknill and others in cultural as well as physical terms. The occupational, migration and household profile of the asylum population reveal the degree to which women were associated with a domestic world in which their marital, household and employment status were elided in a form that denied the possibility of separating their roles. In common with the wider population, the largest constituents amongst the females coming to the Devon Asylum were wives, domestic servants, labourers and dressmakers. More surprising is the degree to which marital status, household position and settlement patterns defined the relations of support and resources which both men and women enjoyed during these decades. Our earlier discussion of distance, migration and household life in Chapter 5 suggested that women and men who participated in the tide of rural population movement and who sustained their own household or gained the support of a marriage partner, appear to have fared consistently better than those who lacked or lost such vital connections. The over-representation of single people inside the asylum is one striking and consistent feature of institutional life during this period. The unmarried often lacked the employment skills and the household status that would enable them to sustain themselves in the outside world. If they were seen as recovering their wits within a reasonable period of time then they were able to escape the asylum, but should they fail, then their prospects for release quickly dimmed. The experiences of the asylum patients discussed here and in the next chapter raise the intriguing question as to whether the same social circumstances that led to their certification and admission also contributed to their failure to find a marriage partner, or if the social penalties imposed on individuals without such means of support influenced their identification as insane and subsequent admission to the asylum.

8

Madness and the market Occupations, class and the asylum, 1845–1914

In October 1882 Henry H. was aged 43 when admitted to the Devon County Asylum. He was certified as melancholic after displaying symptoms which suggested ‘general paralysis’ arising from personal intemperance. A former surgeon, Henry was a widower who lived with his young son in Exmouth, though he was examined at his own mother’s house nearby. The certificate of insanity included the testimony of a neighbour that Henry had threatened to shoot him on several recent occasions, ‘also calling him a Fenian, and a damned Radical’. These reports of threatening behaviour were confirmed by a clergyman who also lived in the same street. Committed to Exminster as ‘not under proper care and control’, it was apparent that Henry was not in any conventional sense a pauper.1 The circumstances of Edward H., a Devonport labourer who arrived following a workhouse examination some months earlier, were very different. Expressing deep guilt at his mistreatment of a fellow labourer, he grandly claimed ownership of the Titchbourne estate, though his wife Elizabeth (a charwoman) occupied a modest cottage in the Stoke Damerel area of Plymouth. Edward was discharged recovered on the last day of 1880 but seems to have returned to the workhouse while his wife headed her solitary household.2 The only violence shown by chimney sweep Thomas G., again admitted suffering from melancholy, was against himself. He had returned from treatment at the North Devon Infirmary for ‘diseases of the Genital Organs peculiar to Sweeps’, despondent to find his wife had deserted the family home. When his son foiled a second suicide attempt by cutting his father down as he attempted to hang himself, Thomas was committed to the County Asylum.3 These three men were sent to the Devon Asylum within a few months of each other as suffering from melancholy or delusions. Yet their personal fortunes and domestic predicaments were very different. Their documents indicated that each had a clear occupation with the means to earn their living and support a household, though the standard of their living ranged from apparent affluence to great penury. Edward H. and Thomas G. were married and Henry H. widowed, though none were living with a spouse at the time of their certification. Reports of violent language and conduct were not confined to males. Violence was not the prerogative of the male lunatic.

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A similar number of female certificates detailed violent expressions and behaviour, though most of these women were spinsters or widows in contrast to a preponderance of violent husbands among the male admissions.4 The targets of both male and female violence were commonly close family members. Laura W. was an unmarried domestic servant of 17 when she arrived at Exminster in 1880. Her insanity was attributed to her being ‘worried by her mistress’, though it was her violent attacks on her own mother that secured certification. Bessie G. was an unmarried dressmaker admitted to Taunton Hospital with supposed spinal paralysis, though was discovered to be suffering from ‘Hysterical Religious Mania’ and certified in 1882. Elizabeth O. was a baker’s wife certified for delusional insanity, though the history of the case was given simply as ‘poverty and misery’, while Sarah D. was a farmer’s wife of 35 who was said to be suicidal and violent, barking like a dog and indecent in her behaviour.5 All these females were admitted in the early 1880s and their working experience illustrates the wide variety of social and personal circumstances among those admitted to the County Asylum. Marital status also figured prominently in discussions of such women’s domestic situation and provided a familiar context within which the facts of their insanity were reported. This diversity in the personal histories of those admitted to the Devon Asylum confirms the conclusion reached in earlier chapters that the constituency of the pauper asylum was never practically limited to those in severe poverty, though they were usually people of moderate rather than substantial income. Many, though probably not the majority, had some contact with the Poor Law workhouse prior to their admission. Most patients appear to have been examined and certified in their own or in a relative’s home. We suggested in an earlier chapter that the Guardians and Relieving Officers of the different Devon Unions were reluctant to house inmates whose violence posed a significant danger to themselves or others. The men and women who were capable of physical aggression represented only a minority of those committed to institutions such as Exminster.6 It is also evident that a limited number were said to be destitute or in severe hardship at the time of their committal.7 The descriptions which can be gleaned from legal and institutional documents in regard to the social circumstances of those admitted to the asylum in the Victorian and Edwardian decades suggest that it is misleading to assume that those committed to the pauper asylums came only, or even overwhelmingly, from the poorest sections of British society. Historians of insanity have considered this question in their discussions of the class composition of the lunatic host in Britain and other countries during the nineteenth century.8 Andrew Scull followed Foucault in emphasising the extent to which the institutionalisation of the insane reflected a concern of bourgeois elites to apply scientific expertise and administrative controls to regulating insanity within the broad mass of the labouring population.9 His interpretation of the growth of these institutions

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emphasises, as we have noted, the ‘commercialisation of existence’ and the spread of calculative, market mentalities that weakened traditional rural and urban social structures, eroding older and more paternalistic techniques for coping with the troublesome. These new model asylums were fashioned, Scull argues, during the Victorian revolution in governance which placed individuals within the ‘domesticated’ environment of the asylum under the control of psychiatric managers.10 We have noted elsewhere that Scull’s explanation may be compared with that of John Walton, whose analysis of asylum provision within industrialising Lancashire pointed to the importance of migration and family ties in the pattern of asylum admissions during the mid-nineteenth century.11 Peter Bartlett’s recent assessment of the English asylums in mid-nineteenth century England provides some support to Scull’s claims that the broad mass of the labouring classes received minimal or low wages and were unable to sustain more than a basic subsistence and therefore vulnerable to pauperisation when key income earners lapsed into insanity.12 Bartlett’s interpretation has been coupled with efforts to rehabilitate the image of the asylum as a place of care, rather than merely a warehouse for the chronically insane, with key decisions in regard to institutional committal or discharge located within family households where bonds of sentiment and compassion, as well as calculations about resources and employment influenced the behaviour of relatives.13 Historical surveys of the importance of class in committals to the asylum during the nineteenth and early twentieth centuries have been influenced by contributions to social and cultural history which have critically reappraised the primary role of class in the formation of collective identities and political loyalties in these years. Political and cultural historians of class in the nineteenth century have long emphasised the degree to which social categories have to be understood in terms of historical assumptions and contemporary expectations rather than simply the expression of wealth distribution or the pattern of income inequalities in industrialised capitalist societies. A growing number of scholars emphasise the cultural diversity as well as specific interests of different occupational communities and the impact of popular discourses and public rhetoric in shaping not only political preferences but also alignments within civil society.14 Much of the debate on class relations in Victorian Britain has been absorbed in detailed accounts of skilled artisans, factory operatives and unskilled labourers who congregated in the larger and smaller urban centres of the northern and midland counties of England, the coal mining economy of South Wales, and the industrial conurbation of central Scotland. Less research has been completed on regions of relative industrial decline, while agrarian dependence and military expansion also figured in the social development of areas such as south-west England in the second half of the nineteenth century.15 Yet the complex geography as well as the varied origins of wealth, income and occupation in nineteenth century Britain, is now widely recognised by social historians.16

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Medical historians have similarly attempted to reappraise and retrieve earlier class models in studies of hospital patronage and doctor–patient relations while acknowledging the presence of distinctive elites and status groups within fashionable society as well as urban landscapes.17 Discussions of class and medical provision during the nineteenth century have included some consideration of variations both between and within regions of the United Kingdom. Historians have sought to understand the influence of class relationships in the identification and institutional committal of the insane by considering the peculiar social environment in which communities, households and the authorities resolved on actions that led to the legal declaration of insanity. Walton’s discussion of asylum provision within industrialising Lancashire included a commentary on different economic and kinship communities during the mid-nineteenth century, ranging from the agrarian plains of central Lancashire to the textiles districts of the western and southern areas. Each contrasted with the great migrant city of Liverpool and the constellation of distinctive towns around Manchester.18 It may be argued that a more accurate understanding of class may be gained from further analysis of regions whose economic progress was not dominated by the expansion of manufacturing and mining production, accompanied by rapid urbanisation, during the Victorian era. The assumption that particular regions provide a classical case study of economic and social change and a dominant chronology of asylum building must be open to question. Economic and social change may be more accurately understood as a spectrum of innovations that transformed the structure of society in diverse and uneven ways. Class relationships were formed and changed as people participated in political as well as economic and social life, including the villages and smaller townships of rural districts as well as cities beyond the manufacturing heartlands. Cities with a large host of migrant labour as well as a substantial industrial workforce often developed distinctive class relations, though this did not necessarily result in an active policy for the accommodation of the insane in dedicated asylum premises. Many of these contrasts may be found in south-west England during our period, as the older mining and handicraft centres declined a mixed agrarian economy sustained relatively high levels of employment until the final quarter of the nineteenth century. The steady urbanisation of the population was reflected in the growth of Plymouth, overshadowing the historic importance of Exeter as the county town, while the coastal areas of south Devon attracted substantial numbers of residents as communities in the rural districts diminished. The terms in which people understood their prospects inevitably varied as the asylum drew in school teachers from larger urban centres as well as individuals such as Mary D., a labourer’s wife in rural Holsworthy, who stated in 1881 that she was bewitched by a local woman whom she claimed to have locked up in ‘a small box and would not let her out for fear of further harm’.19 In considering the influence of class formation and relationships on the

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use of the asylum, it is also worth recalling that the legal and administrative responsibilities for the care of the insane were defined within the boundaries of the British state and its county governance rather than the structure of the capitalist economy. Nor were the largest centres of population growth, urban development and industrial expansion necessarily the locus for institutional innovation and asylum provision. We noted in earlier chapters that the boroughs were responsible under the 1845 Lunacy Acts for the provision of their own asylum accommodation, though many (including Exeter and Plymouth) proved reluctant to undertake the expense of asylum building until the end of the nineteenth century. We also argued earlier that Devon’s larger landowners formed a political elite during the early and middle decades of the nineteenth century, though there were significant philosophical differences within this group, as well as partisan rivalries and personal frictions. The continuing influence of the landed families was still apparent after the reform of local government and asylum governance in 1888, though we have traced the growing reliance on professional administrators alongside the established magistracy and county councillors established in the late nineteenth century. This chapter argues that the relationships of class are not only a reflection of wealth, income or occupational status, but are relationships of economic and social power formed in distinctive historical circumstances. The exercise of such power depended on the possession and use of the resources available to people and their capacity to articulate and assert their collective as well as individual needs. The treatment of the insane embodied these unequal relationships as well as expressing the preferences of different groups. The identification and committal of the insane depended on an evaluation of their social or personal status as well as their resources, in addition to a professional and legal judgement of their mental and medical condition. The fine discrimination of individuals considered eligible for institutional care is evident in the distinctive kind of asylum care that became available for people of different social standing in these years. The range and variety in the individual circumstances of those admitted to these institutions also reveals the huge and continuing diversity of the labouring population, including those providing personal, public and professional services in these decades. In contrast to accounts that sharply distinguish the material conditions of economic life from the culture of popular politics, we view occupational hierarchies, communal associations, kinship ties and institutional practices with regard to the formation and conduct of class relationships. We outlined in earlier chapters the resilience of older landed wealth alongside the expansion of new urban centres and the increasing prominence of professional as well as commercial interests. In the present chapter we extend our analysis of the continuing importance of landed wealth and agricultural employment within a regional economy that expanded public and private services while contracting some older centres of manufacturing as a context for admissions to the asylums in Devon.

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Class relations in Devon encompassed connections of gender, marital, household and communal relationships that largely defined the personal and collective resources available to individuals and their prospects of care when certified. The bulk of the people who were sent to the pauper asylums in our period possessed modest means, though a substantial minority appear to have been members of self-sufficient and respectable working-class households. General labourers, agricultural workers, domestic servants and textiles employees figured prominently within a wide range of occupations. Census titles for work extended from the employment undertaken by professional figures to those, primarily females, who were described as ‘wives of’ or given no occupational status. Significant minorities were (or were related to) skilled artisans, small-trades people and even salaried employees or living on personal wealth. Considerable attention has been paid to the poorest occupational groups in British society, though less research has been completed on salaried and non-manual employees and others who were clearly beyond the status of the labouring poor. The remarkable growth in the number of people admitted to pauper lunatic asylums during the nineteenth and early twentieth centuries was accompanied by a more modest expansion of places in voluntary and private institutions as well as the provision of fee-funded accommodation within the county and borough asylums.20 Mackenzie’s study of Ticehurst examines an elite asylum that rose during the nineteenth century to serve the wealthy rather than the respectably affluent or those of moderate means.21 Direct consideration of class membership rarely figured in the discussions of lunacy reform after the 1840s, though the economic means available to the families of those sent to the pauper asylum were reviewed by Poor Law unions anxious to defray the cost of their maintenance if it was considered that the relatives could contribute to the bills sent by Exminster and other institutions. Greater controversy surrounded the certification of people who were able to dispose of property during the later nineteenth century, more particularly the predicament of women who were considered vulnerable to wrongful confinement in private asylums. Before the passage of the important 1890 Lunacy Act, relatives and even close acquaintances of an individual could petition such private institutions for their admission once two physicians had independently agreed to their certification. The celebrated legal contests of the 1880s have attracted considerable discussion, though the wider role of the fee-paying institutions in the Victorian and Edwardian decades deserve further comment. One way in which class differences were expressed in regard to the institutionalisation of the insane, we argued in earlier chapters, lay in the distinctive experiences of the pauper and the private, fee-paying clients of the asylum at this time. Not only were private patients offered more spacious, relatively private accommodation while they were attended by a relatively large staff of nurses as well as domestic employees, but their families exerted considerably more influence over the discharge as well as the committal of individuals who could afford fees.

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There were fewer contrasts in the specific forms of treatment offered to such patients in the public and private institutions, though the continuing reliance of both certifying physicians and asylum staff on non-technical, common-sense language in which to diagnose and describe insanity left considerable scope for the impress of contemporary social values with regard to the characteristics of social status, gender, marital responsibilities and respectable conduct as well as expectations based on class origins. The remainder of the chapter develops these arguments in an examination of the evidence drawn from Devon. At the end of the eighteenth century there were few counties that could be considered as thoroughly commercialised as Devon, being the fourth most populous county in England. The following century witnessed a relative decline as the south-west regional economy was overtaken by other regions. Population in England and Wales increased by more than 10 per cent per decade until the last years of the nineteenth century, while Devon saw about half this rate of growth in the early decades of the century before stagnating in the mid-century years and reviving from the 1870s to about 5 per cent each decade until 1900.22 The distribution of the county’s population also shifted in the course of the nineteenth century from the central agrarian and mining districts towards urban centres and coastal areas, though agriculture remained the backbone of the county’s economic and social life until the mid-nineteenth century.23 The numbers of people working on the land shrank considerably in the second half of the nineteenth century, though real wages improved substantially, more especially after 1870. A larger proportion of the Devon population was female and they may have fared worse than men with the decline of farm service. We noted the higher migration levels of females in an earlier chapter, though it is worth recalling that males migrated out of the county more readily than did women. The modernisation of the south-west economy during the nineteenth century clearly differed from that of industrial Lancashire described by Walton, involving the decline of Devon’s early manufacturing output and extractive industries as well as agrarian employment from the 1870s, though the later nineteenth century saw major migration flows from the central rural districts into the booming city of Plymouth and coastal urban areas such as Newton Abbot-Torbay.24 Immigrants, females and adults in middle life were much more noticeable in the largest settlements than in the smaller towns and villages, whilst women were much more likely to head a household in the cities than in the least populous areas.25 In contrast to what Walton found for the manufacturing north of England, it appears that the women and men who migrated furthest within Devon and those who arrived in the county from other regions were less likely to spend time in the asylum than those native males and females who were strongly attached to small rural parishes. Rather than the impact of migration being registered mainly in areas of rapid urban expansion, where established kinship

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networks were weaker, it could be argued that those unwilling or unable to participate in the demographic changes of these years lacked (or were deprived of) those skills and resources that could sustain them outside the institutional system.26 Devon remained a heavily agrarian county in the mid-nineteenth century, though the ownership of land that underpinned the power of the county elite such as the Courtenays and Aclands remained profoundly unequal. About 30,000 landowners possessed 1.6 million acres, an average of 50 acres, though half of this land was actually in the hands of a mere 200 people.27 Agriculture remained a major employer of labour throughout the nineteenth century. In 1851 about 5 per cent of males were described as labourers, while those with no stated occupation comprised less than 1 per cent. The numbers of hawkers, beggars, vagrants and gypsies were tiny, while paupers numbered about 1,700. There were great numbers of outdoor agricultural labourers, comprising almost one-fifth (18 per cent) of the males. Another 5–6 per cent were employed as farm servants indoors and a slightly larger number were identified as farmers and graziers. In total at least one-third of adult males were in some form of agrarian employment.28 The next group of occupations in order of numerical significance were the handicraft trades, accounting for about one-seventh of males employed, the bulk of whom were working in traditional rather than modern mechanical crafts. Workers in wood, stone and leather were probably more numerous than metalworkers.29 Industrial manufacturing appeared in a myriad of specific tasks scattered across the census groups in a wide range of places and operations.30 Professional employees accounted for less than 3 per cent of the total at this period, only slightly more than merchant seamen. The structure of the labour force (as well as the ways in which it was enumerated) had changed somewhat by 1891, making direct comparisons difficult, though some continuity is apparent in the employment profile of Devon.31 About 11 per cent of the male workforce remained engaged in agricultural labour, together with almost 6 per cent in farming and grazing, either directly or as a relative of the farmer. Only 6 per cent of adult males were clearly recorded as employed in more general labouring, with about half that number engaged in textiles. About 13–14 per cent in manufacturing and handicraft occupations, about 6 per cent were engaged in transport, while slightly more were enlisted in the armed services. Representing well over half of the males aged ten or older, these returns indicate the declining importance of agricultural work and the growth of industrial, commercial and armed services in the later nineteenth century. A brief examination of the census reveals some of the most significant differences in the male and female employment during the nineteenth century. Approximately 200,000 Devon women may be considered eligible for adult employment in 1851, about one-third of whom were simply described as ‘wives’, in addition to large numbers of married females identified only in relation to their husband’s occupation. The latter included 5 per cent who

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were described as wives of farmers and a further 3 per cent who were recorded as younger relatives of farmers. The single most important female occupation was that of domestic service, accounting for one-tenth of adult women in 1851. Other domestic occupations such as laundress, charwoman, cook and servants at inns claimed about half as many women again, with slightly fewer employed as indoor or outdoor farm servants.32 The manufacture of clothes, textiles and related areas of manufacturing occupied perhaps one in seven Devon women, while teaching accounted for one in fifty adult females. The general picture is one of a heavy concentration of women in a restricted range of domestic and paid employment, textiles and dressmaking the only occupations to employ substantial numbers of women outside domestic service and agriculture. The situation had altered somewhat by 1891. Almost one-fifth of women remained in some kind of domestic or related service employment, while the proportions in dressmaking and textiles had diminished: the share of teaching had been sustained or slightly increased. While there are some indications that the range of female work was widening in Victorian Devon, the largest numbers of married females continued to be identified as ‘wives’ or in relation to their husbands’ employment. Marital status clearly influenced the ways in which women were perceived as well as occupied during these decades. The 1881 census confirms the impression that women generally married rather earlier than men, more wives than husbands being found among people in their twenties. Rather similar numbers of middle-aged men and women were married.33 It would appear that younger women in particular derived considerable status from marriage, though the nature and extent of their employment was also obscured by marriage. Even some wives who were engaged in gainful work appear to have been recorded in terms of their marital rather than their occupational responsibilities. Before undertaking a detailed discussion of admissions to the asylums in Devon, it is worth returning to the question of the pauper status of those admitted to rate-funded institutions in the nineteenth and early twentieth centuries. The limited numbers of inmates housed in Devon workhouses during the later Victorian years were largely composed of children, elderly men and women, along with unmarried females and some able-bodied men.34 Most of those living in workhouses outside the largest cities were the very young or the elderly and the unmarried, particularly elderly spinsters and widows. Labourers and handicraftsmen were most prominent among men where occupations were given, while domestic service and textiles workers constituted the largest groups among the women. Many were given no occupation. The pattern found in the urban Poor Law Union workhouses of Exeter and Plymouth was rather different from that seen in more rural areas of Devon. Most of the workhouse females were again said to have been formerly in domestic service and dressmaking, while the males had been general labourers (as distinct from agriculture workers in rural areas) and involved in handicraft work, along with transport and the armed services in

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the areas of Plymouth where the naval dockyard and service employment was concentrated.35 An interesting question concerns the relative influence of occupational status, gender and age among those admitted to the Victorian and Edwardian asylums. We have noted in earlier chapters that it is misleading to assume that those entering the public asylums in this period were the classical pauper best known to the staff of the workhouse. The men and women entering the asylum constituted a broader range of occupational groups in these decades. Comparing the workhouse inmates with those admitted to the pauper asylums of Devon, it is also apparent that the age profile of the two kinds of institution differed substantially, even though older patients were increasingly prominent in asylums by the end of the nineteenth century. Most of those entering the lunatic asylums in this period continued to be females and males in the early and mature years of adult life rather than the very young or the elderly. There were greater similarities in the occupational profile of inmates and patients, though most workhouse residents had probably not been gainfully employed in the recent past, in contrast to the majority of men and women coming to the asylum from self-sufficient households in which most had made an active contribution. The Devon County Asylum drew the bulk of its admissions from the larger population of labouring, handicraft and service occupations of the county, and their family dependants, rather than the very poorest and destitute sections of Victorian society. The males admitted to the Devon County Asylum in the years 1845–1914 represented a wide cross-section of the labouring, handicraft, agrarian, commercial and lesser professional labour force of this period. Table 8.1 summarises some of the main occupations identified among our large sample of people entering the asylum in these years. Any comparison between the asylum intake and the census population of Devon recorded in 1881 must acknowledge the significant numbers of men and, more particularly, women who entered Exminster with no stated occupation or employment, substantially greater than the proportion found in the decennial census, though the preponderance of females in this group confirms the basic pattern established by the Victorian census that women’s work was recorded less frequently and consistently than that performed by men. The numbers entering without an occupation also rose during the period we examined.36 Many of these individuals probably arrived from the workhouse, though the numbers identified as paupers, vagrants or even pensioners on their admission were tiny (six paupers and one vagrant) and easily outnumbered by those recorded as possessing property or professional status.37 Only two females in this sample were recorded as prostitutes, one of them ‘believed to be’, and while there is a larger group of female paupers, the proportion remained tiny. The largest occupational groups among the male admissions to the Devon County Asylum were those found among the labouring, handicraft and lesser commercial trades. General and diverse kinds of ‘labourers’ accounted

24.2c

24.1

22.2

18.1 22.1

16.3

Totals

(No information) Domestic service, including gatekeeper Innkeeper, cook (not domestic servant), i.e. other service. Includes hospital nurse Farm and agriculture, including farmer, labourer and servant Food – dealing in, including grocer, provision dealer Clothes – making, including old clothes Dealing in general and unspecified commodities, i.e. dealer, shopkeeper, etc. Mechanics and labourer, including engine driver, mechanic, apprentice, machinist, etc. Miscellaneous – and including gentleman, annuitants, paupers, etc. Children

1 4.1 4.2

7.1

Occupation group by census titles

Census occupational codes

301,612

36,708

74,844

12,340

8,396 1,246

6,064

43,760

4,868 ,242

Census male numbers

325,632

36,475

199,444

,131

18,088 1,227

6,886

1,721

37,012 9,146

Census female numbers

1,751

,37

,41

,139

,92 ,75

,35

,428

,98 ,33 ,10

Sample 4,000 male numbers

1,945

,24

,745

,15

,167 ,30

,7

19

,316 ,410 ,90

Sample 4,000 female numbers

Females – sample % – census % ⫺16.5 ⫺10.1 ⫺ 1.9 ⫺ 0.5 ⫺1.7 ⫺ 3.2 ⫺ 1.2 ⫺ 0.7 ⫺22.2 ⫺9.9

Males – sample % – census % ⫺ 5.7 ⫺ 0.3 ⫺ 0.5 ⫺10.3 ⫺ 0.0 ⫺ 2.5 ⫺ 3.9 ⫺ 4.0 ⫺22.4 ⫺10.0

Table 8.1 Exminster Asylum, patients admitted 1845–1914 (4,000 sample) by major occupations and gender. A comparison of asylum admissions with Devon census population of 1881 indicated by percentages of total admissions versus proportions employed in Devon

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for over 300 male admissions, while those formally identified as agricultural labourers (more usually included among farmers and farm servants in the census returns) amounted to no more than 200 male admissions to the Devon Asylum in the Victorian and Edwardian decades.38 A comparison of these admissions with the census returns for 1881 suggests that there were four times as many ‘labourers’ entering Exminster than we might expect from the contemporary census, while the presence of agricultural workers corresponded fairly closely with the census numbers. A detailed analysis of male ‘labourers’ admitted in the years 1880–1882 indicated that between one half and three-quarters of those identified in the Devon Asylum registers merely as labourers were recorded in the census as agricultural workers.39 A careful investigation of the census suggests that we need to radically revise the occupational profile assigned to the male labourers entering the Devon Asylum in these years, whereas many of three-quarters of patients registered as ‘labourers’ may be more accurately designated as agricultural workers. A detailed analysis of all admissions for the period 1880–1882 also indicated that ‘farmers’ accounted for a further 4 per cent of the total. An adjustment of these figures points to a slender over-representation of male agricultural workers in the Devon Asylum, though the numbers are roughly proportionate to the size of the agricultural labour force if we assume that this was larger in the pre-1881 years, when many of the patients were admitted to the institution. The broad implication is that the size of the asylum groups corresponded much more closely to the contemporary labouring population of Devon than an initial examination would suggest. Relatively few male labourers entering the asylum appear to have been directly engaged in mechanised factory or manufacturing production of any kind. There were significant numbers engaged in established rural as well as urban handicrafts, including thatchers, blacksmiths, saddlers and senior servants such as farm bailiffs, though relatively few who were identified directly with animals compared to the census returns. Between 5 per cent and 10 per cent of males admitted appear to have been directly engaged in handicraft work at some point prior to their arrival, including the building tradesmen and stone workers who were prominent in Exminster registers. Among the wide assortment of industrial, mining, fisheries and related occupations recorded in Devon, only tailoring and clothes-makers appear to have been relatively over-represented among those entering the County Asylum, though in this regard it is clear that various textiles weavers and manufacturers did not figure more prominently than in the census population. By including all male handicraft and industrial workers with some degree of skill, it is possible that almost one-quarter of admissions came into this group. The armed services, and more particularly naval personnel (including service pensioners), were well represented, even though the expanding naval centre of Plymouth possessed no legal right of access to the County Asylum prior to the opening of its borough institution at Moorhaven in 1891. In the analysis of 1880–1882, the handicraft, industrial

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and shipbuilding workers with some skills or mechanical experience emerged more prominently than in the whole Victorian and Edwardian period, claiming perhaps one in six male admissions while various seamen and the armed forces together accounted for almost one in ten arrivals. Amid a preponderance of labouring and handicraft males coming to Exminster before 1914, perhaps one in twelve came from non-manual occupations including small dealers and commercial traders and lesser professional groups such as school teachers, clergymen, clerks and similar positions. In addition to farmers, innkeepers and others with some resources, it is possible to find among the annuitants and those living from the proceeds of property some individuals with claims to rank and status in contemporary society.40 Assessing the impact of structural and cyclical changes on the pattern of asylum admissions is less easy than comparing total admissions with a particular census. Measuring the impact of migration patterns even for specific ethnic groups is even more hazardous as Hunt’s detailed analysis of labour migration in the nineteenth century has demonstrated.41 It seems implausible to attribute the noticeable presence of labourers among the Exminster admissions to declines in industrial or agrarian employment during the later nineteenth century. A clear fall in farm servants among the Devon labour force can be detected between 1861 and 1881, for example, as well as a more modest decrease in the numbers of farmers and male relatives of farmers recorded. The decline in numbers of agricultural labourers is again moderate rather than marked.42 A rather rougher comparison between 1851 and 1891 shows that the number of males aged ten or older employed in agriculture fell from about one-fifth to one-eighth of the Devon total, though again the rate of decline is steady rather than steep.43 It may be argued that the pattern of admissions or discharges among the agrarian communities was more likely to reflect the changing demand for labour across the annual sowing and harvest cycle, as households were more willing to tolerate and accommodate awkward members when the need for extra hands was greatest. There appears little support for the view that either admissions or discharges were directly the result of longer-term trends or seasonal adjustments within the county’s agricultural sector. Both tended to rise slightly in the summer months but many ‘discharges’ were in fact the result of death rather than a decision to release labour back to the household.44 The evidence gleaned from the Devon sources indicates that male labourers were represented in the Devon Asylum in broad proportion to their presence in the county’s population. Certain handicrafts trades, including building tradesmen, appear to have been somewhat over-represented in comparison to their numbers as recorded in the 1881 census, while male textiles and clothes workers were similarly rather more prominent at Exminster than we might expect from the 1881 census. In broad terms, however, there is a reasonably close consistency between the numbers in the census classifications and the asylum records. This is an interesting result, more particularly

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as the large urban boroughs of Plymouth and Exeter were not heavily represented among the asylum intake. The ranks of the general labourers increased alongside those of industrial artisans, mechanics and apprentices in the later nineteenth century, though again the growth was moderate rather than dramatic, and factory labour for metalworkers continued to employ small numbers.45 The age profile of the male labourers committed to the Devon Asylum did not alter dramatically over the period as a whole, though after 1880 there was an influx of younger men (younger than 30) to the institution as men in later life (40 years and older) became less prominent among those arriving at Exminster. Further impressions of the influences on the rates of asylum admission for different groups of workers may be gained by a closer analysis of the Poor Law Unions from which these men were sent to the asylum during the decades 1845–1914. The admissions suggest that Exminster’s agricultural workers were fairly evenly distributed across Devon, while the general and industrial labourers were more likely to arrive from the areas of expanding population near south Devon’s coastal area as well as St Thomas, and Totnes rather than the rural heartlands of central and northern Devon. Industrial Devonport sent a significant batch of labourers, though neither Plymouth nor Exeter figure prominently in the lists of labourers at the asylum.46 There was some decline in older handicraft employment such as shoemaking, though not textiles employment, as public and private services continued to grow during the period 1851–1891, though it is difficult to detect significant variations in admissions amid the very wide range of male handicraft occupations which were represented in the Exminster admission books. It is probably more plausible to argue that the growth of population and employment in south Devon and in urban centres was accompanied by an over-representation of general and industrial workers (including those at Devonport) in the ranks of the asylum inmates. Drawing a comparable profile of female employment in the Victorian years is notoriously hazardous, more particularly when one in four women admitted to the Devon Asylum were assigned no clear occupational status.47 About one-quarter of women admitted in these decades were also classified according to their husbands’ employment or more often simply as ‘wife’, with a clear trend for increasing numbers of married women to be identified in this way on their admission to the asylum. The husbands’ occupations listed for married women broadly match those of male admissions, two-fifths of the male occupations listed for wives being agricultural and other labour, though naval personnel and seamen were also well represented among the wives associated with male occupations.48 The largest constituency among those Exminster females accorded an occupation of their own were the domestic servants, accounting for more than one-fifth of women admitted to the Devon Asylum. This intake amounted to about twice their representation within the 1881 census population and three times the proportion of ‘general domestic servants’ recorded

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by the 1861 enumerators. The flow of domestic servants was reasonably constant over the period as a whole and the geographical distribution of the intake broadly reflected their employment within the different Devon Poor Law Unions, though the cities of Exeter and particularly Plymouth again sent disproportionately low numbers to the asylum. This pattern confirms the impression that many rural and remote Unions, as well as the leading centres of population in the coastal and urban districts, were sending female servants to the asylum.49 Another significant group of women workers admitted to Exminster who were over-represented in comparison to their census profile, though less so than those in domestic service, were those engaged in the dressmaking, tailoring and related trades. Altogether about 9 per cent of the asylum women had previously worked at these tasks, compared to a little more than 5 per cent of the 1881 census population. They were sent primarily by the Poor Law Unions of Newton Abbot, St Thomas and Honiton, with a scattering of admissions from other Unions, though it was noticeable (with the exception of ten women from Devonport) that Plymouth and Exeter were major centres for dressmaking but very few dressmakers were admitted from these cities.50 Exminster women also figured in a range of other occupations, including shopkeepers and small dealers, though the only prominent salaried and professional group was that which included teachers, schoolmistresses and governesses. Domestic and other servants were easily the most familiar group among the occupied females who were committed to the Devon Asylum. Their numbers were only rivalled by women described as ‘wives’ and those who were given no employment status. The different domestic as well as employment circumstances of these major groups of certified females appear to have influenced their admission to Exminster. The age profile of domestic servants coming to the Devon Asylum was reasonably stable over the period as a whole, though there was a slight increase in younger females arriving during the 1860s and 1880s, while rather older women were more apparent in the 1870s and after 1900. Marital status emerges as a distinctive and significant feature of those who came to the asylum and their experience of institutional care in Victorian and Edwardian Devon. We have already noted that unmarried individuals comprised almost half of the female intake and a similar proportion of the male arrivals at Exminster, though the patients included rather more husbands than wives and fewer widowers than widows.51 The most simple form of households, those formed by married adults with or without children, provided a majority of patients, though men were far more likely than women to have headed their household.52 Female heads were relatively rare, though not unknown, even amongst the simple households. They much more commonly lived in the households of others rather than heading a solitary or multiple household, figuring most frequently as wives, daughters, sisters or servants.53 The difficulties facing married as well as unmarried women who lacked

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male support were well documented in numerous cases from the earliest days of the Devon Asylum.54 The resources available to men and, more particularly, women appear to have been clearly affected by their marital and household status as well as their position in the labour market and their employment status. Women employed as domestic servants were most likely to be younger and unmarried. This was particularly apparent among those female servants committed to the Devon Asylum, well over four-fifths being single on admission. This occupation had the greatest concentration of unmarried women among any group, substantially higher than those females who were recorded as having no recognised employment.55 This compares to less than half of the Exminster general labourers and even fewer agricultural labourers who were unmarried at the time of their admission.56 Uncovering the various circumstances that were responsible for the presence of large numbers of unmarried female servants in the Devon Asylum would be an enormous task, though some clues may be drawn from the diagnoses given to such females and the details provided for those who entered Exminster in the early 1880s. An analysis of the ways in which women were diagnosed over the whole period 1845–1914 suggests that unmarried women were more likely to be certified as suffering from mania and less likely than women as a whole to be seen as melancholic, demented, delusional or as idiots and imbeciles. Domestic servants were even more likely than single females to be seen as suffering mania and even less likely to be certified as demented or delusional, though the proportion seen as melancholic were very similar to the general female intake. They were noticeably less likely than single females to be identified as idiots or imbeciles. In certain regards, therefore, domestic servants resembled the whole body of women admitted than the unmarried female intake. Closer examination of the women admitted in the years 1880–1882 casts further light on the peculiar experience of servants coming to the Devon Asylum. Nine-tenths of them were unmarried, two-thirds were younger than 40 and only three older than 60.57 The nearest relative named in their certificates was most commonly their father, though the testimony quoted in the ‘facts of insanity’ justifying certification was much more likely to be given by the mother, who also figured most frequently as the reported target of violence. Half of these women were said to be suffering mania, with one in five found to be melancholic, one-tenth were demented and a similar proportion classified as idiots and imbeciles. A limited proportion of the servants were certified as not under proper care and control, or even ‘wandering at large’, suggesting a desperate if not destitute condition. Among those found not to be under care and control was Mary Eliza M., aged 18, who was found in May 1881 by a policeman ‘in a deep river up to her waist’.58 It is clear, however, the greater number of female servants (almost half the 1880–1882 total) were examined at home, usually one they shared with their family.59 In other instances the asylum rejected the diagnosis offered on the

Mania (including acute/chronic) Melancholia (including acute/chronic) Senile dementia Senile mania Senile melancholia Idiocy and imbecility Epilepsy Puerperal General paralysis of the insane (including all references to GPI) No symptons of insanity Delusional Unknown

0,860 0,558 0,078 0,017 0,010 0,091 0,012 0,034 0,022 0,05 0,088 0,058 2,030

42.4 27.5 3.8 0.8 0.5 4.5 0.6 1.7 1.1 0.2 4.3 2.9 100.0

430 207 13 3 3 84 10 4 5 4 37 42 949

All females % Females All single females

Table 8.2 Exminster Asylum, female domestic servants admitted, 1845–1914: main diagnoses

45.3 21.8 1.4 0.3 0.3 8.9 1.1 0.4 0.5 0.4 3.9 4.4 100.0

% Single females

188 98 2 0 1 11 3 6 2 4 9 12 363

Domestics

51.8 27.0 0.6 0.0 0.3 3.0 0.8 1.7 0.6 1.1 2.5 3.3 100.0

% Domestics

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certificate, as when Elizabeth S., also aged 18, was admitted from St Thomas Workhouse, having displayed ‘symptoms of mental imbecility from an early age’, though it was her recent ‘fits of sullen stubborness’ that justified her departure for Exminster. She was discharged as ‘not insane’ within a month.60 In a few instances, a strained relationship with their employer emerges from the facts reported. Louisa D. wandered around uttering the words, ‘I want to be happy, I want to be good’, her mistress at Exmouth testifying that her servant had lost the power of sleep and walked ‘up and down her room for hours talking and muttering to herself incoherently’. Jemima D. of Tavistock was 19 when admitted in 1882, having attempted to jump out of a window and asked her father to stab her rather than starve her as she threatened suicide. Her father testified that she had claimed her last employer had taken ‘liberties with her and said she was not respectable and told her to go out of the House’. Jemima was another servant found not to be insane.61 For female servants in general, the prospects of recovery and release were mixed. About half of those admitted were discharged recovered or relieved, or found not to be insane. Remarkably, more than one-third of the total died at Exminster, while a small number left ‘not improved’. The experience of domestic servants before and after committal to the Devon Asylum indicates that marital status, alongside gender, household and kinship relationships, were bound up with occupation in shaping the passage of women into and out of the Victorian asylum. A brief analysis of male agricultural and farm labourers admitted to Exminster in the same years suggests a greater diversity in the marital status of men employed in this field, and less of a contrast in the institutionalisation of married and unmarried men. Among farm labourers arriving at the asylum in 1880–1882 were equal numbers of husbands and bachelors. The majority of men in each group were examined at their home or that of a relative rather than in the workhouse. The wife was given as the nearest relative of every married man while the kinship relations identified in the admission documents were much more diverse. There was less disparity in the outcomes of their committal. About half of husbands and bachelors recovered. Almost as many died in the institution.62 We have noted in earlier chapters that the absence of a spouse appears to have figured in the pattern of admissions for both females and males recorded at the Devon Asylum. The Exminster Asylum appears to have catered for the broad mass of the labouring population of the county while accepting a wide range of occupational groups that would not have been considered the poorest in contemporary society. These individuals came from the mainstream of Devon society and were mainly composed of men and women with some kind of occupational status, or marital status in the case of married females. Very few appeared marginal, peripheral or outcast from their families, communities or occupational peers. It is also noticeable that male agricultural workers did not figure as an unusually large constituency within a County Asylum which was catering primarily for rural areas and smaller

