District Asylum Research Articles

Critiques, ideals and blueprints in the historical geography of Scotland’s lunatic asylums, 1857–1872

ABSTRACT The historical geography of Scotland’s nineteenth-century lunatic asylums has only been lightly researched to date, and particularly under-studied is what might be termed Scotland’s ‘Asylum Age’ – c.1857 into the 1870s – when publicly-funded and purpose-built district asylums started to appear across the Scottish landscape. This was a period of therapeutic optimism about what these asylums could achieve, as curative institutions buttressed by medical and moral ideas about how lunacy should be treated. Using Annual Reports of the General Board of Commissioners in Lunacy for Scotland over a fifteen-year period, 1857–1872, this paper explores ‘expert’ criticisms directed at the perceived geographical failings of the pre-1857 establishments housing lunatics (royal asylums, private licensed houses and Poor Law facilities). Attending to the macro and micro-geographies discussed in these Reports, the Commissioners’ ideal for asylum location and architecture is reconstructed, noting how this became a geographical blueprint for the emerging district asylum system. Over the fifteen-year study period, ideas about the ideal site and building shifted once more as lunacy numbers increased and money dwindled, suggesting that the ideal was soon to be overtaken by a more pessimistic turn less sure about the curative benefits of rural sites or homely buildings.

Mortality among those certified under lunacy legislation in Scotland during World War I.

Mortality in asylum populations increased during World War I. This paper seeks to analyse the mortality data from Scotland, where governmental statistics allow comparison between different lunacy institutions, poorhouses and prisons, as well as people certified under lunacy legislation but living in the community. Detailed study is made of two Lothian asylums, the Royal Edinburgh Asylum and the Midlothian and Peebles District Asylum, and the 1918 influenza pandemic is considered in the asylum context. Similarities and differences between the situation in Scotland and that in England and Wales are discussed, and parallels are drawn with the Covid-19 pandemic in Scotland.

Characteristics of Asylum Seekers in Collaborative Assessment Program.

The Capital District Asylum Collaborative (CDAC) is an organization that provides psychiatric and medical evaluations to be used as forensic evidence to support asylum applications. Our study assesses the demographics and traumas experienced by CDAC clients. In this retrospective study, 23 completed affidavits for clients evaluated through CDAC between the years 2016 and 2020 were analyzed for demographics, trauma experience, and psychiatric diagnosis given. Most clients experienced at least 4 different forms of trauma. Nearly 78% of clients experienced beating to the body, 43% were raped, 56.5% experienced other forms of sexual abuse or humiliation, 47.8% experienced forced separation from family, and 39.1% experienced illness and poor access to care. Majority of clients were diagnosed with comorbidities most commonly major depressive disorder and post-traumatic stress disorder. This analysis has provided us guidance on how to establish continuing care options for future clients evaluated at CDAC.

A 'Scottish Poor Law of Lunacy'? Poor Law, Lunacy Law and Scotland's parochial asylums.

Scotland's parochial asylums are unfamiliar institutional spaces. Representing the concrete manifestation of the collision between two spheres of legislation, the Poor Law and the Lunacy Law, six such asylums were constructed in the latter half of the nineteenth century. These sites expressed the enduring mandate of the Scottish Poor Law 1845 over the domain of 'madness'. They were institutions whose very existence was fashioned at the directive of the local arm of the Poor Law, the parochial board, and they constituted a continuing 'Scottish Poor Law of Lunacy'. Their origins and operation significantly subverted the intentions and objectives of the Lunacy Act 1857, the aim of which had been to institute a public district asylum network with nationwide coverage.

