by Mark Stevens
Ward Life
Each floor of a block constitutes at least one ward, and each ward is made up of one or more dormitories with additional single rooms. Within the north block, one ward is reserved for cases suffering from acute signs of active insanity, where staff watchfulness is of great necessity. Some of these refractory cases may benefit from a single room where there is less opportunity for destruction. Similarly, wards are set aside for male and female epileptics, who must be supervised carefully for signs of fits at night. Incurables or chronic cases make up the rest of the north block, including those who are elderly and unable to fend for themselves.
On the south side, the convalescents or the tranquil and not actively insane can be found recovering. The convalescent wards are the most lavishly decorated. Ample mirrors are available, especially on the female side, so that the women may be given opportunities to tidy themselves and arrange their hair or clothes – an activity which is acknowledged to be good for their health. Cocoa matting is provided to soften the floor boards, while the refinement of the female convalescent day-room is much admired. Colourful ornamental borders bedeck the walls, and the space also doubles as the sewing room, where able seamstresses can work in comfort.
Here the public asylum differs markedly from the private one. In a private asylum, often the only classification is by wealth: so it is the richer patients who have the larger bedrooms and the more sophisticated furnishings, regardless of their symptoms. Similarly, in the private house, patients with all types of diagnoses may mingle in the day-rooms: the manic may disturb the convalescent; the epileptic frighten the melancholic. This is why the private house is less well-equipped for recovery than a public asylum. Allocation by need is not an option to the man running his house for profit.
It is the south block that you will be sent to first, to the ward set aside for new admissions. Unless there are pressing reasons for a move, you will spend your first few weeks here for observation. To a certain extent this ward is unlike the others, in that there is regular movement of patients in and out of it. It is, of necessity, a temporary home, but despite this the facilities of the admissions ward are much like all the others.
In each ward scrupulous arrangements have been made for hygiene and sanitation conveniences, which are always situated at a distance from the sleeping areas and usually separated by a lobby. There is one white porcelain bath and sink on each of the upper south floors, and two porcelain baths on each of the upper north floors. The result is that there is roughly one bath for every twenty-five patients, while there are two water closets on each floor, or roughly one for every twelve patients. The closets are tiled and have a northerly aspect. Within the male side, there are two additional white earthenware urinals placed in the corners of the passageways opposite the closets.
The closets house lavatories constructed on George Jennings’ patent flushing mechanism with a high level cistern. These devices are very modern, and you may not have used them before. There has been much debate recently about whether the new water closets are more sanitary than the traditional earth closet. Although our architect ensured a very thorough ventilation in each closet and connecting passageway, with the earth closet there is a greater need still for ventilation; even then, the consequent smell can be most noxious. There is also the additional complication that the earth closet requires emptying at least once a day, which necessitates the carrying of each closet’s contents through the building, and is most undesirable.
However, the reliability of the pipes required for water closets has not yet been fully proven. Although our soil pipes are constructed out of earthenware, and sealed with cement, there is still a risk to our wells and water supply by the transportation of foul water to the asylum’s filter beds. Nevertheless, public discourse has increasingly favoured the water closet as the most appropriate convenience for residential accommodation, and we have decided to persist with them. We trust you will not find them unsettling. Please be reassured that any possibility of unpleasant overflows or water discharges into the wards has been adequately prevented, and that our architect has taken all precautions possible against sewage gas and its attendant airborne, infectious maladies.
Maladies, and their treatment, will mark the point at which we end our tour. At the far end of each south block you will find the male and female infirmaries. This is the quietest part of the asylum, where patients who are physically unwell might rest and recuperate. There is space here for up to forty patients, mostly in single rooms which, uniquely, have both coal gas lighting and open fires. This is because of the incapacity of those within, and the resulting lower safety risk, as well as the increased level of supervision. Some of the single rooms are also interconnected, allowing an attendant to sleep in one bed next door to a patient requiring particular attention, and the attendants’ rooms include a locked medicine chest, which acts as an emergency dispensary.
Every effort has been made towards patient comfort: in addition to the open fires, there are hot water radiators with ornamental gratings; the toilet and bath are placed together in one large, accessible space; cocoa matting is provided to the day-room in each infirmary ward.
In line with advice from the Commissioners in Lunacy, we have also recently begun to segregate infectious patients and those suffering from other ailments. At present, these patients are placed within special corridors where we take all precautions to prevent the air spreading to the rest of the asylum. In the longer term, we have recently gained approval to construct a separate, single-storey building to which these infectious cases will be moved and from which the prevailing wind will shift the air away from our main accommodation.
So ends your view of our facilities. By now, the impression that you should have received is one of cleanliness, healthiness and industry. There is a regular programme of whitewashing of the walls and ceilings in the wards and the day-rooms, such that every year parts of the asylum are always freshly painted, and the exterior wood and metalwork are constantly maintained.