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townships rather than the larger urban centres of Devon in the Victorian and Edwardian years. The evidence presented above suggests that the propensity of people to be committed to such institutions should be understood not only in terms of their occupational status and economic resources, but more broadly in terms of the social and collective resources available to such individuals as well as their market power and employment status. The limitations evident among those who arrived at the gates of the Devon institution often derived from the poverty of their social resources as much as their physical capacities and employment skills. Relative income and personal resources may well have played a part in the pattern of admissions, particularly where wives depended on the husband’s income to maintain a family household. Unmarried females were particularly liable to find employment in relatively low-paid domestic labour and also to have been particularly susceptible to social and personal circumstances which led to them being identified as insane and committed for institutional care. Their capacity for recovery was evidently as great as that for males, at least in the early 1880s, as a slightly lower proportion of female servants than male agricultural workers expired within the walls of the asylum. A comparison between the County Asylum and the Borough Asylum established by the borough of Exeter at Digby in 1886 offers one way of evaluating the development of an institution that catered primarily for an urban rather than a rural population in the later Victorian years. Before undertaking an analysis of Exeter’s own asylum it is worthwhile reiterating our earlier point that there is no standard or classical model of institutional provision in this period, any more than there is one predominant case study of economic and social change in the nineteenth and early twentieth centuries. In common with other asylums designed and constructed some decades after the passage of the 1845 Lunacy Acts, Digby was completed in an era when Poor Law authorities and local government were increasingly sensitive to the mixed economy of institutional care that had evolved during the Victorian years and the opportunities that the marketplace offered for private as well as publicly funded beds within their wards. The bilateral divide within the accommodation completed by Exeter Borough in 1886 became immediately apparent in the creation of a private list of patients alongside the pauper records. The Digby Asylum recorded over 400 female admissions in its first decade of life, more than threequarters being paupers, but almost 100 entering as private patients. In the same period, rather fewer males (339) were admitted, more than onequarter contracted as private patients. Nor were private individuals the only contracted patients served by the new institution. The borough asylum was built for the citizens of Exeter, though many of its early admissions were pauper patients sent from other parts of the country, including hard-pressed London Unions, for whom Digby provided accommodation and care. Many of these patients appear to have been people with long-term or ‘chronic’ conditions. This helps to explain the discharge of many inmates

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‘not improved’, rather than as recovered or relieved after a few years of residence at the asylum.63 The occupations given to the males and females need to be treated with some caution since many patients had been resident for some time at other institutions before their transfer to Digby. The general pattern of employment broadly conforms to that recorded in the Devon Asylum during the Victorian and Edwardian years. Little more than one-tenth of the 261 pauper males were said to have no occupation and about 50 are described as labourers, including five farm workers, in the admission registers. There was also a fair sprinkling of military personnel (seven soldiers and four sailors), though the remainder were composed of a wide variety of unskilled and skilled manual workers, small tradesmen, salesmen and shopkeepers, together with clusters of clerks, teachers, farmers and lesser professionals. Although the male entries on both the pauper and private lists at Digby display greater variety of occupations than females, the range of employment given for the fee-paying men was less varied than that recorded for the paupers admitted. Fewer manual workers are found on the private male registers, the largest named groups being farmers (11), clerks (six) and teachers (five). The age profile of such pauper groups as the farm labourers suggests that those admitted to the Borough Asylum were markedly older than their counterparts at the Devon Asylum, all of them dying or discharged not improved, though they were more often sent by authorities such as Somerset County Council and were presumably the more intractable of the cases in such occupational groups.64 Among the general and non-farm labourers admitted to Digby at this time, it was noticeable that they were primarily men in their middle and later years, only ten being younger than 30, 13 in their thirties and 24 older than 40 years. They were also mainly single men, only 12 being married compared to 26 bachelors. Primarily diagnosed as suffering from mania, there were also those identified as ‘demented’ (nine) and melancholic (six). Their experience of Digby was bleak if we consider the outcomes: more than half died in the asylum and almost one-quarter were discharged ‘not improved’, only seven leaving recovered. A comparison with the private list ‘farmers’ reveals that there were similar numbers of husbands and bachelors, these men being either single younger (in their twenties) or older husbands (in their fifties). They were most likely to leave the asylum ‘not improved’ after remaining there for some years. The experience of females at the Digby Asylum again offers an interesting point of comparison with the County Asylum as well as the character of male admissions to an asylum catering for a population that was primarily urban rather than rural. Almost one-quarter of the 300 pauper female entrants were given no employment status on admission and one in eight were described as wives or housewives. The most common employment given was that of domestic service (about 50 females), while almost as many were recorded as dressmakers, needlewomen or seamstresses.65 There were

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very few women who could be clearly identified as paupers, vagrants or others who were in destitution. Among those admitted were three prostitutes and one named pauper. At least as common were those females whose occupational and social status appeared to be above that of the labouring classes, including four teachers (including two governesses). Digby’s domestic servants were overwhelmingly single women, there being only two wives and two widows in their ranks. In contrast to the male labourers, they were primarily younger than 40, only two-fifths of the intake being older than this. A large majority were diagnosed with mania rather than dementia or melancholia and their prospects of leaving the asylum alive were rather better than the male labourers, though only 14 were discharged recovered compared to 25 who left ‘not improved’. The range of employment pursued by those admitted as private patients to Digby was less extensive than the work undertaken by paupers, half being returned as having no occupation and one-quarter being entered as wives, widows or daughters of male relatives. Among the occupations listed were dressmaking, teaching (again four individuals) and housekeeping, while three ‘gentlewomen’ were included. The experience of 20 ‘wives’ admitted to the asylum suggests that their diagnoses were similar but the outcomes of their residence rather different. They were largely older wives, two-thirds being older than 40. Almost half were said to be suffering mania compared to six who were certified for melancholia. The known causes of their insanity were variously given as physical illness (one-third of cases), motherhood and family concerns (four), or worries and intemperance. The prospects for their improvement appear to have been rather better than those for domestic servants or labourers from the pauper list, nine being discharged as recovered or relieved compared to four who died at Digby. This brief review of the admissions and discharges recorded by Exeter’s borough asylum provides some insights into the distinctive profile of the asylum that catered for urban populations in the Victorian and Edwardian decades. The Digby records also indicate the importance of private feepaying income to such institutions in the closing decades of our period. By the end of the century the asylum system appears to have become more concerned with securing an income to justify the more elaborate and extensive facilities that were often demanded by the Lunacy Commission, while the better-known private asylums levied fees beyond the means of the salaried, affluent employees and the lower middle classes of cities such as Exeter. The Plymouth Asylum at Moorhaven received its first admissions on 17 November 1891, a significant cluster of whom were to die in the asylum during the first two decades of the twentieth century. Established on large grounds at some distance from the city, the new institution appears to have catered overwhelmingly for Plymouth Union patients, though private admissions were recorded from the early years. Sparse records permit only the general impression that the Moorhaven Asylum attracted little controversy before the First World War.

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The final part of this chapter considers the distinctive profile of the largest private institution in Devon during these decades, that of Wonford House. An examination of its admissions and the social composition of those who used this establishment will enable us to complete our analysis of the influence of class on the asylum in this period. Wonford House appealed to different economic and social groups from the majority of those committed to the County Asylum or Exeter’s own asylum in the Victorian years, though it would be misleading to assume that the voluntary and fee-paying establishment was the sole preserve of the wealthy and upper classes. The asylum had maintained a system of differential fees since at least the late eighteenth century, with a sliding scale of fees charged to those who entered. More than one-tenth of the male intake had no occupation given, with more than 5 per cent retired. There were also about 60 males described as ‘gentlemen’. The majority of the patients were identified in a distinctive form of employment, more usually dependent on salaries and fees than profits or rents. Table 8.3 indicates the occupations recorded for male patients at Wonford before 1914. More than one in twelve of the Wonford males had been employed in farming prior to their admission, with clergymen and clerks also making notable contributions to the patient population. Past and present members of the armed forces accounted for one in eight of admissions, while doctors and other professions were at least as prominent as smaller businessmen. A surprising number of younger males in education is apparent as well as a long tail of men who were engaged in commercial or industrial enterprise, alongside artisans and other manual workers. Gathering together all professional and salaried employees as a ‘white collar’ group would constitute one-quarter of total committals while commercial and trading people claimed a little more than one-tenth of admissions, not significantly larger than the combined skilled and unskilled employees at the asylum. There seems little doubt that Wonford appealed to a broad cross-section of male occupations across the south-west of England who did not belong to a single social class. Most patients appear to have possessed propertied or professional status above the ranks of the manual workers, though the asylum accommodated substantial numbers of salaried employees and lower-middle-class shopkeepers alongside farmers and more genteel residents. There are few clues as to the social and personal circumstances in which the Wonford males were committed to the asylum. Analysis of the 55 men admitted in 1880–1882 reveals a familiar range of salaried, professional and business occupations, including six clerks, five clergymen, five gentlemen (together with six of no occupation or independent means), five military personnel, five merchants, and three or four shopkeepers, artisans, farmers, financial and legal figures. Half of them had previously been resident in Devon with the remainder coming mainly from Somerset and the Home Counties, though the origins of some were unknown. A clear majority of

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this intake were unmarried men though there was a clear bias towards older men, only 20 being younger than 40 and one-fifth being older than 60.66 Given their ages, the outcomes of residence at Wonford were mainly positive, 21 recovering, 13 departing relieved and only two not improved, while 16 died in the institution. Personal details for only four could be discovered. Edwin C. was an unmarried, retired chemist heading his own household which accommodated his older (unmarried) sister in Great Torrington at the time of the 1881 census, a few months before he was admitted to Wonford on his sister’s authority, suffering from mania. He recovered by spring 1882. Henry C. was an elderly clergymen living with his younger wife near Torquay, each having been born and presumably married in East Anglia, though he was admitted suffering mania on the authority of his brother-inlaw when it was said that he had experienced previous attacks. Failing health was given as the cause of his insanity, though he appears again to have been discharged recovered. William L. did not leave the asylum after his arrival at the end of 1882 aged 44. His condition was given as demented, though the census of 1881 had listed him as the unmarried imbecile son of a Tiverton farmer. Admitted on the authority of his brother Richard, William died in the summer of 1884. Some indication of the subsequent life facing unmarried men who left the Wonford Asylum can be seen from the experience of Thomas W., ‘a gentleman’, who had been admitted from his lodgings in Magdalen Street, Exeter, in May 1880 on the authority of William Mortimer, a stockbroker. Thomas’ melancholy was attributed to his losses following a bank failure and to family troubles, and he was discharged recovered within a few months. When the census enumerator called the following year he was heading his own household within a shared house at Belmont Road. Now aged 69, he was living on the remaining income from bank shares.67 A number of men admitted to Wonford in the early 1880s appear to have arrived from other asylums, or from lodging houses and private dwellings which may well have served a similar purpose. The experience of women admitted to this fee-paying institution may be distinguished from that of their male contemporaries. A greater proportion of female admissions were unmarried compared to men.68 Among 892 females admitted in the period 1855–1914, almost one-third were said to have no occupation, a substantial majority again being unmarried. In addition to the Wonford spinsters, more than one-fifth of the intake were identified solely or mainly in relation to the occupation of their present (or late) husband, or father. The most common occupation of husbands among the wives, widows and daughters was that of farmer, though clergymen were not uncommon.69 Less than half of the females entering Wonford, therefore, were accorded some kind of occupational status in the admission registers. Table 8.4 offers a selected summary of the employment profile of the female admissions, identifying the distribution of the major occupations among those entering the institution.

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Table 8.3 Wonford House Asylum, male patients admitted, 1855–1914, by occupation Occupation None Accountant Architect Architect assistant Army Army (lately) Army (retired) Royal Navy Royal Navy (late/formerly) Royal Navy (retired) Artist (including one photographer) Attorney/solicitor Author Manager Barrister Blacksmith Bookseller Stockbroker, broker, agent, dealer Builder Butcher (one former) Butler Cabinet-maker Carpenter Cattle dealer Cheesemonger Chemist/druggist Civil engineer Clerk in holy orders and other ministers Former clerk in holy orders Clergyman, minister, missionary Son of clergyman Clerk Late/retired clerk Cashier, commission agent, private secretary Civil servant (including one retired) Coachman/coach proprietor Commercial traveller Cordwainer Hairdresser Dairyman Dentist Draper (including one draper’s assistant) Engineer Farmer, yeoman

N 80 3 5 1 22 5 22 7 0 4 10 21 1 2 11 1 3 11 8 5 3 1 5 3 1 9 3 46 1 14 4 37 2 3 7 6 5 1 1 2 2 16 7 61

(%) (10.83) (0.41) (0.68) (0.14) (2.98) (0.68) (2.98) (0.95) (0.00) (0.54) (1.35) (2.84) (0.14) (0.27) (1.49) (0.14) (0.41) (1.49) (1.08) (0.68) (0.41) (0.14) (0.68) (0.41) (0.14) (1.22) (0.41) (6.22) (0.14) (1.89) (0.54) (5.01) (0.27) (0.41) (0.95) (0.81) (0.68) (0.14) (0.14) (0.27) (0.27) (2.17) (0.95) (8.25)

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Table 8.3 Continued Occupation

N

(%)

Son of farmer Retired farmer Fruiterer Gentleman Son of gentleman Grocer Hatter Hotel keeper Independant means Innkeeper Ironmonger (including one assistant) Labourer Land, vineyard proprietor, planter Land agent, estate agent, farm bailiff, steward Draughtsman Journalist, editor Machine tester Maltster Merchant (one late) Retired merchant Manufacturer, mine/quarry owner Miller Student, pupil, undergraduate, schoolboy Apprentice Painter Printer, stationer Pensioner Pawnbroker Physician/doctor/surgeon/medical superintendent Retired surgeon Publican Retired (not otherwise included in occupation categories here) Saddler (one former) Sailmaker School master, teacher, academic Master mariner Shipbuilder Shipowner (one late) Shipping Shopkeeper Tailor Tutor Warehouseman Watchmaker Other handicrafts, manual

7 9 3 58 1 3 1 2 3 4 3 1 6 6 3 3 1 1 14 4 3 3 24 2 2 2 1 2 21 5 2 40 2 2 8 4 1 2 1 2 2 5 2 2 4 739

(0.95) (1.22) (0.41) (7.85) (0.14) (0.41) (0.14) (0.27) (0.41) (0.54) (0.41) (0.14) (0.81) (0.81) (0.41) (0.41) (0.14) (0.14) (1.89) (0.54) (0.41) (0.41) (3.25) (0.27) (0.27) (0.27) (0.14) (0.27) (2.84) (0.68) (0.27) (5.41) (0.27) (0.27) (1.08) (0.54) (0.14) (0.27) (0.14) (0.27) (0.27) (0.68) (0.27) (0.27) (0.54) (100.00)

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Table 8.4 Wonford House Asylum, female patients admitted, 1855–1914, by selected occupations Occupation

N

Per cent of those occupied

None Draper Dressmaker, milliner, sempstress (one former) Retired dressmaker, etc. Clergy Gentlewoman Gentleman’s wife Gentleman’s daughter Governess (one former) Housekeeper Housewife Independent Lady Lady’s maid/companion Landlady, hotel, lodging house keeper Librarian Retired not otherwise named here School mistress/assistant, teacher, lecturer (one former) Retired school mistress, etc. Nurse (one children’s nurse, one school matron) Servant, domestic

264 6 12 3 2 272 2 2 32 10 7 4 7 5 5 1 3 14 1 6 6

(0.00) (1.52) (3.03) (0.76) (0.51) (68.69) (0.51) (0.51) (8.08) (2.53) (1.77) (1.01) (1.77) (1.26) (1.26) (0.25) (0.76) (3.54) (0.25) (1.52) (1.52)

Total Total with some occupational/economic/ social status indicated

664 396

(100.00)

Wife of male with named occupation Daughter of named occupation Widow of named occupation Widow

82 27 10 1 120

One noticeable feature of the records compiled by the Wonford Asylum is the absence of ‘housewife’ as an occupational group. The most common ‘occupation’ was that of ‘gentlewoman’ on admission, the latter title being bestowed on three in every ten women who were committed. This term was applied much more widely than the term ‘lady’ or that of wife or daughter of a gentleman. Rather less than two-thirds of the ‘gentlewomen’ were unmarried and were primarily in their middle life rather than elderly spinsters or widows.70 Since the census enumerators restricted the status of gentlewoman and title of lady to a tiny fraction of the population, the asylum was itself gentrifying those admitted possibly in an effort to distinguish its patients

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from those of the public asylum and to add further polish to its social prestige within the marketplace for institutional care. The most familiar person giving authority for the committal of these females was that of brother and sister, accounting for about half the total, followed by parents, responsible for almost one-quarter of the total. Two-thirds of married gentlewomen were admitted on the authority of their husband, while widows were most commonly sent to Wonford on the authority of their brothers and sons. The most substantial professional group to which the Wonford females belonged was that of governess and school mistress, who figured prominently in our earlier chapter on gender relationships and the Devon asylums. It is worth reiterating that the title of ‘governess’ was bestowed on three times as many females admitted as ‘school mistress’, and the term ‘school teacher’ was rarely applied compared to variants such as ‘tutor’ or ‘music teacher’. In comparison, the pauper Devon Asylum recorded a significant number of ‘school teachers’ at this time but registered relatively few governesses.71 The Wonford governesses were largely younger unmarried women who had usually come to the asylum from an address in Devon or south-west England and who most frequently left recovered or relieved, only two dying inside its walls. The handful of school mistresses had poorer prospects for recovery in this period. The varied social and personal circumstances in which these women were identified as insane, sent to the asylum and received back into society has been considered in detail elsewhere and needs little elaboration here.72 The impression gained from Wonford’s use of such rarefied and even archaic titles such as ‘governess’, where census enumerators and registrar of public asylums would have deployed the term ‘teacher’, again suggests gentrification. Such devices could not disguise the fact that the establishment was regulated by the same Lunacy Commission that monitored the pauper asylum and the workhouses which accommodated the insane of Victorian and Edwardian England. The Commissioners were also involved to some degree in the admission of 40 females and 27 males, mostly in connection with the action of a relative.73 The greater participation of the Commission in the committal of females may have reflected a sensitivity to controversies on the wrongful confinement of propertied and higher-status females to the private asylum, more particularly during the scandals of the 1880s. The insanity question was politicised in peculiar ways during the 1840s and the 1880s as major legislation for the institutional care of lunatics was being considered in England and Wales. It was more commonly addressed in terms of individual predicaments and communal failure than confronted in terms of class deprivation and social oppression. Political themes occasionally surfaced in the certification of men, and less often women, committed to the public and the private asylums in these decades. The surgeon Henry H.’s journey to Exminster was marked by his denunciation of a neighbour as a Fenian and a Radical, while the stockbroker Arthur Ross D. was committed to Wonford in April 1880 on the authority of a surgeon who

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testified that Arthur’s mania and general paralysis could be attributed to the excitement of the general election and masturbation.74 The political context was usually framed as incidental background to an intensely personal experience of physical and moral collapse. Yet the treatment of insanity was fundamentally a question of power and political regulation. The county magistracy were legally and directly responsible for the governance of the pauper asylum as well as the committal of its patients. They were almost invariably drawn from the social elite that served on the committees directing private asylums as well as dominating English county government before and after 1888. They frequently figured in the public and political life of boroughs as well as shires across the country. The Guardians of the Poor Law were similarly drawn from the propertied and the prestigious, sealing the particularistic relationships within local areas where voluntary initiatives and personal intervention contributed to the semblance of social and moral leadership even as the Lunacy Commission and Poor Law Board (after 1871 the Local Government Board) sought to secure common standards by central direction. Social and cultural historians of insanity have long been aware of the importance of class relations in the identification and treatment of those found to be mad. Andrew Scull emphasised the impact of social deprivation as well as the growing commercialisation of social life and the family nexus in the increased use of the asylum by the labouring poor during the nineteenth century, while John Walton stressed the incapacity of tighter-knit working class families and communities to provide support for its distracted members. This chapter has suggested that scholars, including Peter Bartlett, are justified in stressing the significance of the Poor Law in the administration of pauper lunacy and its role in securing the passage of individuals to the local asylum, though it is important to emphasise that the majority of those who entered the asylum were far from the destitute clients of the workhouse. It is difficult to recognise in the occupational profiles of most men and women who were admitted to the pauper asylums in Devon the awkward, unproductive and recalcitrant individuals who have figured in some earlier accounts of lunacy during the industrial revolution and later. The decline of agriculture and increased migration do not appear to have led to dramatic changes in the pattern of admissions and discharges in Devon. Only a minority of those admitted to public or private asylums in Devon were ‘warehoused’ as unproductive individuals for lengthy periods. Most who survived were given employment in the institution and within two or three years they returned to their relatives or friends, though the prospects for the unmarried appear decidedly less favourable. Those admitted to the Devon Asylum appear, for the most part, to have been members of the respectable working and artisan classes, with significant numbers of shopkeepers, small traders, military personnel, farmers, clergymen and lesser professionals in their midst. They were usually examined in their own homes or at a doctor’s premises, rather than in the workhouse, though many who

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came to Exminster had clearly been initially placed in the workhouse on the appearance of insanity. There has been considerable and sustained debate on the role of the lunatic asylum in the management of the labouring poor and the maintenance of class society. Scholars continue to differ on the precise nature and impact of the 1834 Poor Law Amendment Act. Recent research on the English asylum, including the work of Bartlett, Wright and others, have stressed the central importance of the Poor Law to the introduction and administration of lunacy legislation in Victorian England. While we have reiterated the argument that the Poor Law exercised a profound influence on the application of lunacy legislation, we have drawn a sharp distinction between the legal and political framework in which the public asylums were governed and the social composition of those who entered their gates. In particular, we have criticised the arguments made by Scull and restated in a modified form by Bartlett and others, that the asylum catered overwhelmingly, if not exclusively, for the poorest groups in contemporary society. Our evidence strongly suggests that those admitted to the pauper asylums we have examined were drawn from a broad cross-section of the labouring community as well as trades based in handicraft, smaller commercial activities and those engaged as petty officials in Devon society. The private asylum catered for more affluent groups, though again we should not overlook those whose condition may be best described as modest respectability or even genteel poverty. Very few patients were classified as paupers, vagrants, prostitutes or tramps on their arrival at the county or borough asylum, though it is worth noting that older workhouse inmates were frequently given a range of occupations not dissimilar from those at the asylum. In a significant number of cases, the Poor Law Guardians pursued the relatives and friends for contributions to the maintenance of individuals who were committed to the Devon Asylum.75 The most likely and immediate concern of Poor Law officers on receipt of reports of insanity would have been their responsibility not so much for the committal of individuals to the asylum but for the maintenance of any family threatened with the calamity of the serious illness of a principal earner, which might jeopardise its capacity to sustain an independent household. Where females who did not head a household were concerned, the hazards were likely to be rather different, though the responsibility of many wives for the rearing of children and maintenance of the household would again place strains on the other members were they to be certified and committed. Less essential and probably more expendable were the unmarried females and males who may have contributed to a household but whose position within the household remained more dependent and rather less powerful. Where they were employed in work with limited status and remuneration, such as labouring and particularly domestic service, then it appears that their capacity for coping with the predicament of insanity and the resources or support which they could expect from others was more limited than those

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available to the married and to those who sustained their own households. This would help to account for the preponderance of unmarried male labourers and female servants in the registers of the Devon Asylum during these decades. This chapter has examined the influence of class on the public and private asylum by addressing class as a relationship of economic and social power. Our analysis has been based on the argument that social class involves the unequal exercise of economic and social power. An examination of employment and occupational status reveals the extent to which economic life was influenced by relations of gender, household and marital status, as well as the market value placed on individual labour. Our analysis has therefore involved a consideration not only of inequalities of occupation, income and wealth determining the resources, status and expectations available to different groups of people, but also connections of gender, marital status, household, community and kinship as patients engaged with the legal process and institutional requirements that defined the terms on which care was available. We have stressed the importance of authority and discipline in employment relationships (such as those involving domestic servants), as well as the identification and treatment of insanity, including assumptions with regard to the deference due to gender, expertise and social distinction. This approach does not underestimate the impact of hardship, deprivation and extreme duress to which individuals and families were subjected. Rather, we have suggested that sources and perceptions of insanity arose from a multiplicity of combined causes and circumstances, rather than a primary and determining set of conditions or common place calculations. We explain the particular vulnerability of single, younger domestic servants to certification and committal as arising from personal difficulties within a social environment over which individual women had limited control. Class inequalities may also be detected in the basic differences in discretionary power available to those paying fees versus people who were dependent on Poor Law rates for their maintenance, even if the latter were reclaimed from relatives and friends. These differences arose not only from the legislative provisions for private and public institutions but also from the expectations of those who used and administered these different kinds of asylum. A comparison of Exminster with the borough asylum at Digby’s Field and with the fee-paying institution at Wonford House points to important chronological discontinuities in the development of a mixed market for institutional care, as well as differences in the constituencies served by the asylum in the Victorian and Edwardian years. It is also arguable that these institutions contributed to the maintenance of class relationships by their internal arrangements and the social expectations of wider society with regard to class, gender and other inequalities embodied in their treatment regimes. This point is developed in the following chapter on the patient experience. Finally, we have extended the discussion of the influence of class in the

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identification and institutional care of the insane by noting the cultural terms in which the mad were recognised and their care arranged. The attachment of Wonford House to genteel titles and modes of address may appear the production of institutional self-delusion as archaic hierarchies were preserved even as rising numbers of patients were drawn from the middle and even lower middle classes. In fact, the retention of some trappings of gentility was an important expression of the massive importance of personal as well as public services in many regions of Britain, most obviously in the employment of various grades of household employees and servants. The use of such titles also registered one fault line in the cultural expectations of contemporary civil society. Victorian society housed its lunatics in specialised institutions that bore the imprint of an abiding concern with recovery through dutiful labour, while expressing social aspiration to genteel as well as respectable status. It appears ironic that the private asylum at Wonford House should continue to bestow the out-moded title of ‘gentlewoman’ on so many of its female patients while claiming to restore them to a proper sense of their social position. The pauper asylum similarly cared for its patients under the terms of the Victorian Poor Law, while acknowledging in practice the fundamental differences that applied to the care of the insane individual as against the disciplining of the workhouse inmate. These asylums served to uphold the fabric of contemporary class society not merely in the ways in which they classified their inmate but also in the methods they employed to secure their recovery and return to the world of responsible social behaviour.

9

The patient experience of the pauper and private asylum

Recent studies of the asylum have frequently noted the paucity of materials that give us insights into the patients’ experiences of life inside such institutions, or indeed their journey to and from these places. The care of lunatics during the nineteenth century generated a mass of legal, administrative and medical documentation unrivalled in most areas of government provision, though we have very few personal accounts from the people who were the subject of these provisions. In this chapter we attempt to provide some comments on the asylum inmates and the various ways in which they understood their environment and the world they inhabited. These necessarily involve some consideration of the delusions they expressed and which were recorded in the papers of the Devon County Pauper Asylum and the Wonford House private asylum near Exeter.1 Our main concern is to compare and contrast the testimonies that relate to different patients, as well as the character and quality of materials produced by different kinds of institutions in this period. For we suggest here that in the interpretation of the materials that relate to the Victorian asylum patients, we need to understand not only the different agents who contributed to the composition of the documents but also the purpose of these documents and for whom they were provided. One of the most obvious and important audiences was the Lunacy Commissioners who were responsible for regulating and inspecting such places. Along with a sensitivity to the scientific and medical press, there was also inevitably some concern with the public media which would report any unusual or sensational events at the institution. In that context we have frequently noted the importance of the Poor Law authorities with regard to pauper patients, as well as the family and friends of those who were committed. Finally, it is worth noting that private and fee-paying patients were attracted to institutions that maintained a good reputation for care and discretion in these decades. The Devon County Asylum was designed to differentiate male and female inmates as well as those classes of patients who exhibited very challenging forms of behaviour. As noted earlier, the building was arranged in a semicircular arch of two storeys, extending for hundreds of feet, eight galleries radiating outwards from a central administrative hub. Within these long

The patient experience 177 galleries were the dormitories, sleeping rooms and day rooms in which the inmates were accommodated.2 Built to house 400, the asylum was already filled with about 500 inmates by 1860 and the second half of the century was a period of almost relentless expansion. From the early days the majority of inmates were sleeping in dormitories (almost 200 women and more than 100 men in 1852), though significant numbers were also placed in single bedrooms.3 As the buildings expanded and space was absorbed, the original outline of the institution was elaborated and various kinds of staff as well as patient dwellings were constructed in the grounds. The single rooms were generally reserved for those individuals who were allocated a ‘caution card’, identified as either suicidal or dangerous to others or were noisy and disturbing at night. Each ward was allocated day rooms in one of the galleries or in one of the blocks ‘intended for their recreation’.4 Increasingly, as gallery and dormitory space expanded, the entire complex was joined together by long corridors that proved difficult to keep warm in winter despite fireplaces at regular intervals. The segregation into wards and dormitories was done, first, on the basis of period of residence and treatment: admission wards for those fresh entrants and progressing to the chronic wards for those who had remained in the institution and for whom little progress was envisaged. A second criterion for the segregation of patients was the assessment made of the likely behaviour and conduct of the individual based on their diagnosis: so the noisy and demented were separated from the refractory, the epileptic and the suicidal, as well as the paralytic and helpless cases. Such distinctions were intended to enable the staff to manage these groups. The third and most obvious distinction made was that of gender. We have argued in Chapter 7 that gender relations were a fundamental feature of the asylum in its design and architecture and a consistent facet of asylum life into the early twentieth century.5 This chapter is concerned with the experiences of those coming to the asylum. In order to understand the diversity and distinctive characteristics of the patient population as well as their experiences at the institution, we need to investigate the circumstances of their admission as well as the ways in which they were diagnosed and classified within the asylum itself. The following section considers the main constituencies of patients in this period and offers an interpretation of the conditions in which many of those committed to the institution were certified and admitted. We have noted in an earlier chapter that the majority of both males and females were certified and committed as suffering from mania, melancholia and dementia. Men were more likely to be admitted with a mania diagnosis while women were more commonly than men identified as melancholia or demented, though the disparity in numbers between the sexes can be considered moderate rather than marked. Males were rather more likely to be recorded as suffering from idiocy and imbecility than females and men were much more liable to be diagnosed with general paralysis than women.6

178

The patient experience

While they were diagnosed in various ways, the patients’ experiences of asylum life in the later nineteenth and early twentieth centuries were inevitably influenced by the same physical environment. Asylum life was characterised by the steady growth in the number of buildings and facilities on the estate, which reflected the intense pressure of numbers encountered at Exminster during different points in the later nineteenth century. At different moments the institution faced serious overcrowding and by the end of the century was pressing the Lunacy Commission hard, as we noted earlier, to permit a major programme of building.7 Table 9.1 gives a profile of the admissions to the Devon asylum in our period and some impression of the impact on the swelling population of what became one of the largest asylums in England. In terms of the causes of insanity of those coming to the Devon asylum, an examination of the 1880–1882 intake suggests that most of those admitted did not have the specific cause of their illness identified in the documents available at registration. There were also some interesting differences between men and women arriving at Exminster, as Table 9.2 indicates. While the 1880–1882 intake were readily diagnosed in terms of mania, melancholia and dementia, the largest category in the ‘causes’ after the unknowns are excluded remains that of bodily ill-health and accidents. The female life cycle does figure, though not prominently, and is less important than ill-health (which included a range of maladies and complaints). The identification of hereditary causes was again limited to a handful of entrants, equal to the numbers supposedly suffering from insanity induced by religion. More broadly, the ‘moral’ causes of insanity were again limited, as were reported cases of intemperance. General paralysis figured prominently in the diagnosis of male insanity, though it is hardly ever directly attributed to sexual intemperance or even to hereditary influences. This indicates that the general terms in which such diagnoses were made and the clinical links to specific conditions were often not well understood.8 Another way of assessing the patient experience at the Devon Asylum is to consider the length of time people spent inside its walls. In 1892 the asylum population reached 1,000 for the first time.9 Broadly speaking, the asylum saw a distinctive pattern of admissions and discharges over the decades, though the pattern varied somewhat between males and females. The evidence of discharges for males measured by year of discharge is that there was a rising number of those leaving from the 1850s to the late 1860s, as we would expect, with large numbers leaving recovered, though death also accounts for a substantial proportion of these departures, particularly for males. We have shown in Table 9.2 that annual admissions rose steadily after 1854 to about 200 by the late 1860s. It is noticeable that many of the ‘hopeless’ patients who entered Exminster in its very early years remained for many years, but the average length of stay declined markedly in the 1850s. The average length of stay rose again in the 1860s, along with a larger annual intake of patients, and increased again in the 1870s and the

The patient experience 179 Table 9.1 Exminster Asylum, patient admissions, 1845–1914 (4,000 and 13,000), by length of stay Year of admission

Numbers (among 4,000) of those entering

Estimated total (among 13,000) number entering

Average stay of all 4,000 patients (Days)

1845 1846 1847 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885

59 41 35 36 32 40 38 33 34 35 48 48 46 48 53 52 46 58 48 58 54 45 57 61 64 66 56 51 45 47 50 49 52 51 61 74 55 53 51 44 42

192 133 114 117 104 130 124 107 111 114 156 156 150 156 172 169 150 189 156 189 176 146 185 198 208 215 182 166 146 153 163 159 169 166 198 241 179 172 166 143 137

3,783.5 3,485.9 2,721.3 2,152.1 2,188.3 2,046.9 1,411.7 1,484.0 1,365.5 2,465.8 0,862.6 2,044.8 1,022.9 1,891.2 0,792.2 1,939.2 0,946.0 2,643.4 1,781.3 1,685.3 1,941.9 1,587.0 1,718.6 1,949.9 1,890.2 1,376.8 1,939.5 2,520.8 1,433.3 3,212.5 1,796.7 2,020.7 2,128.9 1,941.5 2,418.2 2,678.4 2,000.4 1,500.5 2,160.5 2,515.8 2,299.8

continued

180

The patient experience

Table 9.1 Continued Year of admission

Numbers (among 4,000) of those entering

Estimated total (among 13,000) number entering

Average stay of all 4,000 patients

1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914

45 41 45 55 71 67 63 73 76 64 69 57 47 75 75 79 73 74 91 79 90 81 73 81 83 71 84 92 18

146 133 146 179 231 218 205 237 247 208 224 185 153 244 244 257 237 241 296 257 293 263 237 263 270 231 273 299 59

2,391.5 3,533.2 3,333.0 2,078.1 1,904.5 2,148.7 1,910.5 2,169.0 2,085.4 2,078.9 2,332.0 1,466.7 1,919.0 2,049.9 1,636.5 1,354.4 1,522.1 1,016.9 1,468.5 1,429.3 1,263.5 1,264.4 1,401.8 0,942.4 1,093.7 1,091.7 1,154.0 1,106.2 0,867.2

late 1880s. Only at the end of our period, and more particularly after 1896, is it possible to detect a clear drop in length of stay due to improved rates of recovery as well as the persistence of mortality within the institution. We have noted that almost half of all males admitted to Exminster died there, compared to 42 per cent of females, and that only one-third of men left as recovered in comparison to two-fifths of women. Recovery rates for the two genders varied somewhat over the period as a whole. While admissions continued on a steady if moderate incline over the period as a whole, we see a noticeable decline in recovery rates during the mid-1870s and the mid1880s, again more especially for the male intake. Thereafter the numbers discharged as recovered increase, more clearly for females, though the death rate

The patient experience 181 Table 9.2 Exminster Asylum, patients admitted, 1880–1882: recorded causes of insanity, by gender Males (%)

Females (%)

Unknown Heredity Epilepsy Childbirth/confinement Menopause Ill-health/accidents Intemperance Fright Religion Grief/death Disappointments in love Overwork/over study Troubles/worry (including money)

156 (60) 10 (4) 9 (3) 0 (0) 0 (0) 34 (13) 9 (3) 0 (0) 10 (4) 8 (3) 1 (0) 5 (2) 16 (6)

170 (64) 6 (2) 5 (2) 10 (4) 3 (1) 25 (9) 2 (1) 6 (2) 6 (2) 9 (3) 7 (3) 0 (0) 15 (6)

Total

258 (100)

264 (100)

remains high for both males and females down to the end of the period. The proportion of those discharged ‘relieved’ or ‘not improved’ was modest throughout the period, though the proportion rose markedly (for males) after 1880 and remained a significant element in those discharged until the end of the century. There is a clear contrast between the poor rates of recovery and high death rates for men seen during these periods and the higher and more consistent recovery rates recorded for women, who on these criteria fared much better in the Devon Asylum. By the turn of the century the diagnosed recovery rates appear to have improved markedly, the Visiting Committee noting that, whereas the recovery rate for England was little more than onethird of admissions (35 per cent recovered, the English asylum death rate being 9 per cent), the corresponding figure for Exminster was about half recovered (with a death rate of only 6 per cent). This improvement in recovery rates implies that the sharp criticisms made of the asylum in the Lunacy Commission reports had prompted progressive change in the treatment of patients. However, we should read such testimony in the light of other evidence such as the note made in 1912 which stated that death rates for the inmate population approached 17 per cent.10 Figure 9.1 indicates the trend. It is interesting that when we compare these figures to the numbers who were discharged by year of admission, a similar pattern can be detected: those admitted in the 1860s were noticeably more likely to leave recovered than the men and women admitted during the 1880s, with a significant increase in numbers of males (though fewer females) discharged relieved or ‘not improved’ after 1885.11 Explaining the pattern of admissions, discharges and deaths at the asylum is not easy, but one possible reason for the rising tide of deaths at different points in the history of the institution may

47 18

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

11,000

50 18

53 18

56 18

59 18 62 18

68 18

71 18

Dying in DCA

65 18

Not improved

86 18

89 18

92 18

Recovered and relieved

74 77 80 83 18 18 18 18 Centre of year range

95 18

98 18

Figure 9.1 Exminster Asylum, patients admitted, 1845–1914: length of stay and outcome of stay, by five-year averages.

Stay in days

01 19

04 19

07 19

The patient experience 183 be found in the inexorable pressure on its accommodation and staff, Exminster having one of the highest ratios of patients to attendants by the end of the 1880s when death rates peaked.12 As overcrowding deteriorated again at the turn of the century there were various complaints of rough treatment, though most appear to have been rejected.13 Even if neglect played a part in the deaths recorded at Exminster it is also apparent that many of those sent to the institution arrived in what one superintendent described as of ‘the most unfavourable’ condition, with poor prospects of recovery.14 Such comments echo the remarks made during Bucknill’s tenure with regard to the poor physical as well as mental health of those who were brought to the asylum. In October 1845, Bucknill received Susan M., who arrived in an undressed state from the Totnes Union, provoking the acid comment of the asylum authorities that her shameful condition ‘arose from the hardness of the Parish Officers who had refused decent clothing’.15 Sarah S. was admitted in September 1847 in some distress, after the death of her husband had led her to fall behind with her rent and the loss of all her goods. Her despondency was so great that she would ‘sometimes lie on a bed one or two days together’.16 Men as well as women were often in poor social as well as personal circumstances, as when William S. arrived in 1872, his wife having just given birth to a ‘hydrokephalic’ child and the family in a destitute condition as they all experienced sickness and incapacity for work.17 The Lunacy Commission were alarmed to find that a Sidmouth woman had been grossly neglected prior to her admission to Exminster in 1876. A prominent clergyman in Dorset discovered her condition. On enquiry the woman: gave an unintelligible, wild, and chattering answer . . . her arms, which she threw about, were covered with excrement . . . on the rug, which she had over her being turned up, the smell was so offensive that it was impossible to remain in the room . . . the bed and sacking under her were sodden with filth. She died at the asylum within a few weeks of arrival.18 Even at the end of the nineteenth century a man was admitted displaying ‘extensive bruises on chest, back, buttocks, arms and legs some of which look as if done by a stick’, rope marks revealing where he had been tied. He again died shortly after admission.19 Such accounts indicate that many who came to the Devon Asylum in the early years were frail or feeble. It would be an overstatement to assume, however, that in later decades pauper lunatics usually arrived in very poor bodily condition. The physical examination of those admitted to Exminster in 1880–1882 suggests that men were frequently in good or fair health and were also more robust on their arrival than were the women committed to the asylum. This pattern also held true for the minority of people who were identified in their certificates as non-paupers.

184

The patient experience

Table 9.3 Exminster Asylum, patients admitted, 1880–1882: bodily condition on admission, by gender Pauper admissions

Good Fair Weak Bad/feeble

Male

Female

35 71 84 42

24 66 107 45

Non-pauper admissions

■Male 3 11 10 3

Female 1 9 16 3

Note ‘Non-paupers’ are those identified as not paupers on their certificates.

