by Mark Stevens
A fear or dread of something being about to befall you, no matter how unlikely, such as your bed catching fire or being infected by some fanciful disease.
Holding some unusual desires or notions, such as the need to act as a messenger or a belief that you can predict high tides.
Unusual facial expressions, such as constant grimacing, twitching or other violent movements or the acting out of imaginary fancies.
If a parent, especially a mother, ceasing to show interest in the care of your children. In extreme cases, you may have threatened or attempted to harm your child.
Although hearsay is no longer considered sufficient evidence of insanity, physicians would be remiss if they did not also ask your family or friends for their own observations to build a picture of your state of mind. A basic family history is taken to ascertain whether insanity has been found elsewhere within your family. The doctors also enquire whether you are epileptic, dangerous or of intemperate habits.
The answers to these questions help to inform your prognosis, and without prejudice, the medical officer will reach a conclusion on your situation. If he believes that he has observed evidence of insanity, then within the week you will be examined by another doctor from a different practice. If both physicians agree that you have become insane, the relieving officer must assess your eligibility for asylum treatment. He has already ascertained your legal place of settlement – that is, the place on which the financial burden of your relief will fall – to make sure that your relief is his responsibility, rather than that of another union. Should the latter be the case, efforts are made to speedily effect your removal to that place. The relieving officer works quickly, as there is a penalty placed upon him should he dally and, in theory, the law allows him only three days to arrange for all his enquiries.
Relieving officers are well-known to prefer cheaper workhouse care to prevail for local people suffering from afflictions of the mind, if they can reasonably allow it. Theirs is not a medical profession, but rather that of regulator of the poor. Somewhat bleaker, and with no grounds around it, patients within the workhouse infirmary find care provided only by recruits from amongst the able poor. Rarely are paid nurses employed within a workhouse, and there is often only one doctor to cater for the whole establishment. Patients are surrounded by physical maladies, the aged, the infirm and the disabled. The dormitories are damp and overcrowded. The diet is spare and the day intended solely for monotonous, unrewarding labour such as cleaning, breaking stones or picking oakum.
The workhouse is no bastion of health; it is not a place of cure, but a wretched stable for those who lack a roof. Nevertheless, it is a regrettable fact that even today, many of the indigent and destitute within the workhouse population are also sufferers of insanity. We must constantly urge the relieving officers that if treatment of a lunatic is required, then it must be given in its proper setting: an asylum.
It is not for the relieving officers or the medical men to sanction your admission here; rather, they must defer to the magistrates. The 1845 Lunacy Act requires that a justice of the peace receives the physicians’ certificates and makes an order to admit you to an asylum. This safeguard ensures that only by due process of law are you authorised to be removed from society. It is not necessary for the magistrate to question you or those applying for your admission. Instead, he simply checks that the paperwork was correctly completed before signing the order laid before him, and then the relieving officer is instructed to arrange for your admission here.
At no stage of this process does a patient have any contact with the medical officers in this asylum. That is quite proper, as we wish to place ourselves entirely outside the process of admission. It is our job to manage your condition rather than to seek your custody; to treat, but not to seek out patients who require treatment. We place our confidence in our poor law colleagues to make the right decisions on our behalf.
Arriving at the Asylum
The relieving officer arranges your transport and accompanies you on the journey. Female patients are additionally accompanied by one of the workhouse’s female volunteers. Your care is their responsibility until you are handed over to us. Together with your attendants, patients may journey by horse-drawn carriage, by rail, or a combination of the two. Our own horse-drawn carriage seats four and is open or closed depending on the season, but always affords a good view of the local countryside. Travelling by carriage is generally considered to be a healthy experience, providing opportunity for fresh air, and regular stops for sustenance or rest en route.
Most union towns also have railway stations, offering the opportunity of travelling to the asylum more swiftly by locomotive. The railway is an assault upon the senses, and the fumes of the engine and the noise of the pistons can be quite traumatic when newly experienced. The station itself is unlikely to be grand, but even so paupers must wait while the first and second class ticket passengers board, before they are allowed out onto the platform and into the third class coach.
The workhouse staff will place you on a wooden bench, wedged securely between them. As the coach shudders and jolts, you may feel as though you are being pulled at an unnatural speed. Hopefully, the oblivious expressions of those around you provide some comfort, and the enclosed wagon spares you from catching sight of the scenery rushing past and noticing the sensation of hurry.
By whatever means you travel here, a luggage allowance is made available. Of necessity it is limited, though perhaps your sole personal possessions are either worn on your frame or can be contained within a small parcel. You will also notice that at least one member of staff from the workhouse brought their own bag; they are obliged to oversee your admission and, as a result, will need to spend the night here.
