1843 rules indeed placed very many responsibilities on the physician, who was ‘to attend on three days (to be named by the Board) at least in each week, and on every day at such Asylums in which the number of Patients shall exceed 250’:
•He shall also visit on particular occasions, when called on by the Manager, and shall prescribe for all Patients and Servants who may require Medical aid, and for the Resident Officers who may request Medical assistance. […]
•He shall attend daily on cases of Fever and on any other cases of an urgent nature.
•He is authorized to order such Diet as he may think necessary for any particular case, having, however, due regard for economy in each Article.129
•He should always visit every Patient under restraint, and, when he deems it safe, require such Patients to be temporarily relieved from restraint, and examine them so as to ascertain that they are not cramped or injured; and he should frequently go round the Asylum so as to see the state and condition of every Inmate.130
The asylum ‘manager’ was also accorded a broad range of roles under the 1843 rules, including oversight of the use of ‘restraint’:
He [the manager] is to take charge of the instruments of restraint, and is not under any pretence to allow the unauthorized use of them to any person within the Establishment; all cases placed under restraint, seclusion, or other deviation from the ordinary treatment, are to be carefully recorded by him in the daily report, with the particular nature of the restraint or deviation resorted to. But in no case shall the Shower Bath [Chapter 1] be used without the authority of the Physician.131
Other rules related to the asylum governors, matron, apothecary, clerk and storekeeper, servants, gardener, gatekeeper, hall porter, keepers, nurses, assistant nurses, cook and laundress.132 An addition to the rules in 1853 concerned chaplains, who were ‘to afford Religious Instruction and Consolation to all patients, except such as shall be declared by the Physician to be unfit and incapable of understanding the nature of the Service, and of appreciating the effects of Religion’.133 In addition, ‘controversial subjects shall be scrupulously avoided, both in public service and in private visitations’.
The 1843 rules also laid out regulations governing admissions, placing strong emphasis on the signing of ‘a bond for the removal of the Patient’ in due course:
Every Patient to be admitted upon a special direction by the Board, unless in cases of urgency, when the Physician may admit upon his own authority, stating on the face of his order the grounds upon which he acts. In every case a bond for the removal of the Patient, when required by the Board, to be signed by some responsible person, before the admission of the Patient, unless the Board upon any ground, or the Physician in cases of urgency, shall dispense with the same, or postpone the time for the execution of such Bond.134
And who was to be admitted?
Idiots, as well as Lunatics properly so called, are to be admissible to every Asylum, and so also are Epileptic persons, where the fits produce imbecility of mind as well as of body.135
Clearly, then, admission criteria were broad and the 1843 rules clearly set the scene for the continued growth of Ireland’s increasingly medicalised asylum system throughout the 1800s.
James Foulis Duncan:
‘The Spirit of Innovation is Abroad’
Among the medical professionals and asylum doctors of the mid to late 1800s, the figure of James Foulis Duncan (1812–1895) looms large among his peers.136 While the Richmond was being built in 1813, Dr Alexander Jackson, with the Reverend James Horner, opened a small private asylum in Finglas, County Dublin and, after the Richmond opened with Jackson as physician, Jackson sold Farnham House to James Duncan, a Scottish doctor, in 1815.137 James Duncan, a keen hunter, athlete and traveller (he visited Syria and Algiers), died in March 1868, aged 82 years. His son, James Foulis Duncan, born in 1812, spent much of his childhood at the Finglas asylum.138 Many decades later, in his presidential address to the MPA in 1875, Duncan reminisced about his unusual upbringing:
It is now exactly sixty years since I was first brought – a child of only a few years old – to the asylum then recently placed under my father’s management. My mother was dead, and owing to the circumstance that my father never kept a separate table for his family, I was thrown into closer contact with the inmates of the establishment than usually falls to the lot of children similarly circumstanced; and although there are drawbacks and dangers inseparably connected with such a life, I am here to say that it is not all gloom nor all disadvantage. It has its bright side as well as its dark. In almost all similar institutions of any size there are to be found some of the best and noblest of our race – men of gifted intellect, of high attainments, and of blameless lives. We know not why it should be so, but in the mysterious providence of God the shadow of this cloud is occasionally permitted to darken the path of some eminent for their virtues and their piety. It was my privilege to be indebted to some of these for many acts of kindness, and for much pleasant companionship. My earliest lessons in the Latin language were imparted by one during the short period of his residence at Farnham House, whom I shall ever remember with affection and esteem. Another instructed me, at a later period, in mathematics and the higher branches of science. Many others shared with me all the pleasures of my boyhood. These things have made an impression on me which I can never forget …139
Building on this unusual but effective educational foundation, Duncan was awarded an MD (Medicinae Doctor; Doctor of Medicine) by Trinity in 1837 and became first physician to the staff of the reopened Adelaide Hospital in Dublin in 1858. Throughout his career, Duncan displayed several interesting qualities: he was acutely socially aware, especially of the effects of poverty on health; he supported the use of scientific comparisons to test treatments (in language that prefigured later ideas about clinical trials in medicine);140 and he was highly religious in his views on many matters, including mental ill health, as evidenced in his 1852 publication, God in Disease, or, The Manifestations of Design in Morbid Phenomena.141 From a clinical perspective, Duncan championed both medical and moral treatments for insanity, and Farnham House remained in the Duncan family for over 50 years, providing just such treatment.
Duncan himself achieved considerable prominence in his profession and became president of the MPA in 1875.142 In his presidential address, delivered on 11 August 1875 at the Royal College of Physicians in Dublin, Duncan emphasised the changes occurring in Irish asylum medicine:
The time is not so very long gone by since everything connected with the management – I cannot say treatment – of the insane was a matter of general reproach, and everyone who devoted himself to the pursuit was avoided as much as possible. They were looked on as left-handed neighbours, very useful in their way, because their assistance could not always be dispensed with, but whose acquaintance no respectable person was expected to acknowledge. Too often they were men of inferior social position, low-minded in their taste, imperfectly educated, and with nothing in their character to command respect, even from those who employed them. Sordid in disposition, their only object was to make money out of those entrusted to their charge, and that at the least expense and trouble to themselves. In the present day all this is changed. […]
Insanity in its various forms is now universally admitted to be a disease – differing, indeed, from ordinary disease as to its nature and phenomena – but a disease notwithstanding, and therefore to be viewed in the same light and treated on the same principles as those which regulate medical practice in other branches. […]
Hence the propriety, rather, I should say, the absolute necessity of these cases being handed over to the care of members of the medical profession, who by the nature of their everyday duties are the best fitted to unravel the