Many of the men who were admitted in a ‘good’ or ‘fair’ bodily condition were, in fact, diagnosed as suffering from general paralysis of the insane and they were much more likely to die in the asylum than to recover. The male death rate remained significantly higher than that recorded for female and the women were noticeably more liable to recover than were men, even though they frequently appeared to be in poor physical condition on their arrival. This confirms the impression that the Devon Asylum provided a more congenial, or less hostile, environment for the recovery of female than male inmates.20 We have noted that women were more likely to be diagnosed with mania than melancholia and that the two sexes were diagnosed in roughly similar ways during the period as a whole. It remains to be considered how different groups of inmates were segregated and managed within the walls of the asylum. Men admitted with mania frequently heard voices, such as William K., who in 1872 told the staff that voices were calling him and knocking on the floor. Such cases were frequently presented as those of individuals who had failed in their working lives or aspirations and collapsed.21 Religious mania was another theme in the admission registers and case books. William P. confided to patients and staff that he was the Messiah, reading scriptures throughout the day in a loud voice and threatening to hang the Chaplain, leading to his exclusion from the Chapel.22 The aberrant behaviour of women was more commonly described in terms of failure in dress, decorum, manners and domestic or familial duties. Mary G. was aged 58 when she arrived from the private St Thomas Asylum (the predecessor of Wonford House) in 1848 and was diagnosed as a ‘dirty and destructive’ maniac. She expressed her anger at the husband who placed her in the asylum.23 The case portraits of women who were admitted with ‘mania’ often displayed symptoms very little different from those who entered identified as ‘melancholics’. Elizabeth S. arrived in March 1903 and spent the day lying in bed, ‘quiet and silent, taking no interest in her surroundings’.24 Men as well as women exhibited symptoms strongly suggesting melancholia, including Charles B., aged 25, who was admitted in July

The patient experience 185 1893 and ten years later he continued in the asylum, ‘mentally very despondent’, asking to be allowed to die.25 Among the more flamboyant personalities within the patient population were those who claimed to be famous historical figures, though these were variously diagnosed. John N. was an unmarried accountant of Plymouth who arrived at Exminster in the summer of 1894 certified as suffering acute mania and proceeded to compose long letters to a London solicitor in which he claimed: I am Earl of Balcarries of that Ilk and I am unjustly confined in the above asylum. I was hocussed into it in June ’94 . . . please proceed to start proceedings to get me out.26 Some of the female inmates similarly claimed an elevated rank in society. More poignant in many respects were the women suffering from distress with regard to childbirth, rearing children and dealing with the deaths of family members. Sarah C. delivered a son in 1861 but developed an aversion to the child as well as her husband.27 Another woman had been ‘worn out with watching and grief for the death of her only child’, having previously delivered a stillborn infant.28 Sarah B. was a farmer’s wife who lost both her husband and her eldest son and ‘never recovered her natural spirits’. She was admitted in July 1847 as a private patient and recovered within a few months of treatment, which included opium and ether.29 Many of the women diagnosed as melancholic had suffered multiple losses or bereavements, including Jane J. who lost three children before the death of her sonin-law and grandchild led to her mental collapse.30 Some of the descriptions of people admitted implied the sexual as well as physical abuse of those certified. Louisa G. was 28 and described as ‘demented’ and ‘enfeebled’, as well as previously suicidal, having had an illegitimate child by some man who had ‘taken advantage of her simplicity’.31 Another young woman of 17 had served a master since the age of nine, who had used her ‘very ill’ and had been ‘punished for his conduct’.32 Financial distress drove other people to the brink of disaster. A young wife had tried to kill herself and her new baby, after being threatened with eviction by the bailiffs.33 Male entrants were frequently in personal and physical crisis due to financial problems as well as sickness.34 Religious delusions figured prominently in the accounts of some female as well as male patients at Exminster. Other inmates endlessly repeated questions or walked as though treading on glass.35 Managing the more difficult patients within the wards of the asylum remained a challenge for the overstretched staff. Many of the patients were crying and sobbing while others groaned, wailed or simply lay on the floors of the galleries or ran about the airing courts.36 Violence against staff and the concealment of weapons remained a serious concern, requiring constant vigilance amidst the bizarre behaviour which some patients exhibited.37 Mechanical restraints were resorted to even in the early twentieth

186

The patient experience

century when violent behaviour could not be controlled by persuasion or drugs.38 The small group of deaf and mute patients frequently deteriorated to become ‘wet, dirty, destructive and irascible’, unable to communicate, or they lay quietly with a ‘vacant listless expression’.39 The ‘refractory’ inmates described in the asylum records included some described as ‘demented’, including a significant sprinkling of ‘senile dementia’ diagnoses. Such references alert us to the growing number of older patients within the asylum. Many of these did not enter as older patients but had grown old inside the asylum walls. Quite a number did so, and it is worth spending a little time considering the experience of the older patient at the Devon Asylum. The length of stay of a significant minority of adults in their middle or even young years led to an accumulation of older patients who were more noticeable at the end of the nineteenth century. Many of these individuals who had limited prospects for recovery and release were transferred to ‘chronic’ wards, and allocated to case books where limited notes on their condition were entered. Mary H. entered Exminster in May 1872 aged 45, having been deserted by her husband, after a previous period in the asylum. In good bodily health, she was diagnosed as demented and at an early stage she was characterised as ‘not much changed’. A decade later she was simply transferred to the Chronic Case Book.40 These older admissions were frequently described as in a depressed or ‘desponding’ condition on their arrival, being physically as well as mentally ill in the view of the staff recording their admission. William P. had been neglecting his business, Edward C. was portrayed as ‘a harmless old dement’ who had been a frequent inmate of prisons.41 The reasons for their admission can be traced in the reports of their inability to cope in their own household as well as the disinclination of relatives to maintain them any longer. William G. had been cared for by ‘a man from the parish’ until his riotous behaviour and carousing led to his certification, when he continued to express concern about the state of his potato patch.42 In some instances at least older inmates had encountered abuse by their relatives as well as inflicting violence on their family members.43 Community violence was also an occasion for the certification of some older people. Bucknill told a Select Committee of Parliament about the ‘curious case’ of an elderly woman who was certified as insane, having also been attacked by four youths in her village who claimed to be bewitched by her. They had broken into her home and, to take off the witchcraft, they had cut slashes in her arms and left her bleeding. They had drawn blood to remove the witchcraft. This woman was certified as having had delusions. She was quite sane and remained sane. It was a mistake.44 The elderly inmates did not all die in the asylum, and women in particular were capable of recovery even if they entered Exminster in old age. Table 9.4 indicates the outcome of asylum residence for those aged 60 or more.

The patient experience 187 Table 9.4 Exminster Asylum, patients admitted, 1880–1882: elderly versus all patients Age groups

Recovered

Relieved

Not improved

Died

Not found insane/ unknown

Total

Male 60–69 70–79 80–89

11 2 0

2 2 0

0 1 0

19 12 1

2 0 0

34 17 1

Female 60–69 70–79 80–89

11 4 0

3 1 1

2 0 0

28 8 2

0 0 0

44 13 3

Not found insane

Unknown

Total

4 5

2 1

259 276

All age groups of patients admitted Male Female

84 102

25 36

10 17

134 115

In general, an analysis of the length of stay of older admittants in 1880–1882 indicates that people aged over 60 were much more likely to die in the asylum than the patient intake as a whole, usually within the first year of their stay at Exminster. Those who were discharged as ‘recovered’ almost all departed within a year of their arrival, though some older women also left as cured at a later date.45 At the other end of the scale from the elderly patients were the children who came to the Devon Asylum in the period 1845–1914. An obvious but important point to make is that the Exminster patients were almost all adults and they were increasingly elderly and longer-stay residents in an ageing institution. Among the 13,000 admissions recorded in these years were a little more than 100 children aged between four and 14 years. About two-thirds of these children were male. About one-quarter of the children came from the workhouse, though few of them were orphans and the majority were clearly identified as having a father or mother as their nearest relative. Though all ages were represented, it is noticeable that boys of 14 were prominent among the males in the group.46 About two-thirds of this group were clearly identified as ‘idiots’ or ‘imbeciles’, while many of the remainder were described as ‘fitting’, i.e. epileptics. More detailed analysis of the children confirms the prominence of boys (and girls) who were diagnosed with idiocy or imbecility.47 One of the earliest arrivals was six-year-old Jane M. whose condition was described in highly sympathetic terms, as she reclined in a day bed within a

188

The patient experience

year of her entry in 1847. She died in 1854. Giles H. came in the same year as Jane, also being brought by his mother after fitting. He remained only until 1848 when he died.48 Some children were described as an idiot or imbecile, implying an assumed congenital defect, as well as suffering from epileptic fits. John R. was only seven when he came to Exminster in 1873 and died there a year later.49 While many of the children appear to have been placed in the workhouse prior to their asylum admission, families were frequently if not invariably involved in the decisions made as to the certification and committal of the child to Exminster. In many instances the children were reported to have behaved violently in the family home.50 When a Barnstaple child was the subject of discussion in the 1850s, not only the Medical Officer but also the parents were interviewed by the Guardians prior to an appeal to the Lunacy Commissioners in regard to the most appropriate accommodation for the boy.51 The evidence suggests that in most cases the Poor Law authorities were convinced of the need for asylum committal, possibly for a lengthy period, when it was believed that the child was not only difficult to manage but also posed a serious threat to themselves or others around them. Hazards posed by fire, matches and other forms of accidental harm figure prominently in discussions of the committal of the child. Mary Ann M. was five years old when she was sent to Exminster in 1851, her behaviour being described as violent and dangerous.52 Families often struggled against a rising tide of difficult and aggressive behaviour for long periods before they approached the Poor Law.53 Boys on the threshold of adolescence were seen as particularly dangerous to themselves and others, such as Ernest W. of Brixham who was described on his entry to Exminster in 1903, aged 12, as having been ‘a proper Lunatic for the last two years and yesterday he tried to hang himself’.54 While the risks posed to families and local communities were frequently cited in cases of child admission, the evidence indicates that the domestic circumstances of many of these children were difficult and distressed. Henrietta V., aged six, was discovered by a local clergyman, [I]n a Cradle much too short for her, with her hands tied together at the Wrists, and her ankles tied together, and the body fastened down by a cord passed across the chest. She was making inarticulate noises, and was violently beating her face and head with her fists. She appeared entirely void of intelligence.55 His pleas were little heeded until he wrote to the Home Office and the Lunacy Commission, the latter ordering a physician to examine her prior to her removal to the Devon Asylum.56 Ethel Annie was chained in a passage all day by her father as he attempted to control her ‘destructive habits’. John L.’s mother found his behaviour so intolerable that she was ‘obliged to tie him up with a Dog Chain’.57 Prosecution seldom followed such events.

The patient experience 189 There was no separate ward accommodation at Exminster for these younger inmates, though the Visitors did discuss making separate institutional provision for the admission of idiot children in alliance with other asylums during the 1890s.58 In 1907 a visitation from the Lunacy Commission reported on the warding of small idiot boys in adult accommodation and recommended the provision of a separate room with ‘some toys and other means of amusement’ for their recreation and instruction, which was duly provided by Superintendent Davis.59 The long-standing reluctance of the asylum Visitors to accept children as eligible patients in the asylum is well documented in the minutes of the institution, even where the young person was 14 or 15.60 Most of these children, and more particularly the boys, remained in the institution for a short period only, almost half the males staying for less than three months. A small but still significant cluster became long-stay residents, more than one-third of the females living on for many years at Exminster. The outcome of their stay was frequently rather bleak. Almost half of the child entrants died in the asylum, while one-fifth were discharged ‘not improved’ and a similar number left recovered.61 The inmate population was clearly a diverse and disparate one, with many distinctive groups and diagnoses featuring in the records. While children presented a certain difficulty to an institution which was designed for the care of adult lunatics, the most serious challenge to the maintenance of order within the asylum came from the suicidal. Sometimes those admitted were grieving for friends and relatives who had committed suicide.62 An analysis of admission certificates in 1880–1882 suggests that about 7 per cent of males and 5 per cent of females entering the Devon Asylum were reported to have suicidal tendencies prior to admission.63 They included Edwin H.B., a soldier of 27 who was admitted with ‘general paralysis’ in early 1880 following an earlier suicide attempt and a fever. He was liable to march up and down like a sentry and his mother found him ‘quite unmanageable’, constantly talking ‘and disturbing her quietude and comfort’.64 Richard L. of Brixham had made three determined attempts to commit suicide by different methods before certification when his ‘fits of excitability’ were attributed to a softening of the brain.65 Patients who continued to present a risk of suicide were the subject of a ‘caution card’ requiring placement in a special ward where attendants could be vigilant at night. A minority of patients attempted to kill themselves by a variety of methods, including ingenious attempts to throw themselves from windows, tie cords around their necks or use a range of sharp and blunt objects to end their lives, including even tape for Christmas decorations.66 One woman set fire to herself and resisted the attempts of the nurses to extinguish the blaze, an incident noted by the Lunacy Commission.67 One of the best documented suicides involved Jane P. who was admitted in February 1873, having been ‘intensely melancholic’. In June she rose from her bed and engaged another patient in a ‘rational and composed’ conversation before hanging herself in the asylum gardens. The case book commented

190

The patient experience

that the expression of quiet composure she displayed in death was ‘rarely seen . . . in life’.68 Suicides even occurred inside the padded and secluded cells in which some of the high-risk patients were placed for their own safety.69 Escapes of suicidal patients were also a challenge for the staff of the asylum, patients sometimes running to the nearby Great Western Railway to throw themselves under a locomotive.70 On another occasion, two inmates, thought to be suicidal, were discovered in the local public house ‘comfortably sipping their pot of ale’. The attendant was dismissed.71 In other instances suicidal patients pleaded to be re-admitted to the asylum or even placed under restraint, with staff criticised if they allowed open razors to be left within the reach of such patients.72 Attendants and medical staff at the Devon Asylum were, as the Lunacy Commission periodically noted, relatively few in number and burdened with a heavy workload of patient care. In our earlier chapter on treatment we indicated the limited contact which was practicable between medical personnel and individual patients as the size of the inmate population ballooned in the third quarter of the nineteenth century. Many individuals simply languished for years, often being transferred to the ‘chronic’ case book. However, the asylum sought to employ inmates in useful labour wherever possible. By the early 1860s, the asylum possessed an inmate population of about 270 men and 350 women. Roughly 200 of the males were employed in some kind of work, 50 in the gardens and almost 40 in ward work. Others worked on the farms and the various workshops of the asylum estate, often assisting named officers.73 The females were confined to a more limited range of specific domestic occupations within Exminster, mostly in needle work, ward work and domestic labour.74 This picture remained broadly consistent for the remainder of the nineteenth century.75 Many of those committed to the Devon Asylum in Exminster were regarded as incapable of anything more than simple tasks in the wards. It was said of Ann C. in 1847 that she ‘knows the other patients by name and will fetch them when desired to do so . . . [and] can be made useful in carrying beds’.76 Edgar McK. was similarly occupied in wheeling about ‘infirm patients’, while another cleaned the fireplace and brushed up.77 Other inmates were able to travel from their ward to work in the kitchens and other parts of the asylum estate, with women engaged in domestic tasks alongside the asylum employees, or attending their knitting and sewing within the wards.78 These tasks were often rather basic and those employed on more complex work could not sustain their responsibilities for long periods.79 For most patients daily life in Exminster probably followed a regular and increasingly monotonous routine. As one patient wrote in 1873: the rain continues to pour down here every day, and we have not changes of apparel for every degree of temperature, but just one suit for wet and dry, hot or cold, not exactly as well as the sheep, for they can be shorn to equalise the temperature, but I believe they bestow equally

The patient experience 191 as much care as to the number, for, like the sheep, we are counted in and out.80 Sudden acts of violence, escape or midnight dramas were the exceptions rather than the rule in an institution that contained hundreds of patients across its large and expanding array of buildings in the Victorian and Edwardian years.81 Most individuals who recovered at Exminster appear to have done so with limited intervention from the medical staff. The documentation that survives for the asylum indicates the great diversity in the physical and mental condition of those admitted. Their ages and familial circumstances, as well as the capacity for recovery, also varied, as we have noted in earlier chapters. In reaching decisions on the discharge of individuals from the asylum, the Visitors and the medical staff took into account not only the medical improvement in the patients under their care but also the circumstances to which they were returning. In a recent commentary, David Wright has suggested that the process of asylum discharge requires serious investigation, including the role of family in the release of inmates.82 The evidence from the Devon Asylum suggests that there were a number of different agents involved in the discharge as well as the admission of people to such institutions, including the asylum Visitors, who had received rather less attention than Poor Law officials and family members. It is worth recalling that many of those admitted to Exminster had experienced very difficult family circumstances and the domestic situation of people returning to the community were frequently, if not invariably, assessed prior to discharge. These included many older patients who had arrived believing they were forsaken by God, having worn out their family as well as their friends in their despondency.83 Many younger women had been badly treated in their family homes or the service of others before the committal, or were judged incapable of useful employment.84 Some of those living in the asylum expressed their reluctance to return to their own homes or those of their relatives. Elizabeth B. had worked mangling clothes before her committal, but on learning of her impending release in 1848, she became restless and excited, quarrelling with other patients without cause. She explained that ‘thoughts of going home upset her’ and that she had been ‘of a very nervous disposition’ all her life.85 Another, much younger, woman was permitted to remain for six months when she broke down and cried at the news of her discharge in 1876.86 Such cases were unusual, many patients expressing an anxiety to leave when they felt recovered or even as they insisted that they were wrongly confined.87 Individuals were often said to be ‘anxiously asking whether or when she should go’ or ‘worrying everyone to let her go home’.88 In assessing the suitability of a candidate for discharge, the attendants would often comment, along with the medical staff, on the observed behaviour of patients in the wards. Improvement in mood and freedom from

192

The patient experience

delusion were significant, as was the ability to work regularly and to interact positively with other patients and staff. Staff paid particular attention to the rationality displayed, and in particular the extent to which a patient was showing a ‘connection’ with those about them and with their environment – which implied, in their view, a capacity for coherence and insight found in a rational person. Ann D. was said to speak ‘quite connectedly about herself and her family . . . and speaks freely of her old fears and delusions’.89 Such a demeanour was contrasted with others who showed themselves to be obstinate, stubborn or mistrustful and to express ‘very strong passions’ over which they had little or no control. When such a temperament altered to a ‘willing, obliging and useful’ manner, then discharge was considered a possibility. Such a recovery was often attributed to the ‘kindness and good management’ that characterised the institution.90 The majority of those ‘departing from’ Exminster Asylum died inside its walls. Almost half of the men and two-fifths of women inmates died there, and roughly half of each gender left recovered or relieved, the remainder being transferred or not improved. In 1860 the asylum authorities imposed on the Poor Law Unions of Devon a charge for the burial of patients in the over-full cemetery, unless they were willing to remove inmates for burial in their parish of settlement. The high number buried within the grounds of the asylum is reflected in the Chaplain’s comments in 1900 that he had buried more than 70 patients there during that year.91 The rates of discharge fluctuated across the period. The forms in which discharge could be made also varied. The terms of these releases were set by the Visitors on the advice of the medical superintendent, with different conditions attached to the discharge. A tiny number of admissions were discharged as ‘not insane’, together with a few whose documentation was not in order or was considered to have expired. There were 5–6 per cent ‘not improved’, often sent back to the workhouse from whence many had come. Even some who were seen as ‘relieved’ or ‘improved’ were sent to the workhouse rather than released to friends or relatives. Many more patients were discharged simply as ‘recovered’ with few or no conditions. A significant proportion of those released as recovered (also called ‘cured’) or relieved (or ‘improved’) were sent out on trial, usually for one month, during which their conduct and attitudes were monitored.92 By the end of the nineteenth century, the Visitors also appear to have permitted the release of patients ‘on leave’, without formal discharge, in order to assess their progress before legal release.93 In reaching a decision on the discharge of individuals, the Visitors often played a key role, examining a patient as well as interviewing relatives with regard to the release of an individual.94 Relatives would frequently request the discharge of a patient from Exminster. In 1852, Benjamin D. requested the discharge of his daughter on explaining to the Visitors that he had the means to employ a person to look after her. The sister of Henry C., a farmer, appeared before the Visitors to secure his release, explaining that ‘his friends are able to provide for him and they wish to have him home’. When

The patient experience 193 relatives failed to appear in connection with applications for discharge then consideration was deferred.95 At the end of our period, significant numbers were being discharged on trial, all having been in the asylum for less than four years and most less than a year.96 In other instances the requests of relatives that patients be released were flatly refused or declined after further enquiry. Application from a husband for the discharge of a wife was frequently granted, as was that of a wife for the return of her spouse.97 In other cases the applications were deferred while the Visitors made enquiries of the circumstances of the patient and the family, in one case the release being refused when the husband failed to demonstrate that he could provide adequate accommodation.98 The applications of relatives were frequently flatly refused without explanation, or where a relative was ‘unwilling to sign the usual undertakings’.99 Similarly the discharge of sons and daughters could be declined or granted only under strict conditions.100 In one instance the Visitors refused to release a patient to the custody of a mother whom they considered incapable of looking after her.101 William C. was discharged on trial before Christmas 1860 and, after interviewing his step-father, his final release to the care of this relative was agreed a month later.102 When the ‘friends’ of a violent or unstable inmate applied for their discharge, Bucknill and his successors often vetoed the release.103 If the application was agreed, there were usually conditions set involving a trial period or some kind of monitoring that families sometimes resisted. Even where relatives participated in the arrangements for the discharge of an individual from the asylum, the Poor Law authorities were frequently involved in the procedures for the delivery or accommodation of the individual concerned. In some cases an individual was released so that they might emigrate, even as far as Jamaica.104 In the early years under Bucknill, the asylum firmly refused to discharge inmates back to the Poor Law or families unless he was satisfied that they had recovered or, in the case of ‘idiots’, that adequate provision for their care had been made outside the institution.105 In later decades, some patients who were to be discharged without friends or relatives were sometimes simply sent to the workhouse, even though the Guardians might be reluctant to accept them.106 The Visitors were more likely to return those seen as idiots or imbeciles to friends, relatives or the workhouse, on the grounds that the asylum could offer little cure to mental defectives and was not able to cater for younger people. Some of those discharged ‘on trial’ were sent to the workhouse itself, rather than to family relatives, where they would be lodged at least in the first instance.107 The Poor Law Guardians were frequently contacted by the asylum authorities advising them of the imminent discharge on trial, of patients for whom the Relieving Officer made arrangements including accommodation. In such instances the person concerned may not have been able to rely on relatives.108 In some cases the Visitors agreed to discharge an individual only if the Poor Law Guardians agreed that the person would not

194

The patient experience

be placed in the Union workhouse.109 By the 1870s the Visitors were commonly granting some discharged patients an allowance of seven shillings per week during the trial period.110 Others were declined this allowance, on the basis that they or their families were capable of maintaining them even while they were not fully discharged.111 The allowances became the source of contention and conflict with some local Poor Law Guardians, as some Unions objected to repaying the cost of such allowances (even though the patient had not been formally discharged and they were therefore liable for the maintenance) on the grounds that the trial patient was being cared for by families with the means to keep them.112 In other instances the local Poor Law authorities expressed indignation at the release of a person on trial whom they considered dangerous and a threat to public order in the community.113 The asylum records and those of the local Poor Law Unions demonstrate the continued role of the Guardians and their Relieving Officers in the procedures for discharge as well as admission to the Devon Asylum. There is also considerable evidence that the officers of the Poor Law played a key role in transporting and placing discharged patients back in family homes or other lodgings on release.114 The Relieving Officers were also involved in negotiations concerning the liability of the patients’ relatives for the maintenance costs of asylum residence, in some cases surrendering their claim to reimbursement in return for family members assuming the care of discharged patients.115 Where the asylum authorities considered that the Union concerned did not provide sufficient clothing for the person to be released, the Visitors steadily refused to grant a release.116 The two largest public asylums in Devon – Exminster and Digby – were located within a few miles of the county’s most important private ‘hospital for the insane’, based in the village of Wonford on the outskirts of Exeter, offering a scale of charges for treatment by its well-known physicians. In the six decades after 1855, Wonford recorded almost 900 female and 800 male admissions, compared to about 12,000 admissions recorded at the Devon County Asylum in the years 1855–1914. Whereas the Exminster site housed well over 1,000 patients by the beginning of the twentieth century, Wonford House catered for a much smaller number of residents in a handsome building offering the privacy of separate rooms that was described almost as having the facilities of a hotel.117 When the 1881 census was taken, there were 40 male and 50 female patients at Wonford, cared for by the medical superintendent, R. Sutherland Phillips, and the surgeon Frank Shapley, assisted by 12 male attendants and 12 female nurses, together with a significant number of female domestic maids.118 A ratio of one attendant or nurse to every three or four male and four or five female patients was more than twice as high as staffing ratios recorded at Exminster. The patient experience at Wonford House was shaped by the rules laid out for the admission of patients to the institution and the terms on which their progress was monitored and their release decided. In marked contrast

The patient experience 195 to Exminster, Digby and other pauper asylums regulated under the Poor Law of 1834 and Pauper Lunacy legislation of 1845, Wonford evolved from its early charitable and subscription status to becoming a significant feepaying establishment by the mid-Victorian period. Regulated by the Lunacy Commissioners, institutions such as Wonford admitted patients without a Magistrate’s committal order. Their admission required the certification of an individual by two independent and qualified physicians and the authorisation of a relative or another responsible person. These differences in the terms of entry to Wonford House inevitably coloured the way in which patient care was offered and the decisions for discharge. The release of an individual could usually be secured on the application of the relative who had authorised their admission, or another close relative. We noted in the chapter on family relationships that close family relatives figured in most of the documents authorising admission to Wonford House, with husbands and sisters being particularly prominent for married and unmarried females respectively, with wives, fathers and brothers being most commonly given as the authority for married and unmarried men. The causes to which the insanity of those who came to Wonford was attributed reveal an interesting point of comparison with their contemporaries who entered the Exminster Asylum in the early 1880s, as Table 9.5 indicates.119 Much of the evidence for the ‘causes of insanity’, which frequently appeared in greater detail in the certificates of the two physicians who examined the prospective admission, appears to have been provided by the relatives who were central to the process of admission in private asylums. The fuller and frequently more florid information on the supposed causes of the insanity provided an insight into the relationships in which patients were engaged prior to entry, as well as the basis on which a diagnosis was reached. The causes of insanity of almost two-thirds of the Exminster intake of 1880–1882 were said to be unknown or not given, while the figure for Wonford was less than one-third of the sample for each sex. While this still represents the largest single category, specific causes were identified in more cases and these appear to have been much more varied and detailed than in many of the Exminster admissions. It must be acknowledged that in a substantial number of cases the certifying doctors were unable or unwilling to specify a precise cause for the insanity found in their patient. The information provided in the sample indicates that the personal and familial circumstances of the individual figured prominently in explanations of their illness, while the medical diagnoses (such as that of general paralysis of the insane) were less precise and rigorous than we might have expected.120 A number of people were re-admitted to Wonford, though few as many times as Julia S. who was admitted in 1856, discharged in 1872, readmitted in 1873 and discharged in 1881 but re-admitted in 1883.121 Some of those who arrived did so in violent distress – Sarah Ann G. arrived in a straitjacket in 1877 and was transferred to Northampton County Asylum

2.95 3.58 11.58 3.79 4.00 4.21 2.11 8.42 3.37 2.11 7.16 3.37 2.53 2.74 1.26 31.79 5.05 100.00

14 17 55 18 19 20 10 40 16 10 34 16 12 13 6 151 24 475 790

Total in Wonford admissions

60.13

4.63 4.00

(%)

22 19

Males

Alcohol, alcoholism, Anxiety and over-anxiety Change of life, climacteric, menopause Childbirth, confinement, puerperal Disappointment Domestic trouble Drink, dipsomania Epilepsy Heredity Hysteria Ill-health or injury Influenza Intemperance Mental anxiety, excitement, shock, stress Old age Over-work Over-study, overstrain, overexertion, strain Pecuniary loss, troubles Previous attack Religion, religious excitement, religious mania Sun stroke Syphilis Trouble Unknown Worry Total with above causes

Cause of insanity

100.0

2.78 2.41 0.00 0.00 0.00 0.00 1.77 2.15 6.96 0.00 2.28 2.41 2.53 0.00 1.27 5.06 2.03 1.27 4.30 2.03 1.52 1.65 0.76 19.11 3.04 60.13

% of all admissions

892

14 169 41 562

9 20 33 40 8 8 2 4 65 4 13 15 11 15 14 11 13 3 53 26

Females

63.00

1.60 3.56 5.87 7.12 1.42 1.42 0.36 0.71 11.57 0.71 2.31 2.67 1.96 2.67 2.49 1.96 2.31 0.53 9.43 4.63 0.00 0.00 2.49 30.07 7.30 100.0

(%)

Table 9.5 Wonford House Asylum, patients admitted, 1855–1914: recorded causes of insanity (major), by gender

100.0

1.01 2.24 3.70 4.48 0.90 0.90 0.22 0.45 7.29 0.45 1.46 1.68 1.23 1.68 1.57 1.23 1.46 0.34 5.94 2.91 0.00 0.00 1.57 18.95 4.60 63.00

% of all admissions

The patient experience 197 when the means for her maintenance were exhausted. Patients who were suicidal on entry or who became a danger to themselves or others inside the asylum were secluded in padded cells, sometimes for lengthy periods.122 Patients using the galleries and public rooms of the institution were expected to follow basic rules of decorum, language and behaviour. Serious lapses would lead to their exclusion and detention in particular rooms or wards where they could be kept under closer observation and tighter supervision, or alternatively were sent to a specific residence maintained at Dawlish for the convalescence of the female patients.123 The length of time during which patients remained inside the Wonford Asylum is likely to have reflected not only the perceived severity of their illness but also the inclinations of the relatives. Concerns expressed by families and friends were the usual basis for an individual’s medical examination. In some instances individuals who were not certified as insane (or, more usually, as of unsound mind) took up residence on a voluntary basis. In other cases, a reception order was issued for a specific time of residence that could be renewed or declined by the Committee of Governors on the advice of the medical staff.124 Most patients remained for a relatively brief period and for significantly shorter periods than those at Exminster. There was some variation between different marital groups as well as the sexes in this regard, though more than half of single men and women left the institution within a year of their admission. Less than one-quarter of these unmarried males and females remained for more than three years. More than two-thirds of husbands also departed before a year had elapsed, and less than 15 per cent remained for longer than three years. Wives remained rather longer, with just over half leaving within the year and a slightly greater proportion than men stayed more than three years. One reason for the brevity of the time spent by some males in Wonford was their early death within the institution. In this regard it is remarkable that noticeably more husbands than bachelors expired within the asylum, and substantially fewer married women than men died when in residence, though a much higher number of spinsters were to die within the institution.125 One of the most interesting points is that a substantial proportion of married men died within a short time of their arrival, a majority within a year of admission, while the smaller numbers of married women who died at Wonford usually did so after a much longer period of residence.126 A fundamental fact of patient life in Wonford remained the relatively early ‘departure’ of males as a result of death, particularly the husbands. There was also an important correlation between the marital status of females and the experience of life at Wonford. The patient experience of residence in this private asylum bears comparison with the Devon Asylum in that its pauper patients were also distinguished by a significantly higher mortality rate among husbands than wives and by the survival of a substantial number of single women within the asylum for long periods before they died there. Single women were more than three times more likely than

198

The patient experience

married women to die in the asylum, though a greater absolute number of spinsters also left recovered. Those single women who left after a brief stay were rarely doing so by way of death: only 20 unmarried women died within a year of entry (most of these did so within six months), another nine expiring within three years. Most of the single females dying at Wonford did so only after an extended residence. They included Susannah R., who first entered in 1858 and was re-admitted five times with her last and final entry being November 1883. Her final residence continued until her death in 1902.127 One explanation for the higher mortality rate of the husbands at Wonford may be found in their bodily health on arrival at the asylum. Most of the married men who died on arrival at the institution were described as in moderate, weak or feeble health while a majority of those who survived were said to have arrived in good or fair condition.128 The other group with a high mortality rate at Wonford were unmarried females. Fourteen spinsters died within a few months of their admission, but a large majority of unmarried fatalities at Wonford survived much longer than a year, some of them for many years. The reason for this longer period of stay may similarly be traced to their bodily condition on entry. Those spinsters who died within the first six months were markedly more likely to be described as in feeble and very poor health than in good or fair condition, while the unmarried women who survived for lengthy periods had arrived in what appeared as a healthy state.129 Discovering the reasons for different mortality rates among married and unmarried patients during these decades remains a formidable task, not least because the descriptions of physical condition on entry to the asylum provide only a limited insight into the robustness of the person concerned. It is possible that husbands were considered more valuable to the family household and were cared for at home until they reached a more advanced stage of illness than the comparative situations where wives were concerned. Unmarried females on the other hand appear to have survived in the asylum for considerable periods before their death while wives were more frequently returned to the family home. Acknowledging the importance of death among the private as well as the public asylum inmates in the Victorian period should not obscure the fact that most patients left recovered, following a relatively brief time in institutions such as Wonford House. It would appear that many relatives and at least some patients expected their stay within Wonford to be reasonably limited. The delusions and hallucinations of the patients were frequently described in detail and a variety of ‘visions’ affected a large number of those admitted. Susannah R. of Topsham declared that all the patients should be freed immediately since this was what the Queen desired, while Charlotte C. went further and announced herself as the Queen of England when she arrived in 1882. The delusions expressed by men were often less florid but more absorbed in the mechanics of everyday life and business, such as the schoolmaster William M. who was admitted in 1874 suffering from

The patient experience 199 melancholy and explained that his ideas were ‘fused one into the other’, comparing this ‘to the carriages in a railway collision’. So vivid were these images that his auditory hallucinations included ‘the whistle of an Engine’, which prompted both words and ideas.130 The treatments offered to the patients at Wonford depended initially on their state on arrival, including the use of restraints, seclusion and other forms of supervision noted earlier, where the individual showed violent tendencies. Whereas the case books of the Devon County Asylum are replete with references to opiates and other drugs administered in the Victorian decades, there is relatively little discussion of such use in Wonford House.131 Detailed analysis of the case notes of individual patients would be impracticable for any but a limited minority of patients. In order to provide a point of comparison across asylums as well as within Wonford, we undertook an analysis of female educationalists who were admitted to the asylum in the period 1855–1914, more particularly the group of governesses and schoolmistresses recorded in the admission register of this private establishment. Most of our examples are drawn from these groups of patients. In some instances the patients were suffering from opiate addiction prior to their entry to the institution, including Catherine L. who arrived in 1868, estranged from her family and friends and troubling the police as well as her neighbours. She readily admitted to having ‘drank Laudanum regularly’. Catherine progressed within the asylum to a point where she was invited to take tea with her physician and Mrs Matthews (the housekeeper) on her birthday, though she took the opportunity verbally to assail Dr Shapley for being involved in a conspiracy against her. After recounting further visions of a physician and destroying objects she was removed to the Refractory Gallery and, in 1871, she sprinkled her urine about her bedroom, was continually sullen at her detention and refused to speak to the senior staff. She was discharged as relieved in the autumn of that year.132 The case of Catherine L. exhibits many of the features of treatment and patient progression within this private institution. Conversation as well as manners and the capacity for association with other patients were considered vital social skills, marking out the rationality of the individual, alongside close observation and commentary from the staff members (particularly the housekeeper in the case of females), which provided the basis for an assessment of the mental state of the patient. When sufficient improvement had been recorded, the patient would frequently be released for a trial period of ‘leave’, prior to their formal discharge as recovered or improved, sometimes under the direct supervision of senior staff from the asylum.133 Not all of those who were discharged from this asylum left with the support of the medical staff or even the Committee of Governors who approved the release. The formal application for the discharge of an individual was usually made by a petition from a relative or interested party to the Governors. In these cases the ‘authority’ for release was assumed by the person or persons making the petition, who might include a physician

200

The patient experience

alongside a relative. Where a petition was considered irregular, the discharge was declined. Fathers, mothers and other close relatives figured prominently in the discharges, though in at least some instances the asylum physicians were clearly reluctant to support such releases.134 Eversell W. was discharged ‘relieved’ in early 1902 at the insistence of her sister, only weeks after she had been judged very dirty and destructive, doctors commenting that her condition warranted ‘only a very guarded prognosis’. In other instances relatives were clearly unwilling to accept a patient back into their home even though the asylum physicians may have believed that they had given as much treatment as they could. Mary F. was a single school mistress who was admitted in 1891 and by 1894 was ‘always asking to be sent home’, believing that her relatives were ‘wanting her’. She was transferred to another private asylum ‘not improved’ in spring 1896. A number of those being transferred were sent to public rate-funded institutions, including Digby, presumably when their resources had been depleted and a cheaper alternative was being sought.135 Representing the personal experience of certification and admission to the asylum is a problematic task, involving an interpretation of different documents as well as making assumptions about the patient’s understanding of his or her environment. The patient case notes offer us only some deeper insights into the perceived circumstances of those individuals who were described, rather than factual evidence from which we may compose reliable portraits of patient life. These sources frequently offer some details of the attitudes as well as the behaviour of the person admitted, partly because these opinions, mannerisms and actions usually provided the ‘facts of insanity’ that justified certification. Occasional letters have survived although the authentic ‘voice’ of the patient must be largely discovered through the abundant sources that document the admission, treatment and discharge of the individuals we have discussed in this chapter. The chapter has been concerned with an examination of how we might reconstruct the patient experience of the Victorian asylum by comparing the pattern of admissions, treatment and discharges at the Devon County Asylum with the distinctive features of Wonford House from the mid-nineteenth century until 1914. It has been argued that the experience of patients within these places reflected to a considerable extent their position and resources prior to their admission, as well as their different capacities for coping with the confined life of the institution. The diagnoses for Exminster, Digby and Wonford remained fairly consistent in that mania, dementia and melancholy continued to dominate the certification of patients who entered these places in our period. In the later Victorian and Edwardian years, it is possible to detect more specific and elaborate terms such as ‘delusional insanity’, ‘neurosis’ and ‘dementia praecox’ appearing in case notes that had once been completed with references to ‘monomania’ and ‘religious mania’. It is noticeable that the case notes of the various asylums, including the fee-paying establishment at Wonford House, continued to make

The patient experience 201 frequent references to the ‘dirty’, ‘destructive’ and even ‘repulsive’ behaviour of its inmates, as well as unflattering references to the physical appearance or posture of those being cared for within its wards. The Wonford notes provide a more detailed and frequently more florid commentary on their patients, as well as rather more polite descriptions of their manners, probably reflecting a continuing concern with genteel social manners and sensitivities as a guide to rationality and the recovery of the senses. The profiles of patient life we have discussed also underline the importance of differences in gender, marital status and social position portrayed in the asylum records. The unmarried were clearly over-represented in the Devon asylums, though women appeared to survive such confinement far better than their male counterparts in the fee-paying institutions as well as the rate-aided establishments. More striking is the evidence that males, and more especially married males, appear to have fared so badly in terms of mortality once they entered the asylum, many of them dying within years or even months of their arrival. One clue to some of these deaths may be found in the reports of the bodily condition of those who came to the asylum, for among the Wonford as well as the Exminster admissions we find that those who were in poor or feeble condition died, while those in good health survived much longer. Further clues can be deduced from the causes of insanity, though a large number of diagnoses were made with their cause left unknown (more particularly in the Devon Asylum), and among the remainder it is apparent that physical illness and changes in the body due to age figured largely in the explanations of insanity. On their arrival at the institution, the patients were faced with a range of services and amenities that included kitchens, laundries and grounds as well as wards, galleries and recreation rooms. The patients in both institutions were expected to occupy themselves in moving towards recovery, though an important contrast between the pauper institution and that where clients paid fees lay in the expectation that the inmates of the public asylum would labour at a range of manual tasks, if capable, while in the private institution the emphasis was upon private work and a capacity to engage in social discourse and display appropriate manners in association with others. A distinction may be drawn between the employment of both male and female patients in manual tasks at the Devon Asylum, roughly divided between outside labouring for men and indoor domestic duties for women, as compared to the recreational activities available to recovering patients at private asylums such as Wonford House. In the latter case, residents were more likely to encounter domestic servants providing for their care and comfort rather than as role models for their own re-engagement with social responsibility and employment. The path to recovery is not always easy to detect from the materials examined. The use of opiates as well as physical restraint and seclusion were well-established features of the private as well as public institution very late in this period, while most patients appear to have been encouraged to recover their reason by engaging in communication with staff

202

The patient experience

and other inmates, as well as by taking advantage of the extensive grounds and the opportunity for recreation. The progress of patients was monitored by staff and reports of improvement preceded almost all discharges of recovered and relieved inmates from Exminster, though in the case of Wonford the departure as well as the entry of patients followed a different pattern. Relatives and friends were frequently a significant presence in the decision of the Visitors of Exminster to discharge individuals, on the advice of the medical staff, though the power of the Devon Asylum Magistrates was undoubtedly greater, and their capacity for resisting the requests of relatives more potent, than was the case in Wonford where the relatives usually provided the authority (and resources) for the discharge as well as the admission of their family members. While we have stressed the scope that existed for individual patients to influence the perceptions and assumptions of them by others, it seems clear that they were being acted upon far more frequently and powerfully than they could usually affect the actions of others. This remained one of the fundamental qualities of asylum life even when they moved towards recovery and re-entry to the society they had left on entry. By the turn of the nineteenth century there was a strong belief in Britain as a whole that long-stay confinement was necessary for large numbers of lunatics, and this was in keeping with a burgeoning discourse throughout Great Britain and elsewhere concerning belief in the innate nature of lunacy and feeblemindedness. The fear was that inmates of lunatic asylums, if unchecked, would breed their own kind and, indeed, through sheer numbers resulting from their presumed promiscuity, significantly undermine the strength of the race. This is evident in Devon. Lord Clifford, Chair of the Exminster Visitors, declared in 1908 to the Royal Commission on The Care and Control of the Feebleminded, which recommended the creation of separate institutions for this group of people: ‘it appears that in Devonshire the pressure on the county lunatic asylum has been very acute. To a great extent this has been caused by the readiness with which idiots, imbeciles and epileptics have been certified as lunatics and sent to the asylum.’136 The Chair of Devon County Council, Sir Thomas Dyke Acland, left no doubt that his major fear was of proliferation of hereditary lunacy and defectiveness: ‘it is certainly my experience that the feeble minded girls in the rural villages stand at a frightful disadvantage . . . I think in defence against themselves the best thing to do is to detain them.’ He added that with regard to ‘certain classes of feeble minded men who are distinctly dangerous to their neighbours when they are at large in their villages who have . . . a sort of prurient monomania . . . it is desirable to get them under control.’137 There is some irony in the fact that the asylum began as an attempt to rescue those held captive in often atrocious conditions in the community and, by 1914, was functioning as an instrument of containment for decrepit, mentally impaired, highly damaged and distressed people, many of whom would never leave it alive.