As you approach the asylum, you may strain to look out of the carriage window. Your first sight is of the gatehouse, a small, domestic building, much like any other brick and tile house, with a sloping roof and sash windows. Its only notable feature is a first-floor room looking onto the road by which you arrived, as well as the driveway leading to the asylum itself. This is where the gatekeeper lives and performs his duty to watch those who come and go. All carriages stop here before entering, and the union officer speaks to the gatekeeper for permission to move through.
When the driver turns the carriage through the gates the asylum buildings open up before you. As the horse trots, crunching on the gravel drive while the wheels turn rhythmically behind him, the eye is drawn to the three-storey structure stretching out in front. In many ways, an asylum is designed to look a little like a country house; of course, it is large and imposing, but it should also be welcoming and uplifting, with a sense of grandeur. The architecture is more decorative than that of the workhouse, the windows larger and more airy. Though you may not notice it initially, the materials too are of a high quality. External doors are oak, and stone augments the brickwork; the multiple chimney breasts suggest a constant source of heat within.
By now, your carriage has stopped beside the entrance and the door of the trap is unlocked for you. Alongside your companions, you are escorted down its steps and across the gravel to the entrance door. As you take your first step inside the wood-panelled hallway you may notice some of the asylum staff moving back and forth, engaged in their labours. No one will remark upon your appearance, and all will remain calm as you are invited to take a seat in the waiting room.
The Formalities of Admission
You may be feeling disorientated by the time you arrive and, realising this, we attempt to make the admissions process as simple as possible. Your arrival should be expected – though, occasionally, relieving officers have been known to spring surprise admissions upon us, an action for which they will be censured – and your reception is noted. The union officials are greeted by one of the asylum staff and the paperwork that accompanied you is taken off to our clerk’s office, where it forms the first part of your patient record.
Here is a typical admissions form:
Name
of patient:
Sex and Age:
Married, widowed or single:
Condition of life, and previous occupation (if any):
Religious persuasion:
Previous place of abode:
Whether first attack:
Age (if known) of first attack:
Duration of existing attack:
Supposed cause:
Whether subject to epilepsy:
Whether suicidal:
Whether dangerous to others:
Parish or Union to which the lunatic is chargeable:
Your companions will either leave the asylum now or be taken off to our guest accommodation, while you are invited into the ‘receiving room’, which is situated close to the offices of our medical men. On the walls you can see cabinets containing bottles and boxes, as well as shelves of books, some comprising hand-written records, and a table and a chair. The assistant medical officer will be present and also, if you are a female patient, either the housekeeper or another member of the female staff.
In the receiving room you are asked to stand on a special machine that combines scales with a slide rule to record your weight and measure your height. Next to the receiving room is a bathroom, and here you are invited to disrobe and bathe. We also make a note of any distinguishing marks or features you possess and look for evidence of lice, or known contagious diseases such as scarlet fever, measles, diphtheria, erysipelas, typhoid fever or chickenpox.
If you are suffering from any of these afflictions, then you present a danger of infection to the other patients, and your first days here will be spent quarantined in the infirmary ward. In this case it will not be possible to retain your clothes for future use; instead, they will be burnt in the boiler house. Similarly, it may be necessary to take shears to your hair to assist with the treatment of any infestation, though in most cases effective remedies can be administered without such extreme action.
After your bath you will be given a set of asylum clothing to wear. Your old clothes, if they are clean, and possessions will be taken away to the asylum stores, where they will await your departure at a future date. If it is safe for you to retain any of your possessions, then they will be made available to you in due course. Meanwhile, you will be taken off to the admissions ward.
This is the point at which you leave your previous life behind and take the first step towards convalescence and recovery. You have become an asylum patient and you are now in our care.
Chapter 3
Accommodation
One of the first things you notice on entering the asylum is the scale of our enterprise. Far larger than a union workhouse, dispensary or charitable hospital, this institution more closely resembles a great estate, with a country house and satellite outbuildings. In truth, this is an almost inevitable consequence of the Commissioners’ rules governing the arrangement and construction of our buildings. Wise men have detailed exactly what constituent elements make an asylum work, and these instructions were passed on to our own architects and surveyors as they laid out our property. Some explanation of their thinking may assist you to comprehend the substance of your new home.
Our site
It is a recognised principle that asylums should be built only on land possessing natural qualities which afford the greatest opportunities for recovery and convalescence. The first Asylums Act of 1808 stipulated this, and modern guidance has been offered as to what might constitute a suitable site.
Of course, no asylum should be built close to anything that might be considered a nuisance, and nuisances can manifest themselves in many ways. The great inventions of the industrial world have brought with them as byproducts the fiercest noises and the foulest smells. Therefore, industrial devices are not welcome beside our own endeavours – no factories, mines or steam machinery will be found adjacent to our borders; no offensive discharges are welcome in our air or water. Neither will you find an asylum built on low ground and overlooked, or local persons allowed a right of way across our roads or paths. Tranquillity is a great prescription for the unquiet mind and its dose should not be compromised.