Our asylum is a cheerful proposition. This befits the general view held by most right-thinking people that the patients deserve the best that can be afforded to people in their position. During a recent visit by the local bishop, he remarked that he was ‘struck by the air of brightness and cheerfulness’ in the wards and ‘with the perfect order prevailing throughout the house.’
Clothing and Personal Possessions
Before we leave you on the admissions ward, our remaining task is to deal with your personal possessions. It is not always possible for you to take personal items into the asylum, partly because of your own illness and partly due to the communal nature of the institution; an object which may be harmless in one pair of hands can become dangerous in others. To a certain extent, what you are able to keep depends on which ward you are placed after your movement from the admissions ward; but even then, the assessment will be made with your fellow occupants in mind as much as your own needs.
Patients often like to bring personal photographs or letters on to the wards and we will generally try to guarantee an element of individuality. Other keepsakes, either ornamental such as jewellery, or practical such as braces or cufflinks are not often permitted. Every item that you cannot take will be securely stored in the institution, though with your permission your possessions may also be returned to your family. Items taken onto the wards can be kept in the clothing locker.
You may have noticed on your tour that very few patients wear their own clothes. Generally speaking, the asylum wardrobe is to be preferred as this makes all patients equal and the washing easier for the laundry staff, but we have no objection to special items being provided by your family; indeed, for many patients a favourite hat or shawl may be some comfort as a reminder of their domestic life. You will also see some patients who are always dressed in their own clothes, as some private patients (or, more usually, their families) prefer to maintain this privilege. The same privilege may also be afforded those who are shortly to be dis
charged on trial, assuming they have funds to purchase a suitable set of clothing. But the vast majority of patients possess a hard-wearing, modest yet practical asylum uniform, and you too will be expected to wear it.
Before we opened, fabric samples were requested from a number of other asylums with the aim of procuring cloth that, while meeting our strict financial considerations, was also designed to benefit the comfort, appearance and health of the patients. The clothes are of heavy, durable material so that they may last for a worthwhile period of time, and are also designed for year-round use so that they will not be too warm in summer, yet provide the requisite insulation in winter. You will be issued with underwear, outer garments and night clothes sufficient to provide for the weekly changeovers of clothes.
Underwear is of linen. Drawers, which are knee-length, are changed once a week, as are nightshirts, while socks and stockings are changed twice a week. Similarly, the linen shirts and blouses – a pale grey calico – are changed twice a week. For patients who are minded to sleep without clothes, additional blankets can be provided. Pullovers of Guernsey wool are available too, if required.
For men, the usual outerwear is a three-piece suit of brown tweed, with a similar suit of bright pilot blue for Sundays and holidays. The tweed for the jackets and waistcoats can be fashioned in a small range of differing patterns. Trousers are generally plain and are available with fly or, for those patients desirous of behaving in an indecent manner, a version is produced with a flap; this can be securely fastened to the waistcoat and released by staff when necessary. A tweed cap is available should extra protection be required from sun or rain, and overcoats will be provided if the weather is excessively grave or the patient elderly and infirm.
Women patients are given two dresses of linsey – a rather coarse cloth of wool and linen intertwined, but one that is hard-wearing, economical and warm. There are winter colours in dark shades of brown, blue or green; while in summer a similar dress is provided with a coloured print. Dresses for the most chronic patients will be hemmed up, so that they do not fall below the ankle: a chronic patient is unlikely to lift their hem above the ground, which can be a source of much damage to the cloth in poor weather.
Where possible, decoration is provided, as plain dresses are not becoming to most women. Efforts are made to encourage some patients to take up crochet and to introduce lace effects to their clothing at the wrists and neck. Petticoats are offered as an additional layer between the female under and outer-garments. Women also have the option of a cream tartan shawl, which gives a group of female patients out walking a most picturesque appearance. In the summer, straw hats with a variety of coloured ribbons are available to provide protection from the solar glare, with those worn by the more agitated patients secured with a strap and buckle. Mature patients can be provided with a cloth cap.
Generally, outer garments are intended to last for about two years. Destructive patients are liable to be given garments which have been resewn or patched together from items handed down from other patients, and those who have a tendency to drool may also find their clothes protected by an apron or a pinafore. Please be aware that outerwear is usually fashioned on more generous sizes so that, as much as possible, one size will fit any new admission. We aim to give a broad outline of shape, but do not be too disheartened if you find the fit unfashionable or unsuited to your figure. There is usually a wider range of underwear available, so that stocking, socks or drawers should fit comfortably, whatever the necessary compromises of the other garments.