The patient experience 203 Table 9.6 Exminster Asylum, all patients admitted, 1845–1914 (13,000): summary of re-admissions versus admissions, by gender

Admissions Re-admissions

Female (%)

Male (%)

6,859 1,161 (16.9)

6,142 0,931 (15.2)

By the end of our period it seems clear that the limitations of the lunatic asylum in caring for different groups of patients was more visibly apparent than in the decades following the opening of Exminster. In attempts to assess the efficacy of such institutions as places of care and treatment, it is finally worth noting that many individuals, some of whom we have portrayed in this chapter, were to return to the asylum after their discharge. The pattern of re-admission is indicated in Table 9.6, which encompasses the whole intake during the years 1845–1914. About one in six admissions involved patients who had previously been at the Devon Asylum, or, much more rarely, at another asylum, a substantial proportion of the patient population in those years. We noted in Chapter 4 that married males were slightly over-represented among those re-admitted, but the general pattern is very close to the marital profile of the whole intake. In most instances individuals appear to have returned to the asylum once or twice after their first admission, only a limited minority making a long series of returns in those years. The likelihood of a return to the asylum clearly depended on a range of personal as well as social circumstances which cannot be discussed in any detail, though it is apparent that a large number of those who entered the asylum in Victorian and Edwardian England were making only one of a series of visits. Some of these individuals became so accustomed to life inside the walls of these institutions that they lived out the last years of their lives in the wards and corridors of the asylum. The strong representation of unmarried females and males in these places confirms the conclusions we have reached in earlier chapters that the asylum served to accommodate those for whom social provisions were limited, if not always inadequate.

10 From asylum inmate to outpatient The remaking of the institutional landscape in the twentieth century, 1914–1990 In 1994, the Devon Mental Hospital based at the Exminster site closed permanently. Its residents and staff were dispersed to other, smaller institutions though the majority of former patients were now distributed to homes in ‘the community’ within a programme of reforms that had first been introduced in the 1960s, gathering a momentum that led to the closure of most large mental hospitals by the end of the century. The Exminster asylum had already changed radically by the time the legislation directing the transition to community care was introduced. The Lunacy Commission became a Board of Control in 1913, and although the Exminster site was not used for military personnel during the First World War, it did receive a substantial number of Bristol patients who were transferred to Devon as the Bristol asylum buildings became the Beaufort Military Hospital and the former inmates were moved to Exminster. David Pearce has shown that the Mental Treatment Act of 1930 had substantial consequences for the institution, introducing significant numbers of both voluntary and temporary patients to what became Devon Mental Hospital for the first time.1 This transition away from the Poor Law origins of the former asylum was confirmed in the local government reforms of 1929–1931 which abolished the Board of Guardians and transferred their responsibilities to the local County and County Borough Councils, giving these bodies the opportunity to transfer control of Poor Law medical services from their public assistance committees to their public health committees.2 The transformation of the old asylum was formally completed with the coming of the National Health Service in 1948, though the mental health services altered little in the early years of the new centralised hospital system. Similar changes were seen in the facilities that catered for those seen as mentally deficient and disabled as the former Idiots Asylum at Starcross was integrated under County Council and National Health Service control to take on some of the characteristics of modern post-war care for the disabled.3 Diagnoses and therapeutic techniques also changed as medical staff attempted to address the conditions of their patients, including the use of various drugs and related chemical treatments that included the injection of cardiazol substances to induce epileptic shocks in cases of schizophrenia,

From asylum inmate to outpatient 205 application of mosquitoes to induce malarial symptoms and thereby destroy the syphilis spira, and the continued use of electro-convulsive charges beyond the 1940s. There is also evidence of greater use of psychoanalysis within both public and private institutions in Devon, though the resources of the large mental hospitals clearly limited the scope for prolonged individual therapy. From the 1950s, the availability of new drugs constituted what is sometimes called the ‘psychotropic revolution’ in mental-health care, enabling staff and patients to control symptoms of disordered and violent behaviour, often depicted as ‘acute mania’ in earlier periods. The methods and terms of classification that had preoccupied the Victorians continued in the debates on standardisation of symptoms of mental health and the terms in which particular forms of illness may be diagnosed and treated. In wider society the language used to describe and address citizens with mental illness and disabilities formed part of a larger debate on the nature and origins of mental disorder within modern society and the utility of institutional care for those suffering from such conditions. Attacks on psychiatry and psychiatric practices were not uncommon in the decades when Bucknill and his peers were attempting to raise the professional status of the ‘alienist’ and psychiatrist in the eyes of Victorians, though the medical staff did acquire greater professional recognition with the increase of training and qualifications in the century after the foundation of Exminster. In the years after the formation of the National Health Service, the continued detention of many hundreds of thousands of mental patients in different countries for prolonged periods of time, with limited evidence of radical improvement, contributed to a growing debate on the efficacy of institutional treatments of mental illness. By the 1970s the intellectual and moral assault on the mental hospital and even the practice of psychiatry reached a crescendo under the influence of important studies by anti-psychiatrists such as Goffman, Laing and Foucault, as well as feminist critics such as Phyllis Chesler. The rising tide of criticism of psychiatry and the mental hospital had a dramatic influence on the terms in which the history of the asylum and other medical institutions were viewed, not least because Foucault’s brilliant if flawed analysis of the Enlightenment as a dark age of reason and scientific subjugation was extended in his discussion of the asylum during the era of moral treatment. A number of scholars surveyed in this text, most notably Andrew Scull and Roy Porter, offered serious criticisms of Foucault’s fragile understanding of historical evidence with regard to the British experience while acknowledging the importance of his broader analysis of the disciplinary advances that were made during the eighteenth and nineteenth centuries. This scholarship has been revisited not only in the light of fresh research, often drawing on the massive statistical and qualitative sources created by the institutions which were now closing, but also at a time when the transition to ‘community care’ exposed many of the limitations and hazards created by the withdrawal of large-scale, permanent institutional

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facilities for patients with mental illnesses. Whereas the reformers of the age of Shaftesbury, Elizabeth Fry and Florence Nightingale exemplified a moral concern for the disadvantaged by offering institutional responses to the problems they identified, campaigners and politicians of the age of privatisation recognised the advantages of closing down expensive facilities that appeared to deliver few long-term benefits. The difficulties that have been experienced in the implementation of policies designed to deliver ‘care in the community’ have encouraged a reappraisal of the historical benefits of institutional care, though most authors recognise the hazards of indulging in nostalgia for the pastoral quiet of the Victorian asylum or the organised walks of improving lunatics around the country lanes near places such as Exminster. A number of questions raised in recent debates on the social history of insanity have been considered in the chapters of this book. The first and most obvious issue raised in the literature on the history of the asylum is the extent to which these places may be seen as instruments of societal control over distinctive sections of the population, more particularly as western Europe, north America and other parts of the world were being transformed into a global capitalist economy in the late eighteenth and nineteenth centuries. This question has continued to inform discussions of earlier scholarship on the asylum, most notably that of Scull, as well as the wider growth of government policies with regard to prisons, policing and facilities that Garland characterised as the ‘penal welfare complex’. The approach adopted in the present book has been based on the argument that we should clearly distinguish between the way in which society defines insanity, the influence and intentions of the various actors who were engaged in the design and administration of legislation, and the ways in which the institutions created actually functioned in practice, as distinct from the actual experience of mental illness flowing from the given social situations of people. We have argued that it is possible to understand the institutional care of those diagnosed as insane in terms of a complex politics of insanity. This extended from the high politics of central agencies such as the Lunacy Commission and Poor Law Board to the magistracy, Poor Law Unions, and County or Borough Councils which assumed responsibility for the interpretation and enforcement of the legislation surveyed in this text. We share with Scull an understanding of the asylum as a particular kind of response to the commercial society, though our interpretation has differed in that we see these connections as extending far beyond the calculus of economic gain and loss, or even the assessment of the larger role of the labouring poor as an economic resource in contemporary society. Broadly, we have suggested that the origins and growth of the asylum can be understood in terms of the relations of power and resources within contemporary class society, though the continuing struggles around the foundation and function of these institutions shows that many different classes and special interests exercised a significant influence on the ways in which institutional care was provided.

From asylum inmate to outpatient 207 Our research suggests that a wide section of the employed and nonemployed population of Victorian society were represented in the admissions to the public asylum and that its legal status as a ‘pauper’ institution did not reflect the diverse social composition of those who entered its gates. Similarly, we have suggested that while the fee-paying, private asylum at Wonford House generally offered its services to a more affluent part of contemporary Devon society, many of those committed to this institution came from families of very modest means and that many of the genteel connections claimed by its admission registrars were in fact little more than social veneer. The question of the social origins and character of those admitted to the Victorian asylum raises two distinct but related themes in the recent literature: the first concerns the central role of the Victorian Poor Law in the evolution of lunacy legislation and the administration of asylum care, the second relates to the role of families and kinship groups in the process of admissions and discharges. Recent studies of lunacy provision have included Bartlett’s respected account of the role of the Poor Law in the administration of the seminal legislation of 1845. Our research has highlighted the importance of the legislative framework of that year and, indeed regarding the Lunacy Act of 1890. In her memorable assessment, Kathleen Jones argued that this measure represented a concession to the campaigners against false imprisonment of private lunatics and, in providing a barrage of legal safeguards, slowed the rate of medical progress in the treatment of insanity.4 We have suggested that both scholars provide a valuable assessment of the legislative framework for the institutional care of the insane but some modification of their interpretation is possible. It is clear that most inmates of the asylum were not only far from being the destitute occupants of the workhouse but that the households from which they originated usually possessed the means for an independent existence prior to (and even after) the identification of the individual as a lunatic. A significant minority of those certified were explicitly committed to the asylum not as ‘paupers’ but as persons wandering at large and/or without proper care and control. The institutions of the Poor Law played an important but not dominant role in the evolution of asylum provision and a host of other actors and influences need to be acknowledged if we are to gain an adequate understanding of the social history of institutional provision for the certified. The influence of both the magistracy as Visitors and the Poor Law Unions also appears to have diminished at the end of the nineteenth century when the local government legislation of 1888 came into force. Far from the 1890 Act constituting a regressive step in the medical care of the insane, the Devon evidence suggests that institutional provision at Exminster and in Devon more generally had fallen to a low point in the crowded conditions of the 1880s, despite some improvements in staffing ratios at the end of our period. Strenuous efforts by legislators and the Lunacy Commission to tighten the regulation of workhouse accommodation for the insane

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contributed to the mounting pressures on boroughs to provide their own asylums. The increased judicial control over the admission and detention of private and pauper lunatics also appears to have contributed to a noticeable improvement in the accommodation and, arguably, in the care and prompt discharge of patients in the late Victorian and Edwardian years. Key players in the identification of the insane and the presentation of individuals for institutional treatment were the relatives and friends of those certified as lunatics. The families and associates of the insane have attracted considerable attention in both earlier and recent scholarship. It seems clear that the calculated approach to family lunacy rehearsed in Scull’s original research provided an important stimulus to subsequent research that has revealed a complex conversation between different agents within and beyond kinship groups with respect to the institutional care appropriate for family members. Some scholars have advanced the claim that families played a vital and sustained role in decisions made regarding the care of lunatics placed in the Victorian asylum. We have argued that we need to view the exercise of such influence within the legal and institutional framework of lunacy laws as well as Poor Law provisions and to understand the role of families in relation to a range of other important actors. The terms of the 1845 legislation provided a clear distinction between the pauper and the private patient in this regard. The committal of pauper lunatics required the certification of the individual together with an order from a Magistrate (failing which a clergyman and a Relieving Officer could together sign an order), which were sent to the superintendent. Private patients were admitted on the petition of a relative, providing two medical certificates were presented as proof of insanity. The requirements of the 1890 Act that private as well as pauper patients were only committed on the authority of a judicial figure, as well as two certifying physicians and with reception orders renewed after one year, marked an important advance. Throughout the period considered in this book, the influence of relatives both in the admission and discharge of asylum patients was more apparent and important in the case of private than in pauper admissions. It is worth restating the point that the medical superintendents, whose role and power has been questioned in some recent research, exercised considerable sway over the treatment and release of individuals more particularly in the pauper asylum. Before considering the therapeutic benefits and limits of asylum care, it is worth recalling the communal context in which relatives and friends expressed their preferences about the care of family members. The impact of physical distance, population growth, urbanisation and migration on the pattern of insanity and lunacy provision were energetically debated in the Victorian and Edwardian years and have remained a source of debate among scholars of the asylum. There is little doubt that the massive changes in British society influenced the remarkable rise in the numbers of people who were identified and treated as insane during these decades, though the

From asylum inmate to outpatient 209 evidence considered in this book suggests that those who were well-known members of stable communities with relatively limited migration history were at least as likely to be sent to the asylum as more migratory and less familiar characters. While distance from the asylum does appear to have figured in the pattern of admissions to Exminster, it is difficult to view the influence of physical space outside of the institutional and cultural context of the Poor Law and the inclination of families to remain in touch with their relatives. The contribution of feminist scholars to the debates on western mentalhealth systems during the 1970s has already been noted and the influence of gender on the pattern of admissions to the asylum has remained one of the most debated topics in the social history of insanity. Recent research has questioned scholarship such as that of Showalter which emphasised the gender bias, diagnostic disparities and domesticated character of the Victorian asylum.5 Our research has emphasised the importance of gender in relation to a number of other social characteristics, including those of class, age and marital status. There is little evidence of a gender bias in the pattern of admissions to either public or private institutions in our period, though their experience of the asylum differed in important respects. Most married women at Exminster were identified in relation to their husband’s occupation, given no occupation, or designated as housewives, with little indication of separate occupational or class status. Unmarried females were more likely to have some occupational title though they were noticeably less likely to be released back to their families and many of them remained for many years in the Devon Asylum before dying there. Similar contrasts may be discovered among males, though it is remarkable that husbands often expired relatively quickly at Exminster. Some parallels can be found at Wonford, where females were described as ‘gentlewomen’ rather than simply wives or without occupation, though both of these terms were also used. Most men were given clear occupational status rather than a genteel courtesy title, though it is again noticeable that husbands tended to die in larger numbers than wives and unmarried women (and men) were again overrepresented in the admission registers. We concluded that the influence of gender may be best understood with regard to class and a range of family and marital relationships that endowed individuals with different social resources. The therapeutic nature and consequences of asylum care remain at the centre of discussions of the legacy of institutional provision in the nineteenth and twentieth centuries. Recent scholarship on the asylum has elucidated the social and political relationships that surrounded the growth of these establishments rather than exploring in detail their internal arrangements or the medical practices which were pursued within them, although Susan Burt’s recent research is a notable and distinguished exception to this.6 Scholars have recognised the extent to which the architecture of the asylum embodied important assumptions about the organisation of patient

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life and care, including a strict separation by gender and some discrimination between the facilities for individuals who appeared to be suffering from different kinds of disorder or symptoms that were likely to disrupt the patient community. Research completed for this book shows that even in the early period of Exminster’s life, Bucknill expressed concerns at the weight of admissions on his capacity to provide medical care and appears to have departed as a sceptical if not disillusioned figure, offering criticism of the asylum model later in his career. The burden of overcrowding with which Bucknill began to contend towards the end of his career as a superintendent continued to affect his deputy and successor at Exminster, drawing periodic criticism from the Lunacy Commission and considerable bitterness on the part of Saunders. The scientific and medical assumptions that guided the care of the insane are not always apparent even in Bucknill’s voluminous writings, though concerns with hereditarian influences appear in the early years and some neo-Darwinian influences are reflected in physical descriptions of patients in Davis’ case notes during the Edwardian era. A movement from moral treatment to neo-Darwinian orthodoxy which some scholars have traced in the third quarter of the nineteenth century is not easily discernible at either Exminster or Wonford, where opiates continued to be fairly readily used and patients continued to recover from conditions of mania, melancholy and even dementia in significant numbers. One neglected feature of asylum care that vividly emerges from the Devon Asylum records is the important role of hard-pressed attendants and household staff who were responsible for the everyday care of inmates whose contact with medical personnel often became perfunctory after an initial period of examination and treatment. Their experience of the asylum appears to have been more sombre and onerous than their counterparts at Wonford, where a large attendant and domestic staff permitted much higher levels of staff to patients who were treated more as residents rather than inmates. In both institutions the emphasis was laid upon patient progression through stages of good behaviour, decent conversation and respectable association which led steadily towards recovery or release as a relieved patient. Scholars such as Roy Porter frequently raised the challenge of restoring the ‘patient experience’ to narratives of medical care and retrieving the voices of those who experienced life as a client of the lunatic asylum. Histories of mental hospitals in the middle and later decades of the twentieth century often include important testaments of former patients.7 The evidence that survives for earlier times rarely includes substantial accounts written by those admitted to these places, though we have composed an account of patient life from a variety of sources. We argue that any interpretation of the ‘voice’ of the patient should be based on an understanding of the personal, institutional and political relationships that placed them in the asylum, detained them there and released them, usually after a period when some progress was recorded. Our findings lead to the conclusion that there was no pure ‘patient experience’ but, rather, a composite picture of patient

From asylum inmate to outpatient 211 life that was overwhelmingly recorded by others in circumstances where the individual patient could exercise limited control over their surroundings and care. Any attempt to extract the voice of the patients must recognise these basic constraints that formed an integral feature of asylum life in Victorian and Edwardian England. Some of the most important distinctions with regard to the entry, residence and departure of patients from such institutions appear to have depended on such characteristics as their age, marital status, occupational or social standing, and their personal capacity to survive the environment in which they were placed. As we have noted, children were rarely seen as ‘proper lunatics’, though frequently as idiotic or imbecilic, the lunatic asylum remaining a distinctly adult domain during these years. Further insights into the patient experience will be necessarily based on the testimony of others, including their advocates and, from the certificates and case notes, which are more abundant and florid in the Wonford than the Exminster case, we have provided some account of patient lives before and after entry to the asylum. The close examination of materials related mainly to patients who had been female educationalists indicates that the patient experience has to be understood not as a peculiar, deluded realm but rather as a reflection of a complex social world as well as their distinctive institutional setting. What is important, we would suggest, is not only the florid content of the diverse delusions which the patients reported but rather the terms in which these delusions and their behaviour affected their residence and departure from the institution. The fundamental reality remained that the control over their institutional lives and the conditions of their release depended on their relationship to the staff, who were able to determine (more so in the Exminster than the Wonford cases) how they should be treated and when they should be released. Though in both asylum relationships with family were important to the admissions and discharge, most notably at Wonford House. Our account of institutional care in the later nineteenth and early twentieth centuries clearly bears the impress of the sources we have used and the reliance on evidence drawn primarily if not exclusively from institutions based in one English county. The economic, social and political landscape of south-west England differed in a number of respects from the provisions made in the metropolis, in the northern industrialised regions of England and in the distinctive countries of Wales, Scotland and Ireland during these decades. Much of the early debate on the growth in the numbers of lunatics housed in asylums drew attention to the transformation of Britain into a modern industrial economy, fuelled by mass migration, urban expansion and the spread of commercial relations in the labour market as well as product markets during the century after 1780. In response we would argue that any single pattern of economic and social change, as well as any unitary model of lunacy provision, does not adequately reflect the diverse ways in which Britain was transformed in these decades. Not only was the south-west an

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early industrial region with important urban centres. The continuing struggle between different groups of wealth-holders and political elites that featured prominently in the passage and early application of the Lunacy legislation of 1845 was vividly reflected in the conflicts in Devon, while later contests between the Lunacy Commission, Poor Law Board and other boards also found their register in the south-west. Comparison with other regions and countries within the United Kingdom suggests not merely the importance of local peculiarities in shaping the terms in which provision was actually made for those certified as insane, but also that the contrasts and parallels that can be detected between different areas help to explain the interplay of central direction and local autonomy, as well as the tensions between broad intellectual and scientific teachings and the everyday treatment of the insane which we have described. Finally, the comparison of pauper and private institutions that existed in the south-west offers a point of analysis when we seek to understand the inequalities of resources, power and status that were expressed not only in the class and gender of the inmates but also in the way that these institutions were governed.

Notes

1 Introduction: the English asylum and its historians 1 A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, pp. 335–336. One contemporary view on the rising tide of insanity is provided by H. Maudsley, On Some of the Causes of Insanity, London: Ablard, 1867, pp. 5–6 and passim. 2 Scull, Most Solitary, pp. 341–343. 3 J. Carr (ed.), Cheriton Fitzpaine: Our Village, Witheridge: Moorland Press, 1998, pp. 12–13, drawing on the scholarship of Dr R.R. Sellman. An account of Herman T.’s madness is discussed by R. Porter, Mind Forg’d Manacles: a History of Madness in England from the Restoration to the Regency, London: Athlone, 1987. 4 Devon County Lunatic Asylum Admission Certificates and Admission Register: hereafter Exminster Admission Certificates [EAC]. The number refers to the Patient Number in the Register (EAC 5563). 5 M. Foucault, The Use of Pleasure. The History of Sexuality: Volume 2, Harmondsworth: Penguin, 1987, p. 7: What are the games of truth by which the man proposes to think of his own nature when he perceives himself to be mad; when he considers himself to be ill; when he conceives of himself as a living, speaking, labouring being; when he judges and punishes himself as a criminal? Foucault implies that by understanding the rules of these games of truth we can reach an understanding of the deeper truth in history. 6 S. Lash, Sociology of Postmodernism, London: Routledge, 1990, p. 58. 7 EAC case 5563, February 1880. 8 M. Foucault, Madness and Civilisation: a History of Insanity in the Age of Reason, New York: Random, 1985; c.f. P. Levi, If This is a Man, London: Abacus, 1987, p. 15, for a view of the role of ‘unspoken dogma’ rather than reason in the origins of the total institution of Auschwitz–Birkenau. 9 R. Chartier, ‘Writing the practices’, French Historical Studies 21, 2, 1998, pp. 259–261 and passim. P. Major-Poetzl, Michel Foucault’s Archaeology of Western Culture: Toward a New Science of History, Brighton: Harvester, 1983, pp. 105–148; M. Poster, Foucault, Marxism and History, Cambridge: Polity, 1984, pp. 95–120; G. Wickham, ‘Power and power analysis: beyond Foucault?’, in M. Gane (ed.), Towards a Critique of Foucault, London: Routledge, 1986, for discussion in relation to biopolitics, the location of power and resistance, particularly pp. 163–167. 10 A. Digby, ‘The changing profile of a nineteenth-century asylum: the York Retreat’, Psychological Medicine 14, 1984, pp. 739–748, provided an important

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12

13

14

15

16 17 18 19

Notes

early analysis of social and geographical profiles; G.N. Grob, ‘The social history of medicine and disease in America’, Journal of Social History 10, 1997, pp. 391–409. Grob’s work includes an important emphasis on the role of American almshouses in the development of asylum facilities. The broader literature is too large to summarise, though the History of Psychiatry provides an excellent range of studies. J. Saunders, ‘Institutionalised offenders: a study of the Victorian institution and its inmates with special reference to late nineteenth-century Warwickshire’, University of Warwick Ph.D., 1983; D. Garland, Punishment and Welfare: a History of Penal Strategies, Aldershot: Gower, 1985, for a discussion of the penal–welfare complex; M. Thomson, ‘Sterilisation, segregation and community care: ideology and solutions to the problems of mental deficiency in inter-war Britain’, History of Psychiatry 3, 1992, pp. 473–498; P. Bartlett, ‘The Poor Law of Lunacy: the administration of pauper lunatics in mid-nineteenth-century England with special reference to Leicestershire and Rutland’, University College, London, Ph.D., 1993, published as The Poor Law of Lunacy, Leicester: Leicester University Press, 1999; F. Driver, Power and Pauperism: the Workhouse System, 1834–1884, Cambridge: Cambridge University Press, 1993. N. Elias, The Civilizing Process: Sociogenetic and Psychogenic investigations, Oxford: Blackwell, 2000; A. de Swann, In Care of the State: Health Care Education and Welfare in Europe and the USA in the Modern Era, Cambridge: Polity, 1988; P. Baldwin, The Politics of Social Solidarity: Class Bases of the European Welfare State, Cambridge: Cambridge University Press, 1990. R. Smith, ‘Charity, self-interest and welfare: reflections from demographic and family history’, in M. Daunton (ed.), Charity, Self-interest and Welfare in the English Past, London: University College Press, 1996, pp. 23–24, 27–28; P. Horden and R. Smith, ‘Introduction’, The Locus of Care, London: Routledge, 1998. C.f. E.H. Hunt, ‘Paupers and pensioners’, Ageing and Society 9, 1990, pp. 407–430; S. King, ‘Reconstructing lives: the poor, the Poor Law and welfare in Calverley, 1650–1820’, Social History 22, 3, 1997, pp. 318–338, especially p. 320, for the small numbers who came into contact with the Poor Law in Calverley: ‘Relief obtained by those who did need communal support was at best meagre.’ King stresses the importance of alternatives to ‘harsh communal welfare’, particularly kinship ties. A discussion is given in J.L. Melling, ‘Accommodating madness: new research in the social history of insanity and institutions’, in J.L. Melling and W.J. Forsythe (eds), Insanity, Institutions and Society: a Social History of Madness in Comparative Perspective, 1800–1914, London: Routledge, 1999, pp. 1–30. A. Suzuki, ‘Lunacy in seventeenth and eighteenth-century England: analysis of Quarter Session records’, History of Psychiatry 2, 1991, pp. 437–457 and forthcoming, 2005, University of California Press, provide a commentary on Foucault’s methodology applied to the institutions of the old Poor Law and the legal system; J. Andrews, ‘Raising the tone of asylumdom’, Melling and Forsythe, Insanity, Institutions and Society. J. Brewer and R. Porter (eds), Consumption and the World of Goods, London: Routledge, 1993. S. Schaffer, ‘The consuming flame: electrical showmen and Tory mystics in the world of goods’, in Brewer and Porter (eds), Consumption and the World of Goods, pp. 489–526, for example. R. Porter, ‘Consumption: disease of the consumer society?’, in Brewer and Porter (eds), Consumption and the World of Goods, pp. 58–81, esp. pp. 62–65. R. Porter, ‘Mind Forg’d Manacles; Foucault on de Sade’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of

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24 25 26 27 28

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31 32 33 34

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Psychiatry, London: Tavistock, 1985, see particularly Volume 2. See also M. MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England, Cambridge: Cambridge University Press, 1981, particularly pp. 72–111. L.D. Smith, ‘Cure, Comfort and Safe Custody’: Public Lunatic Asylums in Early Nineteenth-Century England, London: Leicester University Press, 1999a, p. 12. See also L.D. Smith, ‘Close confinement in a mighty prison: Thomas Bakewell and his campaign against public asylums, 1810–1830’, History of Psychiatry 5, 1994, pp. 191–214. A.T. Scull, Museums of Madness: the Social Organisation of Insanity in NineteenthCentury England, London: Allen Lane, 1979. A.T. Scull, Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective, Berkeley: University of California Press, 1989; A.T. Scull, ‘The insanity of place’, History of Psychiatry 15, 4, 2004a, pp. 417–436. Scull, Social Order/Mental Disorder, p. 94, ‘defective human mechanisms were to be repaired so that they could once more compete in the marketplace’, quoted in G.N. Grob, ‘Marxian analysis and mental illness’, History of Psychiatry 1, 1990, p. 225. For the application of a Foucauldian model to another expanding economy, see A. Butchart, ‘The industrial panopticon: mining and the medical construction of migrant African labour in South Africa, 1900–1950’, Social Science Medicine 42, 2, 1996, pp. 185–197, particularly pp. 194–195. Scull, Social Order/Mental Disorder, provided an important source of controversy, for example. D. Wright, ‘Getting out of the asylum: understanding the confinement of the insane in the nineteenth century’, Social History of Medicine 10, 1, 1997, provides a survey. Bartlett, ‘The Poor Law of Lunacy’. L.D. Smith, ‘The county asylum in the mixed economy of care’, in Melling and Forsythe (eds), Insanity, Institutions and Society, pp. 33–47. M. Poovey, ‘From new historicism to historical epistemology’, Journal of Victorian Culture 4, 1999, pp. 131–139; and A History of the Modern Fact: Problems of Knowledge in the Sciences of Wealth and Society, Chicago: Chicago University Press, 1998, for a recent discussion. Eliza B., wife of John B. of Stockaton Farm, Cheriton Fitzpaine, aged 60. EAC case 5910, 7 January 1882. Census Enumeration Returns, 1881, for Emma P. and Mary Ann V., both classified as ‘imbeciles’ under the ‘infirm’ category and both of Cheriton Fitzpaine. The sources and reasons for such descriptions and for completion of an ‘Invalidity’ column within the decennial census are not usually apparent. The 1881 census lists at least 15 heads of households living at domestic addresses, five of them in Stoke Damerel (Devonport), who were also described as ‘lunatics’. See essays by J. Andrews, L. Walsh and O. Walsh in Melling and Forsythe (eds), Insanity, Institutions and Society. J. Bardon, A History of Ulster, Belfast: Blackstaff, 1992, pp. 342–343 for the ethnic and political composition of ‘etheromania’, late-nineteenth-century Ulster, for example. The standard for excellent asylum studies was set by R. Hunter and I. Macalpine, Psychiatry for the Poor: 1851 Colney Hatch Asylum, London: Dawsons, 1974; N. Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, Cambridge: Cambridge University Press, 1984; A. Digby, Madness, Morality and Medicine: a Study of the York Retreat, Cambridge: Cambridge University Press, 1985.

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35 P. Hilditch, ‘The Dockyard in the local economy’, in M. Duffy et al. (eds), The New Maritime History of Devon, Volume 2, London: Conway Maritime Press, 1994, pp. 215–225, notes that the Dockyard’s 12,000–14,000 employees dwarfed any comparable enterprise before 1914. 36 N. Tomes, ‘The great restraint controversy: a comparative perspective on AngloAmerican psychiatry in the nineteenth century’, in W.F. Bynum, R. Porter and M. Shepard (eds), The Anatomy of Madness: Essays in the History Of Psychiatry, Vol. 3, the Asylum and its Psychiatry, London: Routledge, 1988, pp. 190–225. 37 L.J. Ray, ‘Models of madness in Victorian asylum practice’, European Journal of Sociology XXII, 1981, pp. 221–264; H.R. Rollin, ‘What happened to Henry Maudsley?’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841–1991, London: Gaskell, 1991, p. 353. 38 A.T. Scull, C. Mackenzie and N. Hervey, ‘From disciple to critic’, Masters of Bedlam: the Transformation of the Mad-Doctoring Trade, Princeton: Princeton University Press, 1996, pp. 187–225. 39 J. Saunders, ‘Institutionalised offender, p. 69, for comparable experience of Warwickshire; J.L. Crammer, Asylum History: Buckinghamshire County Pauper Lunatic Asylum, London: Gaskell, 1990; C. Philo, ‘Journey to the asylum: a medical–geographical idea in historical context’, Journal of Historical Geography 21, 2, 1995. 40 ‘The English bastille’, Social Science Review 3, 1865, noted that the English county lunatic asylum resembled ‘a large mansion’ whilst the Union workhouse or ‘bastile’ had the appearance of ‘a factory or huge storehouse’. 41 For rural idyll and the Beau Ideal, see L. Davidoff, J. L’Esperance and H. Newby, ‘Landscape with figures: home and community in English society’, in J. Mitchell and A. Oakley (eds), The Rights and Wrongs of Women, Harmondsworth: Penguin, 1976, particularly pp. 163–167. For the Poor Law, see A. Brundage, ‘The landed interest and the New Poor Law’, English History Review LXXXVII, 1972, and P. Mandler, ‘The making of the New Poor Law redivivus’, Past and Present 117, 1987. C.f. K.D.M. Snell, Annals of the Labouring Poor: Social Change and Agrarian England, 1660–1900, Cambridge: Cambridge University Press, 1985, pp. 116–117, and passim for emphasis on the shift of power to commercial farmers. 42 P. Joyce, Visions of the People: Industrial England and the Question of Class, 1840–1914, Cambridge: Cambridge University Press, 1990; J. Vernon, Politics and the People: a Study in English Political Culture, 1815–1867, Cambridge: Cambridge University Press, 1993. Vernon in particular is concerned with what might be termed the aesthetics of political rhetoric and assembly, though his emphasis on multiple narratives of political life would complement our own view of the importance of the Tory traditionalist enterprise in Devon and its distinctive features. 2 The origins of the asylum 1 48 Geo. III cap. 96; and 1828 9 Geo. IV cap. 49. K. Jones, Lunacy, Law and Conscience, London: Routledge, 1955; L.D. Smith, ‘Cure, Comfort and Safe Custody’: Public Lunatic Asylums in Early Nineteenth-Century England, London: Leicester University Press, 1999. 2 8 and 9 Vict. cap. 100 & cap. 126. 3 16 and 17 Vict. cap. 96; 16 and 17 Vict. cap. 97. 4 25 and 26 Vict. cap. 111. 5 4 and 5 William IV cap. 76, sec. 45. 6 53 Vict. cap. 5.

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7 See List of Abbreviations for notes on primary manuscript sources to which we refer in this and subsequent chapters. 8 8 and 9 Vict. cap. 126, sec. 2. For earlier provisions, see 48 Geo. III cap. 96; 9 Geo. IV cap. 40. This measure was enacted in the light of the failure of most counties and boroughs to take advantage of the permissive, enabling legislation of 1808 and 1828. Devon was the last of 20 counties to open an asylum before the legislation came into force. See K. Jones, Mental Health and Social Policy 1845–1959, London: Routledge and Kegan Paul, 1960 p. 7, and L. Smith, Cure, Comfort, pp. 12–51. 9 D. Pearce, ‘Wonford House Asylum, 1801–1850’, University of Exeter, Postgraduate Dissertation, 1996; S. Fleat, ‘The English malady and the female malady: a study of social status, class and gender in the private asylum’, University of Exeter, B.A. undergraduate dissertation, 1999. Throughout the period, one or two tiny specialist private asylums sprang up (like Kenton House for some six lunatic gentlewomen, for example, or Churchingford for two private patients). The only large privately licensed asylum was Plympton House and the only substantial registered hospital was St Thomas-Wonford House. In 1844 Plympton House held 83 patients of whom 17 were private-fee payers. In 1881 the census recorded 41 inmates at Plympton House, while Wonford House held 90 residents. 10 Parliamentary Papers [hereafter PP] 20th Annual Report Lunacy Commission, 1866, vol. XXXII, p. 21, notes that the Idiots Asylum was for children capable of education within ‘a school proper for the reception of such children as may be sent there by the Guardians of Unions’. The first purpose-built Idiots Asylum opened around 1869, though this was preceded by smaller institutions from 1862. 11 J.C. Bucknill and D.H. Tuke, A Manual of Psychological Medicine, Philadelphia: Blanchard and Lea, 1858. 12 William Courtenay, tenth Earl of Devon (1777–1859), son of an Anglican Bishop of Exeter, and his son, William Reginald, eleventh Earl (1807–1888) of Powderham Castle. 13 William Courtenay was chairman of the model Pentonville Prison Board which followed the lines of cellular architecture and individual responsibility. His son was similarly founder and chairman of the Western Counties Idiots Asylum at Starcross (like Exminster itself, sited very near to Powderham Castle), the Exeter Institute for Training of Nurses and President of Wonford House Hospital for fee-paying lunatics. 14 J. Lee, ‘Devon County Pauper Lunatic Asylum, 1828–1861’, University of Exeter, M.Phil., 1995, notes the support given by William Courtenay to Ashley’s bill to prevent women and children working underground in 1842. 15 See B. Hilton, The Age of Atonement: the Influence of Evangelicalism on Sound and Reasonable Thought 1795–1865, Oxford: Clarendon, 1988, and B. Harris, The Origins of the British Welfare State: Sound Welfare in England and Wales 1800–1945, Basingstoke: Palgrave, 2004, pp. 33–34. 16 Trewman’s Exeter Flying Post [hereafter TEFP] 14 January 1830, p. 3; 1 April 1830, p. 3. 17 TEFP 8 April 1830, p. 4; 22 April 1830, p. 3; 20 May 1830, p. 1. There was a radical edge to the rhetoric in the denunciation of the concentration of power in a few hands. See also Devon Record Office, South Hams Agricultural Association Notice of Petition To Quarter Sessions DRO 2165 A/PO 451 for the petition organised by South Hams agrarian rate-payers against a ‘vast pecuniary burthen’. 18 TEFP 22 October 1835, p. 4. 19 TEFP 22 October 1835, p. 4.

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20 The Quarter Sessions voted 39 to 18 to formulate a plan for an asylum. 21 The group included Lord Poltimore, Sir Thomas Acland (Member of Parliament for North Devon 1837–1857) of Killerton, Sir Laurence Palk (Member of Parliament for South Devon 1854–1868) and John Milford. 22 St Thomas Poor Law Guardians’ Minute Books [hereafter STG Mins] 7 October 1836. 23 TEFP 3 November 1836, p. 3. 24 TEFP 3 November 1836, p. 3. 25 TEFP 17 November 1836, p. 2, for a limit of £10,000. TEFP 1 December 1836, p. 4. 26 TEFP 17 October 1839, p. 3; 9 April 1840, p. 3; 21 October 1840, p. 3. 27 TEFP 21 October 1840, p. 3; TEFP 8 April 1841, p. 3, cited by L. Brizendine, ‘British psychiatric reform 1830–1860: a sociohistorical study of Devon County Lunatic Asylum and J.C. Bucknill’, Yale University, D.Med. thesis, 1981, p. 23. 28 Devon County Quarter Sessions Minute Books [hereafter DQS Mins] 1/29 discusses the appointment of Charles Fowler, architect. Report Midsummer 1841, 19 July 1844. The gatehouse at the entrance to the Devon asylum was copied from Pentonville. 29 TEFP 30 June 1842, p. 3, including key role of Reverend Palmer in the project. 30 TEFP 7 April 1842, p. 3; 10 April 1845, p. 3. In fact, it proved to be £63,035. DQS Mins 1/29 Michaelmas Session 1846. 31 Bucknill lived 1817–1897, qualifying in medicine and surgery at University College in 1840 and practising in London until deteriorating health brought him to Devon in search of a warmer climate. He was appointed medical superintendent at the new Devon asylum in May 1844 after the first candidate declined the post, and was therefore a relatively young man on his appointment. Devon County Pauper Lunatic Asylum Minute Books of the Visiting Trustees [hereafter VJP Mins] 147/1 16 May 1844. Bucknill had a successful public career and was himself a JP for Warwickshire (see A.T. Scull, C. Mackenzie and N. Hervey, ‘From disciple to critic’, in Masters of Bedlam: the Transformation of the Mad-Doctoring Trade, Princeton: Princeton University Press, 1996, pp. 187–225. A.T. Scull, ‘Sir John Charles Bucknill’, Oxford Dictionary of National Biography, Oxford: Oxford University Press, 2004. 32 A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, p. 236. 33 E. Renvoise, ‘The Association of Medical Officers in asylums and hospitals for the insane: the Medico-Psychological Association and their presidents’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841–1991, London: Gaskell, 1991, pp. 45–46. 34 J. Bucknill, Journal of Mental Science III, 21, April 1857, p. 289; L. Brizendine, ‘British psychiatric reform’, p. 81, notes that, for Bucknill, the existence of mental disease could be traced to ‘physical lesions even if they cannot be detected yet by present methods of observation in post mortem psychological studies.’ 35 J. Bucknill, Asylum Journal 1, 1854, cited by Brizendine, ‘British psychiatric reform’, pp. 5, 35–38. A. Digby, ‘A moral treatment at the Retreat 1796–1846’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 2, Institutions and Society, London: Tavistock, 1985a, pp. 57–72; J. Walton ‘The treatment of pauper lunatics in Victorian England: the case of Lancaster Asylum 1816–1870’, in A.T. Scull (ed.), Madhouses, Mad Doctors and Madmen: the Social History of Psychiatry in the Victorian Era, Philadelphia: University of Philadelphia Press, 1981, pp. 166–197.

