THE ADMINISTRATION OF INSANITY IN EAST LONDON 1800-1870 Thesis submitted for the degree of PhD in History of Medicine University College London Elaine Murphy Wellcome Institute for the History of Medicine 2000 Department of Anatomy and Developmental Biology University College London ProQuest Number: 10015820 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10015820 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT The policies and operational management practices for mentally dependent people devised by the Parish Vestry Trustees of the Poor and the Boards of Guardians in East London are examined for the period 1800 to 1870. The study is set within the rapidly changing socio-demographic context of an increasingly overcrowded, impoverished, mobile local population comprising the parishes in the Tower Division of the Ossulstone Hundred and for the old poor law period, the City of London. Documentary sources include the records of the Vestries, Trustees and Overseers of the Poor, the Boards of Guardians, the archives of the County Lunatic Asylums at Hanwell and Colney Hatch, contemporary records of the Metropolitan and later national Commissioners in Lunacy, the Poor Law Commission and its successor the Poor Law Board and local archival materials from the Borough Archives of Hackney and Tower Hamlets. A wealth of institutions for the insane had been established locally in the eighteenth century and earlier. Large privately owned ‘pauper lunatic asylums’ and huge pauper farms determined an institutional solution to managing insanity at an earlier date than was generally the case elsewhere in England. The old poor law period was characterised by a flexible, individual approach to managing the insane using a ‘mixed economy’ of private and public placements, the parishes showing considerable variation in their choice of placement. This diversity of approach between neighbouring districts of Boards of Guardians continued after the Poor Law Amendment Act of 1834, there being substantial continuity of practice before and after the Act in some districts. Financial and legal incentives gradually changed the placement policies of the Guardians, encouraging the use of the public asylums. Relations between the County Asylums and the Guardians, seen through the negotiations between Guardians’ officers, doctors and asylum staff, were often conducted through the language of dangerousness and the need to choose the most economic alternative. The Commissioners in Lunacy and the Poor Law Commissioners had only a modest impact on local policy and quality of local provision in workhouses but the culture of non-restraint and the moral stance of the Lunacy Commissioners and Hanwell Asylum may have influenced some Guardians’ policies. The Guardians lost much of their responsibility for the care of the insane when the Metropolitan Poor Act of 1867 gave birth to the Metropolitan Asylums Board and the new imbecile asylums. It is argued that the move away from local, individual planning and purchasing for each case to centralised, comprehensive planning for categories of classified paupers was not necessarily in the best interests of insane paupers. FOREWORD and ACKNOWLEDGEMENTS When I was training in psychiatry and geriatric medicine in North and East London in the 1970s, I found that although I was nominally attached to prestigious teaching hospitals, the beds for aged and mentally ill patients were without exception in secondary hospitals that had started life as workhouses, workhouse infirmaries. Metropolitan Asylums Board hospitals and LCC asylums. My interest in these institutions and the people who worked in them began on bored nights on call, exploring the basements, back stairs and forgotten archives. Returning to East London as an administrator after a gap of 15 years, during which time I had been an academic, health service manager and government Commissioner, I found the pattern of institutions in 'my patch' almost unchanged. My 'new' office was in the old 'workhouse infirmary wing' at St Leonard's Hospital, the former Shoreditch Workhouse, where Dr Arthur Morris, a noted local medical historian, had been medical superintendent in the 1950s. Morris's knowledge of the early history of St Leonard's and of the numerous private madhouses nearby has been both an inspiration and a responsibility. The claustrophobic geography of these institutions fascinated Morris and was the starting point for my own study of the work of our administrative predecessors, the East London Parish Trustees and Guardians of the Poor. A novice explorer needs a guide and good companion and there could be no finer than Professor