Disease, danger and death: illness and injuries among staff of Monaghan District Asylum (1869–1950)

ObjectiveThe purpose of this paper has been to investigate the vulnerability of staff in an Irish district lunatic asylum (1869–1950) to infection and injury as exemplified by the records of Monaghan District Asylum (renamed Monaghan Mental Hospital in 1924 and St Davnet’s Hospital in 1954). Some comparisons with other Irish district asylums are included.MethodsThe Minutebooks of Monaghan District Asylum, located in St Davnet’s Complex, Monaghan, were sampled in December of each year from 1869 to 1950 with the sampling extended outwards as required. In addition, the reports on the District, Criminal and Lunatic Asylums in Ireland (1869–1921) and the annual reports of the Inspector of Mental Hospitals (1923–2013) were surveyed for comparisons.ConclusionsStaff in Monaghan District Asylum were vulnerable to infection from contagious diseases including typhoid, tuberculosis and Spanish influenza. As with other Irish district asylums, overcrowding was the norm and isolation facilities were either absent or inadequate. The close proximity of staff to patients in an overcrowded and frequently insanitary institution placed them at increased risk of contracting disease. Moreover, staff at all levels, from resident medical superintendent to attendant, were, on occasion, at risk of injury from patients. The Monaghan experience would seem to indicate that any consideration of staff patient relationships within asylums should be nuanced by a consideration of the risks posed to staff due to their occupation.

The socio-demographic and clinical profiles of patients admitted to the Sligo District Lunatic Asylum in the late 19th century with some modern comparisons

PurposeThe purpose of this paper has been to identify and describe the demographic, social and clinical characteristics of persons admitted to an Irish district lunatic asylum in the late 19th century as exemplified by the records of the Sligo District Lunatic Asylum. Some 21st century comparisons and epidemiological considerations from the same catchment area have been attempted.MethodThe register entries and case books of a series of consecutive admissions to Sligo District Asylum during the decade 1892–1901 were surveyed in the Irish National Archive.ConclusionsMost admitted patients were of lower socio-economic status, the majority male, poorly literate, unmarried and described as suffering from mania or melancholia. Most were first admissions. The predominant (62.5%) reason given for admission was for assault or threat of assault. These admissions were by order of the Lord Lieutenant as ‘dangerous lunatics’. Although it may be maintained that this admission process was a device of social convenience to maintain the peace and integrity of local communities and the convenience of families, clinical information indicates that the majority of admissions had symptoms of mental disorder recognisable in terms of 21st century psychiatric diagnostics.

Asylum Doctor Extraordinaire: Dr. Thomas Drapes (1847-1919).

Dr. Thomas Drapes (1847-1919) was resident medical superintendent of Enniscorthy District Asylum in County Wexford, Ireland from 1883 to 1919, and one of the leading figures in Irish asylum medicine for several decades. Drapes' career was as complex as it was remarkable. Drapes was elected president of the Medico-Psychological Association for the term 1911-12 but had to decline on health grounds. In 1912, however, he was unanimously elected as co-editor of the Journal of Mental Science, to which he devoted his considerable energies and intellect. Drapes published widely, opposing Emil Kraepelin's proposed division of "functional" psychosis into manic-depressive illness and dementia praecox; openly examining the use of "punitive measures" in asylums (Enniscorthy had notably low rates of restraint and seclusion); and publicly bemoaning the folly of "psychophysical parallelism", or the spurious division between mental and physical symptoms in medicine. Although not immune to passing trends in medical thought (e.g. regarding sterilisation of the mentally ill to prevent further mental disorder), Drapes was generally independent-minded, insightful and incisive, and his legacy was to help shape Irish mental health care for many decades.

Shell shock in Ireland: The Richmond War Hospital, Dublin (1916-19).

The history of mental disorders occasioned by World War I is a complex and important history, indelibly linked with social, political and cultural circumstances, and the history of the war itself. The Richmond War Hospital was a 32-bed establishment on the grounds of the large Richmond District Asylum in Dublin which, from 16 June 1916 until 23 December 1919, treated 362 soldiers with shell shock and other mental disorders, of whom more than half were considered to have recovered. Despite the limitations of the Richmond War Hospital, it was a generally forward-looking institution that pointed the way for future reform of Ireland's asylum system and, along with the other war hospitals, brought significant changes to the practice of psychiatry.

