Life in the Victorian Asylum: The World of Nineteenth Century Mental Health Care

by Mark Stevens

  The chaplain’s key responsibility, of course, is of pastoral care for his flock. This care extends to staff as well as patients and also to former patients out on trial, if it is practicable for him to visit them. You will see the chaplain regularly around the asylum, as in addition to the fixed daily and weekly services he is also at liberty to hold prayers in any of the wards or day-rooms at a time of his choosing. This is of particular benefit to patients who may be unable to attend chapel due to the symptoms of their illness or poor physical health. In fact, the chaplain is instructed to pay special attention to the sick or dying, and he visits the infirmary ward on most days.

  The other principal element to his pastoral care is that of education. The chaplain is our schoolmaster and librarian. He purchases newspapers, periodicals and literature for the patients, adding to some 600 books available within the institution. He promotes reading and undertakes such elementary education as he feels may benefit his cohort in writing and arithmetic alongside religious knowledge. You may also find that the chaplain, on one of his regular visits to the wards, may decide to make a presentation on some secular topic, such as natural history or the story of foreign nations, or to engage you in some improving conversation.

  The Assistant Medical Officer

  The role of assistant medical officer suggests a more junior post than that of superintendent, and it is true that many medical officers arrive at asylums fresh from their university or professional training. After a period of schooling, or the more traditional apprenticeship to an experienced physician, this post can be seen as a first stepping stone to seniority. However, the job is also suitable for a mature man who is happiest with his patients and lacks the desire or aptitude to become responsible for management. Our present assistant is 36 and a native of Ireland; he enjoys shooting and fishing in his spare time and is also master of the local masonic lodge. A sociable character, he is very popular with the patients and has made many friends within the village.

  Whatever the age of the incumbent, this post is generally considered more appropriate for the single man, and most asylums do not provide married quarters for their assistant medics. The medical officer’s accommodation here consists of a one-bedroom apartment above the patients’ dining room. His salary is also slightly less than one quarter of the superintendent’s, while his leave is a less generous four weeks. These restrictions make it difficult for such a gentleman to maintain a family home.

  The medical officer’s role is to support his superior physician. He does this by reporting anything of note or cases that require attention, and while he can suggest remedies, he may only act on them with permission from above. He does, however, maintain some day-to-day discipline amongst the attendants and acts as chief of the asylum during the superintendent’s absence. To the medical officer also falls much of the patient care. His sole administrative responsibility is writing up observations into the asylum case books, thereby keeping a regular record of each patient’s symptoms and health; otherwise, he is free to give himself up to ward rounds and study. He is always on hand to deal with daytime incidents, and can be summoned to deal with an emergency or medical crisis.

  In practice, while the superintendent is asked to check on the sick or troubling cases, all the other wards are the province of his assistant for inspection on a daily basis. For this reason you can expect to see far more of the assistant officer than the superintendent. The nature of their shared responsibility is such that it is very rare to see both men attend the same ward at the same time, and each must rely on the other’s information to gain a full picture of the institution.

  As the principal practitioner of medicine within the asylum, it is the assistant’s job to take charge of surgical equipment. He keeps our instruments dry and inspects them regularly for signs of damp or rust. If necessary, he sterilises them in a solution of potassium cyanide. These instruments are kept in the assistant’s surgery room, though some items, such as tubes required for emergency or therapeutic procedures, are placed about the wards. The assistant also acts as apothecary and pharmacist. He manages supplies of drugs and spirits and keeps the dispensary stocked ordering supplies as required.

  In most asylums the assistant officer is also tasked with some specialist jobs dependent on his skills. Increasingly an assistant is provided with a photographic studio, built against a north wall, in which he may take photographs of new admissions or patients ready for discharge. He is also expected to play a role in the sporting and artistic life of the asylum. Our present assistant is a most proficient musician, and will be found playing the piano at evening events and the harmonium each Sunday in chapel. He takes a leading role in dramatic entertainments and usually directs proceedings.

  The Clerk and Steward

  It is the steward’s job to ensure the asylum is maintained and well supplied, and the clerk’s to ensure that our paperwork is in order. In our small institution these two posts are combined, though in larger institutions the roles are separately demarcated. You may occasionally see our clerk and steward inspecting some part of the building. He is originally from Yorkshire, a Chelsea Pensioner and a family man.

  As clerk, he is the head of our administrative staff, and under direction from the superintendent he keeps the books of record up-to-date, copying the details from admissions forms into various registers and transferring the lists of those departed into others. The clerk ensures that we conform to the requirements of record-keeping as set out by Parliament, and he sends notices and statistics to the Commissioners in Lunacy and the local poor law officers, also writing letters on the superintendent’s behalf.

  Our clerk is additionally tasked with the asylum’s accounts, maintaining financial probity. In this he may be helped by a patient, if a suitably neat and accurate person can be found, or a former clerk who should require little direction or supervision.