Roy Porter, my supervisor. His company alone would have been sufficient to retain my enthusiasm for the task. He has taught me to reflect as well as to document, to read what I would formerly have tossed aside. The journey has been above all the best fun and my expression of thanks to him is bound to be inadequate. Thanks are also due to the community of social historians who have been so generous with their time and advice, both at the Wellcome Institute and further afield. There are' too many to mention everyone but Andrea Tanner, Ruth Richardson, Nick Hervey, Jo Melling and Peter Bartlett have been exceptionally encouraging. I have been assisted generously by the archivists at the London Metropolitan Archive, the Guildhall Library and Tower Hamlets Archive but specially want to thank David Mander and his team at Hackney Archive, Robert Leon at St Luke's Woodside and Mrs Priscilla Mitchell for their enthusiasm and practical help. Finally, numerous Health Service managers in East London have unearthed old plans and drawings, taken me on tours of the oldest parts of their hospitals and accompanied me 'asylum-hunting'. I am grateful for their cheerful if sometimes puzzled indulgence. Elaine Murphy CONTENTS of Volume I Chapter 1: Managing Insanity in East London: the Administrative Page Problem 6 Chapter 2 : Life in East London 1800-1870 20 Chapter 3: Institutions for Pauper Lunatics in East London: A 34 Significant Service Industry Chapter 4: Managing Insanity under the Old Poor Law 84 Chapter 5: The Amendment Act and the New Boards of Guardians 119 1834-1855 Chapter 6: The Middlesex Magistrates and the County Asylums 186 Chapter 7: Central Regulation: the Lunacy Commissioners and the 210 Guardians 1845-1867 Chapter 8: Last years: the Metropolitan Poor Act of 1867 245 Chapter 9: Conclusion: the Victory of Centralism 256 CONTENTS of Volume II (for detail, see Volume II page 280) Appendix A: Bibliography 282 Appendix B: East London Licensed Houses 322 Appendix C: Biographical Notes 353 Appendix D: Statistical Tables 398 I t a b l e s and FIGURES, Volume I. Figure 2.1 Map of Parishes, Ossulstone Hundred, East London 1819 20 Figure 3.1 Institutions for lunatics and idiots in East London 1814-1815 34 Figure 3.2 Institutions for lunatics and idiots in East London 1840 34 Figure 3.3 Institutions for lunatics and idiots in East London 1850 34 Figure 3.4: The White House 1794 42 Figure 3.5i: Bethnal House c l843 42 Figure 3.6 ; 3 4 Hoxton Street, surviving part of Hoxton House Asylum 54 Figure 3.7 ; Burrows or Holly House, 1830s 63 Figure 3.8: Farmhouse for City and other poor kept by Mr Thomas Tipple 69 Figure 5 .9 - Grove Hall Asylum, Bow c 1900 73 Figure 5.1 Map of Boards of Guardians, East London 1840 119 Figure 5.2 Percentage Fall in Poor Relief after the Poor Law Amendment Act 170 1834 Figure 5.3 Administration (staff) costs as a Percentage of Poor Relief 170 (Efficiency Index) 1841 Table 5.1 Union Costs for Placements of Lunatics and Idiots 1841-1842 182 Table 5.2 Union Annual Total Spend, Average Rate of Spending per 183 Patient and per 1000 Population, 1841-1842 Figure 5.4 Impact of Declared Institutionalisation Rates. Comparative 183 Spending on Lunatics and Idiots, East London Unions 1842 Figure 5.5 Impact of Individual Placement Choice on Spending on Lunatics 183 and Idiots, East London Unions 1842 Figure 6.1: General Summary Returns of Pauper Lunatics in Middlesex 206 1850-1852. Table 7.1: Return of Unions in which the Sane are not intermixed with the 225 Insane, 1861-2 Figure 7.1 : Shoreditch Worlchouse Infirmary 1865 241 Figure 7.2: Offices for the Relief of the Poor, St Leonard Shoreditch 1863 243 Figure 9.1: Insane Paupers as a Percentage of Chargeable Paupers, East 266 London and England and Wales Figure 9.2: Insane Pauper Rate per 10,000 Population in Middlesex and 266 England and Wales Rise in Percentage of Paupers classified as Lunatics and Idiots 1842-1875; Chapter 1: Managing Insanity in East London: the Administrative Problem James Lock, a man in his late 60s, came into Stepney Union’s Mile End workhouse in the winter of 1838. This is Mr Warren, the Relieving Officer’s account:’ On the 3 December while the Relieving Officer happened to be at the residence of the medical officer Mr Story on other business, a message was brought requiring the immediate attendance of the latter upon a man in Devonshire Street supposed to be insane. Both officers immediately attended and found James Lock sitting by the fire. It seems he had gone to the necessary and having stopped long his daughter went to look for him and found him lying on the stairs in the yard quite exhausted from cold.