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36 J. Bucknill, The Supremacy of the Will, cited by Lee, ‘Devon County Pauper Lunatic Asylum, 1828–1861’, p. 196. 37 M. Foucault, Madness and Civilization: a History on Insanity in the Age of Reason, New York: Vintage, 1965, discussion of Pinel, pp. 242–243. 38 J. Walton, ‘Casting out’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness, Vol. 2, p. 142. Scull, Most Solitary of Afflictions, p. 224, points out that the cultivation of an institutional environment in which patients were encouraged to improve by gradually assuming more responsibility was only one facet of psychiatric treatment in the later nineteenth century. 39 Journal of Mental Science VI, 34, July 1860, p. 506. 40 A. Digby, ‘Moral treatment’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 1, People and Ideas, London: Tavistock, 1985, p. 53. 41 Journal of Mental Science V, 28, January 1859, p. 220. 42 Annual Report of the Devon County Pauper Lunatic Asylum 1850 [hereafter AR] DRO 117/4. Two small wings were opened for them and, in 1850, ‘six ladies’ were under treatment, each at 31s 6d per week. Only one such patient remained in 1853, none in 1860, two in 1907. For criminal lunatics, 8th Annual Report Lunacy Commission, PP 1854, vol. XXIX, p. 50; 14th Annual Report Lunacy Commission, PP 1860, vol. XXXIV, p. 105; 61st Annual Report Lunacy Commission, PP 1907, vol. XXX, p. 292. 43 The point here is that the status of pauper lunatic was a legal and administrative rather than a medical category. Anyone certified insane under sections 48 and 51 of the statute of 1845 was also legally defined as a lunatic. Once an individual was certified insane by a medical practitioner, it was possible (though not necessary) for them to be the subject of a legal order for their committal to a public asylum. In order to qualify for admission to and treatment in a Union workhouse or the public asylum maintained by the rates, it was usually required that the individual be identified as a pauper lunatic. 44 M.A. Crowther, The Workhouse System 1834–1929, Athens: University of Georgia Press, 1981, p. 164. 45 The physician involved may have been a man whose services were regularly used by the Poor Law, though not always a contracted officer in the sense that the workhouse physician and district medical officers were so employed. From 1853 the district medical officers certified lunacy. District Medical Officers were also often in tension with Guardians, being on short-term contracts, low stipends, bad conditions of service and poorly regarded compared to other medical personnel by the community. See M. Peterson, The Medical Profession in MidVictorian London, Berkeley: University of California Press, 1978, p. 111. 46 L. Brizendine, ‘British Psychiatric reform’, p. 61; Select Committee To Enquire Into The Operation of Acts of Parliament and Regulations For the Care and Treatment of Lunatics, PP 1859, Session 1, Vol. III, p. 55. The self-governing boroughs of Devon had not contributed to the cost of the asylum’s maintenance and were thereby levied a higher rate for the use of the facilities. See S. Allen, The History of Devon Mental Hospital 1845–1945, Exminster: Exminster Management Committee, 1945, p. 13. 47 Select Committee House of Commons To Enquire Into The Care and Treatment of Lunatics, PP 1859, Session 2, vol. VII, pp. 90 and 93, which was told by Bucknill that the work of the asylum attendant was ‘so very disagreeable and onerous that it is astonishing to me that we meet with such good men who are willing to undertake it’.

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3 The asylum and the British state in the administration of pauper lunacy, 1845–1914 1 M. Foucault, Discipline and Punish: the Birth of the Prison, Harmondsworth: Peregrine, 1979. 2 A.T. Scull, Museums of Madness: the Social Organisation of Insanity in NineteenthCentury England, London: Allen Lane, 1979, pp. 212–213 and A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900, New Haven and London: Yale University Press, 1993, pp. 354–355. There appears to be some inconsistency between the general argument that the asylums reduced tolerance to insanity amongst all sections of the community and the suggestion that people would have avoided the stigma of pauper lunacy at all costs. Scull implies that only those in desperate need would have sought, and been able, to overcome the various gates blocking access to the pauper lunatic asylum. J.D. Mellett, The Prerogative of Asylumdom: Social, Cultural and Administrative Aspects of the Treatment of the Insane in Nineteenth-Century Britain, London: Garland, 1982, p. 167. Both Scull and Mellett develop the argument that these institutions became (in Scull’s words) a ‘convenient dumping ground for the decrepit’. See also: W.J. Forsythe, R. Adair and J.L. Melling, ‘The New Poor Law and the county lunatic asylum: the Devon experience’, Social History of Medicine 9, 1996, pp. 335–356; R. Adair, J.L. Melling and W.J. Forsythe, ‘A danger to the public? Disposing of the pauper lunatics in late Victorian and Edwardian England’, Medical History 42, 1998, pp. 1–25. 3 P. Bartlett, ‘The Poor Law of Lunacy: the administration of pauper lunatics in mid-nineteenth-century England with special emphasis on Leicestershire and Rutland’, University College, London, Ph.D., 1993, pp. 198, 266–267, and 294. 4 N. Hervey, ‘The Lunacy Commission 1845–1860: with special reference to the implementation of policy in Kent and Surrey’, University of Bristol, Ph.D., 1987, vol. 1, pp. 207–208, 275 and 455; C. Bellamy, Administering Central–Local Relations 1871–1919: the Local Government Board in its Fiscal and Cultural Context, Oxford: Oxford University Press, 1988; For the Lunacy Commission approach to the issue of compulsory treatment, see P. Fennell, Treatment Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845, London: Routledge, 1996, pp. 14–23. 5 J.D. Mellett, ‘Bureaucracy and mental illness: the Commissioners in Lunacy 1845–1890’, Medical History 25, 1981, p. 243. 6 Bartlett, ‘The Poor Law of lunacy’; R. Porter, Mind Forg’d Manacles: a History of Madness in England from the Restoration to the Regency, London: Athlone, 1987, p. 278; Scull, Most Solitary of Afflictions, p. 45. 7 Bartlett, ‘The Poor Law of lunacy’, p. 47 8 51 and 52 Vict. cap. 41; 53 Vict. cap. 5. 9 3rd Annual Report of the Poor Law Commission, PP 1837, vol. XXXI, p. 2. A number of local Guardians were appointed ex officio, including Magistrates (also known as Justices of the Peace). 10 M. Rose, ‘The Anti-Poor Law movement’, in D. Fraser (ed.), The New Poor Law in the Nineteenth Century, London: Macmillan, 1976, p. 152. See also: Trewman’s Exeter Flying Post [TEFP] 11 February 1836, p. 2; 18 February 1836, p. 3. 11 W. Forsythe, ‘Paupers and policy makers in Exeter 1830–1860’, Transactions of the Devonshire Association for the Advancement of Science, Literature and the Arts 117, 1985, pp. 151–160. 12 J.L. Melling, ‘Accommodating madness: new research in the social history of insanity and institutions’, in J.L. Melling and W.J. Forsythe (eds),

Notes

13

14

15 16 17

18 19 20 21

22 23

24

25 26

27 28

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Insanity, Institutions and Society: a Social History of Madness in Comparative Perspective 1800–1914, London: Routledge, 1999, pp. 1–30, provides a discussion. B. Webb and S. Webb, English Local Government, Volume 10: English Poor Law Policy, London: Longmans, Green & Co., 1910, pp. 8 and 49; M.A. Crowther, The Workhouse System 1834–1929, Athens: University of Georgia Press, 1981, p. 54; F. Driver, Power and Pauperism: the Workhouse System 1834–1884, Cambridge: Cambridge University Press, 1993. J. Saunders, ‘Quarantining the weak minded: psychiatric definition of degeneracy and the late Victorian asylum’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History Of Psychiatry, Vol. 3, the Asylum and its Psychiatry, London: Tavistock, 1988, pp. 273–296; J.D. Mellett, The Prerogative of Asylumdom: Social, Cultural and Administrative Aspects of the Treatment of the Insane in Nineteenth-Century Britain, London: Garland, 1982, pp. 136–137. R. Hodgkinson, The Origins of the National Health Service: the Medical Services of the New Poor Law, London: Wellcome Historical Series, 1967, p. 585. Crowther, The Workhouse System, p. 51. After 1853, the doctor was almost invariably a Poor Law medical officer. For the ‘hybrid agglomeration’ of the ‘medical profession’ in early Victorian England, see M.J. Peterson, The Medical Profession in Mid-Victorian London, Berkeley: University of California Press, 1978, p. 38. P. Bartlett, ‘Poor Law of lunacy’, pp. 140–141. P. Bartlett, ‘Poor Law of lunacy’, p. 44; 25 and 26 Vict. cap. 111, sect. 11. For the complexity of the role of the workhouse medical officer as ‘sanitarian, surgeon, psychiatrist, mid wife and disciplinarian as well as physician’, see Crowther, Workhouse System, p. 164. L. Brizendine, ‘British psychiatric reform 1830–1860: a sociohistorical study of Devon County Lunatic Asylum and J.C. Bucknill’, Yale University, D.Med., 1981, pp. 58 and 67. Peterson, The Medical Profession in Mid-Victorian London, p. 111. St Thomas Poor Law Guardians’ Minute Books [hereafter STG Mins], 29 March 1888. Report of Select Committee to Enquire into the Operation of Acts of Parliament and Regulations for . . . Lunatics, PP 1859, vol. III, p. 55; Brizendine, ‘British psychiatric reform’, p. 61; S.M. Allen, The History of Devon Mental Hospital 1845–1945, Exminster: Exminster Management Committee, 1945, pp. 13–14. Exeter Corporation of the Poor (DRO) Devon Record Office, Minutes, 5 December 1846. A differential amounting to an addition of three or four shillings per week per inmate was levied on those sending non-county pauper lunatics. Bartlett, ‘The Poor Law of lunacy’, p. 6. The data provided for the proportion of paupers who were classified as lunatic paupers is only available for 1871, 1874 and 1876, whilst figures for the proportion of the Union population who were paupers is available for 1850, 1860, 1870, 1874 and 1876. The data presented here covers the period 1864–1880. As indicated earlier, the earlier data is taken from that compiled by the Lunacy Commission for this purpose. Dictionary of National Biography, Oxford: Oxford University Press, 1906, ‘Lord Devon was for many years the most influential man in his county and was generally known as “The Good Earl”.’

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29 STG Mins, 7 October 1836–28 October 1836. 30 TEFP 20 May 1830, p. 1; DRO, Circular Against Exeter Asylum 1835, 1292 M/Printed/Misc/14. TEFP 17 October 1839, p. 3. 31 Axminster Poor Law Guardians’ Minute Books [hereafter AG Mins], 3 November 1836. 32 AG Mins, 6 June 1868; AG Mins, 3 January 1845; 9, 25 February 1859. 33 R. Lethbridge, ‘The Bideford and Okehampton Railway of 1831’, Transactions of the Devonshire Association 34, 169, 1902, pp. 168–200. 34 Papers of Calmady Pollexfen Hamlyn, DRO: 1292/M undated/unsigned note in Bundle marked undated/unsigned: ‘I have very often, since I saw you, turned over in my mind your favourite proposition, that the County of Devon throws open the doors of Quarter Sessions to the public.’ C.f. M. Nolan to C.P. Hamlyn, 5 July 1822, on the abuse of parish funds. A nice contrast to the filial relationship between the Courternays can be found in the Hamlyn papers where Calmady’s ten-year-old son was encouraged to calculate life interest rates in letters to his father. See 1837 bundle, No Date, Osbert Calmady Hamlyn to C.P. Hamlyn; TEFP 22 October 1835, p. 4. 35 TEFP 21 March 1839, p.4; 8 April 1840, p. 3. 36 Okehampton Poor Law Guardians’ Minute Books [hereafter OG Mins], 28 April 1836; 25 July 1836; 8 August 1836; 13 February 1837. 37 OG Mins, 21 November 1836. 38 OG Mins, 4 April 1846. 39 OG Mins, 10 October 1846. 40 OG Mins, 15 April 1848. 41 OG Mins, 17 March 1866. 42 STG Mins, 22 July 1838. 43 Further Report of the Commissioners of Lunacy, PP 1847–1848, vol. XXXII, p. 99. 44 STG Mins, 11 June 1845. 45 AG Mins, 20 March 1846; 10, 30 December 1869. 46 AG Mins, 11 August 1881. 47 Lunacy Commission Special Report, PP 1847–1848, vol. XXXII, pp. 99–100. 48 OG Mins, 19 December 1846. 49 OG Mins, 25 April 1846; 9, 1 May 1847; 24 May 1851. 50 OG Mins, 20 February 1864, for the case of George B. of Chagford. 51 STG Mins, 27 February 1885; W.L. Parry Jones, The Trade in Lunacy, London: Routledge and Kegan Paul, 1971, p. 284. 52 AG Mins, 11 November 1875. 53 STG Mins, 20 January 1837; 3 April 1846; 28 November 1856. 54 The sample numbers for various analyses of this population may seem to jump around alarmingly: this is usually because the information available for each individual is limited. Within Plympton St Mary, individual districts were the responsibility of a district medical officer appointed to treat sick paupers referred by the Relieving Officer, including those suspected of insanity. If the lunatic remained in the community itself, then an individual could reach Exminster by a different route. 55 Exminster Admissions Certificates, 1845–1914 [hereafter EAC] The ‘facts of insanity’ observed by the certifying practitioner and communicated to him by others were usually reproduced, including florid details, in the case books of the Devon County Asylum as the first entries within the patient records of these decades. Our information on individual patients is primarily drawn from the certificates, admission registers and case books, the last often reproducing details from the other two sources. See 31 July 1886 for case of Henry B. who was described as having been an epileptic for many years ‘but lately the Fits

Notes

56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87

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have been increasing sometimes having as many as six a day, which leaves him in a very violent state’. EAC, 13 November 1871; 23 November 1903; 29 March 1905; 19 October 1895; 18 October 1897. EAC, 1 September 1873. EAC, 28 November 1870. EAC, 13 July 1872. EAC, 1 September 1873. EAC, 28 February 1907; 29 September 1899. EAC, 27 November 1880. EAC, 29 September 1899. EAC, 16 October 1872. EAC, 11 August 1888. EAC, 2 December 1909. EAC, 22 October 1870; and 5 December 1874 for Elizabeth A. EAC, 12 January 1877. EAC, 10 August 1883. EAC, 26 March 1874. Her details noted that she had ‘always appeared half an idiot’. EAC, 18 March 1871, for the case of William T., who was blind on admission to Exminster, where he died within weeks, and was reported to have been ‘searching for things with mischievous intent’. EAC, 21 December 1900; 5 April 1879; 23 October 1912. EAC, 21 November 1904. EAC, 20 July 1909. EAC, 3 July 1884. EAC, 26 January 1905. EAC, 31 August 1905. Plympton St Mary Poor Law Guardians’ Minute Books [hereafter PSMG Mins], 13 July 1872; 22 July 1872. PSMG Mins, 9 October 1869. PSMG Mins, 21 December 1911; 4 January 1909; 13 October 1903; 14 April 1892; 8 May 1911. PSMG Mins, 15 July 1914; 21 January 1893. PSMG Mins, 7 November 1904; 9 November 1904. PSMG Mins, 16 December 1905; 26 December 1905. PSMG Mins, 22 September 1908; 26 September 1908. R. Hodgkinson, Origins of the National Health Service, p. 590; K. Williams, From Pauperism To Poverty, London: Routledge and Kegan Paul, 1981, p. 214. N. Hervey, ‘The Lunacy Commission 1845–1860: with special reference to the implementation of policy in Kent and Surrey’, University of Bristol, Ph.D., 1987, p. 165. Further Report of the Commissioners in Lunacy to the Lord Chamberlain, London, PP 1847–1848, vol. XXXII, pp. 121–2, 197 and 216; Eighth Annual Report Lunacy Commission, London, PP 1854, vol. XXIX, pp. 125–129; N. Tomes, ‘The great restraint controversy: a comparative perspective on Anglo-American psychiatry in the nineteenth century’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 3, the Asylum and its Psychiatry, London: Tavistock, 1988, pp. 190–225. See also: Eighth Annual Report Lunacy Commission, London, PP 1854, vol. XXIX, pp. 125–129; Eleventh Report, London, PP 1857, Session 2, vol. XVI, pp. 2–3; Twelfth Report, London, PP 1857–1858, vol. XXIII, p. 8; Thirteenth Report, London, PP 1859, Session 2, vol. XIV, pp. 10–11.

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88 Minute Books of the Lunacy Commission held in the National Archive [hereafter LC Mins], MH50, vol. 8, 27 August 1856; DRO, Devon County Pauper Lunatic Asylum Minute Books of the Visiting Justices [hereafter VJP Mins], 147/2, 2 June 1857; Eleventh Annual Report Lunacy Commission, London, PP 1857, Session 2, vol. XVI, pp. 2–3; Twelfth Annual Report Lunacy Commission, London, PP 1857–1858, vol. XXIII, p. 8. 89 Eighth Report Lunacy Commission, London, PP 1854, vol. XXIX, pp. 38–39, for cases of Charles L. and Edward L.; J. Bucknill, Journal of Mental Science 15, 1855, pp. 116–120. 90 Eleventh Annual Report Lunacy Commission, London, PP 1857, Session 2, vol. XVI, p. 2; Thirteenth Annual Report Lunacy Commission, London, PP 1859, Session 2, vol. XIV, pp. 10–11. 91 J.D. Mellett, ‘Bureaucracy and mental illness: the Commissioners in Lunacy 1845–1890’, Medical History 25, 1981, p. 228; LC Mins, MH50, vol. 9, 23 September 1857; 9 June 1858; 17 June 1859; 13 December 1860, for tensions over certification between Bucknill and Commission; N. Hervey, ‘The Lunacy Commission’, p. 190. 92 Eighth Annual Report Lunacy Commission, London, PP 1854, vol. XXIX, p. 216; Fourteenth Annual Report Lunacy Commission, PP 1860, vol. XXXIV, pp. 104–105. By January 1859, there were 247 men and 324 women, plus 11 criminal lunatics housed in an institution built for 400. LC Mins, MH50, vol. 11, 20 March 1861. 93 LC Mins, MH50, vol. 11, 10 July 1861; 8 November 1861; 3 December 1861. 94 LC Mins, MH50, vols 8–10, 28 December 1855; 4 January 1856. The Commission on 10 October 1860 advised the Poor Law Board of their Commissioners’ report on the ‘prison like rooms in which Lunatics were confined.’ 95 LC Mins, MH50, vol. 12, 23 September 1863; 26 August 1863; 5 January 1864, for correspondence on provisions of 1862 Act. 96 LC Mins, MH50, vol. 11, 3 December 1861; Seventeenth Annual Report Lunacy Commission, London, PP 1863, vol. XX, p. 35; Eighteenth Annual Report Lunacy Commission, London, PP 1864, vol. XXIII, p. 8. 97 Twenty-first Annual Report Lunacy Commission, London, PP 1867, vol. XVIII, p. 128; Twenty-second Annual Report Lunacy Commission, London, PP 1867–1868, vol. XXXI, pp. 64–65; Twenty-fifth Annual Report Lunacy Commission, London, PP 1871, vol. XXVI, p. 148. 98 VJP Mins, 147/1, 17 April 1869; 22 May 1869; 12 August 1870; 10 January 1871; DRO, Devon County Quarter Sessions Minute Books [hereafter DQS Mins], 1/3, Epiphany Sessions, 1871, p. 291. 99 TEFP 9 August 1871, p. 7; PRO, LC Mins, MH50, vol. 16, 7 March 1871, decide against demanding explanation from Visitors as to the leniency shown to the guilty steward. 100 AG Mins, 3 September 1885. 101 AG Mins, Barnstaple Poor Law Guardians’ Minute Books [hereafter BG Mins], 25 November 1887; 2 December 1887; Bartlett, ‘Poor Law of lunacy’, p. 272, for Lutwidge’s castigation of the Barnstaple Guardians in the 1850s. 102 OG Mins, 3 September 1898; 25 November 1899; BG Minutes, 26 April 1907; 64th Annual Report of the Lunacy Commission, London, PP 1910, vol. XLI, p. 440. 103 Bartlett, ‘Poor Law of lunacy’, p. 198. 104 J.L. Melling, R. Adair and W.J. Forsyth, ‘Families, communities and the legal regulations of lunacy in Victorian England: assessments of crime, violence and welfare in admissions to the Devon County Asylum’, in P. Bartlett and

Notes

105 106 107

108 109 110

111 112 113 114 115 116

117 118 119 120 121 122 123

124 125 126 127

225

D. Wright (eds), Outside the Walls of the Asylum, London: Athlone Press, 1999, pp. 153–180. Annual Report of the Devon County Pauper Lunatic Asylum [hereafter AR], 1891, DRO 1037M/SS3/2, Ford of Branscombe Papers, p. 17. 46th Annual Report Lunacy Commission, London, PP 1892, vol. XL, pp. 58, 171; VJP Mins, 174/4, 6 August 1895; 46th Annual Report Lunacy Commission, London, PP 1892, vol. XL, p. 172. VJP Mins, 147/4, 7 August 1900; 7 December 1909; 1 September 1914; 147/4, 5 January 1892; 6 September 1892; 1 November 1892; 28 February 1893; 26 September 1893; 3 October 1893; 147/4, 13 April 1894 at 5 June 1894; 5 April 1898; 3 May 1898, for case of Ada W. H. Finer, English Local Government, London: Methuen, 1945, p. 226, for obligatory committee of Visitors created under the 1890 Lunacy Act. Devon County Council Finance Committee, DRO 154/4/1/2, 23 March 1894. LC Mins, MH50, vol. 25, 18 November 1891, for Commission’s letter of regret to Devon Asylum Committee at ‘finding so many matters unfavourably commented on’; VJP Mins, 147/4, 7 October 1890; 4 August 1891; 6 October 1891. VJP Mins, 147/4, 6 October 1896 for auditors’ suggestion that Saunders keep a proper ledger showing the engagement and discharge of attendants. Devon County Council Finance Committee, DRO 154/4/1/2, 1 March 1895; 28 May 1897; 2 June 1897. Devon County Council Finance Committee, DRO 154/4/1/2, 27 August 1897–10 December 1897. Devon County Council Finance Committee, DRO 154/4/1/2, 25 February 1898; 27 May 1898. Devon County Council Finance Committee, DRO 154/4/1/2. Letter of H.C. Munro of Local Government Board to Devon County Council, 12 October 1899. Devon County Council Finance Committee, DRO 154/4/1/2, 23 March 1900; 1 June 1900; Devon County Council Quarter Sessions/County Council, 147/4, 6 March 1900; 27 March 1900; 5 June 1900. Devon County Council Finance Committee, DRO 154/4/1/2, draft reply of letter at 24 March 1899. VJP Mins, 147/4, 22 November 1899; 2 January 1900; 6 February 1900; 3 April 1900; 3 July 1900. VJP Mins, 147/4, 5 June 1894; 4 December 1894; 6 August 1895; 5 October 1897. VJP Mins, 147/4, 7 May 1895; 2 July 1895; 6 August 1895. VJP Mins, 147/4, 7 July 1896; 3 November 1896; 4 May 1897; VJP Mins, 147/4 5 October 1897; 2 November 1897. VJP Mins, 147/4, 4 January 1898; 1 February 1898; 1 March 1898. VJP Mins, 147/4, 3 May 1898. VJP Mins, 147/4, 4 April 1905; VJP Mins, 147/4, 7 November 1905; 6 March 1906; 7 August 1906; 5 March 1907; 5 May 1908; LC Mins, MH50, vol. 33, 23 November 1904; 8 March 1905; 22 November 1905; 6 December 1905; vol. 34, 28 March 1906; 4 July 1906; 25 July 1906, for three cases where further enquiry demanded. Devon County Council Quarter Sessions Minutes, 147/4, 6 April 1909; LC Mins, MH50, vol. 35, 29 April 1908; 17 February 1909; vol. 36, 11 October 1911; vol. 37, 5 November 1913. VJP Mins, 147/4, 6 February 1906; 4 September 1906; 7 August 1906. VJP Mins, 147/4, 7 August 1906. BG Mins, 19 August 1898; 5 May 1911.

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4 The ethos of treatment, care and management at the asylum, 1845–1914 1 Exeter Corporation of the Poor Minute Books, DRO 15 March 1881. 2 St Thomas Poor Law Guardians’ Minute Books [hereafter STG Mins], 10 March 1882. 3 Exeter Corporation of the Poor Minute Books, 31 January 1882. 4 See Chapter 3 on state management of the asylum. 5 A.T. Scull, Museums of Madness: the Social Organisation on Insanity in NineteenthCentury England, London: Allen Lane, 1979; N. Tomes, ‘The great restraint controversy: a comparative perspective on Anglo-American psychiatry in the nineteenth century’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 3, the Asylum and its Psychiatry, London: Tavistock, 1988, pp. 190–225. 6 PP 55th Annual Report Lunacy Commission, PP 1901, vol. XXVIII, pp. 8–9. 7 C. Mackenzie in A.T. Scull, C. Mackenzie and N. Hervey, Masters of Bedlam: the Transformation of the Mad-Doctoring Trade, Princeton: Princeton University Press, 1996. 8 A. Digby, ‘A moral treatment at the Retreat 1796–1846’, in W.F. Bynum, R. Porter and M. Shepherd (eds), The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 2, Institutions and Society, London: Tavistock, pp. 57–72. 9 L. Brizendine, ‘British psychiatric reform 1830–1860: a sociohistorical study of Devon County Lunatic Asylum and J.C. Bucknill’, Yale University, D.Med., 1981, pp. 33–43; E. Renvoize, ‘The Association of Medical Officers in asylums and hospitals for the insane, the Medico-Psychological Association and their presidents’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry 1841–1991, London: Gaskell, 1991, pp. 29–78. 10 J.C. Bucknill and D.H. Tuke, A Manual of Psychological Medicine, Philadelphia: Blanchard and Lea, 1858, p. 347. Bucknill wrote the previous year: ‘consequently the existence of any pathological state in the organ of the mind [i.e the brain] will interrupt the functions of that organ and produce a greater or lesser amount of disease of mind, that is of insanity’, Journal of Mental Science III, 21, April 1857, p. 289. 11 L. Brizendine, ‘British psychiatric reform’, pp. 35–38, 81. 12 Bucknill and Hack Tuke wrote: ‘no term has of late been more profusely and empirically employed, and none has been less understood than the moral treatment of insanity . . . if the English physician looks to the writing of his countrymen . . . he finds little more than vague generalities’, quoted by Digby, ‘A moral treatment at the Retreat 1796–1846’, in Bynum, Porter and Shepherd (eds), Anatomy Of Madness, Vol. 2, p. 53. 13 A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, p. 224. 14 Bucknill and Hack Tuke wrote in a celebrated passage that the student of insanity would ‘not go far wrong if he regards insanity as a disease of the brain’, quoted in Scull, Most Solitary of Afflictions, p. 236. 15 Bucknill and Tuke, A Manual of Psychological Medicine, pp. 444–447, 452–453. 16 Bucknill, in Asylum Journal 1, 1854, cited by Brizendine, ‘British psychiatric reform’, p. 5. 17 J. Bucknill, The Supremacy of the Will, cited by J. Lee, ‘Devon County Pauper Lunatic Asylum, 1828–1861’, University of Exeter, M.Phil., 1995, p. 196. 18 J. Walton, ‘The treatment of pauper lunatics in Victorian England: the case of Lancaster Asylum 1816–1870’, in A.T. Scull (ed.), Madhouses, Mad Doctors and

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19 20 21 22 23

24 25

26 27 28 29 30

31 32 33

34 35 36 37 38

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Madmen: the Social History of Psychiatry in the Victorian Era, Philadelphia: University of Philadelphia Press, 1981, pp. 166–197. S. Allen, The History of Devon Mental Hospital 1845–1945, Exminster: Exminster Management Committee, 1945, p. 12; 61st Annual Report of Lunacy Commission, PP 1907, vol. XXX, p. 292. Allen, Devon Mental Hospital, pp. 10–11. 7th Annual Report Lunacy Commission, PP 1852–1853, vol. XLIX, p. 55. In 1852, 81 men and 52 women slept in single bedrooms and 113 men and 187 women in dormitories. Report of the Select Committee House of Commons to Enquire into the Care and Treatment of Lunatics, PP 1859, Session 2, vol. VII, pp. 90 and 93. Annual Reports of the Exminster Medical Officer, in Annual Reports of the Devon County Pauper Lunatic Asylum [hereafter AR] for 1860 117/6 and for 1848 117/2. These reports form part of the papers of the Devon Quarter Session from whose number the Visiting Justices of the Asylum were appointed. AR 1848 117/2; 1854 117/5; 1866 117/10. Minute Books of the Lunacy Commission held in the National Archive [hereafter LC Mins], MH50, vol. 11, 20 March 1861. Eighth Annual Report Lunacy Commission, London, PP 1854, vol. XXIX, p. 216; Fourteenth Annual Report Lunacy Commission, PP 1860, vol. XXXIV, pp. 104–105. By January 1859, there were 247 men and 324 women plus 11 criminal lunatics housed in an institution built for 400. Journal of Mental Science VI, 34, July 1860, p. 506. Journal of Mental Science VI, 34, July 1860, p. 495. E. Showalter, ‘Victorian women and insanity’, A.T. Scull (ed.), Madhouses, Mad Doctors and Madmen: the Social History of Psychiatry in the Victorian Era, Philadelphia: University of Philadelphia Press, 1981, p. 320. Journal of Mental Science V, 28, January 1859, p. 220. N. Morgan, ‘Against the tide at Exmouth: J.C. Bucknill 1817–1897’, South West Psychiatry, Spring 1990, 4, p. 75. Later in life he became a founding member of the Mental Aftercare Association. W.L. Parry Jones, ‘The model of the Gheel Lunatic Colony and its influnce on the nineteenth-century asylum system in Britain’, in A.T. Scull (ed.), Madhouses, Mad Doctors and Madmen, pp. 201–217. Report of the Select Committee of the House of Commons to Enquire into the Operation of the Acts of Parliament and Regulations for the Care and Treatment of Lunatics and their Property, PP 1859, Session 2, vol. VII, p. 94–95. 58th Annual Report Lunacy Commission, PP 1904, vol. XXIX, p. 284. Four patients were boarded out in 1904. Exminster Case Books [hereafter ECB], with admissions numbers given to the individual patient. We abbreviated the surnames of the individuals whose experiences are used to illustrate our arguments. We identify such patients by the first initial of their surname or by the admission numbers they were given on admission to the Exminster asylum. These admission numbers also appear in the case books from which we have drawn most of our material (ECB 420, 442, 465). A.T. Scull, C. Mackenzie and N. Hervey, Masters of Bedlam: the Transformation of the Mad-Doctoring Trade, 1996, pp. 188–189, 221. Devon County Quarter Sessions Minute Books [hereafter DQS Mins] 1/31 1857 Epiphany Sessions. J.C. Bucknill, ‘Description of the New House at the Devon County Lunatic Asylum’, Journal of Mental Science IV, 25, April 1858, p. 324. Bucknill, ‘Description of the New House’, p. 324. Bucknill, ‘Description of the New House’, p. 324. Also, Devon County Pauper

228

39 40 41 42

43

44 45 46 47 48 49 50 51

52 53 54 55 56 57 58 59

Notes

Lunatic Asylum Minute Books of the Visiting Justices [hereafter VJP Mins] 147/2, 2 June 1857. 11th Annual Report Lunacy Commission, PP 1857, Session 2, vol. XVI, pp. 2–3. Also, J.C. Bucknill, Journal of Mental Science IV, 2 April 1858, pp. 324–327. Bucknill, April 1858, p. 328. 12th Annual Report Lunacy Commission, PP 1857–1858, vol. XXIII, p. 8. ECB, August 1860–December 1860, clearly show the comparatively sparse character of entries made by Bucknill on individual patients compared to the florid entries of his early years. This was a source of criticism in Lunacy Commission correspondence. W.J. Forsythe, J.L. Melling and R. Adair, ‘The politics of lunacy: central state regulation and the Devon County Pauper Lunatic Asylum’ in J.L. Melling and W.J. Forsythe (eds), Insanity, Institutions and Society: a Social History of Madness in Comparative Perspective, 1800–1914, London: Routledge, 1999, pp. 68–92. 29th Annual Report Lunacy Commission, PP 1875, vol. XXXIII, p. 123; 64th, 1910, vol. XLI, p. 319. In 1860 there were 639 patients (231 men and 408 women) and in 1890 the figure was 907 (370 men and 537 women). 28th Annual Report Lunacy Commission, PP 1874, vol. XXVII, p. 30; 32nd Annual Report Lunacy Commission, PP 1878, vol. XXXIX, p. 163. 47th Annual Report Lunacy Commission, PP 1893–1894, vol. XLVI, p. 174. 49th Annual Report Lunacy Commission, PP 1895, vol. LIV, p. 80; Allen, Devon Mental Hospital, p. 26; 52nd Annual Report Lunacy Commission, PP 1898, vol. XLIII, p. 263. 54th Annual Report Lunacy Commission, PP 1900, vol. XXXVII, p. 21; DRO Devon County Council Asylum Sub-committee Minute Book, Devon Quarter Sessions 147/1/1, 27 October 1899. Allen, Devon Mental Hospital, p. 18. Also, 35th Annual Report Lunacy Commission, PP 1881, vol. XLVIII, p. 210; 36th Annual Report Lunacy Commission, PP 1882, vol. XXXII, p. 247. Devon County Council Asylum Sub-committee Minute Book, DRO 147/1/1, correspondence, St Thomas Rural District Council and Devon County Council Clerk, 18 June 1900; 27 June 1900; 29 June 1900. PP Annual Reports Lunacy Commission, 24th, PP 1870, vol. XXXIV, pp. 132–133; 29th, 1875, vol. XXXIII, p. 158; 34th, 1880, vol. XXIX, pp. 204–205; 38th, 1884, vol. XL, p. 189; 42nd, 1888, vol. LII, p. 177; 47th, 1893–1894, vol. XLVI, p. 172; 52nd, 1898, vol. XLIII, pp. 263–265; 57th, 1903, vol. XXVII, pp. 277–278; 62nd, 1908, vol. XXXIII, p. 310. It should be noted that the quinquennia do not run precisely to five-yearly intervals because figures for staffing and inmate population on the day of inspection are only presented in the reports intermittently. 45th Annual Report Lunacy Commission, PP 1890–1891, vol. XXXVI, p. 155. 46th Annual Report Lunacy Commission, PP 1892, vol. XL, p. 171. Select Committee of the House of Commons to Enquire into the Operation of the Acts of Parliament and Regulations for the Care and Treatment of Lunatics and their Property, PP 1859, Session 2, vol. VII, p. 91. Select Committee, PP 1859, p. 92. Select Committee, PP 1859, p. 92. Allen, Devon Mental Hospital, p. 29. Annual Report Medical Officer AR 1903 DQS, DRO 117/24. B. Nicholls, ‘The economic and social power of the landed families in nineteenth-century rural Devon’, University of Exeter, M.Phil., 1996 p. 212, table 29, after Finch.

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60 Ford of Branscombe Papers DRO 1037 M/SS3/2 Annual Report Lunatic Asylum 1907, p. 16. 61 VJP Mins, DRO 147/6, 6 February 1906. 62 AR Medical Officer 1897 Report DQS, DRO 117/21; 1907 DQS, DRO 117/24 63 PP 34th Annual Report Lunacy Commission, 1880, vol. XXIX, p. 205; 43rd Annual Report Lunacy Commission, 1889, vol. XXXVII, p. 196. 64 Ford of Branscombe Papers DRO 1037 M/SS3/2 AR 1906, p. 14. 65 VJP Mins, DRO 147/7, 5 March 1912. 66 Ford of Branscombe Papers DRO 1037/M/SS3/2 AR 1891. 67 VJP Mins, 147/2, 17 April 1869. 68 VJP Mins, 147/2, 24 October 1870. 69 VJP Mins, 147/5, 5 August 1902; 147/7, 3 December 1912 for a similar incident. 70 VJP Mins, 147/7, 6 June 1911. 71 VJP Mins, 147/7, 14 June 1912. 72 VJP Mins, 147/7, 7 March 1911. 73 VJP Mins, 147/7, 1 July 1913. 74 VJP Mins, 147/6, 1 November 1904. 75 VJP Mins, 147/6, 7 April 1908. 76 VJP Mins, 147/2, 10 February 1874. 77 VJP Mins, 147/5, 5 September 1899. 78 VJP Mins, 147/6, 4 October 1904; 147/7 2 June 1914. 79 VJP Mins, 147/5, 6 March 1900. 80 VJP Mins, 147/7, 2 May 1911; 6 June 1911; 4 July 1911. 81 Scull, Most Solitary Of Afflictions, p. 249. 82 E. Renvoise, ‘The Association Of Medical Officers in asylums and hospitals for the insane, the Medico-Psychological Association and their presidents’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841–1991, London: Gaskell, 1991, p. 62. 83 50th Annual Report Lunacy Commission, 1896, vol. XXXIX, part 1, p. 58; 55th Annual Report Lunacy Commission, 1900, vol. XXXVII, p. 62. 84 VJP Mins, 147/5, 7 January 1902. 85 22nd Annual Report Lunacy Commission, 1867–1868, vol. XXXI, pp. 64–65; 25th, 1871, vol. XXVI, p. 148; 46th, 1892, vol. XL, p. 171. 86 Trewman’s Exeter Flying Post, 9 August 1871. 87 VJP Mins, 147/3, 6 August 1895; 147/5, 3 October 1899; 46th Annual Report Lunacy Commission, 1892, vol. XL, p. 171. 88 In total 3 per cent of female admissions and 2 per cent of males were found to be ‘acute melancholics’. 89 R. Davidson, Dangerous Liaisons: a Social History of Venereal Disease in Twentieth Century Scotland, Amsterdam: Rodopi, 2000, re the Wasserman Test; J.R. Walkowitz, Prostitution and Victorian Society: Women, Class, and the State, Cambridge: Cambridge University Press, 1980, for analysis of Plymouth. 90 Comparable analysis of Hampshire County Asylum admissions and diagnoses may be found in S. Burt, ‘ “Fit objects for an asylum”: the Hampshire County Lunatic Asylum and its patients 1852–1899’, University of Southampton, Ph.D., 2003. 5 Journey to the asylum: residence, distance and migration in admissions to the asylum, 1845–1914 1 M. Anderson, Family Structure in Nineteenth-Century Lancashire, Cambridge: Cambridge University Press, 1971 and D. Levine, Family Formation in an Age of Nascent Capitalism, New York: Academic Press, 1977. See M. Anderson,

230

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3

4 5

6

7

8

Notes

Approaches to the History of the Western Family 1500–1914, London: Macmillan, 1980, pp. 40–42, 78–84, including criticism of the ‘sentiments’ approach to family development; J. Walton, ‘Lunacy in the industrial revolution: a study of asylum admissions in Lancashire, 1848–50’, Journal of Social History 13, 1979, p. 18; M. Finnane, Insanity and the Insane in Post-Famine Ireland, Croom: Beckenham Helm, 1981, p. 162: ‘what does stand out in this evidence is the centrality of the family as the context of madness’; L. Stone, ‘Family history in the 1980s: past achievements and future trends’, Journal of Interdisciplinary History 12, 1, 1981, particularly pp. 64–73; D. Wright, ‘Getting out of the asylum’, Social History of Medicine 10, 1, 1997, p. 24; S. Gouglas, J. Moran, D. Wright, ‘The confinement of the insane in Victorian Canada’, in R. Porter and D. Wright (eds), The Confinement of the Insane: International Perspectives, 1800–1965, Cambridge: Cambridge University Press, 2003, pp. 102–105. A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, pp. 1, 29, 31–45, 361, footnote 79; C.f. M. Finnane, ‘Asylums, families and the state’, History Workshop Journal 20, Autumn 1985, p. 135. J. Walton, ‘Lunacy in the industrial revolution’, Journal of Social History 13, 1981, pp. 7 (table 2), 6–7, 16–18; J. Walton, ‘Poverty and lunacy: some thoughts on directions for future research’, Bulletin for the Society for the Social History of Medicine 1986, p. 65; Finnane, ‘Asylums, families and the state’, pp. 135–141; P.E. Prestwich, ‘Family strategies and medical power: “voluntary” committal in a Parisian asylum, 1876–1914’, Journal of Social History 1994, pp. 799–800; See also B. Reay, ‘Kinship and neighbourhood in nineteenth-century rural England: the myth of the autonomous nuclear family’, Journal of Family History 21, 1, 1996, pp. 87–104. J. Walton, ‘Lunacy in the industrial revolution’, pp. 14–15, table 6. Wright, Moran and Gouglas, p. 120, note 84, suggest that Walton and the present authors have ‘tended to downplay the role of migration (either of patients or their families) as a factor in the likelihood of an individual being confined’. We would suggest that our interpretation differs both from that of Walton and of Wright in a number of respects. A.T. Scull, C. MacKenzie and N. Hervey, Masters of Bedlam: the Transformation of the Mad-Doctoring Trade, Princeton: Princeton University Press, 1996, particularly pp. 103–105. A.T. Scull, The Asylum as Utopia: W.A.F. Browne and the Mid-Nineteenth Century Consolidation of Psychiatry, London: Tavistock and Routledge, 1991. F. Driver and G. Rose (eds), Nature and Science: Essays in the History of Geographical Knowledge, Bristol: Cheltenham and Gloucester College Historical Geography Research Group, 1992; C. Philo, ‘ “Fit localities for an asylum”: the historical geography of the nineteenth-century “mad-business” in England as viewed through the pages of the Asylum Journal’, Journal of Historical Geography 13, 4, 1987, pp. 398–415; C. Philo, ‘Journey to the asylum: a medical–geographical idea in historical context’, Journal of Historical Geography 21, 2, 1995, pp. 148–168. See also H. Parr and C. Philo, ‘A forbidding fortress of locks, bars and padded cells: the locational history of mental health care in Nottingham’, Historical Geography Research Series 32, 1996; G.N. Grob, Edward Jarvis and the Medical World of Nineteenth-Century America, Knoxville: University of Tennessee Press, 1978. Philo, ‘ “Fit localities for an asylum” ’, pp. 398–415, for a detailed discussion of Bucknill’s contributions. C. Philo, A Geographical History of Institutional Provision for the Insane from Medieval Times to the 1860’s in England and Wales, Lampeter: Edward Mellen Press, 2004, provides a detailed exposition.