For the workers, or those permitted to go on long walks outside, leather boots are provided; while cloth shoes suffice – with leather galoshes for wet weather – for those who remain indoors or whose external world extends only to the airing courts. All boots have buckles for fastening, with buttons for the shoes; laces are best avoided for the melancholy. Working men and women additionally receive a pair of cloth slippers to be worn in the evenings or at activities such as dancing.
The Cost of Your Stay
All of these facilities: heat, light, food, bedding and clothing are provided by the local poor rate. Around thirteen shillings a week is allocated for your care. Do not forget to thank the ratepayers for their beneficence in providing you with care at no expense to yourself. It is, of course, now an accepted tenet of our civilised society that those who have the means should support those with no hope of providing for themselves. Nevertheless, the sacrifices of the ratepayer must not be taken for granted.
That is not to say that it is impossible to enhance your stay in any way. While you may be without means – and your arrival here is likely proof of that – your family or friends may be granted the indulgence of providing little things for you. There is no system of patient accounts as you might find in a private house or a government asylum, but the occasional book or other treat might be passed on to you if it is considered safe to do so. If you or your friends truly wish some freedom to be allowed within the bounds of your position here, then there is always the option of transferring your case to the register of private patients.
Chapter 4
Diagnosis
The path by which you have arrived here has been constructed by well-intentioned persons, though individuals who are unlikely to possess expertise in the diseases of the human mind. It is our duty to test their conclusions and to form a diagnosis, and we shall do so through both inquiry and observation. Once you are settled on the admissions ward, one of the medical officers will conduct an interview with you. They will make notes on physical matters such as your skin and hair colour; the state of your tongue and your appetite; matters relating to your reproductive organs; the responsiveness of your senses; and to the regularity and consistency of your bowel movements. There will also be questions about your emotions, how you feel at that moment and what symptoms you are experiencing.
There are a number of predisposing causes of insanity which we are bound to investigate by inquiry. These relate mostly to your own history and that of your family members, for example, the condition of your parents at the time of your birth may provide clues as to your current state. If they were suffering from some illness or intoxication at the moment of conception, then this may have been passed on to you. Similarly, the act of labour may have resulted in damage to you or to the mother who nursed you. It is a well-established fact that childbirth is performed less easily amongst the women of developed nations, and many commentators argue that our own industrial improvement has made a severe impact on the prevalence of insanity.
Of equal weight, at least, are your own experiences during the critical periods of life, be that teething, puberty, sexual maturity or, for women, the additional risks arising from pregnancy, lactation and cessation of the menstrual flow. Physical triggers for insanity can also be found through illnesses, including fevers, head injuries or over-exposure to the sun.
Although it is sometimes suggested that the female of the species is more physically predisposed to insanity, it is also acknowledged that proportionately, the male is more at risk of succumbing to disease, as a result of the far greater agitation from moral causes afforded during the average man’s daily life. Partly this is due to choice of profession: the Commissioners in Lunacy’s reports regularly comment on the high levels of insanity amongst ex-members of the armed forces, as well as gentlemen of superior learning, or those involved in trade or finance. It is also due to the pressure on the male to maintain a suitable level of income to ensure his family’s security, and assert his own professional power to carve out a position in life.
Hereditary factors were once regarded as playing an important role in a diagnosis of insanity, though this presumption is increasingly being challenged. Nevertheless, the question will be raised, but not in such a manner as to cause you or your family embarrassment. The same is true of questions about your consumption of liquor. Tact is one of the principal duties of our medical men. Nor do we make assumptions about your illness. Our initial questions are a chance
for you to tell us how you are feeling, and whether anything is troubling you. Please do not feel obliged to answer any question that makes you feel uncomfortable. We shall lead you gently through the pathways of your life history, and thrust open no door that you wish to remain closed.
There are, of course, also ways for us to observe you, and these will not cause you any disquiet, indeed, you may not be aware of them at all. While some men can be judged insane by conversation alone, for others it is by their conduct that diagnosis will be made. To a certain extent, such conduct is likely to have been remarked upon in the paperwork that accompanied you: most physicians will draw attention to a want of order in your actions or personal appearance. Some patients prefer to clothe themselves in fanciful costumes or wear nothing at all; sometimes their bodies have swollen through the intake of food, yet others respond to the act of digestion with revulsion; sometimes language is missing, while in others it is excessive; there may be an unnatural fondness for a particular article in your possession; and at times a patient’s range of facial expressions is enough to suggest a particular illness.
Our interview and observations will, in due course, inform your allocation to a permanent ward. Influencing factors include the duration of the illness – for a chronic case is always less hopeful than an acute one – as well as any tendency to behave in either a noisy, unclean, violent or suicidal manner. Desire to work is another factor, as is a desire to engage in offensive habits. All these elements add up to a picture of what current level of supervision may be required. Generally, patients of similar behaviours are grouped together, so that those with a propensity to disrupt their fellows are at least together with those too cocooned within their own annoyances or pay them any heed.