The birth and death of a diagnosis: monomania in France, Britain and in Ireland

ObjectiveThe purpose of this paper is to trace the origins and decline of the diagnostic entity monomania, which became prevalent in the early 19th century and to investigate its use in Irish psychiatry.MethodThe French psychiatric scientific writings of the early 19th century have been surveyed to identify and describe the clinical entity of monomania. The clinical description of monomania has been investigated and its cultural diffusion through literature and the arts has been reviewed. The increase in its use as a diagnosis and its ultimate decline has been documented in France, Britain and Ireland. The clinical characteristics leading to the diagnosis in Ireland have been investigated through the clinical symptoms recorded in patients accorded this diagnosis in the 19th century case books and committal documentation of the Richmond District Asylum and case books of the Central Mental Hospital.FindingsThe diagnostic entity of monomania first emerged in France in the 1820s and had disappeared from use in the hospitals of Paris by 1870. It first appeared in Ireland in the patients’ admission register of the Richmond District Asylum in 1833 and increased substantially before decreasing just as markedly with the last patient, given the diagnosis on admission being in 1878. However, the diagnosis of monomania was applied to admissions to the Central Mental Hospital as late as 1891. The Irish asylum case books have been of limited value in elucidating the clinical and symptomatological presentations leading to its use by 19th century Irish psychiatrists.ConclusionsMonomania, although enjoying a scientific and cultural success in France, both within and without psychiatric circles, was a tenuous clinical entity with an ill-defined and uncertain core and fragile boundaries, both in France and more particularly in Ireland. In pure form, rarely described, its closest modern equivalent would have been delusional disorder, but case descriptions only occasionally correspond to this concept as it is understood today. Its popularity dating from around 1830 declined and by the 1870s it was in terminal decline. The factors delineating its rise and fall are unclear.

The Richmond District Asylum and the 1916 Easter Rising

The Richmond District Asylum and the 1916 Easter Rising

Mental health need amongst the intellectually disabled

The College of Psychiatry of Ireland concludes that ‘‘the provision of mental health and forensic mental health services for people with an intellectual disability, as set out in A Vision for Change, requires immediate prioritisation’’ [1]. The issue is both important and long-standing. In 1907, Dr Conolly Norman, outspoken and progressive medical superintendent at the Richmond District Asylum (now St. Brendan’s Hospital, Dublin) lamented the absence of services for individuals with intellectual disability: ‘‘It is neither wise nor humane to neglect [the intellectually disabled] as they are neglected in this country’’ [2, 3]. References

One hundred years ago. Glasgow District Asylum, Gartloch (report for the year ending May 5th 1899)

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Poor and mad: a study of patients admitted to the Fife and Kinross District Asylum between 1874 and 1899.

This is the first detailed study of patients admitted to a Scottish pauper asylum. A one in four sample of patients admitted to the Fife and Kinross District Asylum between 1874 and 1899 was undertaken and yielded 262 males and 266 females. Each patient's case-notes were studied from admission to the time of discharge and a wide range of information relating to sociodemographic and clinical features was extracted and subsequently analysed. The study found that while the Fife and Kinross Asylum shared many of the features of its English counterparts, the general picture was less bleak: the Asylum population did not grow to such large numbers; the recovery rate did not fall so precipitately and even rose towards the end of the century and cases of general paralysis were less frequent. In the discussion, these findings are related to other asylum studies.

The Foundations of Psychiatric Nurse Training

The gradual transition from unqualified attendant to the trained psychiatric nurse of the present day was described in detail by Walk. A key turning point in this story occurred at the Quarterly Meeting of the Medico-Psychological Association in Edinburgh on 16 November 1883, when Dr A. Campbell Clark, Medical Superintendent of the Glasgow District Asylum, read a paper entitled ‘The special training of asylum attendants'. This paper was published in the Journal of Mental Science in January 1884. Whilst attention had been given by many other asylum doctors to the training of attendants, Clark's experience of organizing attendant training courses and his firm recommendations opened the way to practical steps which set training on a new footing. Clark acknowledged the work of Dr T. S. Clouston, Physician Superintendent of the Royal Edinburgh Asylum, who read a paper to the annual meeting of the Association in 1876 entitled ‘On the question of getting, training, and retaining the services of good asylum attendants'. This paper aroused a good deal of interest amongst members of the Association, and a small committee was formed to report ‘on the advisability of the formation of an association or registry of attendants in connection with this Association and the best manner of carrying it into effect’. However, there is no record of any report by this committee.