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9 E.A. Wrigley, ‘Men on the land and men in the countryside: employment in agriculture in early-nineteenth-century England’, in L. Bonfield, R. Smith and K. Wrightson (eds), The World We Have Gained: Histories of Population and Social Structure: Essays Presented to Peter Laslett on his Seventieth Birthday, Oxford: Blackwell, 1986, Tables 11.2, 11.5 and 11.7 provide evidence of the widespread importance of handicraft as compared to modern industrial and factory employment in the earlier nineteenth century. 10 The rise of Plymouth may be reasonably compared, for example, with seaport economies such as that of Liverpool in a common dependence on commercial trade, shipbuilding and maritime or military services. 11 C. Geertz, The Interpretation of Cultures, New York: Basic Books, 1973. Also V.P. Pecora, ‘The limits of local knowledge’, in H.A. Veeser (ed.), The New Historicism, New York: Routledge, 1989, pp. 243–276. We use the term to suggest not only specific loyalties and connections associated with particular parishes or towns, but also the rival ‘traditions’ of aristocratic responses to the modernisation of the British state discussed in the first two chapters of the text. 12 J.L. Melling, R. Adair and W.J. Forsythe, ‘ “A proper lunatic for two years”: pauper lunatic children in Victorian and Edwardian England. Child admissions to the Devon County Asylum, 1845–1914’, Journal of Social History 30, 4, 1997, pp. 371–405. 13 The admission data for 1845–1854 was compared, for example, with the Devon population recorded in 1851 and an idea of what was the ‘standard’ propensity to send was established. The z-stat (or ‘z-score’) formula was as follows: if the total population is N and the total number of lunatics is M then p ⫽ M/N; q ⫽ (1⫺). Let the population of any particular subgroup be n, and the number of lunatics admitted from there be m. Then for any particular subgroup the expected number of lunatics is np and the z-stat is given by: z-stat ⫽ m ⫺ np/the square root of npq. 14 We measured distances as the crow flies rather than by proximity to roads, railways and canals, as Jarvis claimed to have done. This estimate was combined with a calculation of the distance between the particular parish and the centre of the Poor Law Union, taken as the location of the workhouse. Many of the parishes sending significant numbers to Exminster included substantial commercial, market and trading centres such as the fishing port of Brixham, the ancient town of Ottery St Mary and the booming area of Newton Abbot. Such ‘high’ senders were frequently within reach of the emerging tourist resorts along the Devon coastline in these decades, though a limited range of factors cannot easily explain their prominence. 15 Detailed results of these regression exercises on parish data may be received on application to the authors. 16 Including Plymouth and Exeter in the regression exercise changes the ‘sign’ for the physical area equation to positive and the results then indicate that large parishes were associated with admissions, though Plymouth and Exeter are clearly identified as ‘outliers’ (i.e. atypical) and having markedly opposing signs in 1851, and Exeter as an outlier in every period thereafter. Such results suggest that the two cities would have a distorting effect on the results, leading us to omit them for most purposes. 17 As noted above, including Plymouth and Exeter results in a strongly negative correlation between size of population and propensity to send, more particularly after ‘1881’, i.e. after the period 1875–1884. Excluding the smaller boroughs of Barnstaple and Tiverton from the regression led to no significant change in regression results for those Unions, suggesting that the building of alternative amenities by Exeter and Plymouth in 1886 and 1892, respectively, had their

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19 20

21

22

23

24

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greatest impact on those cities rather than on other Devon Unions using their facilities after these dates. There were very few towns with such large populations, though substantial townships were growing steadily throughout the period, usually at the expense of smaller settlements. Our research shows large numbers of known lunatics in Plymouth and Exeter were housed elsewhere than in state asylums prior to the building of their own borough institutions, though they were rarely as significant a proportion of the urban population as in other Devon towns. The boroughs of Barnstaple and Tiverton appear to have displayed a low propensity to send lunatics in the latter part of the period. To undertake this exercise we divided the population of each parish by its physical area and multiplied the resulting figure by 20 million to make the numbers more manageable. We coded the parishes according to the size of their population. The scale ranged 0–8 in each direction with ranges from 0.0001–5.0 per cent to more than 35 per cent plus or negative. Since population data was not available for 1921, we have not included 1911, though we did extract data for 1841 so the 1851 figure is provided. The period was 1875–1884 matched against the trend in population 1871–1891. Towards the end of the period there is some sign that the most rapidly growing parishes were associated with greater admissions, while those losing most people were poorly represented. Further details are available in R. Adair, J.L. Melling and W.J. Forsythe, ‘Migration, family structure and pauper lunacy in Victorian England: admissions to the Devon County Pauper Lunatic Asylum, 1845–1900’, Continuity and Change 12, 3, 1997, pp. 373–401. A search of 28 parishes revealed that more than three-quarters of those individuals who were resident in workhouses and otherwise outside the asylum were identified as idiots or imbeciles. More than half of these people (56 per cent) were resident in their parish of birth, compared with 50 per cent of asylum patients. Some 90 patients (comprising 32 per cent of the total number of entrants to Exminster in 1851 and 1881) were not found and excluded from the analysis. There appears little reason to doubt that our patient group is representative of the whole patient body. We considered the possibility that patients moved in the period (i.e. up to a year) between the census and their entry to Exminster. The lodgers, boarders and servants were the most likely itinerant characters and six out of 15 for which data are available did indeed move between the census and their entry to the Devon asylum. The evidence also indicated that even the most mobile individuals tended to gravitate back to their closest families when insanity struck. It is difficult to characterise them as abandoned. For an interesting discussion of related points, see R. Wall, ‘Historical developments of the household in Europe’, in P. Hooimeijer, E. van Imhoff, A. Kuijsten and L. van Wissen (eds), Household Demography and Household Modelling, New York: Plenum Press, 1995, pp. 36, 46–47. The frequency with which kinsfolk were used as servants has been clearly pointed out by D. Cooper and M. Donald, ‘Households and “hidden” kin in early-nineteenth-century England: four case studies in suburban Exeter, 1821–1861’, Continuity and Change 10, 2, 1995, pp. 257–278, particularly pp. 270–273. All the servants were female, with only one aged over 45. They were distributed across a range of household types (four simple, and one each of solitary, extended and multiple) and one was accompanied by her husband, forming a household within the household. Of the lodgers, boarders and visitors, eight were female and four male, with half being over 45, and were

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again spread across a range of households, though eight out of 12 were in simple households, thus displaying similar proportions both to servants and to the patients as a whole. Some analysis for the comparable experience of Hampshire can be found in S.M. Burt, ‘ “Fit objects for an asylum”: the Hampshire County Lunatic Asylum and its patients, 1852–1899’, University of Southampton, Ph.D., 2003, pp. 225–226 and passim. We are suggesting that certain kinds of household members may have been more ‘visible’ to the Poor Law than others. Single householders without dependents may have been less likely to come within the purview of the Relieving Officers and also less likely to have members of established families advocating their relief. Alternatively, where single people formed part of a family household, then they were still unlikely to qualify for Poor Law relief on standard scales unless they had dependent children or were classed as ‘lunatics or idiots’. The scale of relief for both deserted mothers and lunatics and idiots was often at the discretion of the Guardians (St Thomas Poor Law Guardians’ Minute Books [hereafter STG Mins], 5 July 1850, Scale of Relief, for example). Families might therefore be more inclined to present single people to the Poor Law authorities, and the authorities might then be more disposed to send them on to Exminster (and less anxious to retrieve them) than with family members who occupied a more central role within the family economy of the household, particularly where the dependent relatives were being maintained by the Poor Law in the absence of the breadwinner or principal carer. This second possibility appears to require two assumptions to hold true. The first is that the onset of an attack of insanity would become apparent to family, neighbours or others who would then be willing to arrange for the individual to be placed within some kind of household. The second is that such an attack should be serious enough to require intervention to break up the solitary household, but hardly ever serious enough to demand early admission to the asylum, since there would have to be a sufficient period for the person to be effectively resettled within the household that the asylum records as their place of residence. Large numbers of widowed people entered the Devon Asylum in our period and we must conclude that remarkably few of these were also living on their own at the time of admission. Since we know that many of the admission entries that appeared in the Exminster records describe a short duration of attack prior to admission, there appear to be still outstanding issues which deserve further analysis. Evidence from the Devon Unions of Poor Law Guardians show that the individual parishes continued to bear financial responsibility for their paupers and it seems likely that arrangements affecting the admission of individuals to the workhouse as well as the County Asylums began in discussions between families and the parish overseers of the poor. In this sense there may have been a dialogue within ‘communities’ rather than a sharp alternative of family versus institutional relief. Very little evidence of parochial financial arrangements affecting pauper lunatics appears in the Union Guardians’ minutes. One other multiple household combined both elements and was excluded from the analysis. Given the significant numbers of patients whose attack of insanity was recorded as of relatively short duration, there still appears to be a problem to explain. Exminster case books certificates [hereafter ECB] DRO 3769/H2 series. 3769, 5904. This was despite the fact that another sister lived elsewhere in Crediton. ECB, 5785 (Emma) and 5910 (Eliza). ECB, 5876, for case of William S., living with his uncle and aunt in Devonport

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rather than his mother, and 5941, for John L. of Tawstock, living with his brothers rather than his mother residing in the same parish. Isaac Q. of Sherford’s certificate noted he had been violent to his parents and lived with his sister and her husband, 5782. This comprised three brothers-in-law, two mothers-in-law, one father-in-law, one ‘relation’, two brothers, one sister, one nephew and one father. This larger group included 13 heads of households and eight wives. The remainder comprised three sons and two daughters. E. Showalter, The Female Malady: Women, Madness and English Culture, 1830–1870, New York: Virago, 1987, remains extremely influential. For a critique, see J. Busfield, ‘The female malady? Men, women and madness in nineteenth-century Britain’, Sociology 28, 1, 1994, pp. 259–277. As a father, brother, nephew, father-in-law, two brothers-in-law. It is not true in all cases that these women had no resident kin. For instance, in one case a servant lived with her husband within a wider household and two of the workhouse inmates had family with them, such as Maria S., an unmarried 27-year-old pauper servant who was in Barnstaple Workhouse along with her five-year-old son, William. Nevertheless, in general these individuals do not appear to have had the support available from a familial network. The classic (and only) solitary household was Sarah S. of Stoke Fleming in 1881. This is computed from all patients in the 1851 and 1881 samples for which ages are given, 141 in all. Although they represented only a limited proportion of total admissions, this group of future inmates who were neither in the workhouse nor in settled family units contributed to the sizeable element of single people amongst the intake at Exminster. This may especially apply to servants. Four out of the five servants in the sample whose marital status was traceable were unmarried, although as we have seen it is dangerous to assume that they were all unrelated to any members of the household in which they worked. The diminishing numbers in these samples are obviously a problem as the figures for single people in extended, multiple, and category-two households are seven, four and six respectively. Seven of the eight individuals in this category were aged 30 or more. It makes sense to include category-two households with the extended and multiple households since these are all examples of family structures involving patterns different from those of simple households, and all include the co-residence of individuals beyond the immediate nuclear family. Clearly, many such individuals would have lived in simple households at an earlier stage of their lives, but this does not alter the fact of their current status. There may appear to be an obvious bias in that the Poor Law physicians and workhouse officers administered the certification process, and arrivals at Exminster were frequently identified as coming from the workhouse rather than a parish. For this reason we omitted the obvious workhouse residents and those whose parish of origin was unclear. An intra-Union distance effect remained visible. The results from calculations for 1851, for example, suggested an R Square of 0.13142 and an adjusted R Square score of 0.12307. This means that a direct comparison with our data on the admissions to the Devon Asylum, which are constructed from the ten years around the census year, is not possible. The data for census years prior to 1871 were too fragmentary and inconsistent to utilise for our analysis of institutional policies of the Devon Unions. Since independent boroughs did not contribute to the initial construction costs

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of the County Asylum, they had no immediate right of access and were charged a higher rate than that imposed on county Poor Law Unions for housing inmates. There appear to have been a total of 120 known pauper lunatics in such houses in Devon itself in 1876, rising to 281 in 1886. There was a sprinkling of other Unions’ inmates but the only noticeable presence was that of Newton Abbot, which used both private madhouses and the workhouse to a significant degree in the period 1876–1906, probably in response to overcrowding at the County Asylum. All data was derived from the Annual Reports of the Lunacy Commissioners. A total of approximately 300 lunatics were recorded in Devon workhouses until the end of the century, with numbers falling below 200 in 1901. Most Boards of Guardians responded to pressures from the Lunacy Commission by making less use of workhouses from the 1880s, though the flight from workhouse accommodation was a slow retreat rather than a sudden rush. These numbers include Exeter and Plymouth. There appear to have been about 300 Devon lunatics cared for in ‘the community’ in 1871 and a little over 200 by 1901. Whereas this group had been equivalent to almost half of the numbers held at Exminster in 1871, it represented the equivalent of one-fifth in 1901. The Lunacy Commission data included East Stonehouse and Stoke Damerel (two of the three ‘towns’ of Plymouth which each comprised a distinct Union for Poor Law purposes), as well as Exeter and Plymouth. The returns given in these Reports frequently vary in some respects from our results based on the analysis of Exminster admission registers. This probably arises from the exclusion of ‘workhouse’ inmates from our data where the parish of origin is unclear, and also from the inclusion in Commission Reports of all asylum inmates within one particular Union, rather than those in the Devon County Asylum. As noted earlier, the data from the Lunacy Commission Reports is only easily useable from the 1860s, and has various technical difficulties for comparative purposes. The figures we derived from the Reports on Devon covered only the census years, whereas our Exminster data covers the decade ‘around’ the census year (e.g. 1845–1854 admissions and census population for 1851). To provide a check we also made calculations from data recorded for the mid-decennial points of 1866, 1876, etc. The results were broadly similar to those for the decennial years. The proportions of Devon county Poor Law pauper insane held in asylums increases rather more than the absolute figures indicate, of course. The broad patterns of the Devon Unions excluding Plymouth and Exeter are broadly similar, though the marked ‘under-representation’ of Newton Abbot amongst the recorded insane and the distinctive patterns of institutional use in Barnstaple and Honiton should be emphasised. Philo, ‘Journey to the asylum’, p. 149. By way of contrast with Newton Abbot and the south coastline of Devon, we examined the experience of the Barnstaple Union on the north Devon coast and found that, although Barnstaple town itself may have made only limited use of the County Asylum, the regression results on the Barnstaple Union suggested that membership of this Poor Law Union had either no significant, or a mildly positive, influence on admissions to the asylum. Such returns may again suggest the need for more specific and complex models to capture the various demographic effects on asylum entry. We further tested the significance of the ‘Union effect’ by replacing the results of the St Thomas and Kingsbridge Unions with those for Newton Abbot, a

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Union with a steadily rising population, and Barnstaple (which included a borough which used the asylum only lightly at different periods). The regression results gave a slightly improved ‘fit’ as indicated by the R-squared return at some points, but there was little variation from the results using the first two Unions. This would imply that little difference arises from using different Union data and that Union-wide effects have a limited impact on the results. Devon Quarter Sessions–County Council Asylum Visitors Committee Minutes, DRO QS-CC 147/4; 3 February 1891; 3 March 1891; 7 March 1893; 6 June 1893, for examples of decisions on the discharge of inmates to their relatives. Philo, ‘Journey to the asylum’, pp. 159–160, where various private facilities are discussed. For reasons of space we have not discussed the existence of private madhouses in Devon. Briefly, we can note that Plymouth used the much-criticised establishment at Plympton for many years, while the Exeter Guardians sent their pauper lunatics to Somerset and Dorset institutions. Philo suggests that the existence of such profit-making establishments helps to explain the limited distance-decay effect in English counties, as the more affluent families sent their relatives to these places rather than the pauper asylums. There appears little evidence, in Devon at least, that private madhouses significantly affected the distance-effect pattern we have outlined. For these institutions see W.L. Parry Jones, The Trade in Lunacy: a Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries, London: Routledge, 1972, and C. MacKenzie, Psychiatry for the Rich: a History of Ticehurst Private Asylum, 1792–1917, London: Routledge, 1992. The whole question of social position, resources and the use of pauper institutions justifies detailed reappraisal in this respect. Barnstaple and Bideford provided 15 females and 11 males. Reay, ‘Kinship and neighbourhood’, p. 100, for example, returns to Anderson’s study of Lancashire as the focal point for debate. We might expect that those families with ‘idiot’ children and elderly, incapable relatives might have been restricted in their mobility as compared with similar kinds of household which did not possess such members. Families with relatives identified as insane or mentally incapable in some respect may have been particularly hampered. The greater association of lunacy admissions with more ‘complex’ family formations may be partly explicable in these terms.

6 Community, friends and family: asylum lunatics and the social environment, 1845–1914 1 S. Cherry, Mental Healthcare in Modern England: the Norfolk Lunatic Asylum/St Andrew’s Hospital circa 1810–1998, Woodbridge: Boydell, 2003. 2 J. Saunders, ‘Institutionalised offenders: a study of the Victorian institution and its inmates with special reference to late-nineteenth-century Warwickshire’, University of Warwick, Ph.D., 1983, p. 313. 3 J. Walton, ‘Casting out’, in W.F. Bynum, R. Porter and M. Shepherd, The Anatomy of Madness: Essays in the History of Psychiatry, Vol. 2, Institutions and Society, London: Tavistock, 1985, pp. 140–141. 4 D. Wright, ‘Getting out of the asylum: understanding the confinement of the insane in the nineteenth century’, Social History of Medicine, 1997, 10, 1, pp. 137–155. 5 Devon County Pauper Lunatic Asylum Minute Books of the Visiting Trustees (hereafter VJP Mins), 147/7, 7 September 1909. 6 55th Annual Report Lunacy Commission, PP 1901, vol. XXVIII, p. 25. 7 Devon County Lunatic Asylum, Exminster Case Books (hereafter ECB), 416, 424, 432, 492, 496.

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8 C. MacKenzie, Psychiatry for the Rich: a History of Ticehurst Private Asylum, 1792–1917, London: Routledge, 1992, p. 215. 9 VJP Mins, 174/3, 4 November 1879. 10 VJP Mins, 147/5, 5 September 1899; 7 January 1902. 11 VJP Mins, 147/6, 7 March 1905. 12 J.C. Bucknill and D.H. Tuke, A Manual of Psychological Medicine, Philadelphia: Blanshard and Lea, 1858, pp. 513, 518. 13 Of the 172 individuals admitted between census night and the end of 1882, more than two-thirds (68.6 per cent) were identified in the census as householders, wives, sons or daughters. 14 There were only 18 admissions found wandering at large, but 75 others were declared to be not under proper care and control. The majority of the latter group (43) were female, most of them unmarried, while the males were substantially married men who gave their wives as the nearest relative (fathers and mothers being the most common ‘nearest relative’ among the unmarried). A large majority of these women were examined at home and a lesser majority of men, with more of the latter being examined in ‘other’ places. The Act of Parliament where the provisions of detention were given is 16 and 17 Vict. cap. 15, sec. 68. 15 Bucknill and Tuke, A Manual of Psychological Medicine, pp. 121–130. 16 See Chapter 3. 17 In one case we find the opinion of a policeman who brought Samuel L. to Exminster, that he ‘had Brain Fever’, soberly noted in the certificate. Exminster Admissions Certificate, 1845–1914 (hereafter EAC), 18 January 1870. These bundles form part of the major Exe Vale deposit at the Devon Record Office, Exeter. Article 19 of the General Order for Accounts issued by the Poor Law Board in January 1867 specified that records of admissions and discharges should be recorded, though very few of these documents have actually survived. 18 In 1871, 1881 and 1891 there were 247, 142 and 129 entrances to the workhouse, of whom 80 per cent, 65 per cent and 75 per cent were there for reasons of destitution. Lunacy was given as a reason in only five cases overall (1, 1 and 3) representing a tiny proportion of those admitted before 1891. Among the 239, 141 and 141 leaving, only two, four and two in the three years respectively were sent to the County Asylum. 19 Of the 101 pauper lunatics who went to Exminster between 1867 and 1914 from Plympton St Mary workhouse, only 36 were identified as workhouse residents in the Exminster admission registers. A detailed analysis of 93 individuals for the whole period 1867–1914 has revealed that 58 of this group (62 per cent) had no other contact with the workhouse apart from their entry prior to being sent on to Exminster. 20 Plympton St Mary Poor Law Guardians’ Minute Books (hereafter PSMG Mins), DRO 1576/10, 9 June 1882. 21 PSMG Mins, 1 February 1884; 24 October 1884. 22 J.L. Melling and R. Turner, ‘The road to the asylum’, Journal of Historical Geography 25, 1999, pp. 298–332. 23 R. Hodgkinson, The Origins of the National Health Service: the Medical Services of the New Poor Law, London: Wellcome Historical Series, 1967, pp. 179, 164. 24 8th Annual Report Lunacy Commission, PP 1854, vol. XXIX, pp. 38–39; Devon County Quarter Sessions Minute Books (hereafter DQS Mins) 1/30 Epiphany Sessions 1852, p. 488; N. Hervey, ‘The Lunacy Commission 1845–1860: with special reference to the implementation of policy in Kent and Surrey’, University of Bristol, Ph.D., 1987, p. 269. 25 L. was found confined in a tiny room. Bucknill described him as being contorted

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38 39

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so much that ‘his nose was almost between his knees, his legs drawn up’. One of his legs was broken. J.C. Bucknill, Journal of Mental Science 15, 1855, pp. 116, 120. Exeter Corporation of the Poor Minute Books, DRO 25 October 1864. ECB, 2251, 2308 and 4885 admitted 1860, 1861 and 1876 respectively. ECB, 4260 William S., admitted 1872; 5038 Mary B. admitted 1877; 9856 admitted 1902. ECB, 443 for William F., for example. E. Renvoise, ‘The Association of Medical Officers in asylums and hospitals for the insane, the Medico-Psychological Association and their presidents’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841–1991, London: Gaskell, 1991, p. 62; A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, p. 249. Special Report of the Commissioners in Lunacy to the Lord Chancellor on the Alleged Increase of Insanity, PP 1897, vol. XXXVIII, p. 2. 24th Annual Report Lunacy Commission, PP 1870, vol. XXXIV, p. 132. 48th Annual Report Lunacy Commission, PP 1894, vol. XLIII, p. 194. 26th Annual Report Lunacy Commission, PP 1872, vol. XXVII, p. 130. 33rd Annual Report Lunacy Commission, PP 1878–1979, vol. XXXII, pp. 218–219. ECB, 4293, for Susan L.’s appreciation. DRO Ford of Branscombe 1037 M/SS3/2 Annual Report of the Devon County Pauper Lunatic Asylum (hereafter AR), 1906, p. 18. Trewman’s Exeter Flying Post (hereafter TEFP) 8 January 1852, p. 8. TEFP 21 January 1878, p. 7. TEFP 16 February 1876, p. 7. AR, 1874 DQS 117/18. 50th Annual Report Lunacy Commission, PP 1896, vol. XXXIX, part 1, p. 246. VJP Mins, 2 March 1909. Mackenzie, Psychiatry for the Rich, p. 147. Report of the Royal Commission on the Care and Control of the Feeble Minded, PP 1908, vol. XXXIX, pp. 38–39, 43. Dyke Acland told the Commission that it is certainly my experience that the feeble minded girls in the rural villages stand at a frightful disadvantage . . . I think in defence against themselves the best thing to do is to detain them. With regard to ‘certain classes of feeble minded men who are distinctly dangerous to their neighbours when they are at large in their villages who have . . . a sort of prurient monomania . . . it is desirable to get them under control.’ VJP Mins, 147/1, 1 April 1847, of Jane P.; 147/2, 8 September 1857, Sarah S. was eventually released in November 1857. VJP Mins, 147/1, 1 June 1852, for example, when it was agreed that: ‘The friends of the following patients applied for their discharges and agreed to undertake that the patients should be properly taken care of and that they should not become chargeable to the parish.’ VJP Mins, 147/2, 7 January 1862; 1 January 1858; 8 January 1861, for the cases of Miss W., Mrs P. and Pelham William C. In the last it was agreed that Ordered Pelham William ‘be finally discharged to the custody of the said Robert Middleton’. VJP Mins, 147/1, 1 June 1852. VJP Mins, 147/1, 1 June 1852. VJP Mins, 147/2, 5 May 1857. St Thomas Poor Law Guardians’ Minute Books (hereafter STG Mins) 26 July

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53 54

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59 60

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1907, for William H. and Axminster Poor Law Guardians’ Minute Books (hereafter AG Mins) 23 September 1880, for Miss P.’s cases. VJP Mins, 147/6, 6 October 1903; 5 May 1903. ECB, 4050 for Mary C. who was finally discharged 7 May 1872. AG Mins, 9 March 1905. Jesse H. was re-admitted. ECB, 4348 for Catherine N., whose daughters reported that ‘they have been quite worn out with anxiety and watching’. ECB, 7804, for Henry W. VJP Mins, 147/2, 1 November 1870. VJP Mins, 147/2, 10 July 1860. Mary A. ECB, Rhoda N., 4861. She was admitted in 1872 and was released in early spring 1874 on a month trial but was recalled to the asylum (note of 28 March 1874). She was formally re-admitted 22 November 1875 which suggests a discharge later in 1874 or in 1875. VJP Mins, 147/2, 4 February 1868. For example, ECB, 5551 George C., ‘Fancies his wife is untrue to him and that people enter his house at night . . . He arms himself with an axe. Threatens to kill anyone who comes in.’ ECB, 5586, Elizabeth R., ‘Told me that she should pray for all cats and dogs to enter the Kingdom of Heaven . . . She threatened to jump out of the window. Has been very violent.’ Three males and three females were sent from Amberd House, Taunton, three females and two males from Bailbrook House at Bath, another three females and two males from Barwood House, Gloucester and three females and one male from Brislington House at Bristol. For private patients more generally, see MacKenzie, Psychiatry for the Rich, pp. 19–20, and passim. S. Burt, ‘ “Fit objects for an asylum”: the Hampshire County Lunatic Asylum and its patients, 1852–1899’, University of Southampton, Ph.D., 2003. F. Driver, Power and Pauperism: the Workhouse System, 1834–1884, Cambridge: Cambridge University Press, 1993, for a Foucauldian view of the New Poor Law as the history of power ‘inscribed in administrative texts, the calculating power of institutional design, sometimes the power of popular resistance, frequently the power of local recalcitrance and, for the most part, the powerlessness of paupers themselves’ (p. 165). Driver also notes local variations within the workhouse system after 1852 (pp. 53, 69–71, 148–149). Two out of five of the 1880–1882 admissions had been insane for a month at most. More wives than husbands had been insane for more than 100 days prior to entry, which compared with a slightly lower proportion of spinsters and bachelors. Only four married men under 30 were admitted in 1880–1882, having all been insane 50 days or less, whilst we found 39 bachelors, over half of whom were reported as insane for more than 100 days. Husbands tended to be older and mostly insane for less than 100 days. There were few wives under 30 amongst the 1880–1882 intake, and half of the 27 wives in their 30s were reported as insane for 30 days or less. Spinsters recorded higher periods of insanity prior to entry, including a minority said to have been insane since birth. The very high proportion of girls under 20 who were recorded as having been insane all their lives is noticeable in comparison to the proportion of boys. Twothirds of both spinsters and bachelors in their 40s had a previous history dating more than a year and the ratio of those with a history then drops for single people in their 50s, whilst it increases for married people. Amongst the 1880–1882 intake, 47 husbands were dead within 1,000 days compared to 13 wives. Similarly, 13 spinsters died within the same period and only nine bachelors.

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7 Reading the rules of domesticity: gender, insanity and the asylum, 1845–1914 1 Axminster Poor Law Guardians’ Minute Books (hereafter AG Mins), 19 December 1878–27 February 1879. 2 AG Mins, 29 August 1878–19 December 1878. The Archdeacon’s widow claimed that her late husband’s rent payment was ‘a matter of private person[al] assistance’. 3 AG Mins, 27 March 1879–8 May 1879; 12 February 1880–26 February 1880. In the event he did not enter. 4 AG Mins, 2 December 1880, for petition of the Lancaster Union reported in Local Government Chronicle. 5 Devon County Pauper Lunatic Asylum Exminster case books (hereafter ECB). Devon Record Office (DRO) 5951. St Thomas Poor Law Guardians’ Minute Books (hereafter STG Mins), 19 May 1882. The bank contacted the Guardians. Within a few weeks of his admission, the St Thomas Board of Guardians claimed more than £5 from an account standing in the name of Mr and Mrs T. at the Devon and Exeter Savings Bank in reimbursement of their costs, recording an intention of making a further claim ‘should the man’s chargeability continue’. Only one occupied clergyman appears in a sample of 4,000 male and female admissions, though numerous lay preachers appear in the certificates. 6 J.W. Scott, Gender and the Politics of History, New York: Columbia University Press, 1988, p. 174. 7 A. Clark, ‘The rhetoric of Chartist domesticity: gender, language, and class in the 1830s and 1840s’, Journal of British Studies 32, 1992, pp. 62–63, 72–73. 8 C. Smart, ‘Disruptive bodies and unruly sex: the regulation of reproduction and sexuality in the nineteenth century’, Regulating Womanhood: Historical Essays on Marriage, Motherhood and Sexuality, London: Routledge, 1992, pp. 7–32; and J.J. Matthews, Mad Women in Twentieth-Century Australia, Sydney: Allen and Unwin, 1984, especially pp. 175–197, offer recent sophisticated formulations. 9 Anne D., aged 26, arrived 23 August 1847, released 31 January 1848, Devon County Lunatic Asylum, Exminster Admissions Registers (hereafter EAR), DRO, admission 439. 10 E. Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980, London: Virago, 1987, p. 28: ‘The most significant innovation of Victorianism, however, was the domestication of insanity.’ See Showalter, p. 52, for discussion of preponderance of females in almost all institutions for the insane by 1890s. Most of this evidence is drawn from government publications and A.T. Scull, Museums of Madness: the Social Organisation of Insanity in Nineteenth-Century England, London: Allen Lane, 1979, but c.f. A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven and London: Yale University Press, 1993, p. 256, n. 111, for emphasis on the common experience of male and female lunatics. J.E. Kromm, ‘The feminisation of madness in visual representation’, Feminist Studies 20, 3, 1994, pp. 511–518, offers visual evidence for the Showalter thesis in relation to Shakespearean heroines and medical illustrations. 11 Showalter, The Female Malady, pp. 53–59, 102–116, 122–123; J.C. Bucknill and D.H. Tuke, A Manual of Psychological Medicine, Philadelphia: Blanchard and Lea, 1858, p. 18, make the infamous observation: There is a latent devil in the heart of the best of men; and when the restraints of religious feeling, of prudence and self-esteem, are weakened or removed by the operation of mental disease, the fiend breaks loose . . . religious and moral principles alone give strength to the female mind; and

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21

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that, when these are weakened or removed by disease, the subterranean fires become active, and the crater gives forth smoke and flame. A key thesis on domestication, separate spheres and the feminisation of subjectivity is developed in L. Davidoff and C. Hall, Family Fortunes: Men and Women of the English Middle Class, 1780–1850, London: Routledge, 1987, especially pp. 25–34, 388–396; C. Hall, White, Male and Middle Class, Cambridge: Polity, 1992, p. 75; L. Davidoff, ‘Mastered for life: servant and wife in Victorian and Edwardian England’, Worlds Between: Historical Perspectives on Gender and Class, Cambridge: Polity, 1995, pp. 18–40, ‘The rationalization of housework’, Worlds Between, pp. 73–102. For housework, see J.R. Gillis, ‘Servants, sexual relations and the risks of illegitimacy in London, 1801–1900’, in J.L. Newton, M. Ryan and J.R. Walkowitz (eds), Sex and Class in Women’s History, London: Routledge, 1983; E. Higgs, ‘Domestic servants and households in Victorian England’, Social History 8, 2, 1983, pp. 201–210. J. Busfield, ‘The female malady? Men, women and madness in nineteenthcentury Britain’, Sociology 28, 1, 1994, pp. 259–277, particularly pp. 263–268 for Showalter’s use of Lunacy Commission returns; J. Oppenheim, ‘Shattered Nerves’: Doctors, Patients and Depression in Victorian England, Oxford: Oxford University Press, 1991, pp. 182–195, 226–227, for a critique of Showalter’s reading of medical practice. N.M. Theriot, ‘Women’s voices in nineteenth-century medical discourse’, in B. Laslett et al. (eds), Gender and Scientific Authority, Chicago: University Chicago Press, 1996, pp. 124–126. J. Andrews and A. Digby, ‘Gender and class in the historiography of British and Irish psychiatry’, Sex and Seclusion, Class and Custody, Amsterdam: Rodopi, 2004, pp. 7–44. These essays appear in Andrews and Digby, Sex and Seclusion. A. Suzuki, ‘Framing psychiatric subjectivity: doctor, patient and record-keeping at Bethlem in the nineteenth century’, in J.L. Melling and W.J. Forsythe (eds), Insanity, Institutions and Society: a Social History of Madness in Comparative Perspective, 1800–1914, London: Routledge, 1999, pp. 115–136, for example. In only three years did the proportion of males in the intake fall below 40 per cent, and in only two years did it rise about 54 per cent. Since a number of the 13,000 admissions were re-admissions (accounting for some 17 per cent of the total), there were rather fewer than this number of individual patients in the period. Female entrants displayed a mean age of 43 years compared with 41.6 years for men. There is evidence of widespread rounding of ages (particularly roundingup) to the nearest decennial age point for both males and females, presumably where there was uncertainty as to the exact age of the individual. In 1881, approximately 41.5 per cent of Devonians aged 15 or more were aged 20–39, compared to less than 35 per cent of the intake of the Devon asylum. The age profile of women and men entering aged 40–59 roughly matched the wider population. The Digby Asylum admissions in its first decade amounted to 573, 312 of whom were female, while there were 175 fee-paying admissions, 98 of whom were female. Moorhaven Asylum recorded 200 females and 158 males in residence on 1 January 1909. The admissions for 1909–1913 inclusive suggest a higher number of women came to Moorhaven (274 females among 466 admissions), a ratio of 59:41. More than three-quarters of both female and male inmates in 1909 had been resident for ten years or more. Busfield, ‘Female malady’; L.J. Ray, ‘Models of madness in Victorian asylum practice’, European Journal of Sociology XXII, 1981, pp. 231–232, 234, shows most people admitted to Victorian asylums were released alive or dead within a

242

22 23

24 25 26 27 28 29 30 31

32

33

34 35

Notes

few years of entry; also D. Wright, ‘The discharge of lunatics from County Asylums in mid-Victorian England, 1853–72’, in W.J. Forsythe and J.L. Melling (eds), Insanity, Institutions and Society, pp. 93–112. Amongst those who died at the asylum, the mean average length of stay was 8.5 years for females and less than six years for males. Three-quarters of all entrants under 20 left within five years. A further 9 per cent of young females and 10 per cent of young males left within ten years. Thereafter prospects for release declined dramatically, particularly for the youngest females. About 5 per cent of females in this group were released after residing between ten and 20 years at Exminster, and another 8 per cent staying between 20 and 45 years. Slightly more males were released after ten (but under 20) years, but fewer are recorded as very-long-stay inmates. Almost three-quarters of females entering middle age departed within five years, compared to the two-thirds of men who left within one year of entry. Whilst married women remained eight years before dying and married men less than four years, spinsters survived for more than 12 years on average and bachelors for more than ten years. Less than one in five of the 1880–1882 intake were wandering or without care. The small group of wanderers included more males than females. Single women (usually under 30) were three times more likely than bachelors to be found beyond care and control, whilst wives and husbands were equally numerous. Those aged 15–19 comprised 16 per cent of Devon’s population. Of the females admitted, 86 were aged 16 or less compared to 117 males. EAR, 4278, Susan L., admitted 26 March 1872, from Ashburton, aged 16. More than one in four unmarried women and one in four single men had no next of kin clearly identified, compared to one in eight wives and one in seven husbands with no recognised kin entered. Amongst 4,000 entrants which made up our large sample, 400 women and over 200 men were assigned no clear occupational code. Half of the women were unmarried, as were a significant majority of the males, with very few husbands and widowers. In 1880–1882, a large majority of both males and the (more numerous) females with no occupation were unmarried. Only 16 of 4,000 had ‘pauper’ entered as their occupation. No wives were so identified, though five widows and five spinsters were. This was true of males and of females, though to a lesser degree. Less than 5 per cent of the Exminster intake were diagnosed as belonging to these categories as compared to more than one-third of males with no stated occupation and between 12–14 per cent of females. The 1881 census of the asylum confirmed the lack of occupational status and marital partners amongst those enumerated as ‘imbeciles or idiots’. The 4,000 indicates a high proportion (10 per cent) of patients without occupations lacking a clear diagnosis in 1880–1914. Amongst 958 single women in the 4,000 sample, an estimated 350 were servants and more than 200 had no occupation. There was greater diversity of occupations amongst bachelors, though one-third were labourers. One in five of the 132 single women admitted in 1880–1882 lacked an occupation, more than half of the employed spinsters being in some form of domestic work. Amongst 100 married women, 13 had no occupation and 80 of the remainder were entered as a wife. In a sample of 4,000 admissions, there were 143 males and 91 females in this category, with a similar ratio of idiot to imbecile. 500 female and 300 male melancholics appear in our 4,000 sample, and the 1880–1882 intake suggests a narrower gap between the sexes. Mania (and acute)

Notes

36

37

38 39 40 41 42 43

44 45 46 47

48

49 50 51 52

243

claimed one-third of female and male entrants, whilst melancholy accounted for about one-quarter of female entrants and one-sixth of males. Of the 4,000 sample, 1 per cent indicated a clear diagnosis of puerperal insanity. Closer analysis of 1880–1882 admissions revealed seven clear diagnoses and three others of mania or melancholia caused by childbirth or confinement, representing 4 per cent of 250 female admissions. H. Marland, ‘ “Destined to a perfect recovery”: the confinement of puerperal insanity in the nineteenth century’, in Forsythe and Melling (eds), Insanity, Institutions and Society, pp. 137–155, argues that admission figures understated the numbers suffering. C. Quinn, ‘Include the mother and exclude the lunatic: a social history of puerperal insanity c.1860–1922’, University of Exeter, Ph.D., 2003. Among the 892 Wonford female admissions were perhaps 44 whose insanity was said to be caused by childbirth, or less than 5 per cent of the total, though if we exclude those whose cause of insanity was said to be unknown, the proportion rises to almost 6 per cent. This compares with 33 females whose certification was said to be caused by the climacteric or menopause. EAC, 430, Maria H., aged 27, admitted 2 August 1847. EAC, 4927, Sarah B., aged 40, admitted 1 May 1876. EAC, 4795, Susan D., aged 31, admitted May 1875. EAC, 5928, Susan D., now aged 38, was re-admitted February 1882. There are only three references to ‘change of life’ amongst ‘causes’ in 1880–1882, which represented 1 per cent of females, compared to the 3–4 per cent of cases indicated in the Wonford Asylum admissions. There were four instances in the main 4,000 sample data from 1870–1914. An examination of 1880–1882 reveals one explicit diagnosis and four references amongst female mania sufferers. The medical case books of patient careers include more references. Three-quarters of both males and females were certified in 1880–1882 admissions as of unsound mind. 140 males were identified as having ‘general paralysis’ (7.5 per cent of total males), as compared to only 22 women (1 per cent of all diagnoses). EAC, 475, Charles West S., aged 33, admitted February 1848. About one-quarter of the general paralysis (g.p.) males in the 4,000 sample were from Devonport, East Stonehouse or Plymouth itself. One-fifth of these g.p. were engaged in armed services and maritime work, being mostly married men. Over 100 died, 20 recovering. Most of the women diagnosed were married, though only two of 22 were married to servicemen. For Plymouth, J.R. Walkowitz, Prostitution and Victorian Society: Women, Class, and the State, Cambridge: Cambridge University Press, 1980, pp. 157–167. There were relatively few before 1860, rising to 40 males a decade in 1860–1880, but declining sharply for both sexes from the mid-1880s. G.E. Berrios, ‘Psychosurgery in Britain and elsewhere: a conceptual history’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, 1841–1991, London: Gaskell, pp. 182–184. Almost half the 1880–1882 g.p. intake had no cause given. About one-fifth referred to physical brain damage, injury or fever and eight to excessive (or lack of) work. Four mentioned intemperance. If all references to general paralysis are placed together, they form the largest single diagnostic category in 1880–1882. Higher recovery rates in such a group (1:4.5 versus 1:7 for the whole period) suggests loose usage. Exminster case books (hereafter ECB), 7460 Dan M. It was said that this merchant had exhausted his considerable means in the pursuit of his lost love. ECB entry for November 1894. Mr M. died in the asylum in 1904.

