who was instrumental in establishing a patients’ library in 1844, became senior physician at the asylum in 1848, following the death of Dr Alexander Jackson.44 Mollan was a remarkable figure who had previously assisted with the fever epidemic in Galway (1822) and went on to serve as president of the King and Queen’s College of Physicians in Ireland (1855–6).45 He took an active part in the formation of the Royal Medical Benevolent Fund and was noted for his charitable works. In 1852, Mollan was also involved in efforts to establish a school at the Richmond, an initiative which was taken up with enthusiasm by Dr Joseph Lalor, RMS from 1857 to 1886,46 who wrote:
I consider that education and training are most valuable agents in the treatment … and that it expresses in name and substance what has been long known in reference to lunatics in general as to their moral treatment … starting with the proposition that education and training form the basis of the moral treatment of all classes of the insane.47
Under Lalor, the school at the Richmond taught a broad range of subjects including reading, writing, arithmetic, algebra, geometry, geography, drawing, needlework and various arts and crafts:48
In reference to the education or training of the insane, no matter of what class or age, I wish to state that I try to have the patients engaged in the same pursuit for not more than from one to one hour and a half consecutively. Monotony, whether of work, education, or recreation, appears to me to be injurious to the insane of all classes and ages. I consider the alternation of literary, aesthetical, moral and physical education, with industrial employment and recreation (so as to produce variety of occupation), to be of great advantage in the treatment of the insane, whether the particular form of the insanity be mania, melancholia, monomania, dementia, idiotcy, or imbecility.49
Professional teachers were employed and the National Board of Education recognised the classes in 1862. Lalor was extremely proud of the school:
Summarizing what I consider some very important items of our system here, I note that out of 479 male patients in the house on the 17th May [1878], 400 were employed either at school or industrially, or both combined, and only 79 were wholly unemployed; 45 of the unemployed were so in consequence of being under medical treatment, leaving only 34 men unemployed purely owing to their state of mind. Of 553 female patients in the house on the same day, 448 were employed either at school or industrially, or both combined, and 105 were wholly unemployed; 89 of the unemployed were so in consequence of being under medical treatment, leaving only 50 unemployed purely from the state of their mind.50
Lalor was a major figure in the Irish asylums,51 as evidenced by his influence on other doctors such as Dr Joseph Petit, who was appointed as Lalor’s assistant in 1874 and went on to serve as RMS in Letterkenny and Sligo.52 Throughout this period, however, Lalor had an extraordinarily complex relationship with the governors at Grangegorman (who had excluded him from meetings since 1871) and a deeply conflictual one with the Inspector, Dr John Nugent, who was continually involved in asylum management; all of which led to an enquiry in 1883, clearly vindicating Lalor.53
In 1861, Lalor became the eighth president, and first Irish president, of the Medico-Psychological Association (MPA), which held its annual meeting in Dublin, providing a significant opportunity for Lalor to promote the importance of resident medical superintendents (rather than ‘visiting physicians’) in the Irish asylums.54 This was one of many themes that exercised the energetic Lalor; another was – inevitably – the self-reportedly progressive approach to management that he recounted from the Richmond:
The total disuse of restraint, and the very infrequent use of seclusion – the freedom allowed to all our patients to exercise and have various sorts of games on the open grounds, in place of enclosed yards – are very gratifying features. The number and cost of our staff, estimated per head on the daily average number of patients, is less in this than in the other district lunatic asylums of Ireland, and this fact, taken in connection with our large teaching and training power, shows that education and industrial employment carried out, as they are here, systematically, by skilled hands, do not necessarily increase expense. […] The amount of quietude and good order, of literary and industrial occupation, and of contentment, cheerfulness, and amusement here is very satisfactory.55
Dr Daniel Hack Tuke (1827–1895) wrote approvingly of the Richmond schools in the influential Journal of Mental Science:
To myself, the schools which are in active operation there under Dr Lalor were of deep interest, and I venture to think that some useful hints may be gathered from what we witnessed on the occasion. Indeed so valuable did the system pursued appear to me to be, that I stayed another day in Dublin in order to see more of the working of the schools […]. The pupils are divided into three classes on both sides of the house, there being three male and three female trained teachers […]. The patients stood in circles marked out by a chalk line, presenting a very orderly appearance, while the teacher asked them questions on geography, &c., or gave them an object lesson. While of course there was a great difference in the expression of those who were being taught, and in their responsiveness to the questions put to them, there was a general air not only of propriety but of interestedness which was very striking. Some, in fact, were extremely bright and lively …56
Following Lalor’s death, his obituary in the Journal of Mental Science described him as ‘excellent and kind-hearted’ and highlighted his achievements with the school at the Richmond:
It is stated on good authority that [prior to Lalor’s appointment to the Richmond] refractory patients were confined in cells for most of the day as well as the night, receiving their food in such a way as best suited the convenience of the attendants. Open-air exercise was rarely permitted, and then only in the dark confined yards or sheds surrounded by stone walls. All this was changed by Dr Lalor; better grounds were prepared, games were introduced, and the general comfort of the patients was attended to. Dr Lalor, as is well known, enthusiastically carried out the school system […].
It should be stated that for two years before he became Superintendent a school had been in operation on the female side under an excellent school mistress. It was Dr Lalor who introduced the same system for the male patients, and he obtained additional teachers, trained under the National Board, for the female school. Singing and music were much cultivated, while object and picture lessons were given, as well as others in natural history and geography. At the Exhibition held some years ago in Dublin, drawings, paintings, and industrial work, all executed by the patients, attracted considerable attention. Along with the schools, concerts were given every fortnight, or even weekly …57
Similar sentiments were expressed in the Irish Times, which paid generous and deserved tribute to Lalor’s foresight and perseverance.58 Throughout this period, the educational approach advanced by Lalor was not, however, the only therapeutic paradigm in evidence at the Richmond or elsewhere. As Cox notes, the use of moral management did not exclude the employment of various additional medicinal treatments such as purgatives, bloodletting and emetics, which continued until the late 1870s.59
Notwithstanding this persistence of older medicinal paradigms in the asylums, Lalor was by no means alone in trying to improve matters for the mentally ill in a fashion that was as enlightened as the institutional framework of the times permitted, even if Lalor and others clearly failed to challenge that framework sufficiently at the time. Such initiatives were heavily influenced by developments in England and elsewhere, and were duly reflected in the literature of the time, including Sir Alexander Halliday’s General View of the Present State of Lunatic Asylums in Great Britain and Ireland and in Some Other Kingdoms, which stated confidently that a new era of enlightenment and rational treatment had now finally arrived.60 It hadn’t, but there were increasing signs of progress in that direction as evidenced by, for example, the careful, thoughtful writings of John Cheyne.
Cheyne (1777–1836), another leading British physician, worked in Dublin and is best remembered for his description of a breathing pattern seen in conditions such as chronic heart failure,
