ABOVE ALL A PATIENT SHOULD NEVER BE TERRIFIED: AN EXAMINATION OF MENTAL HEALTH CARE AND TREATMENT IN HAMPSHIRE 1845-1914 DIANE TERESA CARPENTER ‘The thesis is submitted in partial fulfilment of the requirements for the award of the degree of Doctor of Philosophy of the University of Portsmouth.’ September 2010 ABSTRACT ABOVE ALL A PATIENT SHOULD NEVER BE TERRIFIED: AN EXAMINATION OF MENTAL HEALTH CARE AND TREATMENT IN HAMPSHIRE 1845-1914 Challenging significant historiography this study argues that the period 1845-1914 was a time in which to have been in receipt of the care of county lunatic asylums was substantially preferable to the alternatives for the local poor and mad, suggesting wider studies might show the same for other parts of England. Case examples are provided from the close research of two pauper lunatic asylums built in Hampshire during the period. Underpinning these is a methodology which synthesises an ‘alltagsgeschichte’ deriving from the Annales School with medical and local history. The research follows a metaphorical patient-journey beginning with the pre-patient stage when policy enforced the building of county lunatic asylums, examining the concept of architecture for sanity as well as local reaction to the building programme. It has identified a novel perspective for our understanding of the loci of control responsible for translating ideology into the physical structure of the asylum. Patient assessment and the asylum admission process are critically reviewed, and the identification of the symptoms of insanity as well as contemporary beliefs about aetiology are interrogated. Medicalization of aberrant behaviour and the early attempts at classification and diagnosis are subsequently analyzed. Significant differences in causes for and forms of disorder were revealed between rural and urban populations, contributing new knowledge. An important question, which hitherto has been incompletely addressed, is the extent to which insanity had risen to epidemic proportions. This study comprehensively evaluates local evidence to conclude that it had not. The medical and physical treatments prescribed are scrutinized and eliminated as contributing to the recovery rate whereas the dominant method of intervention, the dual approach of moral treatment and management was found to be significantly successful as curative or palliative. The roles of the staff in contributing to the comfort and welfare of patients are examined within the spirit of policy, legislation and developing scientific knowledge. 1 CONTENTS Declaration 4 List of Figures 5 List of Graphs 5 List of Maps 5 List of Tables 6 Abbreviations 7 Conventions 9 Glossary 10 Acknowledgements 13 Dissemination 14 Dedication 15 Introduction 16 Chapter 1 LITERATURE REVIEW 27 Chapter 2 MONUMENTS OF HONOUR OR DISGRACE? 45 ARCHITECTURE FOR SANITY AND THE ASYLUM BUILDING PROGRAMME Chapter 3 A PROPER SUBJECT FOR AN ASYLUM 76 Chapter 4 PILLS, POISONS AND POTIONS 109 Chapter 5 MORAL TREATMENT: THE QUALITY OF ASYLUM 138 LIFE Chapter 6 BEATINGS, BELLS AND THE BIBLE: THE 169 MAINTENANCE OF CONTROL AND ORDER Chapter 7 WELL BEGUN IS HALF DONE 195 Conclusion 230 2 Appendix 1 PROVISION FOR LUNATICS IN THE SOUTH WEST 236 REGION 1615 – 1914 Appendix 2 TABLE OF THE MAIN STATUTES RELATING TO 240 ASYLUMS AND THE CARE AND TREATMENT OF LUNATICS, 1800-1913 Appendix 3 PROSOPOGRAPHY 245 Appendix 4 ASYLUM SETTINGS AND BUILDING OUTLINES 267 Appendix 5 CONTRIBUTIONS TO ASYLUM DESIGN BY 272 CHARLES FOWLER AND HENRY BURDETT Appendix 6 ASYLUM PHOTOGRAPHS 276 Appendix 7 TABLES OF ADMISSIONS, DISCHARGES AND 280 DEATHS, 1853-1914 Appendix 8 COMPARATIVE DIETARIES 286 Appendix 9 CAREER HISTORIES OF ASYLUM STAFF 290 Appendix 10 PROFESSIONAL EXAMINATIONS AND TRAINING 295 NOTES Bibliography 297 3 DECLARATION ‘Whilst registered as a candidate for the above degree, I have not been registered for any other research award. The results and conclusions embodied in this thesis are the work of the named candidate and have not been submitted for any other academic award.’ 4 LIST OF FIGURES Page 1 Chapter 2 Photograph of the Hampshire County Lunatic Asylum 62 2 Chapter 2 Photograph of the Borough of Portsmouth Lunatic Asylum 63 3 Chapter 2 Postcard of the Borough Asylum 63 4 Chapter 7 Page from Nurse Dorrington’s Training Notes 219 5 Chapter 7 List of BPLA Nurses and Attendants who had obtained the 222 M.P.A. Certificate 6 Chapter 7 Grace E. Norris’s Certificate, May 1918 223 7 Chapter 7 Badge for the Holders of the M.P.A. Certificate 224 LIST OF GRAPHS 1 Chapter 3 Aetiological Comparison of Buckinghamshire, Portsmouth, 102 Hampshire and Norfolk Asylums (1854-1903) 2 Chapter 3 Comparison of Forms of Disorder for Buckinghamshire, 104 Hampshire, Norfolk and Portsmouth Asylums (1854-1914) 3 Chapter 4 Asylum Populations for Buckinghamshire, Portsmouth