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Notes

53 Including William F., aged 23, admitted 9 September 1847, EAC, 443, brought from South Molton gaol after brother and father had taken out warrants of the peace; Henry W., aged 27, admitted for the third time in January 1893, EAC, 7804. 54 Mary P., admitted 8 May 1872, aged about 36. EAC, 4309. She returned to the asylum as a widow in 1894 for a year. EAC, 8213. 55 Emily B., aged 34, admitted February 1872, EAC, 4264. 56 Less than 20 of 500 admissions in 1880–1882 were certified as wandering abroad. 57 Sarah W., aged 17, admitted 1872, EAC, 4378; Sarah S. admitted 6 December 1875, discharged 5 September 1876, EAC, 4869. 58 Susan H., aged 17, admitted 1848, EAC, 494; c.f. the case of Mona L., aged 31, ECB, 4429, including detailed of letters from the employer, a Broadclyst physician. 59 Mary Jane G., first admitted 11 February 1862, EAC, 2460. Released recovered within two months, re-admitted the following May, remaining three months and discharged recovered, ECB, 2689. 60 Sarah R., admitted August 1872, ECB, 4381. Discharged recovered within months. 61 There were only two clear prostitutes amongst the 4,000 sample: Susan K. of East Stonehouse, wife of a shoemaker, entered February 1870, EAC, 3893; Emma E. of Devonport, entered November 1871, occupation prostitute, EAC, 4230. The medical case books reveal more prostitutes, such as Matilda E., laundress, re-admitted from Devon County Gaol in 1861 within two years of a previous discharge. She was infected with gonorrhoea, having fallen in with ‘some low prostitutes who induced her to steal money from her grandmother’ (ECB, 2306). Miss E. recovered within six months but seems to have returned ten years later and remained until her death in 1908 (ECB, 4245). 62 Catherine M., age unknown, admitted 22 October 1860, discharged 23 June 1863 (ECB, 2233). 63 Of the 4,000 sample, 19 had criminal status in their notes, males 2:1 majority. Nine discharged recovered, one not insane. 64 One criminal was serving 14 days for vagrancy. 65 The larger sample of 4,000 shows 26 per cent of women suffering from melancholy or acute melancholy, whilst 17.5 per cent of men were so affected. Mania and acute mania claimed 35 per cent of women and 33 per cent of males. More males were described as demented. Chapter 9 considers in more detail the relationship between initial diagnosis, length of stay and outcome of institutional care in the Devon asylums. 66 A selection from the 1880–1882 intake makes the point. Of the 100 males who entered in fair or good health, 56 died and 44 recovered or left relieved; and of 118 in poor or feeble health, 78 died and 40 recovered or left relieved. Of 82 women who came in good or fair health, half died and half recovered; 135 women were thought to be in poor or feeble health with 74 dying and 61 recovering or relieved. 67 Amongst the 1880–1882 intake, a larger proportion of married women in poor or feeble health were discharged recovered than wives in good health and many more spinsters in bad health died at the asylum than those who entered in fair condition. 68 Jane T.J. of Plympton St Mary, aged 42, re-admitted 1873, EAC, 4441. 69 EAC, 4898 and 6321. 70 A slightly higher proportion of the 6,859 female admissions were re-admissions (17 per cent versus 15 per cent of the 6,142 males). The impact of length of stay of the asylum population is discussed at greater length in Chapter 9.

Notes

245

71 Husbands formed the second-largest group of re-admissions in 1880–1882, but two-thirds of these had been outside for more than three years whilst spinsters, the largest group, and the smaller groups of wives and bachelors achieved only half their number with this distinction. 72 Only one of seven recorded visits lasted as much as a year and on each occasion she was discharged recovered. 73 For example, William S., aged 35, admitted 1872, ECB, 4359, ‘Works well at the farm and goes about as he likes’. 74 William W., admitted 25 November 1847, EAC, 472. 75 John S., admitted March 1872, EAC, 4280. 76 Mary S., ECB, 416: entries for June 1847, 1 January, 15 February, 4 April, 14 April, 1848. 77 The widowed Christine D. was first admitted in autumn 1871 and discharged back to Totnes workhouse in spring 1872 (ECB, 4211). She returned in early 1873, having pined ‘for the comforts of the Asylum’. She was again returned to her Union two years later (ECB, 4437). 78 The Exeter Borough Asylum at Digby’s Field in 1886 and the Plymouth asylum at Moorhaven in 1892. 79 There were 346 single males, or 44 per cent of the male intake, as compared to 496 (i.e. 56 per cent of the females) who were unmarried on admission. Approximately 47 per cent of the men were married as compared to 31 per cent of the women. 80 Among 358 residents were 200 females on 1 January 1909. In 1909–1913 there were 466 new admissions, 274 of whom were women. 81 The register for Moorhaven admissions, 1909–1913, indicates that 151 females were discharged and 73 died, compared to only 63 males discharged and 82 who died (Plymouth borough asylum, Moorhaven, admission registers (hereafter MAR)). 82 The Moorhaven data indicates that of 174 males admitted in 1913–1914, 72 died, 77 were discharged (plus six recovered) and 15 removed. Among the 1913–1914 intake, 166 were to live at Moorhaven for less than five years. 83 Among 13 female patients resident in early 1909, five were subsequently ‘removed’ and three discharged, three dying and the outcome of two others is unknown. The outcome of only three private male patients is known, two of whom were discharged and one removed. Among the 32 women and 12 males admitted as private patients in 1909–1913, almost two-thirds of the females were discharged and only three ‘removed’, seven dying. More than half of the 12 private male patients were discharged and one-third died in Moorhaven. About half of the female private patients resident in early 1909 had been at the asylum between one and five years, while another three had stayed longer still. In comparison, two-thirds of the women and the men admitted in 1909–1913 departed within a year of arrival, only one or two of those leaving within a year did so by death. 84 K. Jones, ‘Law and mental health: sticks or carrots?’, in G.E. Berrios and H. Freeman (eds), 150 Years of British Psychiatry, London: Gaskell, 1991, pp. 94–95. 85 Bucknill introduced a system of first- and second-class private patients at the asylum, though only 14 individuals are listed. Three other admissions are described as ‘gentlewomen’ or ‘wife of a gentleman’.

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Notes

8 Madness and the market: occupations, class and the asylum, 1845–1914 1 Devon County Pauper Lunatic Asylum, Exminster Admission Certificates, DRO (hereafter EAC), 6047. Henry was recorded in the 1881 census as an MD and member of Royal College of Surgeons (not practising), while his son Henry was nine. A combined 11 per cent of males and females were identified as ‘not pauper’ as such, with the term ‘pauper’ removed by the Magistrate on the committal order for the 1880–1882 intake. This indicated that the person was still eligible to receive treatment at the asylum. There were also some variations in certification between the pauper and ‘non-pauper’ groups. Female diagnoses of unsound mind were associated more strongly with such non-paupers than the possibly more pejorative ‘lunatic’, though the difference is slight and may derive from the greater likelihood of paid employment (and avoidance of pauper status) amongst husbands of certified wives. 2 EAC, 5549 for Edward H., who shared the same surname as Henry H. His wife Elizabeth was living in her own household at Clowance Cottages at the time of the 1881 census, her husband being a resident of Stoke Damerel workhouse. An entry for Elizabeth also at the workhouse appears to have been an error as the gender is male. A comparable case to Edward’s is that of Edward S., an unmarried butcher, living in ‘a state of great poverty’, though he imagined large amounts of property were to come into his possession. Witnesses again testified to his violent intentions with firearms as he threatened to burn down his cottage and claimed that a local policeman had ‘told him to shoot any boy that annoyed him’ (EAC, 5978). 3 EAC, 6049. 4 Among the 1880–1882 intake, there were 80 male and 84 females whose admission documents included some reference to violent speech and/or conduct. Of these, 40 men were married, compared to 29 bachelors, while 41 of the women were unmarried and 27 were wives. Rather more widows than widowers were said to be violent. 5 EAC, 5654, 5942, 5850, 5878. 6 In 1880–1882, the Devon Asylum admitted 276 females and 262 males. Perhaps one in five were said to have shown violence of some kind prior to committal. 7 For further discussion of the general question of Poor Law provisions and family income, see L.H. Lees, The Solidarities of Strangers: the English Poor Law and the People 1700–1948, Cambridge: Cambridge University Press, 1998. See also B. Harris, The Origins of the British Welfare State: Social Welfare in England and Wales 1800–1945, Basingstoke: Palgrave, 2004, p. 97 and passim. 8 The wider significance of class relationships for the identification and treatment of those considered insane has recently been considered in a useful survey by Andrews and Digby, primarily in regard to gender (J. Andrews and A. Digby, ‘Gender and class in the historiography of British and Irish psychiatry’, Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry, Amsterdam: Rodopi, 2004, pp. 7–44). 9 M. Foucault, ‘Governmentality’, in G. Burchell, C. Gordon and P. Miller (eds), The Foucault Effect: Studies in Governmentality, Hemel Hempstead: Harvester, 1991, pp. 98–101. A.T. Scull, The Most Solitary of Afflictions: Madness and Society in Britain 1700–1900, New Haven: Yale University Press, 1993, p. 3. In discussing Foucault, Scull notes that: Reform did indeed have deep structural roots in the changing nature of English society, but these roots were embedded to a far greater extent and

Notes

10 11

12 13

14 15

16 17 18

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in far more complex ways in broader transformations of the English political and social structure and especially in the nature of capitalism as a social phenomenon than conventional simplistic references to urbanization and industrialization have managed to grasp. See also pp. 10–11. Scull, Most Solitary of Afflictions, pp. 26–29, 32–34, 45–46, 62–63, 105–107, 352. J. Walton, ‘Lunacy in the industrial revolution: a study of asylum admissions in Lancashire, 1848–50’, Journal of Social History 13, 1979, pp. 2–4 and passim: ‘the distribution of asylum admissions in a particular area will not reflect the distribution of medical or other symptoms so much as the norms governing social conduct and administrative reactions to the operation or breakdown of these norms’ (Table 2). This indicates that larger cities accounted for 57 per cent of admissions, with less than 43 per cent of the population, while textile towns claimed two-fifths of Lancashire’s population but little more than one-quarter (29 per cent) of admissions (Walton, ‘Lunacy in the industrial revolution’, p. 10, Table 4). ‘Labourers’ accounted for about 6.6 per cent of Lancashire’s population, but almost 14 per cent of admissions, whilst cotton textiles workers had 17.8 per cent of admissions and 18.1 per cent of the population. Female domestics claimed a little over 9 per cent of all workers and 17 per cent of admissions, compared with about 15 per cent of cotton textiles workers and almost 18 per cent of admissions. P. Bartlett, The Poor Law of Lunacy: the Administration of Pauper Lunatics in MidNineteenth-Century England, Leicester: Leicester University Press, 1999, pp. 42–43, 58–59, 62–63. D. Wright, ‘The discharge of lunatics from County Asylums in mid-Victorian England, 1853–72’, in W.J. Forsythe and J.L. Melling (eds), Insanity, Institutions and Society: a Social History of Madness in Comparative Perspective, 1800–1914, London: Routledge, 1999, pp. 93–112; P. Michael, Care and Treatment of the Mentally Ill in North Wales 1800–2000, Cardiff: University of Wales Press, 2003; S. Cherry, Mental Healthcare in Modern England: the Norfolk Lunatic Asylum/St Andrew’s Hospital circa 1810–1998, Woodbridge: Boydell, 2003. P. Joyce (ed.), Class, Oxford: Oxford University Press, 1992, pp. 233–235 and passim; P. Joyce, Visions of the People: Industrial England and the Question of Class, 1840–1914, Cambridge: Cambridge University Press, 1990. M.K. Hilson, ‘Working class politics in Plymouth 1890–1920’, University of Exeter, Ph.D., 1998, for class and politics in Devon’s largest city; L. Davidoff, ‘Mastered for life: servant and wife in Victorian and Edwardian England’, Worlds Between: Historical Perspectives on Gender and Class, Cambridge: Polity, 1995. W.D. Rubinstein, ‘Wealth, elites and class structure in modern Britain’, Past and Present 76, 1977, pp. 99–126. A. Borsay, ‘A middle class in the making: the negotiation of power and status at Bath’s early Georgian General Infirmary, 1739–65’, Social History 24, 3, 1999, pp. 269–286, for a critique of Wahrman and Neale. J. Walton, ‘Lunacy in the industrial revolution: a study of asylum admissions in Lancashire, 1848–50’, Journal of Social History 13, 1981, p. 16, citing Medick. The suggestion is that extended peasant families functioned to conserve property whilst the extended proletariat family functioned to alleviate the poverty of nuclear families by redistributing resources and burdens. Walton suggests that such characteristics are to be more clearly found in the textiles towns than in urban conurbations, whilst also relieving the kind of pressures on the family to maintain agrarian property, which may explain higher reporting of lunacy amongst dependent members in rural districts. For Plymouth and wider Devon

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19 20 21 22 23

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migration, see M. Brayshay and V. Pointon, ‘Migration and the social geography of mid-nineteenth-century Plymouth’, Devon Historian 28, 1984, pp. 3–14. EAC, 5830. The other woman was named P. J. Andrews, ‘Raising the tone of asylumdom: maintaining and expelling pauper lunatics at the Glasgow Royal Asylum in the nineteenth century’, in W.J. Forsythe and J.L. Melling (eds), Insanity, Institutions and Society, pp. 200–222. C. MacKenzie, Psychiatry for the Rich: a History of Ticehurst Private Asylum, 1792–1917, London: Routledge, 1992, pp. 170–171, Table 6.1. Whilst Devon accounted for 3.35 per cent of the population of England and Wales in 1841, by 1911 its 702,000 inhabitants represented only 1.95 per cent of the total. Whilst about 35 per cent of the British labour force was found in agriculture, forestry and fishing in 1801, and 22 per cent were still so employed in 1851, compared with a rise from 29 per cent to 42 per cent in mining, manufacturing and building, Devon saw a rise of numbers in agriculture in the 1830s–1840s to a peak of 32 per cent in 1851. The descent in agricultural employment across Britain in the second half of the nineteenth century was steep (from 22 per cent to 9 per cent), but the rate of decline was almost matched in Devon (falling from 32 per cent to about 15 per cent). Amongst the male agricultural workforce, the fall in agricultural employment was actually more rapid in Devon in 1851–1891 than in England and Wales. Crudely the census returns for the different sectors were as follows: Census occupational group

Agriculture Industry ‘Domestic’ Commercial Professional ‘Non-productive’

1871

1891

M

F

29.0 35.2 3.4 7.7 14.6 10.1

2.5 15.7 75.6 0.9 1.7 3.6

■M

21.1 37.1 1.3 9.5 12.1 18.9

F 0.5 11.6 19.0 0.2 3.3 65.5

24 Walton, ‘Lunacy and the industrial revolution’. For Plymouth and wider Devon migration, see Brayshay and Pointon, ‘Migration’. 25 In 1881 parishes of 2,500–4,999 people possessed 43 per cent native and 11 per cent immigrant women, compared to 36.5 per cent native and 9.5 per cent immigrant males. Almost one-quarter of households in the largest cities were led by a female, as compared to one in ten of the small parish households. 26 See R. Adair, J.L. Melling and W.J. Forsythe, ‘Migration, family structure and pauper lunacy in Victorian England: admissions to the Devon County Pauper Lunatic Asylum, 1845–1900’, Continuity and Change 12, 3, 1997, pp. 373–401, for details. 27 B. Nicholls, ‘The economic and social power of the landed families in nineteenthcentury rural Devon’, University of Exeter, M.Phil., 1996, Table 4.1.2, after Bateman, Great Landowners, 1878. They comprised Duchy of Cornwall, Rolle, Bedfords, Courtenays, Fortescues, Poltimores, Knights, Earls of Portsmouth, Stucleys, Aclands, Clintons, Lopes, Prestons, Carews, Palks. Rentals varied considerably, with Palk overshadowing the rest, though Rolle, Bedfords and Courtenays were all very substantial. Some 31,800 landowners held the 1.6 million acres, though the 15 largest held 300,000 acres.

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28 In 1851, there were 300,267 females and 272,063 males recorded in the census, just over 200,000 females and about 175,000 males were 15 or older. There were about 11,500 farmers and graziers (about 7 per cent of the total). Groups such as farm bailiffs, drovers, shepherds and ‘about animals’ made up rather less than 1 per cent of the total, and their addition does not change the picture significantly. 29 To carpenters and joiners could be added the 1,187 sawyers and 144 wood turners, as well as the box makers and so on. 30 Mining of copper, lead and tin together employed perhaps 2,550 men or 1.5 per cent of the total, and other miners and workers in minerals were tiny by comparison, though stone workers and lime quarriers still figured in the totals and employed a little under 1 per cent collectively. 31 Extracting figures from the 1891 census, it is assumed that there were about 230,000 males and 270,000 females above the age of ten, and most of these eligible for some kind of employment. 32 About 4 per cent of females were described as indoor and outdoor servants. In addition about 2 per cent of females were described as housekeepers. The term ‘labourer’ was rarely applied to females. 33 The 1881 Devon census suggests marriage was relatively uncommon before the age of 20, while about half of the people aged 20–35 were married. The unmarried represented more than one in ten of those older than 35 (i.e. the great majority were married or widowed). Widowed women outnumbered widowers by three to one among those aged over 35. 34 Analysis of the Exeter and St Thomas workhouses at the time of the 1881 census reveals that a substantial majority of both male and female occupants were younger than 14 or older than 60. 35 Among the 110 females and 118 males in the Exeter Workhouse in 1881, excluding scholars and children, were 37 female domestics, 30 dressmakers and related among the women, and 31 labourers and eight agricultural labourers, some 42 tradesmen and ten-to-15 commercial tradesmen and shopkeepers. Among the 27 females and 61 males in the St Thomas Workhouse in 1881 were eight female domestics, five laundresses, nine dressmaking and lace workers. Well over half the adult males in the workhouse (37) had been agricultural labourers. A similar age and occupational profile is evident in a comparison of Plymouth and Stoke Damerel workhouses at this time. The largest occupational groups among males being ‘labourers’, various handicraft trades, agricultural labourers and a variety of hawking and service employment. Females were primarily listed as having no occupation, servants, charwomen, services and dressmakers. 36 Rather less than one in five females and one in ten males were given no occupation on admission to Exminster among our 4,000 sample. The proportion of males without an occupation increased from 9 per cent to 15 per cent during the period. 37 Blank entries and unknowns amounted to about one-eighth of the male intake and more than one-fifth of the female intake in our sample of 4000 and may have included large numbers of the non-respectable but since many are wives this seems unlikely. 38 The inclusion of labourers with ‘mechanics’ and others, while agricultural workers were grouped with farmers and farm servants, makes direct comparisons with the 1881 and other census returns more difficult, though skilled handicraft mechanics were included with other metal craftsmen in class 10.1 of the 1881 census, indicating a clear distinction of handicraftsmen and labourers. To the agricultural workers might be added 33 gardeners and six dairymen who

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39

40

41

42

43

44

Notes

entered the Devon Asylum. This table is based on admissions to 1910 rather than 1914 to include most for whom the outcome of admissions is well known. Three groups of seven male labourers were selected from the large sample of 4,000 individuals, encompassing those who entered Devon Asylum around the time of the 1881 census. The first group consisted of males entering and leaving Exminster before the census date. The second were selected from those entering before 1 April 1881 but leaving after the census was taken. A third group was taken from those entering and leaving after the census. In addition, a further seven male labourers were selected from our comprehensive analysis of all patients admitted in 1880–1882 (our study having examined every male and female admission for these particular years rather than merely those who figured in our large sample of 4,000 across the period as a whole), who had not been found in the sample. The results suggested that where individuals were traced 50–75 per cent of each group were identified, apparently more accurately, as agricultural labourers in the census having been recorded simply as labourers by the asylum authorities. At least ten of the 28 individuals could more appropriately be identified as agricultural labourers, eight could not be traced, three were engaged in miscellaneous occupations and only four reasonably confirmed as general labourers. At least 5 per cent and possibly 8 per cent of males could be considered in this group, though the term ‘pensioner’ and annuitant remained ambiguous as to the extent of the resources involved. A comparison of admissions between the intake 1845–1879 and 1880–1914 suggests that this group appears to have remained fairly stable over the period as a whole. E.H. Hunt, ‘Industrialisation and regional inequality: wages in Britain, 1760–1914’, Journal of Economic History XLVI, 4, 1986, pp. 941–944, 947–948. Lancashire moved from the low wage standards of the eighteenth century to relatively high wages by the mid-nineteenth century while Devon and the south-west suffered from low agricultural wages by the end of the eighteenth century and failed to improve their standing in the wages league until almost a century later when the region’s wage labourers overtook the eastern counties of England blighted by a depression in wheat and cereals prices (J.G. Williamson, ‘The impact of the Irish on British labour markets during the industrial revolution’, Journal of Economic History XLVI, 3, 1986, pp. 698–700, 715–718). The 1861 census indicates 28,628 male agricultural labourers alongside 12,601 indoor farm servants, almost 11,000 farmers and over 5,000 male relatives. In 1881, the number of agricultural labourers had increased slightly (though this number now included farm servants), while farmers had fallen to a little over 9,000. The proportion of farmers among male employment appears to have declined slightly from about 6 per cent to less than 5 per cent, though landowners and others were not included by 1891. Including male relatives of farmers results in a decline from about one-quarter to a little over 15 per cent of Devon males eligible for employment. Our analysis of the admissions of agricultural labour shows little significant variation over the period 1845–1914 and no consistent, substantial variation across the seasonal calendar. We undertook a detailed analysis of agricultural workers, their years and months of entry to the Exminster asylum and their age profile over time. There appear to be few significant variations in the patterns of admissions over the years 1845–1914 nor were there clear differences in admission or discharge in different months of the year. The ages of labourers and agricultural labourers were also broadly consistent over the whole period, though rather younger males were admitted in 1845–1860 compared to the years

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48

49

50

51

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1861–1890, with some resurgence of younger males entering in the 1890s. There appears little clear evidence of a relationship between seasonal, cyclical or structural change in the agrarian economy and the admission of male labourers to the Devon Asylum. There were less than 8,000 ‘labourers’ included in the 1861 census, compared to well over 11,000 ‘general labourers’ by 1881, though this represented an increase of only 1 per cent of the male workforce to almost 4 per cent by 1881. Newton Abbot and St Thomas both sent more than 50 labourers to Exminster in our sample, whereas Devonport and Totnes each sent about 30. Plymouth and East Stonehouse together accounted for 12 and Exeter only seven. These figures are taken from the 4,000 Exminster sample. Our detailed analysis of all admissions for Exminster in 1880–1882 also revealed that about 15 per cent of females were accorded no occupation at this period, outnumbered by ‘wives’ (one-third of the total) and almost matched by domestic servants (14 per cent), dressmakers and various textiles workers (almost 10 per cent) (B. Hill, ‘Women, work and the census: a problem for historians of women’, History Workshop Journal 35, 1993, pp. 78–94); D. Cooper and M. Donald, ‘Households and “hidden” kin in early-nineteenth-century England: four case studies in suburban Exeter, 1821–1861’, Continuity and Change 10, 2, 1995, pp. 257–278, particularly pp. 270–273. The importance of domestic servants among the females at Exminster is confirmed by the 1881 census returns for the inmate population, which indicates that domestic, labouring and dressmaking occupations were easily the most significant among 468 women resident at that time. A comparison of the pre-1880 and post-1880 admissions shows the proportion of females with no known occupation rising from one-sixth to more than onequarter. There is a four-fold increase in the number of married women returned simply as ‘wives’. In the same period the proportion of dressmakers coming to the Devon Asylum decreases. Newton Abbot sent 60, St Thomas 44, Totnes 37 and most other leading Unions slightly more or less than 20. These figures roughly matched employment where Newton Abbot recorded 6,473 domestics in 1881, St Thomas 3,224, Totnes 2,367 and Barnstaple 2,561 (including the borough), though Plymouth claimed 4,107 servants, Stoke Damerel 2,222 and Exeter about 3,000. The latter three areas were seriously under-represented. Although females identified as ‘farm servants’ have been excluded from our analysis of domestic service, it is possible that some ‘servants’ were in fact farm servants. Female employment among the latter group was declining in the later nineteenth century. A detailed analysis of female ‘servants’ was undertaken to asses their employment, possibly as agricultural rather than domestic servants. The designation of ‘farm servant’ was very rarely used in the Exminster registers. Thirty female servants who left the Devon Asylum after the 1881 census were searched in the census. The results indicated that most of those identified as servants were domestic servants, though some titles such as ‘housekeeper’ were applied to family members as well as employees. The 1881 census shows Plymouth, East Stonehouse and Stoke Dameral together account for almost 5,000 dressmakers compared to almost 2,000 in Newton Abbot and a little more than 1,500 in Exeter. Among the Exminster sample only the seamstresses and laundresses were significantly over-represented rather than milliners and dressmakers who formed the main constituent of the census occupational code. Thirty of the intake came from Newton Abbot, while St Thomas, Devonport and Honiton each sent ten to twelve. Handfuls were sent by Totnes, Barnstaple and Exeter and two or three each from other Unions. This compares to the census population in 1851 where about one in five females

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54

55

56

57

58 59

60

61 62

Notes

and fewer eligible males were unwed. Among the admissions, married women were more likely than married men to be in mature and later adult life. Four out of every five male patients originating from simple households with resident children having headed their household. There was one male servant. More than half the 1880–1882 intake were wives and more than one-third were daughters of the head of household. Admissions for these years show rather fewer women had lived in 3B households compared to both asylum males and the 1881 Devon population (27 per cent versus 45 per cent in the latter case). About two-fifths of the males in our 1880–1882 sample came from 3B households and only 10 per cent from 3A households, compared with 45 per cent and 13 per cent for Devon in 1881. Higher proportions of Exminster males also came from extended households than was common in Devon. EAC, 450, Sarah S., age not given, admitted 29 September 1847, dying in 1880, for example. She had been ‘a quiet, industrious woman attending to her family’ until her husband’s death 18 months earlier, followed by her landlord’s seizure of her goods, eviction and admission to the workhouse. Admitted in deep melancholy, she improved but remained in the asylum until her death. An occupational analysis of our sample of 4,000 admissions indicates that 87 per cent of female servants were unmarried, 8 per cent being married and 5 per cent widowed. This compares to about 56 per cent unmarried women among those with no stated occupation. Approximately 47 per cent of general labourers in our large sample were unmarried compared to 44 per cent married and 8 per cent widowed. Among agricultural workers and related occupations, 43 per cent were single while 45 per cent were married and 12 per cent widowed. These were the two largest groups of occupations among the male intake. Some 60 females identified as either ‘domestic servants’ (17) or ‘servants’ more generally were admitted to Exminster in 1880–1882. The total female intake for these years comprised 132 spinsters, 102 wives and 41 widows, indicating the remarkably high ratio of unmarried to other women employed as servants. Among the 17 ‘domestic servants’ the age distribution was wider, nine being younger than 30 and eight older than 40, though again they were overwhelmingly (15) unmarried. EAC, 5808, Mary Eliza E. Fathers were given as nearest relative in more than one-third of cases, while mothers figured only nine times, a similar occurrence as for sisters and brothers. Other male relatives were also more prominent (seven times) but employers do not appear to have figured. Eight women were certified as not under care and control, another three found ‘wandering’, but 27 of the 60 were examined at home and 16 in the workhouse, with five certified in the physician’s house and 11 elsewhere. Among ‘domestic servants’ more than half (nine of 17) were examined at home and only four in the workhouse. Among the 17 ‘domestic servants’, mothers were the nearest relative in seven instances compared to three each for fathers and sisters. EAC, 6012, Elizbaeth S. Maria L. was similarly admitted from Newton Abbot workhouse in Spring 1882, Exminster case books (hereafter ECB), 5948, as ‘very moody and depressed’, but discharged after a fortnight as ‘not insane’. For a discussion of a possible link between domestic service and mental illness, see J. Lewis, Women in England 1870–1950, Brighton: Harvester Wheatsheaf, 1984, p. 56. ECB, 5819, Louisa D. and EAC, 6001, Jemima D. A total of 30 farm and agricultural labourer admissions were recorded in 1880–1882 (farm servants and farmers being excluded from the analysis), 13 of

Notes

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64 65

66

67 68 69

70

71

72

73

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whom were married, 13 single and four widowed. Nine husbands and eight bachelors were examined at home. Fathers and mothers accounted for seven nearest relatives for unmarried males and six of each died, while seven recovered. Two of the four widowers died. Digby admissions during its first decade indicate 148 males and 150 females were chargeable to Exeter Union. London County Council paid for 40 males and 74 females, while Somerset County Council was responsible for 25 males and 26 females. Barnstaple and Bideford together paid for 16 males and 31 females. Devon Poor Law Unions such as St Thomas, Tavistock and Tiverton also figured. Many of these ‘imported’ patients were discharged ‘not improved’ within a few years of admission. Of the pauper males, 31 were given no occupation, 49 being labourers. There were also ten ‘former’ occupations, including soldiers and a police constable. There were 46 dressmakers, milliners, gloveresses and needlewomen. If 11 laundresses were added, they became the largest female occupation at the asylum, though if the ten charwomen were added to domestic servants then the latter resumed first place. 27 of the 54 males (one male being admitted twice) had previously lived in Devon, seven in Somerset or Bristol, four in London or Middlesex, seven elsewhere and the previous addresses of seven were not given. Two were widowed and 29 unmarried. Ten were younger than 30, 29 aged between 30 and 49 years and 16 older than 50. Wonford House Asylum Admissions Certificates DRO (hereafter WHAC), 834, 862, 899 and 796. There were 496 unmarried females admitted to Wonford, together with some 277 wives and 99 widows. Husbands outnumbered bachelors by a slight margin (367–346) in the same period, with less than 50 widowers admitted. Among the 892 females were 269 given no occupation, of whom 167 (62 per cent) were unmarried, 73 married and 25 widowed. There were also 128 described as wives mostly with their husbands occupation given, a handful being ‘housewives’. Again there were 55 daughters with father’s occupation and 19 widows with their late husband’s occupation. About one-quarter of the wives (31), widows (six) and almost half the daughters (25) were connected to a male farmer. There were 14 church ministers’ wives. One-quarter of the gentlewomen were married and about half this number were widowed, the remainder being single women. Only 18 per cent were 60 or older and less than 16 per cent younger than 30. It is possible that some of the middle-aged gentlewomen were recently bereaved. There were 35 female ‘teachers’ in the 4,000 sample of those entering DCLA 1845–1914, which represented between 2 per cent and 4 per cent of women with some occupations identified. There were only ten governesses who were admitted in the same period. This suggests that while the titles of ‘governess’ and ‘school teacher’ were not exclusive and could be interchangeable, there was a strong bias for those described as ‘teachers’ to enter the DCLA and for those perceived as ‘governesses’ (in society and/or on admission to the institution) to be confined within the fee-paying asylum. J.L. Melling, ‘Sex and sensibility in cultural history: the English governess and the lunatic asylum, 1845–1914’, in J. Andrews and A. Digby (eds), Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry, Amsterdam: Rodopi, 2004, pp. 177–221. Among the females, the relationship given in 12 cases for the authority sending the individual was simply ‘and’ or ‘with’ the Commissioners in Lunacy. Among the remainder, the most common individuals signing the admission certificates

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alongside the Commissioners were Fathers (seven), Husband (six), Brother or Brother in Law (three) and Sister (three). Mothers and others were mentioned only once or twice. 74 WHAC, 795. 75 See Axminster Poor Law Guardians’ Minute Books, DRO, 5 September 1895; 31 October 1895; 14 November 1895–9 January 1896, for the complicated case of illegitimate Matilda S., aged 19, involving a dispute with Plymouth. 9 The patient experience of the pauper and private asylum 1 Patient records for the Exeter Borough and Plymouth Borough Asylums were not consulted. The latter have not survived and Digby records were only available for selective consultations. 2 S. Allen, The History of Devon Mental Hospital 1845–1945, Exminster: Exminster Management Committee, 1945, pp. 10–11. 3 7th Annual Report Lunacy Commission, PP 1852–1853, vol. XLIX, p. 55. There were 81 males and 52 females in single bedrooms compared with 187 women and 113 men in dormitory accommodation. 4 Devon County Quarter Sessions Minute Books (hereafter DQS Mins), 1/32, Epiphany Sessions 1863. 5 46th Annual Report Lunacy Commission, PP 1892, vol. XL, p. 171. 6 Well over one-third of males and rather less than one-third of females were diagnosed with mania, as compared to almost one-quarter of female admissions and rather less than one-fifth of males who were identified as suffering from melancholia. About one-quarter of female entrants and almost one-fifth of male arrivals were said to have dementia or senile dementia. General paralysis claimed more than 7 per cent of male admissions. 7 See Devon County Pauper Lunatic Asylum Minute Books of the Visting Justices (hereafter VJP Mins), 147/4, 3 January 1893 for expansion plans. 8 Among the 50 male cases of general paralysis where cause of insanity was given, almost half were ‘unknown’ (22), physical illness and accidents claimed almost one-third (15), worry and anxiety more than one-tenth, while heredity and intemperance together accounted for only one in ten of the cases. 9 VJP Mins, 147/1, 6 September 1892. 10 VJP Mins, 147/4, 2 January 1900; 2 July 1912. In the latter meeting it was still noted that the death rate in the asylum had been declining more steadily than for the wider community. For death rates in England and Wales, see R. Fitzpatrick and T. Chandola, ‘Health’, in A.H. Halsey and J. Webb (eds), Twentieth-Century British Social Trends, Basingstoke: Maxmillian, 2000, p. 96. 11 Based on a five-year moving average of discharges and deaths by year of admission. 12 VJP Mins, 147/1, 2 July 1889, shows a ratio of one attendant to 15 male patients compared to one to 12 in Exeter asylum and one to nine in Somerset asylum. The causes and circumstances of physical sickness, debility and death among asylum patients remain a complex subject, not least because a number of asylum inmates were recorded as having died of ‘phthisis’ or tuberculosis. For trends in sickness and morbidity in this period, see C. Edwards et al., ‘Sickness, insurance and health, assessing trends in morbidity through Friendly Society records’, Annales de Demographie Historique, 1, 2003, pp. 131–167, especially p. 143. 13 VJP Mins, 147/1, 7 May 1901, for example.

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14 VJP Mins, 147/1, Davies commented, 7 May 1901, that a group of 24 admissions were ‘quite the most unfavourable owing to age and heredity that have been admitted since I have been here.’ 15 VJP Mins, 147/1, 27 October 1845. 16 Exminster case books (hereafter ECB), 450. 17 ECB, 4260. 18 30th Annual Report Lunacy Commission, PP 1876, vol. XXXIII, p. 77. 19 49th Annual Report Lunacy Commission, PP 1895, vol. LIV, p. 221; ECB, 8115. 20 The death rate is likely to have been affected by trends in the composition and age of the asylum population, though our evidence for the early 1880s indicates that many males arriving died within a short time after their admission. 21 ECB, 424, John W., aged 34, a dissenting preacher. 22 ECB, 4373, William K., and 8097, William P. 23 ECB, 496, Mary G. 24 ECB, 10058, Elizabeth S. 25 ECB, 7924, Charles B. The notes were dated 7 June 1903. 26 ECB, 8155, John N. 27 ECB, 2261, admitted 11 January 1861. 28 ECB, 495, Rhoda S. See also cases 450 and 457. 29 ECB, 423, Sarah B. Also ECB, 55, Mary C. 30 ECB, 5055, Jane J.; ECB, 4732, Sarah B., whose loss of husband was relevant. 31 ECB, 4258. 32 ECB, 494. 33 ECB, 5038. 34 ECB, 9856 and 469. 35 ECB, 100, 7924, 2277, 8075, 8155, 4301, 425. 36 ECB, 420, 424, 2206, 4281, for example. 37 ECB, 2248, William B., admitted 1860 from Hanwell Asylum, who concealed knives, and 4260, William S., admitted 1872. William B., 4267, who danced and made ‘extraordinary noises’ as well as hiding knives in his bed. One violent female patient was Eliza S., who appeared to work placidly in the laundry before suddenly turning on a maid ‘and nearly strangled her’. Also 4270, Sarah D., who wounded herself and ripped off the dresses of attendants in 1872. 38 VJP Mins, 147/4, 13 June 1911 and 4 July 1911, showing mechanical restraints used on 129 occasions and seclusion used for 1,241 hours. Almost all of the latter appear to have been devoted to one female who attempted to harm herself. 39 ECB, 7812, 7954. 40 ECB, 4312. 41 ECB, 2206, William P., 2217, Edward C. Also 4329, Thomas B., ‘a thin, weakly, wheezy, little old man’. 42 ECB, 422. Another elderly entrant was 2251, Ann P. (age 78), who had been ‘insane’ for 20 years but housed with her friends at Powderham before her entry in 1860. 43 ECB, 526, Grace W., aged 68, had been ‘deprived of all the necessaries of life’ by her son and daughter-in-law. 4885, Charlotte R. (age 76), on the other hand had become ‘unstable and sometimes violent towards her husband’. 44 Report of the Select Committee of the House of Commons to Inquire into the Operations of Lunacy Law as Regards Security Against Violations of Personal Liberty, 1877, PP vol. XIII, p. 91. 45 Among the 52 males and 60 females aged 60 or older who were admitted in

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48 49 50 51 52 53 54

55 56 57

58 59 60

61

62 63

64 65

Notes 1880–1882, 32 males and 38 females died in the asylum, 20 of each group within a year of their admission. Among the total of 13,000 entries between 1845 and 1914 were 109 admissions of children aged 4–14 inclusive, comprising 37 females and 72 males. Our figure for workhouse children is taken from the 4,000 sample. The sample of 4,000 cases revealed 47 boys and girls in the age group 4–14, of whom 24 males and eight females were found to suffer from idiocy or imbecility. A small number were diagnosed as suffering from mania, but other categories are almost absent. ECB, 431, Jane M., and 441, Giles H. ECB, 4430, John R. Okehampton Poor Law Guardians’ Minute Books (hereafter OG Mins), 20 February 1864. George B., whose age is not given. Barnstaple Poor Law Guardians’ Minute Books (hereafter BG Mins), 10 December 1858; 17 December 1858. ECB, 919, 13 August 1851. Also ECB, 1691, Frances A. of Wells, 2 July 1857 aged five, and AC, 4430, John R. of Hemyock, 20 January 1873. For example, ECB, 4581, 11 February 1874 and 9254, 23 December 1899. ECB, 10013 Ernest Thomas W. of Brixham, 16 January 1903. See also 1595 for Silas S., 4 December 1856, and 4903, Jane R., 13 March 1876. These and other cases involving children are discussed in detail in J.L. Melling, W.J. Forsythe and R. Adair, ‘ “A proper lunatic for two years”: pauper lunatic children in Victorian and Edwardian England. Child admissions to the Devon County Asylum, 1845–1914’, Journal of Social History 30, 4, 1997, pp. 371–405. ECB, 3015, 4 March 1865. This was the case investigated by the Lunacy Commission after the complaints of the local clergyman went unheeded by the Poor Law Guardians. 19th Annual Report Lunacy Commission, PP 1865, Vol. XXI, pp. 41–42. ECB, 10456, 17 September 1904 and 1625, 18 February 1857, for Ethel Annie Pile G. of Bratton Fleming and John L. of Oakford respectively. 3302, Elizabeth E. was only four and was ‘held firmly or tied the whole day’, while 10590, Effie Gladys E. showed no inclination to violence but was ‘kept under restraint.’, 4 December 1866 and 15 March 1905, respectively. VJP Mins, 147/4, 17 November 1892. VJP Mins, 147/4, 7 May 1907. VJP Mins, 147/4, 4 March 1890, for example, when Dr Saunders told the Visitors that two half-brothers aged seven and 14 were ‘unfit subjects for the Asylum’; also Minutes, 2 September 1890, for case of a ten-year-old boy sent back. Among the 30 males in the 4,000 sample, nine remained for more than 1,000 days and five for more than 3,000 days, while the corresponding numbers for females were ten and seven respectively. Nineteen boys left within a year, as did seven girls. A total of 21 died (thirteen boys and eight girls), compared to 11 recovered (eight boys and three girls), and ten not improved (eight boys and two girls). ECB, 89, Mary B., aged 50, was admitted in 1845. An analysis of 234 male and 246 female pauper admissions and 28 and 29 non-paupers respectively for 1880–1882 indicates about 7.5 per cent of males and about 5.5 per cent of female admissions were said to have attempted, threatened or contemplated suicide. ECB, 5543, Edwin H.B. ECB, 5793, Richard L.