Renfrew District Asylum as a War Hospital for Mental Invalids: Some Contrasts in Administration. With an Analysis of Cases admitted during the First Year

I purpose giving first of all a short description of the steps taken in connection with the conversion of this institution into a war hospital, and of the necessary additions to the staff. No structural alterations were required to the buildings, as they were to be used only for mental cases, and the changes therefore required were very slight in comparison to what, for example, took place at Bangour or at other asylums. Most of you will have read the minute and vivid description by the President of our Association, Lieut.-Col. Thomson, when the Norfolk County Asylum was converted into a war hospital for the sick and wounded, but the radical changes described there in the buildings and amongst the staff were quite unnecessary at Dykebar, as it was taken over as a going concern. Consequently we were able to admit soldier patients almost at once when the others had been removed. It happened by good luck that the new nurses' home had just been completed, otherwise it would have been impossible to have accommodated all the female staff. With the exception of four orderlies who are billeted with the married orderlies, and tradesmen, all the others are housed in the institution. The daily routine in the institution is much the same as you are all accustomed to, except that there is here a certain liveliness, as the majority of the patients are young, strong, active men, and a march out here is quite a different thing to the slow and decrepit walking parties formerly in vogue, and in the farm and garden there is displayed energy never seen before. Work, and especially outside work, is encouraged, but of course there is always a certain proportion who cannot be persuaded to do anything.

Waterford District Asylum

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The Employment of Female Nurses in the Male Wards of Mental Hospitals in Scotland

Ten years ago I was requested by the Secretary of the Medico-Psychological Association to open a discussion at the annual meeting of the Association on this subject. It was then regarded by some asylum medical officers as “the topic of the hour,” largely because of certain views on administration which I had expressed, and certain innovations in methods I had made at the Stirling District Asylum.

Some Features of the Recent Outbreak of Enteric Fever at Omagh District Asylum

Though the subject of enteric fever would not seem to come within the purview of this Association, yet special features, mental and otherwise, of the outbreak in Omagh Asylum in the end of last year prompted me to put some of the facts before the members of the Irish Division. They will pardon me if they find my remarks rather bald, being mere records of observations, but I hope they will not be altogether uninteresting.

An Investigation as to the Therapeutic Value of Thyroid Feeding in Mental Diseases

The history of the use of thyroid extract in insanity dates back to the year 1893, when McPherson (1), of Larbert Asylum, reported a case of myxódematous insanity which recovered from both the myxódema and the mental disorder under its use. Its use in cretinism has also met with much success. My investigations, however, are confined to its use in mental conditions not associated with myxódema or cretinism. In 1894 McClaughey (2), of the District Asylum, Maryborough, reported two cases as improved, and in 1894–5 McPhail and Brace's results (3) and observations of treatment were published in detail. The publication of their results and their belief that “in thyroid feeding we possess a valuable addition to our armamentarium in the treatment of certain cases of insanity” incited many other alienists to test its efficacy. Besides Clarke, Brush and Burges in America must be mentioned Mabon and Babcock (4), who give a review of the results obtained in 1032 collected cases of insanity from twenty-four different observers, and who show that 23·9 per cent. recovered and 29·4 per cent. were improved. They also report on a further use of thyroid on sixty-one cases at the St. Lawrence State Hospital.

Report on Thirty-one Cases of Maniacal-Depressive Insanity which came under treatment in the Down District Asylum during the year ending December 31 st, 1907

For the purpose of this report the definition of Maniacal-Depressive Insanity as laid down by Kraepelin has been adopted.