MENTAL HEALTH IN HISTORICAL PERSPECTIVE Civilian Lunatic Asylums During the First World War A Study of Austerity on London’s Fringe Claire Hilton Mental Health in Historical Perspective Series Editors Catharine Coleborne School of Humanities and Social Science University of Newcastle Callaghan, NSW, Australia Matthew Smith Centre for the Social History of Health and Healthcare University of Strathclyde Glasgow, UK Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways. More information about this series at http://www.palgrave.com/gp/series/14806 Claire Hilton Civilian Lunatic Asylums During the First World War A Study of Austerity on London’s Fringe Claire Hilton Centre for the History of Emotions Queen Mary University of London London, UK Mental Health in Historical Perspective ISBN 978-3-030-54870-4 ISBN 978-3-030-54871-1 (eBook) https://doi.org/10.1007/978-3-030-54871-1 © The Editor(s) (if applicable) and The Author(s) 2021. This book is an open access publication. 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Cover credit: Print Collector/Contributor/GettyImages This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland In memoriam Professor Tom Arie CBE (1933–2020) A psychiatrist who led the way in humanising mental health services and inspired others to do likewise May his memory be for a blessing Foreword I am delighted to provide a foreword for this detailed and insightful book exploring the life of London’s asylums during the First World War. It is a compelling but also harrowing read for all those interested in the history of psychiatry and mental health services. The book explores the structural, legal, relational and procedural side of asylum life in the First World War with a particular emphasis on the experience of patients. It draws on a breadth of source material reflecting their experiences. In England and Wales there were 100,000 patients in asylums and whilst it might be tempting to think, when exploring the horrors of mili- tary life, that asylum life might be a welcome respite, the experiences of patients were quite the opposite. The book shows us that mental health care never existed outside the context of culture, politics and world events and was particularly prone to adversity when resource and workforce pres- sures abounded. There were huge staff shortages and general goods were in short supply but what was particularly obvious was the deficit in terms of innovation that had made some headway prior to the First World War. There were some enlightened voices urging a focus on what would benefit patients, but treatment could be harsh and there was disregard for personal dignity along with poor hygiene and high death rates. It did make me feel grateful for our safeguarding procedures, mental health law that prioritises and protects patients and for regulators with real teeth, along with encouraging the externalising of complaints and concerns, rather than suppressing them. vii viii FOREWORD An important reason to explore the past is to learn lessons for the future and Claire Hilton’s book does that. Some challenges are still very much present 100 years on: stigma, human rights, power imbalances, resources, workforce, research, regulation and organisational structure remain part of our current discourse. Read on with an open mind, a thirst for knowledge and with grati- tude for what we can do for our patients. Continued self-reflection and challenge are vital. We could still do so much more. Dr. Adrian James President of the Royal College of Psychiatrists London, UK Preface Bombarded by historical analyses of First World War “shell shock” and the suffering of military casualties left me wondering how 100,000 “pauper lunatics” fared in the wartime civilian lunatic asylums. Asylum patients were low priority on the scale of social welfare, regarded as a burden on the economy and unable to contribute to the war effort. Standards of care and treatment fell, discharge rates plummeted, and death rates due to infectious diseases escalated far in excess of those in the community. The neglect was particularly disturbing because the asylum leadership knew what should be done in the interests of the patients, but too often failed to act on that knowledge. This book centres round the patients who were the raison d’e tre of the asylums. It explores how individuals helped them and hindered them and how the system let them down. It is an un-told story, about real people, which deserves to be heard. London, UK Claire Hilton ix Acknowledgments Many people have helped, cajoled, criticised, supported and guided the research and writing of this book. Librarians and archivists, particularly at the Wellcome Collection, London Metropolitan Archives, Royal College of Psychiatrists and the National Archives at Kew have helped sort endless requests for documents. The Wellcome Collection generously provided the funds to publish this book open access. Matt Smith and Cathy Cole- borne, series editors, and Molly Beck, Joe Johnson and Meera Mithran at Palgrave, have been a supportive team to work with. Two anonymous peer reviewers, one who read the synopsis and another who read the entire manuscript offered valuable feedback and helped shape the final text. Rhodri Hayward read chunks of the work and his comments were much appreciated. Advice from Nicol Ferrier about post-mortems was most welcome and discussions with Louise Hide are always thought provoking and fruitful. Adrian James found time to write the foreword, and I am grateful for his continued interest in the history of psychiatry. Hugh and Gus Fowler-Wright and library staff at King’s College London provided invaluable copyright information about illustrations. My husband Michael has allowed me to disappear into lengthy anti-social hibernation with my laptop, and he has continued to explore former asylums and asylum ceme- teries with me. I am particularly indebted to David Jolley for his enthu- siasm and encouragement and valuable comments after reading the entire manuscript, some parts more than once. xi Contents 1 Introduction: Civilians, Lunacy and the First World War 1 2 Infrastructure: Rules, Walls, Obstacles and Opportunities 31 3 Certified Insane: Concepts and Practices 73 4 Personnel: Staffing the Asylums and Serving the Colours 117 5 Food, Farm and Fuel: An Inequitable Supply Chain 147 6 Patients and Their Daily Life 173 7 Difficult Diseases: Tuberculosis and Other Infections 213 8 Accidents, Injuries, Escapes and Suicides 239 9 Shackles and Chains: Some Concluding Thoughts 263 Index 279 xiii Abbreviations AR Annual Report BJPsych British Journal of Psychiatry BMJ British Medical Journal BoC Board of Control CiL Commissioners in Lunacy CMO Chief Medical Officer CRDI England and Wales, Civil Registration Death Index, 1916–2007 d ‘Old’ penny. 1d = ½p EC Earth closet GPI General paralysis of the insane HC House of Commons HL House of Lords HoP History of Psychiatry (Journal) JMS Journal of Mental Science LAB Lancashire Asylums Board lb Pound weight. 1 lb = 0.45 kg LCC London County Council LMA London Metropolitan Archives, City of London MACA Mental After Care Association MDA Mental Deficiency Act 1913 MOH Medical Officer of Health MRC Medical Research Committee/Council MP Member of Parliament MPA Medico-Psychological Association MS Medical superintendent NAWU National Asylum Workers’ Union xv xvi ABBREVIATIONS oz Ounce.