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66 Rough Asylum Sub-Committee Note Book 1909–1913, DRO 147/2/1. Jury Verdicts on W. B., Clara E.; PP 45th Annual Report Lunacy Commission, 1890–1891, vol. XXXVI, p. 51, for the attempt with Christmas tape. 67 51st Annual Report Lunacy Commission, PP 1897, vol. XXXVIII, p. 22. 68 ECB, 4442, Jane P. 69 ECB, 2330. 70 39th Annual Report Lunacy Commission, PP 1884–1885, vol. XXXVI, p. 93. 71 VJP Mins, 147/4, 1 May 1900. 72 ECB, 7823, 4913. 36th Annual Report Lunacy Commission, 1882, vol. XXXII, p. 103; 62nd Annual Report Lunacy Commission, 1908, vol. XXXIII, p. 309. VJP Mins, 147/4, 7 January 1908; 4 February 1908; 3 March 1908 for tighter controls with regard to the shaving of suicidal patients. 73 Annual Reports of the Devon County Pauper Lunatic Asylum DRO, DQS 1863 117/7a (hereafter AR). 74 AR 117/7a. 75 AR, 1872 DQS 117/16. 76 ECB, 448; ECB, 4364. Another was Elizabeth P., who was extremely distressed on her arrival, ‘occasionally does a little work but not often’. 77 ECB, 8147, 8170. 78 ECB, 471, 475, 4271. 79 ECB, 4329, 4353. It was noted of one individual that he ‘goes down to work, where he helps to turn a mangle’, while another ‘works, when able, in the tailor’s shop’. 80 Letter from Jon Simon R. to Mrs M.R. dated 4 Jan. 1873, ECB, 4289. 81 This is not to underestimate the tragic experiences of individuals who faced considerable ordeals at the asylum. See, for example, ECB, 4926, Sarah B., 1876, who gave birth prematurely alone at night. 82 D. Wright, ‘Getting out of the asylum: understanding the confinement of the insane in the nineteenth century’, Social History of Medicine 10, 1, 1997. See also S.M. Burt, ‘ “Fit objects for an asylum”: the Hampshire County Lunatic Asylum and its patients, 1852–1899’, University of Southampton, Ph.D., 2003. 83 For example, ECB, 437, Ann S., aged 62; Elizabeth H., aged 77, 2250; and Catherine N., 4348, who wore out her daughters. 84 ECB, 4378, 4429. 85 ECB, 421. 86 ECB, 4869. 87 Among our 4,000 sample were nine women and eight men who were found to be ‘not insane’ when examined at the asylum. 88 ECB, 440, Ann D. and Elizabeth P., case 4364, for example. 89 ECB, 440. 90 ECB, Charlotte P., case 466. 91 DRO St Thomas Poor Law Guardians’ Minute Books [hereafter STG Mins], 5 October 1860; DQS Annual Report of the Asylum Chaplain, AR 1900 DQS 117/22. 92 At one session the Visitors discharged four individuals on trial along with one discharged as recovered. See Visitors’ Minutes, 6 November 1894. 93 See Quarter Sessions County Council Visitors’ Minutes, DRO 4 August 1908, for example, when Mrs P. was allowed ‘to be absent for one month from the Asylum’ in the charge of her daughter. 94 Quarter Sessions County Council Visitors’ Minutes, DRO 6 August 1901, for example, when two Visitors examine Mary Ann C. 95 VJP Mins, 1 June 1852.

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96 VJP Mins, 2 June 1914. 97 VJP Mins, 3 September 1901, for husbands applying for wives. 98 VJP Mins, 6 August 1895, for example, for application of a wife to have her husband discharged. VJP Mins, 12 January 1858, for a refusal to release a wife to husband on basis of inadequate accommodation. 99 VJP Mins, 3 February 1891; 6 June 1893. 100 VJP Mins, 1 July 1890, for example. 101 VJP Mins, 7 January 1862, for Miss W. 102 VJP Mins, 147/2, 7 January 1862, for William C. 103 VJP Mins, 147/1, 1 April 1847, for example. See also VJP Mins, 8 September 1857 for Bucknill’s refusal to release a ‘dangerous’ wife. 104 VJP Mins, 1 November 1870, for the case of Mrs D.; and STG Mins, 4 December 1903, for example. See VJP Mins, 2 February 1909 for Jamaican emigrant. 105 DQS 117/4, AR, 1850, p. 5. 106 VJP Mins, 6 June 1899–11 July 1899, for Mary G. to be left at the door of St Thomas workhouse if not collected by the Relieving Officer as requested. In this case Superintendent Davies adamantly refused to consider the continued certification of the patient. 107 VJP Mins, 5 August 1902, for example. 108 STG Mins, 28 August 1846, E.L., for example. 109 VJP Mins, 10 July 1860, Mary A. 110 AR, DQS 117/19, Report for 1875, Medical Officer’s Report, pp. 12–13. 111 VJP Mins, 4 August 1908 and 5 December 1911. On the latter date, 11 patients were discharged with an allowance and 28 without such an award. 112 VJP Mins, 7 July 1903, for clash with the Tavistock Union, which called for the abandonment of the allowance system and the insistence of the Visitors that the Tavistock Relieving Officer had been fully consulted. 113 VJP Mins, 11 November 1904. 114 STG Mins, 30 October 1846; 4 January 1850. VJP Mins, 23 December 1856, for Lunacy Commission directive in regard to transport of patients. 115 DRO Axminster Poor Law Union Guardians’ Minute Books [hereafter AG Mins], 23 September 1880, for Miss P. 116 VJP Mins, 7 November 1871, in regard to Barnstaple Union. 117 The advertisements for Wonford House in the DRO files indicate that the Earl of Devon was President while Thomas Shapter and Augustus Drake were Consulting Physicians, and Arthur Cumming was Consulting Surgeon. Thomas Lyle was at this time (the 1870s) the Resident Medical Superintendent. The advertisement describes its dining, drawing, music and billiard rooms as ‘all exceedingly handsome and well furnished’, affording ‘all the comforts of a first-class asylum’, while combining ‘the universally recognised advantages of a public institution.’ 118 In addition to the housekeeper and five housemaids (one also a nurse), there were two parlour maids, two scullery maids, one kitchen maid (plus helper), one laundress and four laundry maids in residence. 119 A more detailed analysis of a sample of 657 Wonford female admissions whose ‘cause of insanity’ was examined, confirmed the trends in this table. In this larger group, the insanity of more than one-quarter was said to be unknown, while one-tenth was due to heredity, one in 12 to previous attacks, and one in eight to childbirth or menopause, compared to less than 4 per cent due to over-work and over-study. 120 Wonford House Asylum, admission registers of patients, DRO 3992F/ H20/2–9 (hereafter WHAR), For example, Julia Eleanor J., a lady’s compan-

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122

123

124

125

126

127

128

129

259

ion, 1041, admitted in October 1887, was said to be ‘suicidal but not epileptic’ in mania. Fanny Sussanah Mary H., 1064, admitted July 1887, was said to have hereditary influences on her insanity as there was ‘a strong neurotic trait of the Father’s side’. Wonford House Asylum, patient care book, DRO 3992/H22/1–24 (hereafter WHCB), Julia S., 594 in 1873 and appears in case books 3992 H32/1–24. More usual were cases such as Edith Emily Y., admitted in 1907 as 1618 and discharged ‘relieved’ on the petition of her brother in 1908, but re-admitted as 1680 in 1909 and transferred to Plympton House in 1910. WHAR, Sarah Ann G. was a Lady’s Companion, 717, admitted in 1877. She had suffered acute mania for four days prior to her admission. Mary Peggy H. was admitted in 1882, WHCB, 875, was placed in a padded room and force fed before being discharged back to the care of her husband. Eleanora A. was admitted in July 1884, WHCB, 954, and held in a padded cell for two months. Ellen B., WHCB, 1131, arrived in November 1889 at the age of 64 and in 1889 was removed to the ‘second gallery’ after showing great depression. Ellen L. was admitted in August 1884, WHCB, 971, but after stealing from other patients and showing violence was sent to Plantation House at Dawlish for convalescence in 1885. WHCB also contain various letters from patients who were resident in premises maintained by an arrangement with Wonford, including Raleigh Lodge at Exmouth from where Emma T. wrote to Dr Shapley, 23 June 1879. Mary Margaret C. was admitted as suicidal in December 1894, WHCB, 1268, and was placed in room G4 under observation as depressed, but in April 1895 was also described as sexually excited. Maud Isobel R., WHCB, 1424, was a voluntary boarder before certification 13 August 1900. Grace F., 1565, was admitted from St Andrew’s Hospital in Northampton in June 1905 as an acute maniac, but was discharged in February 1906 since ‘the Reception Order’ was not ‘properly continued.’ More than one hundred (108) married men died in Wonford compared to only 73 bachelors. This is in marked contrast to 90 spinsters who died there compared to 26 wives. The numbers of widowed patients were small. These figures do not include those whose marital status was unknown or where the outcome of treatment was unclear. These were generally those dying after 1914. A total of 51 husbands died within a year (34 within six months), and 49 after a longer period (18 of them within one to three years). Only nine wives died within a year of admission, compared to 17 beyond a year (15 of them after three years or more). A total of 56 unmarried females died at Wonford in this period after being resident for more than three years, almost half of them (25) after recording more than 10,000 days as a patient. Susannah R.’s first entry in 1858 was as patient 286, and her final admission in November 1883 was 944. She died in 1902 of ‘senile decay’, aged 84. An examination of the bodily condition of those admitted to Wonford House indicates that 39 of the husbands who died arrived in ‘good’ or ‘fair’ condition compared to 67 who were considered in moderately poor, weak, feeble or very bad health. The respective proportions for those who did not die was 146 in good or fair health versus 99 in frail, feeble or very bad health. Interestingly, those who left recovered were divided almost equally between those in good or fair health and those in poor health. Among the spinsters who died within six months, 12 were said to be feeble, four moderate and none in good health, while six of ten women who died within one to three years were described as in good health.

260

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130 WHCB, Susannah R., first admitted in 1858 as patient 286, re-admitted in 1869 as 503 and while ‘murmuring defection’ was also described as ‘very much the Lady in manner and address’. She claimed that the Queen wished all to be freed and also each to marry anyone the others wished, 18 June 1870. Charlotte Ann P.C. was admitted September 1882, 883, with delusions of ‘belong[ing] to the Royal Family’. William Robert M., admitted May 1874, 624, discharged in April 1876, also had visions of a figure in white at the foot of his bed at Wonford, 15 March 1875. 131 An exception was Lavinia E., 732, aged 21, who arrived in October 1877, and a few months later she was injected with hydrocyamine to induce her to talk. 132 WHCB, Catherine L., admitted March 1868, 472, discharged November 1871. 133 WHCB, Julia S., re-admitted July 1873, 594, was finally discharged April 1881, after spending a period of ‘prolonged leave’, including a period with Mrs Matthews (housekeeper) in Torquay. 134 WHCB, Gladys May S. was a musician admitted in July 1913, 1824, and in October it was discovered that the original petition was irregular, prompting her discharge, re-certification and her transfer to Catford asylum, ‘not improved’; Beatrice N., 1733, was a German national, admitted May 1911, reported to be ‘neurotic & self centred and hysterical’ in late May 1911, but within a month had been discharged on the authority of her father as ‘recovered’. 135 WHCB, William Robert M. was discharged in April 1876 on the authority of G. Slade and Dr Hallett, for example. Eversell W. was admitted in November 1901, 1463, and was discharged relieved in February 1902. Mary Sophia F., admitted in December 1891, 1190, transferred to Kingsdown House, March 1896. Sophia Maud F., 1408, admitted February 1900 and removed to Digby ‘not improved’ in the following October. Annie Jessie R. was admitted in July 1914, having been in hospital in Lausanne and was finally transferred to Chichester County Asylum in March 1921. 136 Report of the Royal Commission on the Care and Control of the Feeble Minded, PP 1908, vol. XXXIX, p. 43. 137 Minutes of Evidence Taken Before the Royal Commission on the Care and Control of the Feeble Minded, PP 1908, vol. XXXVI, pp. 38–39.

10 From asylum inmate to outpatient: the remaking of the institutional landscape in the twentieth century, 1914–1990 1 These were primarily drawn from high income groups of wage and salary earners, rather than the poorer sections of the county’s population, further distancing the institution from the Poor Law. 2 B. Harris, The Origins of the British Welfare State: Social Welfare in England and Wales 1800–1945, Basingstoke: Palgrave, 2004, pp. 203, 218. 3 D. Pearce, ‘The operation of the 1930 Mental Treatment Act in local psychiatric hospitals: the introduction of voluntary patients and new treatment regimes in the Devon Mental Hospital 1931–1938’, University of Exeter, M.Phil., 2002; P. Dale, ‘The Mental Deficiency Acts 1913–1948: medical care, control and eugenics’, University of Exeter, Ph.D., 2001. 4 K. Jones, Mental Health and Social Policy 1845–1959, London: Routledge and Kegan Paul, 1960; P. Bartlett, The Poor Law of Lunacy: the Administration of Pauper Lunatics in Mid-Nineteenth-Century England, Leicester: Leicester University Press, 1999.

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5 E. Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980, London: Virago, 1987. 6 S. Burt, ‘ “Fit objects for an asylum”: the Hampshire County Lunatic Asylum and its patients, 1852–1899’, University of Southampton, Ph.D., 2003. 7 D. Gittens, Madness in its Place: Narratives of Several Hospitals 1913–1997, London: Sage, 1998; G. Reaume, Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870–1940, Ontario: Oxford University Press, 2000.

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Index

abuse: by asylums 25, 41, 43–4, 61, 100–1, 237n8; by employers/relatives 111, 185, 186, 188; complaints of 100–1 Acland, Sir Thomas Dyke 113, 152, 202 administrative change 24–5 admissions: procedure 26–7, 50–2, 109–12, 115–18, 178–83, 195, 200, 237n17; role of Poor Law 20–1, 109–11, 112 adolescents 77, 128, 188 age profile of patients 67–8, 89, 128–9, 150, 154, 159, 164–5, 241n17–18; see also adolescents; children; elderly patients agriculture: employment in 152, 156, 157, 158; profile of workers 162–3, 164, 231n9, 248n23, 249–50n38–9, 250n42–3, 250–1n44–6, 252–3n62 Alleged Lunatic’s Friend Society 14 allowances, discharged patients 194, 258n111–12 armed services 156, 164 arson 34–5 Association of Medical Officers of Asylums and Hospitals for the Insane 48, 218n33, 226n9, 229n82 Asylum Journal of Mental Science 19, 126 asylums: amenities 201–2; conveyance to 26–7; function and meaning of 6; as instruments of societal control 20–6; limitations of 203; location of 112; as necessary destination 2; rise of 3; role of 6–7; rules 135, 197 attendants: conditions of service 73; defence of 21; discipline 58–9; length of service 58; recruitment/retention 50, 57, 219n47, 225n111; role 55, 57–8, 210

Axminster Union 28–30, 31–2, 41, 125 Barnstaple Union: committals 92–6, 114, 231–2n17, 232n19, 235n56, 235n58, 235–6n59; criticisms of 224n101; medical examinations 45; workhouse amenities 41 Bartlett, Peter 23–6, 41, 44, 107, 147, 172–3, 207 Bath 116 Beaufort Military Hospital 204 behaviour: forms of 34–6; rules of 5, 6, 34 Belle View 32 Bethlem Hospital, London 118 Bideford Union 96, 100, 236n62 Board of Control 204 boarding out see cottage care model Boards of Guardians 17, 18–19, 21, 23–4, 25, 27, 30–1, 33, 41–2, 44, 172, 193–4, 220n9 bodily health 134–5, 178, 183–4, 198, 244n66–7, 259n128–9 Bodmin 125 borderline cases 36–7 Borough Asylums 15–16 Bowhill House 15, 159 Brain 48 Bratton Fleming 111 Brislington, Bristol 118, 239n55 Bristol 116 Bristol Asylum 204 Brizendine, L. 49 Bucknill, John Charles 218n31, 245n85; therapeutic strategies 10, 16, 18–20, 39–40, 42, 46–58, 74, 126, 130, 135–6, 144, 183, 186, 210, 230n8 Busfield, Joan 126

272

Index

care, responsibilities for 149, 238n39 ‘care and control’ 128, 132–3, 145, 160, 207, 237n14, 242n27 case books/notes 20, 51–2, 54, 61–5, 66, 222–3n55, 227n33, 228n42 caution cards 177, 189 Certificate of the Medico Psychological Association 58 certification: legislation 13; process 33, 109–11, 123, 200, 224n91 Cheriton Fitzpaine 1, 7, 135 Cherry, Steven 99 Chesler, Phyllis 205 childbirth 130–1, 243n36–7 children: abuse of 30–1; admission of 17, 77, 187–9, 231–2, 256n46–7, 256n60–1; care of 35 Chronic Case Book 186, 190 chronic wards 186 class 145–75, 246n8; segregation by 19; system 76 classical liberal principles 30–1 Clifford, Lord 42, 202 collective resources 163, 206–7 committals 220n4; importance of class 147; legislation 13; orders 26, 195; triggers for 33–9 community care 32, 93, 235n52; transition to 205–6; see also family community contact 112–13 community preferences 3, 9 community resources 4 community violence 186 complex households 90–1, 236n64 Connolly, John 4 Contagious Diseases legislation 13 contractual agreements 25 Cooper, Anthony Ashley, Lord Shaftesbury 13, 14, 16–17, 22 core family members 87–9 Cornwall 95, 116, 125 Corporations of the Poor 25, 27 cottage care model 40, 52–3, 115 County Asylums, establishment of 5, 13–14; see also Devon County Pauper Asylum County Councils: creation of 15, 24–5; governance by 33, 42–3, 113, 204 Courtenay family 24, 27, 28–30, 31, 152, 222n34 Courtenay, Lord William Reginald 16–18, 217n12–14 Crediton 87

criminal lunatics 101, 134, 219n42, 244n63 dangerous lunatics, removal from workhouse 26–7, 39 Davis, Dr Arthur 43–4, 54, 58–9, 65, 101, 210 death rates: patient profiles 67–71, 104–7, 120–1, 140–1, 180–4, 197–8, 255–6n45; trends 254n10, 255n20 delusional insanity 66, 176, 185 dementia: diagnoses 66, 68, 129; gender profile 64, 109, 254n6; outcomes 67, 69–70, 244n65 deserving poor 17, 18, 19, 31 Devizes 125 Devon: class relations 150; demographics 76–7, 82, 97, 98, 151–3, 248n22–3, 250n41; as locus of study 8 Devon County Council 42–3, 45, 54, 202 Devon County Gaol 134 Devon County Pauper Lunatic Asylum: accommodation 50, 54–5, 176–7, 178, 189; admissions 127, 232–3n25; campaign for 16–18; clients of 92–3; contractual agreements 25; corruption 41, 42; effects on admissions 77–94; ethos 18–22, 46–74, 209–10, 211; expansion programme 54–5; female patients 127–36; mismanagement 40–1, 42–4, 51; as model for institutional treatment 15–16; occupations of patients 154–64, 172–4; opening of 14–15, 217n8; origins of patients 77–84; patient experience 176–94; relationship with Lunacy Commission 39–41, 42–5, 55–6, 57, 61, 225n10, 228n42; relatives and friends of patients 101–14; role of government agencies 24; withdrawal of patients 27; see also medical staff; medical superintendents; staff Devon and Exeter Hospital 58 Devon Mental Hospital 204 Devonport 54, 95, 139, 145, 158–9 diagnoses: changes over time 204–5; gender influences 61–5, 125–6, 129–33, 177, 178; and outcomes 66–72; quality of 51; women 129–33

Index 273 Digby Asylum: clients 96; opening of 14–15, 92, 136; patient profiles 127, 143, 163–5, 174, 195, 241n19, 253n63; patient transfers 118 ‘dirty habits’ 34–5, 36 discharge 241–2n21–4, 245n81–3; effect of relationships 104–7, 236n60; as ‘improved’ 192; as ‘not improved’ 181, 192; process 113–15, 123, 178–83, 191–4, 199–200; as ‘recovered’ 66–7, 68, 104–6, 120–1, 141, 181, 192; as ‘relieved’ 66–7, 68, 105–6, 120–1, 141, 181, 192; as removed’ 141–2; to workhouses 37–8 distance, impact on admissions 75–95 distant relatives 87–8 domestic circumstances/duty 7, 133–4 domestic employment 129, 153, 158–9, 160–2, 251n47, 251n49, 252n57, 252n59 domestic regularity, virtues of 126–7 Dorset 95, 116 Eager, Dr 5 Ebrington, Lord 17, 30 economic change/power 4–5, 75, 98, 148–9, 174, 211–12, 229n59 education, capacity for 35 elderly patients 186–7 Elias, N. 3 Enlightenment 2, 205 epilepsy 67–8, 71, 187–8 escapes 190 ex-soldiers, employment of 57 Exeter 14, 25 Exeter Borough Pauper Lunatic Asylum see Digby’s Asylum Exeter Corporation of Poor: asylum provision 44–5; committals 92, 95–6, 158, 231–2n16–18; pauper relief 25; workhouse population 249n34–5 Exminster Asylum see Devon County Lunatic Asylum Exmouth, therapeutic excursions to 40, 53 extended households 84–9, 98 family: capacity/willingness to care 75; care role of 96–7; circumstances 188–91, 233–4n49; importance of 75, 229–30n1; structure 77, 84–91 family–community welfare model 3 female educationalists 199–200; see also governesses; school mistresses

female employment 129, 158–60, 164–5, 167–71, 173–4 female hysteria 131, 143 female insanity, settings for 132–4 female life cycle 126–7, 129–33, 144, 243n37, 243n42 Finch, Dr 46 Fisherton House 32, 46 Foucault, M. 2, 3–5, 6, 7, 76, 112, 146, 205 246–7n9 Fowler, Charles 18, 218n28 friends, influence and role of 99–124, 208–9 Fry, Elizabeth 205 Gardiner Hill, Robert 48 Garland, David 206 gender: and diagnoses 61–5, 66, 125–6, 129–30, 177, 178; and employment 152–3; and patient outcomes 66–72, 104–8, 115–16, 120–1, 134–5, 140–1, 178–83, 197–8; profiles 127–9, 241n16–20, 245n79–80, 251–2n51; separation by 40, 177; traditional views of 52; see also female; male general paralysis: diagnoses 64–5, 131–2, 243n45, 243n47, 243n50; patient profiles 67, 68, 71, 73, 254n6 gentrification 170–1, 209 Gheel experiment, Belgium 52, 227n30 Gilbert, W.S. 17–18 Goffman, Erving 205 governesses 171, 253n71–2 Great Torrington 167 Great Western Railway 190 Hamlyn, Calmady Pollexfen 17, 30, 222n34 Hampshire County Lunatic Asylum 123, 229n90, 233n26 handicrafts 152, 231n9 Hanwell Asylum 48 hereditary lunacy 178, 202 Hervey, Nicholas 24–5, 40, 44 high-risk patients 189–90 Hill, Robert Gardiner 19, 48 historians of insanity 1–12 Holloway’s Sanatorium, Surrey 118 Holsworthy Union 148 home care 107–8, 111–12, 113–15 Home Office 188 Home Secretary 13 Honiton Union 93, 159, 235n56

274

Index

household: membership of 104, 233n27–8; profiles 144, 252n52–3; status 159, 160; structure 77, 84–91 humanist approach to psychiatry 20 Hunt, E.H. 157 hygiene 49, 52 Idiots Asylum, Starcross 204, 217n10 ‘idiots’: children as 35, 187–8; committal 38–9; diagnoses 109; numbers of 64; outcomes 67, 70–1, 73; profile 67–8, 129; specialist provision 16, 189 Ilfracombe 132 ‘imbeciles’ see ‘idiots’ immorality 34–5 ‘improved’ 192 industrial manufacturing 152, 154 industrialised regions 75, 76 inequalities of class 174 inherited disabilities 113 insanity: categories 61–5, 143, 200–1; causes 20, 195–6, 218n34, 222–3n55, 226n10, 226n14; domestication of 240–1n11–12; duration prior to admittance 107–8, 116–17, 233n28, 239n60–1; growth in 1; politicisation of 171–2 institutional care: mixed economy of 163–4; reappraisal of 206 institutional conventions 3 institutional politics 7–8, 20–1 institutionalisation: adaptation to 107; capacity to survive 134–5 intemperance 178 Ireland 8, 9, 136, 211 Jarvis, Edward 76 Jamaica 193 Jones, Kathleen 207 Journal of Mental Science 40, 48, 53 Kekewich, Samuel T. 27, 29, 42 kin-linked households 75, 90 Kingsbridge Union 44, 94, 235–6n59 labourers: employment as 152, 154–6, 157, 158; profile of 162–3, 164 Laing, R.D. 205 Lancashire: studies of 76, 97, 98, 147, 148, 236n63, 247n11, 247–8n18; wage standards 250n41 landowners 6, 24, 29–30, 33, 149, 157, 228n59, 231n11, 248n27

legislative change 24–5 Lewtrenchard 111 Lincoln Asylum 48 Liverpool 75, 148 Local Government Act (1888) 42 Local Government Board 41, 43, 45, 172 local knowledge 77, 231n11 London 3, 118 London County Council 96 long-term conditions 163–4 long-term patients 37, 51, 66, 68, 127, 136, 141, 186–7 Lord Chancellor’s Office 14, 19, 40, 48 Lunacy (Amendment) Act (1862) 14, 26, 42 Lunacy Act (1890) 1, 6, 13, 14, 25–6, 37, 38–9, 42–3, 142, 207–8 Lunacy Acts (1845) 1, 13, 15, 27, 32, 41, 43, 45, 149, 172, 195, 208, 212 Lunacy Commission: establishment of 1; impact on asylum development 23, 24, 39–42; legislatory powers 13–16; relationship with Lunacy Commission 39–41, 42–5, 55–6, 57, 61, 165, 171–2, 176–8, 183, 188–90, 195, 204–6, 210, 225n10, 228n42; reports of 39, 40, 42, 45, 92, 235n53–4 Lunatics Act (1808) 13 Mackenzie, Charlotte 47, 100 McNaughten Rules (1843) 48 Magistrates 18, 7–8, 23–4, 25, 44, 172 maintenance: costs 36, 150, 173, 174, 194, 221n24, 233n29, 240n5, 253n63; grants 21, 27; obligation for 125 male employment 154–8, 164, 166–7 Manchester 75, 148 mania: diagnoses 129; outcomes 66, 67, 70–1; patient profiles 35, 62–4, 68, 242–3n35, 243n43, 244n65, 254n6 Manual of Psychological Medicine, A 19, 48–9 marital responsibilities 153 marital status 136–8, 143, 249n33; and household structure 88–90; and patient outcomes 72, 104–7, 118–20, 134–5, 197–8; and patient profiles 136–9, 159–60, 162, 164–5, 167–71 Marx, Karl 5 Masters of Lunacy 14

Index 275 Maudsley, Henry 1, 10, 20, 48, 126 mechanical restraint 19, 39, 46, 49, 50, 185–6, 226n5, 255n38 media 176 medical examinations 21, 109–11; location of 37–8, 109; rigour of 38–9, 45 medical practice, tensions in 20–1 medical provision and class 148 medical records see case books/notes medical regime, Devon Asylum 50–1 medical staff 221n17; contact with patients 190; pressures of overcrowding 72–3; recruitment/retention 59–60, 219n45; role 114–15, 221n20; status of 8 medical superintendents 22, 24, 25, 115, 208; relations with Poor Law Unions 27, 37–9 medicinal treatments 49, 52, 199 Medico-Psychological Association 58 melancholia: age profile 68; gender profile 64, 66, 129, 184–5, 229n88, 242–3n35, 244n65, 254n6; outcomes 67, 70–1, 73 Mellett, D.J. 24 Membury 125 menopause 130, 131 Mental Treatment Act (1930) 204, 250n3 mesmerism 46 Michael, Pamela 126 Middlesex 76 migration: effects on admissions 75–98, 236n6; flows 151–2, 157, 230n5, 248n25 Milton, John 52 mischief 35–6 mixed economy of provision 3–4 monotony 190–1 Moorhaven: opening of 45, 54, 156; patient outcomes 245n81, 245n83; patient profiles 127, 136, 139–42, 143, 165–6, 241n20 moral authority 133–4 moral causes of ill-health 178 moral regulation 6 moral restraint 2–3 moral treatment: Bucknill’s views of 19–20, 50, 209–10; theory of 46–8, 219n40, 226n8, 226n12 Mrs Spicer’s house 31 multiple households 84–9, 233n30

National Health Service 204, 205 neglect: by asylums 183; by relatives 40, 111 Neo-Darwinism 47, 210 Newton Abbot Union 93, 151, 159, 235n50, 235–6n56–9 Nightingale, Florence 205 non-familial households 88–9 non-institutional care see home care non-manual occupations 157 non-patients households 84–91 Norfolk Asylum 99 North America 76 Northampton County Asylum 195 ‘not improved’ 181, 192 observed behaviour 191–2 occupations 144, 152–65, 242n31–3, 248n23, 249n28–32, 249n35–6, 249– 50n38–9, 250n42–3, 250–1n44–50, 252n57, 252n59, 252–3n62, 253n64–5, 253n69, 253n71–2 Okehampton Union 17, 28–9, 30–1, 32, 41 opiates 36, 199 organic origins of insanity 48–9 outdoor relief 1, 25, 28 overcrowding 27, 33–4, 43, 54–5, 72–3, 107, 183, 210, 224n92, 227n25 Palmer, Revd William 17, 218n30 parishes: origins of patients 77–84, 90–6, 231n14–16, 231–2n17–24; urban–rural divide 93–4 Parker, J.B. 46 paternalism 18 patient households 84–91 patient registers 51–2, 54, 61–5; see also case books/notes patients: duration of stay 118–20, 128, 135, 138, 140–1, 178–83, 241–2n21–5; experiences 176–203, 210–11; outcomes 66–72, 245n83; resources 207–8 patriarchal moral regulation 6 pauper asylums 2, 3–4, 212; building and governance of 13–14; influence of class 150–1, 174; patient profiles 153–4, 172–3; see also Devon County Pauper Asylum pauper patients 163–5, 208, 219n43 ‘pauper’ status 7, 246n1 Pearce, David 204

276

Index

Pentonville Prison 18 personal circumstances, inability to appreciate 65 personal histories, diversity in 145–6 personal resources 163, 206–7 Phillips, R. Sutherland 194 Philo, Chris 76, 94, 97 Philosophical Radicalism 8 Plymouth 14–15, 25, 139, 148, 185, 216n18, 231n2, 231n10, 231n16 Plymouth Corporation of the Poor 25, 27, 53, 76, 82, 92–7, 136, 153–6, 151, 158–9, 185; access rights 156; asylum provision 44–5; committals 92, 158; pauper relief 25; see also Moorhaven Asylum Plymouth Naval Dockyard 139 Plympton House Asylum, Ivybridge 16, 18, 31, 32, 117, 217n9 Plympton St Mary Union 18, 33, 34–9, 36–7, 109–11, 222n54, 236n61, 237n19 Plympton St Maurice 37 police, role in admissions 110 politicisation of insanity 171–2 politics of insanity 206–7 Poor Law: administration 3–6, 13, 98, 207; impact on development of asylums 23–39, 44; negotiations with 99, 123–4; provision 8–9; role in admissions process 20–2, 109–11, 112; role in discharges 114–15; significance of 172 Poor Law Amendment Act (1834) 17, 25–7, 30, 31, 32, 173, 195 Poor Law Board 17, 32, 40, 172, 206, 212 Poor Law, Old 27 Poor Law Unions: creation of 25; disposal of patients 28–33, 92; influence 207; policies 24, 27–38; relations with medical superintendents 27; role of 14 Porter, Roy 3–4, 205, 210 Portsmouth Borough Asylum 111 Powderham 17 power relations 206–7, 217n17, 239n58 prejudice, confrontation of 53, 220n2 private asylums 3, 18, 143, 212, 217n9; admissions 116–21, 123, 236n61; fees 165, 166; hostility towards 39; impact of distance 94–6; influence of class 150–1, 174; patient profiles

136–7, 166–71, 173; pauper lunatics in 31; see also Digby’s Field; Wonsford House Asylum private knowledge 7 private patients 140, 141–2, 163, 165, 208, 245n85 pro-asylum unions 94 professional employment 152, 154 prostitution 65, 134, 142, 244n61 psychiatry 2, 4, 5, 6, 205–6, 219n38, 223n87; humanist approach to 20 public asylums see pauper asylums puerperal insanity 130–1, 132, 243n36; see also childbirth punishments 34 Quarter Sessions 15, 16, 18, 24, 30 ratepayers: concerns of 17–18, 32; election of Guardians 24, 25 re-admissions 36–7, 72, 115–16, 120, 135, 195–6, 203, 244–5n70–1 reception orders 197 ‘recovered’ 104–6, 120–1, 178, 180, 181, 191–2 recreation activities 41, 66, 112–13, 135 relational capacities 131, 133, 136 relationships: effects on admissions 101–4, 107–8; effects on discharges 104–7 relatives 242n30; influence of 99–124, 208–9; role in releases 191, 192–3, 199–200 ‘relieved’ 105–6, 120–1, 181, 192 Relieving Officers 13, 21, 26–7, 33, 38, 193, 194 religious mania 184, 185–6 repetitive behaviour 36 restorative intervention principle 17 Retreat, York 49, 226n8 Royal Commission on the Feeble Minded (1908) 113, 202 rules: of asylums 35, 197; of society 5 rural–urban shifts 93–4, 97 Rutland and Leicestershire 44 Sanders, E.A. 42 Saunders, Dr George Symes 40–1, 43, 46, 50, 51, 53, 54, 58, 65, 73, 114, 115, 210 Saunders, Janet 99 school mistresses 171, 253n70–1 Scotland 8, 9

Index 277 Scott, Joan 125 Scull, Andrew 4, 5, 6, 11, 22, 75, 97–8, 146–7, 173, 205, 208 seclusion rooms 51, 66, 190, 197, 255n38 segregation 19, 177, 184 sexual abuse 185 sexual intemperance 178 sexual relationships 132 Shapley Dr 197 Shepherd, Anne 126 Showalter, Elaine 66, 126 Sidmouth 183 simple households 88–91, 159, 252n52 Smith, Richard 3 social behaviour, modelling of 4–5 social boundaries 117–18 social change 75, 98, 148, 211–12 social circumstances: inability to appreciate 65; workhouse lunatics 38 social norms, conformity to 136 social obligations 126 social power 125–6, 149, 174, 228n59, 248n27 social resources 163, 206–7, 209 socio-economic structure, Devon 76–7 solitary households 84, 89, 91, 98 Somerset 116, 166 Somerset County Council 164 south-west England: economy of 148, 151, 211–12, 250n41; as locus of study 9 specialist institutions 2, 16, 25–6 St Andrews, Northampton 118 St Thomas Hospital see Bowhill House St Thomas Union 17–18, 27–9, 30, 31–3, 54, 79–80, 93, 94, 96, 159, 162, 235–6n59, 249n34 staff: accommodation 58; conditions of service 57–8; discipline 58–9; pressures of overcrowding 72–3; recruitment/retention 50, 57, 59–60, 61; responses to patients 65–6, 210; see also attendants; medical staff staff-patient ratios 54, 55–7, 194, 210, 254n12 standardisation, pressure for 24–5 Starcross Idiots Asylum 16, 35, 204 status: characteristics 143; from marriage 153, 158 stigma 23 Stoke Damerel 145 Stonehouse (East) 139

suffering 99–100, 101 suicide 34–5, 55, 189–90, 256n63 survival rates 134–5 syphilis 64–5, 131–2, 142 tailors/clothes-makers 156, 157, 159 Taunton Hospital 146 Tavistock 162 Teignmouth 133 therapeutic work 135–6, 190, 257n79 Three Counties Asylum, Bedfordshire 76 Ticehurst Asylum 100, 150 Tiverton 92–3, 96, 231–2n17, 232n19 Topsham 198 Torbay 97, 151 Torquay 167 Tory evangelical reform movement 16–18, 29–30 ‘total institutions’ 23 Totnes Union 183 traditional: obligations 29–30; treatments 20 treatments 65–6, 199: changes over time 204–5; Poor Law Unions as locus of 38–9; see also medicinal treatments Trewman’s Exeter Flying Post 45, 61 trial licences 114, 192, 193–4, 199, 257n93 Tuke, Daniel Hack 16, 19–20, 48, 109, 111 ‘unsound mind’ 131, 142, 243n44, 246n1 urban centres 75, 76, 77 urban–rural shifts 93–4 vagrancy 104, 128, 133, 134, 160, 207, 237n14, 242n26, 244n56 violence: against relatives 132, 188, 239n54; against staff 185–6; deaths from 44; as indication of insanity 115–16, 246n4, 246n6; targets of 145–6; as trigger for committal 33–6, 39 visions 198–9 Visitors 13, 14, 15, 18–19, 24, 25, 27, 41, 42–3, 225n108 visitors: access by 111, 112, 116, 209; influence of 207; responses to 100; role of 192–4 voluntary confinement 197 Volunteer Movement 57

278

Index

Wales 8–9, 10, 147, 211 Walsh, Oonagh 126 Walton, J. 5, 75, 97–9, 147–8, 151, 172 Warwick Asylum 50 Wasserman test 64 ‘weak-mindedness’ 64, 67, 129, 221n14 Weber, Max 5 Weldon, Georgina 142 Western Counties Asylum for Idiots see Starcross Idiots Asylum Whigs 17 Wonford House Asylum: facilities 258n117; opening of 15; patient experiences 194–202; patient profiles 16, 95–6, 116–21, 122, 127, 130,

137–9, 143, 217n9, 243n37, 253n68, 259n125, 166–71, 174–5, 195–202, 207, 209–11; staffing 258n117–18 workhouses: care in 9; discharge to 192, 193–4; distribution of pauper lunatics 28–39, 41; occupations of inmates 153–4; pauper lunatics in 26–7, 92–3, 235n51, 237n18–19; regime 34; role in diagnoses 109–11; specialist services 25–6, 31 Wright, David 75, 107, 126, 191 wrongful confinement 14, 150, 171, 207 York Retreat 48