clarity and, in relation to the mentally ill, charity.
St Patrick’s Hospital, Dublin:
‘Swift’s Hospital’
Following Swift’s bequest and his death in 1745, on 8 August 1746 a royal charter was granted to St Patrick’s by King George II (1683–1760) and St Patrick’s became the first psychiatric hospital in Ireland, and one of the first in the world.65
On 29 August 1746, the board of governors held its first meeting and the first patients, four women, were admitted on 26 September 1757, at which point the hospital had just sixteen admissions rooms.66 They were joined by five male patients in early October.67 The hospital expanded significantly over the following decades and admitted growing numbers of patients, although reports from the early 1800s indicated difficulties providing treatments and concern about lengths of stay.68
Such concerns were by no means unique to St Patrick’s and, in March 1817, Robert Peel, Chief Secretary, persuaded the House of Commons to set up a select committee to look into the need to make greater provision for ‘the lunatic poor in Ireland’.69 The committee considered all such establishments, including St Patrick’s, and concluded that ‘the extent of the accommodation which may be afforded by the present establishments in the several counties of Ireland’ was ‘totally inadequate for the reception of the lunatic poor’.70
During the course of its deliberations, the committee received a letter from ‘Mr James Cleghorn’, ‘medical attendant’ at ‘Saint Patrick’s or Swift’s Hospital’, dated 17 March 1817, with interesting information about the hospital.71 Cleghorn pointed out that recent years had seen ‘very considerable improvements’ at St Patrick’s, which, by that time, housed 96 ‘paupers’ and 53 ‘boarders’.72 Cleghorn was ‘fully aware of the advantages to be derived from dividing the different description of insane persons into classes, according to the nature and stage of the disease’, but noted that ‘the original construction of Swift’s Hospital does not admit of their separation, as it consists of six very long corridors or galleries, each containing twenty-eight cells’.
Cleghorn ‘was very anxious to have some separate cells for the noisiest of the patients, built apart from the principal building’ but the government did not grant money for this development, citing the ‘great accommodation for the insane, which the Richmond Lunatic Hospital would afford, which was then in progress’.73 Cleghorn regretted the government’s decision:
… the reasonableness of enabling us to adopt the system of classification in the most material point would have ensured to us more extensive aid; medical treatment in maniacal persons, and the insane in general, except in the very early stages of the disease, has ever appeared to me to be of little service towards the cure of it … moral treatment, as it is called, is of much more moment than medical, and I am sure that in this particular, much improvement has taken place of late years; and that the late investigations will contribute much to the amelioration of the state of lunatics.74
Cleghorn was at pains to point out the infrequent use of restraint at St Patrick’s:
The system observed in Swift’s Hospital, before I was concerned in it, was of the most humane kind; and it has always been my object to avoid any other coercion or restraint but what was required for the safety of the patients and those around them. The strait waistcoat and handcuffs are seldom resorted to, and we prefer the latter to the former, as being more convenient for cleanliness, and not so heating; occasional confinement to the cell is the principal restraint which we employ.75
Cleghorn reported, with satisfaction, that he had ‘succeeded, last spring, in prevailing on the governors to take a lease of the ground on the east side of the hospital, containing two acres and a half, and affording a good view into the Phoenix Park, where the greater number of the patients are at liberty to walk about and to take exercise’. Many were also ‘employed, with their own consent, in working the ground, and have been much happier and freer from their malady in consequence of it’.
Cleghorn also addressed distressing allegations regarding transport of mentally ill persons to Dublin from elsewhere in Ireland:
I wish, while writing to you on this subject, to take notice of certain statements which I have seen in the public prints, as having been lately made in the House of Commons, relative to the conveyance of mad persons to Dublin from the country. It has been said, that they have been tied to cars, and so bruised as to render the amputation of their limbs necessary, and that death has ensued from the mortification occasioned by this cruel mode of conveyance, During fourteen years I have attended Swift’s Hospital, I have never known an instance of the kind where any ill consequences have followed.76
Cleghorn heard ‘it rumoured, that it is intended to have either provincial or county asylums for lunatics and idiots: such a design is founded in wisdom and humanity, and will be a great relief to the pressure on the establishments in the capital’. This rumour was correct and, having taken account of the evidence of Cleghorn and others, the 1817 Committee duly recommended that ‘there should be four or five district asylums capable of containing each from one hundred and twenty to one hundred and fifty lunatics’.77
Notwithstanding the later development of these public asylums during the 1800s, numbers at St Patrick’s continued to rise and, by 1857, the profile of patients had changed significantly: in 1800 there had been 106 ‘free’ patients and 52 ‘paying’ patients; by 1857 this balance had reversed, with fewer ‘free’ patients (66) and more ‘paying’ patients (83).78 The Lunatic Asylums, Ireland, Commission of 1858 was not pleased:
We cannot consider this as indicating a satisfactory application of [Swift’s] endowment. It is true that the average payment by boarders is somewhat less than their actual cost in ordinary years, and so far they may be considered as maintained in part by the charity; but if the diminution of free patients and the increase of paying patients are to continue, it may one day result that no inmates of Dean Swift’s Hospital will be maintained entirely out of his bequest, which certainly does not appear to have been in the contemplation of the founder.
It appears by the evidence that the reception of paying patients has been so profitable, that the governors have been enabled to accumulate the sum of £20,000 thereby, the interest of which is available for the support of the institution. We cannot but think that the objects of the endowment would have been more properly carried out, if the income had been entirely appropriated to the maintenance of free patients.79
As regards conditions for patients, although a library was introduced in 1851, along with various other changes and innovations, there were persistent problems with infectious diseases in the hospital.80 The 1858 Commission had several further concerns, including that there was ‘only one fixed bath for 150 patients of both sexes’ and that was ‘out of order’, so that ‘patients wash in tubs in the day-rooms’; ‘the hospital is not lighted with gas’; ‘the hospital cannot be sufficiently warm in the winter months’; and various other issues, which led the Commission to the conclusion that St Patrick’s was, ‘in many respects, one of the most defective institutions for the treatment of the insane which we have visited’.81
To remedy matters, the report recommended that ‘the master of the hospital should be a member of the medical profession’, and that greater control and inspection were needed:
On the whole, the condition of this hospital satisfied us that it is absolutely necessary it should be placed under the control of the Central Board, which may be established for the direction of lunatic asylums in Ireland, and that it should be subject to the visits of the Commissioners as frequently as the district asylums. It is, no doubt, a private endowment, but in former times received large aid (£24,194) from the state; and what, in the interest of the public, we have suggested, should be done for its better government, will be in furtherance