  In our asylum, the part of the job relating to the role of steward is by far the larger. For while the chaplain fulfils the spiritual needs of the patients, to the steward falls the material considerations of fabric, fittings, furnishings, food and fuel, clothing, sanitation, water, light and heat – the raw materials for each area must be ordered and then put to work. In some large asylums the steward is assisted by a storekeeper, but here he assumes ultimate responsibility for supplies, aided by the housekeeper on the female side. Our steward is below only the superintendent and chaplain in strict order of salary. He is also responsible for a number of servants who labour to create the comfortable conditions that surround you.

  The steward is therefore a most practical man. He has an understanding of both commerce and construction. He must fathom the principles of drainage, imagine building alterations in his mind’s eye, and predict the likely wear of cloths presented to him. These skills allow him to advise the superintendent, who is not expected to have such intimate knowledge of the world of manual labour.

  The Housekeeper

  The most senior female member of staff, the asylum housekeeper has significant responsibilities. To a certain extent she acts as a maternal superintendent on the women’s side, combining her role with that of a head female attendant, and is tasked with the day-to-day management of that division. For this reason some asylums refer to the position as matron. The housekeeper’s high standing is reflected in her terms and conditions: she is entitled to one months’ leave per annum, which places her on the same level as the junior male officers, and also receives a salary slightly above that of the assistant medical officer.

  Male patients are unlikely ever to see the housekeeper outside mealtimes or communal events, yet female patients look to the housekeeper, at least in the first instance, for all their needs. The housekeeper is directly responsible for the appearance of every patient in her care. It is her job to ensure the personal cleanliness of every female (particularly in regard to hands and hair), that their clothing is appropriate and neat, their bedding is fresh and that the wards and day-rooms on the female side are clean and free
of dust. She does this through regular inspection, and as the superintendent and his assistant officer make their rounds to observe the patients’ health, employment and intake of fresh air, so the housekeeper makes a similar round on the female side.

  She takes at least two tours each day, usually in the morning, at mealtimes, or shortly before patients are put to bed. In the morning, she makes sure that everyone is out of bed and that the ward windows have been opened. She is present at the bathing of every female patient to check that the bath temperature is correct; at every mealtime to ensure that each patient takes her food; and to personally receive each new female admission. At night, she locks the communicating doors between the female side and the rest of the asylum, and she is also obliged to make occasional, unannounced nocturnal visits to the wards.

  The housekeeper has in her charge all the female staff of the asylum, extending her jurisdiction beyond the wards and into the kitchen, the laundry, the sewing room and even the female attendants’ personal quarters. All must be inspected and kept tidy, with each female attendant allocated a job according to a rota. This is a position of considerable power and should not be abused, though it is a well-known fact that women in authority are more susceptible to the influence of personal friendships or vendettas, and so the superintendent will maintain a regular interest in the housekeeper’s supervision of her staff.

  Nevertheless, it occasionally falls to the housekeeper to practise discipline. Attendants must be present for their duties, meals must be properly cooked and foodstuffs correctly stored, washing must be efficient and each garment sewn must be robust and comfortable to wear. In this regard it is helpful to have a separate stock of supplies to hand, and the housekeeper keeps a small store.

  In some asylums, the feeling persists that the best housekeeper is a mature spinster who will not leave to be married and can thus provide continuity of care. Here, we have employed married women providing they are past the age of childbearing, as an experience of domesticity is invaluable in creating a home for so many people. However, we recognise that a married housekeeper is far more likely to fall prey to the pressures of asylum work; unless her husband is on the staff, the domestic home will be located some distance away from our main building. Our present housekeeper is a widow and therefore able to live in a flat on the premises.

  The Asylum Attendants

  The Head Attendant

  Within the attendant class it has been found desirable to institute a level of supervision. In very large asylums this can be threefold, with a head attendant above those in charge of each annexe or block, and further charge attendants for each ward. Our asylum dispenses with the middle layer; but the post of head attendant is still required. A good head attendant holds a deep attachment to nursing and can give an equal priority to the circumstances of both his patients and his staff. He can lead by example and discipline those who do not follow his lead. He is obsessed with details of presentation, but not to the extent that he cannot see the wood for the trees. The values of an asylum can often be measured from the man who fills this role.

  Our head attendant is a navy pensioner who grew up in the East End of London. He is married with three children, and has successfully studied for the certificate in proficiency available from the Medico-Psychological Association, which means that he is well-versed in the experiences of life as well as theoretical study of disorders of the mind and the care of the insane. To this theoretical knowledge he has added a period of work at an asylum 100 miles distant, so he is accustomed to the nature of this type of institution and the variety of patients found within it.

  On the male side, the head attendant fulfils a more limited portion of the duties ascribed to the housekeeper, and so he is paid a remuneration of around half that of the senior female officer. His duties are no less significant, however, and he must construct the male staff duty rotas, ensuring that each attendant knows his daily role, and act as a conduit between his staff and the medical officers. The standard of cleanliness of the male patients, their clothes, bedding and wards is laid at his door. Like the housekeeper, he is also present at the reception and discharge of his patients.

