While Norman’s campaign in favour of alternatives to large institutions met with distinctly mixed success at the time, it still paved the way for many future reforms, as did his efforts to provide specialist treatment for the intellectually disabled and persons with alcohol problems. Fittingly, Norman’s own house at Grangegorman was later named ‘St Dymphna’s’ and devoted to the treatment of alcohol problems. Later again, it was renamed ‘Conolly Norman House’ and housed a mental health service; it is now a mental health service management centre.
In terms of his overall contribution, it is clear that Norman continued and deepened the progressive tradition of certain of his predecessors, such as Hallaran in Cork who, a century earlier, had similarly combined intellectual enquiry with energetic innovation and pragmatic efforts to improve care of the mentally ill.261 Norman is, however, remembered not just for his reforms of asylum care and his writings, but also his contributions to the development of psychiatry as a profession. These contributions include, not least, Norman’s strong promotion of the career of Dr Eleonora Fleury and the historic change that her professional progression brought to the emerging discipline of psychiatry in Ireland and Great Britain.
Dr Eleonora Fleury:
Republican Doctor
As the 1800s drew to a close, there were, finally, emerging signs of significant change in the Irish asylums. The increase in inpatient numbers might have shown no signs of abating, but this apparently unstoppable trend was now accompanied by subtle but definite signs of reform. These changes were, in the first instance, most visible within the profession of psychiatry itself, and their complexity is well demonstrated by the life and career of Dr Eleonora Fleury (1867–1960),262 the first female psychiatrist in Ireland or Great Britain.
Eleonora (Norah) Lilian Fleury was born in Manchester in 1867.263 Fleury studied medicine at the London School of Medicine for Women and the Royal Free Hospital. She received first class honours and in 1890 became the first female medical graduate of the Royal University of Ireland.264 In 1893, Fleury was awarded an MD from the Royal University of Ireland and won a gold medal.265 She then went on to work at Homerton Fever Hospital in London, the Richmond Asylum in Grangegorman and its sister asylum in Portrane (later St Ita’s Hospital).266
The Richmond Asylum had opened in 1814 in response to growing evidence of unmet medical and social need amongst the mentally ill.267 As the 1800s progressed, however, the Richmond, like the other asylums, expanded at an alarming rate.268 As a result, official attention shifted from the humane treatment of individual patients to the management of the increasingly complex institutions, which were beset by problems relating to overcrowding, staff shortages, poor funding, and lack of activity for patients.269 Nationally, this led to significant disillusionment with the asylum project itself.270 By the early 1890s, when Fleury arrived to work there, the Richmond Asylum had almost 1,500 patients resident in accommodation designed for 1,100.271
Notwithstanding these problems, as the 1800s drew to a close psychiatry had clearly emerged as a profession within Irish medicine. In Great Britain, this process took a significant step forward in 1841 with the foundation of the Association of Medical Officers of Asylums and Hospitals for the Insane, later known as the Medico-Psychological Association (MPA).272 The purpose of the organisation was to facilitate communication between doctors working in asylums and thus improve patient care. An Irish division was formed in 1872, although Irish members had participated in the organisation long before that,273 and the organisation consistently urged Dublin Castle to appoint medical doctors as managers of asylums.274 The MPA (as it was known from 1865 onward) was central to the emergence of psychiatry as a profession in Ireland and was indelibly linked with the asylums. From its foundation, however, the organisation admitted only men until, in 1893, Fleury’s name was put forward for membership by the ever forward-looking Norman.275
A discussion ensued at the MPA and, in 1894, its rules were duly altered:276 Fleury became the first woman member and, thus, the first female psychiatrist in Ireland or Great Britain. The following year, Fleury’s paper on ‘Agitated Melancholia in Women’ was read at the meeting of the MPA’s Irish Division, held at the College of Physicians, Kildare Street, Dublin. Fleury herself was unavoidably absent but her paper outlined specific cases of ‘agitated melancholia’ in younger and older women. These case histories are remarkable not only for their astute clinical descriptions, but also the extent to which Fleury linked psychiatric problems with social and life events such as examinations, marital difficulties, separations and bereavements.277
Also in 1895, the British Medical Journal announced that Fleury had been appointed to the post of assistant medical officer at the Richmond.278 Fleury’s work at the Richmond involved not only treating patients but also teaching nurses and attendants studying for the newly established certificate of proficiency in mental nursing.279 Interestingly, the Medical Directory for 1905 records both Fleury and Dr Ada English (1875–1944; see Chapter 4) at the Richmond that year, with English there as a clinical assistant, shortly after graduating.280 The lives and careers of Fleury and English were to bear significant similarities to each other in the decades to follow.281
Following the death of Norman in 1908, Fleury was made medical officer in charge of the female house at the Richmond.282 In 1912, when there was a vacancy for a new head of the asylum in Portrane, Fleury was passed over, as the committee felt it would be inadvisable to place a woman in such a position. Fleury later became deputy medical superintendent in Portrane.283
Like English, Fleury’s medical concerns extended to population health and wellbeing, and, like Dr Kathleen Lynn (1874–1955), a contemporary doctor and political activist, Fleury was very concerned about the spread of venereal disease in the early 1900s.284 Also, like English, Fleury was deeply involved in the nationalist movement, often using the Richmond and Portrane asylums to conceal and assist wounded republican fugitives.285 As was the case with English, Fleury’s activism landed her in trouble with the authorities and she was arrested and imprisoned in 1923.286 (This period in Fleury’s life is discussed in greater detail in Chapter 4.) During her imprisonment, Fleury was especially concerned with the medical welfare of republican women prisoners – a concern which persisted following her release – as she highlighted the prisoners’ plight and appealed for better conditions.
Following her release from prison, Fleury returned to work at the asylum in Portrane and continued her medical career. After her retirement, she lived at Upper Rathmines Road in Dublin and, like Lynn, remained exceptionally physically active all her life. Fleury died in 1960 and is, like Norman, buried in Mount Jerome Cemetery in Harold’s Cross, Dublin.287
Over the course of her life, Fleury, like English, combined academic ability with progressive medical practice and persistent republican activism. In these regards, Fleury had much in common not only with English but also with Lynn,288 Dr Dorothy Stopford Price (1890–1954), a republican doctor remembered for her work on tuberculosis,289 and Dr Brigid Lyons Thornton (1898–1987), a politically active public health doctor.290 All combined progressive medical practice with acute social conscience and political activism. They made remarkable contributions at a time when Ireland was undergoing a period of exceptionally rapid political change and when there appeared to be genuine opportunities to effect political, social and medical reform, for the betterment of all.
Emily Winifred Dickson (1866–1944) was another comparable figure who worked in asylums and shared Fleury’s concern with public health, although Dickson worked in the English asylum system and for shorter periods than Fleury. Dickson had graduated with first class honours from the Royal College of Surgeons in Ireland in 1893 and later worked at Rainhill Mental Hospital in northern England.291 Like English, Dickson lectured extensively, was involved in the Irish Women’s National Health Association,292 and was deeply concerned with public health, especially among the socially excluded (e.g. women and children in workhouses).293
While