Often, you will find an asylum built on chalk or rocky ground, and placed upon an eminence. The reasons for this are partly practical. While the command of an inspiring view, preferably to the south, is of benefit to the spirit, it also affords the necessary drop to take advantage of gravity’s assistance with the inevitable waste flow from our sewage pipes. Water ingress and egress are important factors.
To date, we have dug a total of three wells on our site to ensure an adequate supply of clean water for washing or drinking. The first well was sunk to the depth of some 40 feet, which yields a maximum of nearly 2,000 gallons an hour. This well is replenished every autumn, while the two additional wells are used only in the driest summers. The water is pumped from these wells into two great cisterns, one within our north tower, the other in the south. Smaller hot water cisterns in each tower are heated by the boilers. In the event of extreme weather, we also have access to an underground rainwater tank, filled from the gutters and downpipes on the building roofs.
We have no lofty grounds as such, but our buildings are situated on the elevated portion of our site, set some 400 feet back from the public highway that passes by our entrance gates, and from which we are divided by a wire fence. What we lack in altitude we make up for with a private estate of 80 acres, sloping down towards the water meadows a short distance from one of England’s greatest rivers. Generally, water features are to be avoided in asylums on the grounds of safety; here, however, we are obliged to work with nature, and the flow of the river offers up a wondrous sight, whilst remaining at a safe distance from our gardens.
The view across the south side of the estate rises up across the river to rolling folds of the greenest hills, which are cloaked in natural forest. You can watch the sun rise behind these undulations in the morning until it passes before them in the afternoon, casting long shadows of grey and pink across the straightest spears of the stateliest trees. A handsome iron viaduct crosses the river to the south-east, and distant billows of smoke rise rhythmically from passing engines.
We are also on prime agricultural land, which is of great importance for producing asylum food. The whole of the acreage extends roughly half a mile from north to south and one quarter mile from east to west. As very little of this space is built upon, oats, wheat and barley are cultivated above ground for use in bulking out the asylum diet, while potatoes are grown beneath.
Our position is additionally prudent in terms of transportation. Though removed from the nearest centres of population, we remain within a mile of a mainline railway station, and the rails skirt the edge of our estate. A stout iron fence prevents ready access to the railway embankment, however. The main road nearby also brings much traffic from the closest town, some two miles distant, and so your friends and family will find it easy to travel here.
The grounds are divided into sections with different uses. On either side of the asylum driveway are landscaped areas dedicated to grass and native trees both deciduous and evergreen. These not only shield the buildings from the road, but provide a canopy of grandeur on the north side without depriving us of light. The drive is of gravel, laid on earth, so that heavy rainfall should not prevent the path from being usable. Similar precautions have been taken on the private walkways around the grounds.
Immediately to the south-east of our main building is a formal garden, where pathways, lawns and beds provide some seasonal colour. Convalescing patients will find vantage points on the seats and benches to enjoy the fresh air. Trees have also been planted to shade the glare of the sun. Enclosed between the gardens and the accommodation blocks are four walled airing courts, two for the men and two for the women, which consist of more simple spaces, bounded by walls and planted with shrubs. Some of these courts allow the convalescent patients to shelter, while others give the more troublesome cases a safer means of enjoying the great outdoors.
You will noti
ce also the kitchen gardens, stretching on either side of the pathway that leads down from the main block towards the river. Though the river is most strictly out of bounds to patients, within the kitchen gardens patient labour is encouraged. Amongst fruit trees and bushes is a small orchard of cooking apples and the annual multitude of root and sprouting vegetables. These patches of soil lie barren in winter, but for the spring and summer months they are ablaze with colour and alive with insects.
The recommendation of the Commissioners in Lunacy states that an asylum site should provide a ratio of one acre of land for every four patients – an abundance of open space. The importance of our grounds cannot be stressed enough; they provide not just room for supplies, but, we hope, enough space for your mind to regain its former bearings.
The Asylum Buildings
Aside from the opulence of the principal block, our buildings are much like those you might see in any town or village. Let us deal first with the structures placed irregularly around the grounds. To one side of the entrance drive sits the courtyard, around which the farm buildings and the dairy are arranged. These are simple, single-storey structures, providing shelter to livestock. There is a covered stables too, for the asylum horses and those of visitors. Carriages are unharnessed in the courtyard and then stored beside the stables, while the dairy – the largest single part of the complex – provides accommodation for the cows and for their milking, with a pathway to the fields for grazing just beyond it.
A little further on is the asylum gasworks, which appear slightly out of proportion with the miniature farm, as their rounded, brick chimneys tower significantly higher than the other buildings. We create our gas by burning coal, and the coal gas is stored in large containers, the area of which is out of bounds for patients. Opposite the farm and gasworks, on the other side of the asylum drive, is the chapel, with a gravelled pathway leading towards it. The chapel’s varicoloured brick walls are set against a deeply sloping roof of grey slate tiles, and the whitewashed roof beam ends extend to meet the slates like teeth protruding from an upper lip.