and 114 Norfolk Asylums Compared with the National Average (1847- 1914) 4 Chapter 4 Comparison of Buckinghamshire, Portsmouth, Hampshire and 116 Norfolk Asylums Total Populations and Admissions 5 Chapter 4 Proportion of Admissions to Total Asylum Population BCLA 117 (1861-1911) 6 Chapter 4 Proportion of Admissions to Total Asylum Population BPLA 117 (1881-1911) 7 Chapter 4 Proportion of Admissions to Total Asylum Population BPLA 11 8 (1880-1914) 8 Chapter 4 Proportion of Admissions to Total Asylum population HCLA 118 (1856-1911) 9 Chapter 4 Proportion of Admissions to Total Asylum Population HCLA 119 (1860-1914) 10 Chapter 4 Proportion of Admissions to Total Asylum Population NCA 119 (1856-1911) 11 Chapter 5 Comparison of the Weekly Dietary for male Patients at Five 143 Asylums 12 Chapter 7 Salaries for Buckinghamshire, Hampshire, Portsmouth and 210 Norfolk Asylums (c. 1885-1914) 13 Chapter 7 Average Asylum Salaries and Comparable Occupational 211 Equivalents (1885-1901) LIST OF MAPS 1 Introduction Administrative Areas of the South West Region of England 20 (c. 1864-1928) 5 LIST OF TABLES Page 1 Chapter 2 Number and Place of Lunatics and Idiots in Hampshire, August 48 1843 2 Chapter 3 Patients Transferred from Grove Place Asylum to the HCLA 79 1852 3 Chapter 3 The Probable Causes Apparent or Assigned of the Disorders in 96 the Admissions, HCLA During the Year 1874 4 Chapter 3 The Causes, Apparent or Assigned of the Disorders in the 97 Admissions, BPLA During the Year 1884 5 Chapter 3 Forms of Disorder in the 130 Patients Admitted into the HCLA 103 In 1854 6 Chapter 3 Forms of Mental Disorder for Male and Female Paupers, BPLA 105 (1907-1925) 7 Chapter 3 Forms of Mental Disorder Identified by Kraepelin and Mendel 106 8 Chapter 4 Asylum Statistics for the BCLA, BPLA and HCLA (1861- 113 1911) Indicating Recovery Rates 9 Chapter 4 Proportion of Lunatics for the Hampshire Population (1845- 122 1911) 10 Chapter 4 Number of Patients Discharged Recovered or Relieved per 123 Number of Admissions 11 Chapter 5 HCLA Dietary for Males, 1853 140 12 Chapter 5 BPLA Dietary for Males, 1879 141 13 Chapter 5 Return of Work performed by Female Patients, BPLA (1879- 152 1880) 14 Chapter 5 Articles Made in the Tailor’s Workshop, BPLA (1879-1880) 152 15 Chapter 5 Articles Repaired in the Tailor’s Workshop BPLA (1879-1880) 153 16 Chapter 5 Occupations of Patients Admitted to the HCLA, 1854 157 17 Chapter 5 Occupations of Patients Admitted to the BPLA, 1897 158 18 Chapter 6 BPLA Daily Regime 184 19 Chapter 7 List of Staff Employed in the HCLA March 1910 197 20 Chapter 7 Comparison of Salaries Between Staff at the Hampshire and 209 Portsmouth Asylums (1898-1899) 6 ABBREVIATIONS A.M.O. Assistant Medical Officer A.R. Annual Report B.C. Board of Control BCLA Buckinghamshire County Lunatic Asylum BPLA Borough of Portsmouth Lunatic Asylum C.A.B. Condition on Admission Book C.B.M.F. Case Book, Male and Female Patients C.I.L. Commissioners in Lunacy C.R. Chaplain’s Report C.V.M.B. Committee of Visitors’ Minute Book E.R.O. Early Removal Orders G.P. General (Medical) Practitioner G.P.I. General Paralysis (or Paresis) of the Insane HCLA Hampshire County Lunatic Asylum H.C.P.P. House of Commons Parliamentary Papers H.R.O. Hampshire Record Office H.T. The Hampshire Telegraph G.R. Guardian’s Report JMS Journal of Mental Science J.P. Justice of the Peace L.M.F. Library and Museum of Freemasonry M.C.I.L. Metropolitan Commissioners in Lunacy (predated C.I.L.) M.D. Doctor of Medicine Mist. Mistura (Mixture) 7 M.P.A. Medico-Psychological Association M.P.S. Medico-Psychological Society M.R. Membership Registers M.R.P.F. Medical Registers, Pauper Female Patients M.R.P.M. Medical Registers, Pauper Male Patients M.S. Medical Superintendent N.A. National Archives N.C.A. / N.L.A. Norfolk County Asylum (formerly Norfolk Lunatic Asylum) O.E.D. Oxford English Dictionary P.C.R.O. Portsmouth City Record Office P.N.M.P. Patient Notes, Mainly Paupers P.N.R.O. Patient Notes, Reception Orders P.T. The Portsmouth Times R.D.D. Register of Deaths and Discharges R.D.R.D. Register of Discharges, Removals and Deaths Revd The Reverend R.I.B.A. Royal Institute of British Architects R.O. Relieving Officer Rx Prescription (Recipe) S.L.A. Sussex Lunatic Asylum S.O.E.D. Shorter Oxford English Dictionary U.G.L.E. United Grand lodge of England V.R. Visitors’ Report 8 CONVENTIONS Referencing and Bibliography conform to the University of Portsmouth’s conventions for History: http://referencing.port.ac.uk/history.html, ‘Referencing at Portsmouth’, University of Portsmouth. Consistent with these conventions, references to parliamentary papers and legal citations conform to the OSCOLO guidelines. University of Oxford: Faculty of Law OSCOLA 2006: Oxford Standard for Citation of Legal Authorities (Faculty of Law, Oxford 2006) 16.