  Although he has his own office and an apartment on the ground floor of the main block, he is more usually to be found on duty within the wards, workshops or airing courts. He has the same responsibility for regular inspection as the housekeeper. Every morning he sees that each male patient is roused and that the windows have been opened, attends when bathing is in progress, is present at every meal to ensure that all are served, and also attends chapel, sporting events and entertainments to deploy his staff. He is expected to accompany the superintendent on the latter’s rounds. The result is that in the men’s wards you will see our head attendant regularly as the constant face of management, glimpsed briefly but consistently throughout each day.

  The Attendants

  It may seem cursory to group these staff together, but although they are legion – at any one time around thirty-six are on our books, divided roughly in half between each side of the asylum – each attendant performs the same duties. By far the greater number – some fifteen men and fifteen women – are on duty during daylight hours, while three guard the dormitories on each side at night.

  The attendants are responsible for nursing care and these are the members of staff with whom you will forge the closest bonds. You may never register a new servant; you may notice only obliquely a different officer; but a change of attendant will be deeply felt. For this reason we do everything we can to stem the traffic of staff to pastures new. Even within the asylum, we try not to move attendants around too much. As a patient you will value the sight of familiar faces on the ward, which in their own way bolster your routine. You may feel anxious if a stranger wakes you in the morning or prepares you for bed at night. We understand this.

  Nevertheless, you must prepare yourself for a somewhat high turnover of the staff, as only around half our attendants could be described as long-serving, and a loss of one in four a year is not uncommon. Unfortunately, this is mainly due to the terms and conditions of their employment, which are sadly outside our control. Nurses and carers must be paid a rate that preserves the asylum hierarchy and, while the ratepayers may be content to see larger sums paid to senior men, they will not tolerate the same expenditure on those of lower birth and education.

  It is true that the attendants often feel hard done by. They are the first on duty, yet the last to leave or take their meals – and cold dinners do not make a man embrace his work. A few among them resent the speed with which they are admonished when compared to the slower thank-you for all that has gone well during the day. They have little control over their own duties and are not encouraged to have independent thought. They are the worker ants, without whom the colony would not endure but whose contribution does not find ready testimony.

  Over time, the role of attendant has been seen increasingly as a specialism in its own right. Providing care is a more complex skill than those who built the asylum first conceded. As a result, we have managed to introduce some small changes to the attendants’ terms of employment. Although each working day still begins at 6am, on each alternate day attendants are permitted to stop work at 8.30pm, rather than 10pm. Once a week, they are able to leave their duties at 3.30pm for a free afternoon. The beer ration they previously enjoyed has been converted into a more flexible monetary allowance and we have also purchased a terrace of nine cottages nearby to let to those attendants who require married quarters. We provide food to the attendants on duty, while those on night shift have their heated room in which to sit and view the ward.

  Long service is rewarded with either a little extra pay or additional leave. There are opportunities too for advancement, and when the more senior posts of charge attendants become vacant we try to promote existing staff. We also endeavour to do what we can to remove the burdens of institutional life. Every attendant is allowed to tend an allotment in the kitchen garden; there is a quarterly dance
to relieve the monotony of their routine; and a sumptuous meal of roast goose at Christmas, with lemonade and a dance to follow. Attendants who become unwell are offered the use of a seaside home in which to convalesce.

  Uniform is issued to all attendants: a dark blue suit for the men and a similarly-coloured dress for the women, both available in seasonally appropriate, heavier or lighter fabrics. The men wear a dark blue cap, the women white caps and a fetching white apron with feathered straps. Each attendant has three sets of clothes so that they can present a smart appearance at all times. The attendants’ dress forms a part of their nursing care, as it gives them authority that all but the most disorientated patients can recognise. The charge and head attendants are marked out more clearly by the gold braid on their caps and jackets, if they are male, and by a coloured ribbon around their caps if female.

  You will easily be able to identify our newest recruits as they work here for a month in their own clothes. They are young men and women, usually in their early twenties, who have often come to employment from adjacent counties or from London. They are obliged to sign a declaration that they will dedicate themselves to the recovery of the patients and to securing their comfort, welfare and safety, while they are also issued with a copy of the rules and regulations for the governance of this asylum. These items form the foundations of their work.

  Much has been written about the greater ease with which female asylum attendants can be found in contrast to equivalent male recruits and there is some truth in that. A male attendant has often tried other lines of profession first, without success, suggesting that his general suitability for work might be questionable. A female attendant has probably undertaken duties within the family home or may have some experience of domestic service, but she will have identified asylum care as her professional goal and set out to achieve it. The quid pro quo, of course, is the greater risk of losing female staff. The women are just as likely to quit their post for money or position, but additionally they must leave our labour upon marriage, in order that they can dedicate themselves to the family home and the prospect of maternity.