of the journal (as the Asylum Journal) in 1853 and editor until 1862.262 In an incisive commentary, Bucknill also drew attention to various other aspects of the 1858 report and the publicly expressed view of Dr Nugent, Inspector of Lunatic Asylums, that the commission’s report was excessively negative and one sided.
Overall, however, despite the objections of Nugent and others,263 and despite the apparently caring attitudes of certain asylum managers, doctors and governors, the picture painted by the commission was undeniably horrific. As the asylums had grown, grotesque institutional apathy had commonly replaced the relatively enlightened ideals of moral management. A bill aimed at remedying matters by implementing the commission’s recommendations was introduced by Lord Naas, the Chief Secretary, in 1859 but did not progress owing to the fall of the government. In 1860, Lord Naas’s successor, Edward Cardwell, made some progress on the matter by having an order in council made by the Lord Lieutenant, establishing a new Board of Correspondence and Control, made up of the two inspectors of lunatic asylums, the chairman and a commissioner of the Board of Works. Real, systematic reform of the asylums would, however, take much longer to achieve.
Life and Death in the
Nineteenth-Century Asylum
A significant step forward was taken on 16 January 1862, when new Privy Council rules were issued, designed to improve the running of district asylums in Ireland and to pacify both visiting and resident physicians.264 These General Rules and Regulations for the Management of District Lunatic Asylums in Ireland covered a broad range of areas, including the role of the Board of Governors; procedures for admission, treatment and discharge of patients; the posts of Resident Medical Superintendent (RMS) and ‘consulting and visiting physician’; and the astonishing range of other posts in the asylums, including chaplains, matrons, apothecaries, clerks, storekeepers, servants, attendants, cooks, laundresses, porters, land stewards, gardeners and gatekeepers.
Particular attention was paid to the precise roles of the RMS and visiting physician, the latter of whom had to visit the asylum three days each week, and every day if the number of patients exceeded 200. Either the RMS or visiting physician had to examine the mental state of each patient at least once every fortnight. Discharge, for the most part, required an order from the board on a certificate signed by both medical officers, but discharge of a ‘dangerous lunatic’ required a joint certificate from the medical officers that the patient was no longer dangerous. The 1862 rules, which strongly favoured the RMS (‘he shall superintend and regulate the whole establishment’),265 were warmly welcomed in the Journal of Mental Science, which noted that the previous rules (1843) were contradictory and generally unsatisfactory.266
The rules were revised again in 1874 and admission procedures laid out clearly:
Persons labouring under mental disease, for whom papers of application are filled up in the prescribed forms, to the satisfaction of the Board, and who shall be duly certified as insane by a registered physician or surgeon, who shall state on the grounds on which he forms his opinion, shall be admissible into District Asylums, after having been examined by the Resident Medical Superintendent or, in his absence, by the visiting physician or surgeon.267
[…] No patient, other than a ‘dangerous Lunatic’ shall be admitted without the sanction of the Board, except by order of the Lord Lieutenant, or of the Inspectors of Lunatics or one of them, or in case of urgency, when any three Governors or the Resident Medical Superintendent, or in his absence, the Consulting and Visiting Physician of the Asylum, may admit upon their or his own authority, stating on the face of the order the ground thereof, provided always that when a patient has been admitted under this rule, the Resident Medical Superintendent, or in his absence the Visiting Physician, shall submit that case to the special consideration of the Board at its next meeting for the decision of the Governors thereon.268
Various other regulations governed conditions and procedures within the asylums, and provide a valuable insight into the recommended patterns of asylum life:
•‘The patients shall, on admission, be carefully bathed and cleansed, unless the Resident Medical Superintendent shall otherwise direct. They shall be treated with all the gentleness compatible with their condition; and restraint, when necessary, shall be as moderate, both in extent and duration, as is consistent with the safety and advantage of the patient’.269
•‘Patients, except when special reasons to the contrary may exist, are to be clad in the dress of the institution, and their own clothes are carefully to be laid by, to be returned to them on their discharge’.270
•‘Strict regularity shall be observed with respect to the hours for rising in the morning and retiring for the night; that for rising being fixed at six o’clock from the 1st of April to the 30th of September, called the Summer six months, and for retiring at an hour not earlier than half-past eight o’clock nor later than nine for the same period. During the Winter six months the patients shall rise at seven, and retire not earlier than seven nor later than eight o’clock’.271
•‘The like regularity must be observed with respect to meals; in no case shall the ordinary number of meals be less than three, and they shall be supplied during the Summer six months at the following hours, viz: breakfast at eight o’clock; dinner at one o’clock; and supper at six o’clock; – and during the Winter six months at the following hours, viz: breakfast at nine o’clock; dinner at two o’clock; and supper at six o’clock; but patients actively employed in or out of doors may have an additional allowance of food between the usual meals by direction of the Resident Medical Superintendent’.272
•‘On the admission of a patient the Resident Medical Superintendent, or if he shall be absent on leave, the Consulting and Visiting Physician, shall make himself acquainted as far as possible with the history of the case, and note the same down in the General Registry; he shall also examine into the bodily condition of the patient, who is to be placed in an appropriate division, and carefully attended to both medical and personally’.273
•‘Patients may be visited from time to time by their friends, with the permission of the Resident Medical Superintendent, and as a general rule between the hours of noon and 4 o’clock, P.M.’.274
These revised rules were certainly much needed as there was, during the 1860s and 1870s, a compelling and recognised need for better regulation of the asylums. John A. Blake (1826–1887), MP for Waterford and a governor of Waterford Asylum, was especially outspoken about asylum conditions, which, he claimed, had not improved despite the stark findings of the 1858 commission. In the early 1860s, Blake drew particular attention to the low quality of asylum staff, arguing that both staff selection and working conditions were deeply unsatisfactory.275 He also highlighted the lack of recreation or employment for patients, which impacted greatly on their wellbeing. Other problems included violence towards staff and between patients, sometimes resulting in death by, for example, choking (in Ballinasloe, 1873).276 A chamber pot was a common weapon: one female patient killed another with a chamber pot in the Richmond in July 1889,277 while five years later, in the Cork asylum, a male patient died owing to a combination of ‘shock’ and being hit on the head by another patient with a delf chamber utensil.278
There were many other problems in the asylums too, not least of which were various illnesses and the relatively high risk of death as an inpatient.279 In the Richmond, for example, numerous patients were affected by a mysterious illness in the summer of 1894, and several died of the disorder which appeared to involve inflammation of the nerves. The RMS, Conolly Norman, consulted various experts, including Dr Walter G. Smith (president of the Royal College of Physicians of Ireland) and Sir Thornley Stoker280 (president of the Royal College of Surgeons in Ireland and brother of Bram, author of Dracula),281 among others. Though the condition was initially deeply puzzling for the physicians it ultimately proved likely that the asylum diet (low in fruit and vegetables and high in white bread) had led to beri beri,282 stemming primarily from a nutritional deficit in vitamin
