by Mark Stevens
In a situation like this your help becomes vital. Should a patient arrive at your domicile unexpectedly, please make immediate contact with your local poor law officers, who will take the necessary steps to escort the patient back to the asylum. Once they have been returned, we will review the ward on which they are accommodated; a short period of time within a more secure ward is often recommended, and privileges will also be withdrawn.
Please also be aware that if more than fourteen days elapse between escape and recapture, then the warrant authorising detention becomes invalid due to the limitation periods prescribed by the Lunacy Act. Should you wish to secure a readmission, you will have to lobby your local poor law officers and construct all the necessary paperwork once again.
The Death of a Patient
Sadly, death is a common resolution to most of our patients’ time with us. On average, somewhere between one in seven and one in ten of our patients will die each year. This may appear a high figure - and is a fact not noised about to the patient group - but it is inevitable that a place of long-term care should produce such figures. As far as possible, we ensure that death occurs away from the busy wards and within the quieter infirmary area.
Staff are well practised at recognising the onset of a final illness and perform the necessary removal of a patient quickly and without fuss. All patients are given peace and privacy at the end, and additional comfort can be provided through the prescription of sedatives.
We will communicate with you whenever a patient becomes gravely ill, by telegram should the end be imminent. If you are unable to visit then we will keep you informed as to how matters progress. If the patient has outlived their friends and family then we shall endeavour to make contact with more distant relatives.
Certain practical procedures must also be followed whenever a patient dies. The first duty we perform is to conduct a post mortem examination, as any previously undetected injury or disease can be discovered and also there is an opportunity for medical research. All organs are examined and weighed, while the shape, colour, clarity and consistency of the brain are investigated. The results may be contributed to a medical journal or compared with current literature.
Your consent to a post mortem is not required, though the superintendent can consider limiting its extent. It may be considered prudent to leave the head of the deceased intact, for example, should you wish to arrange an open casket before burial. Please inform us if you wish this to be done.
We are also obliged to inform the local coroner of any death within the asylum, and to make a statement verifying whether or not the circumstances of the death were unusual. If they were – or, more properly, if the coroner considers that they were – then it is likely that an inquest will follow on our premises (rather than in a tavern, as is customary). The coroner has the power to call witnesses, and will wish to hear from those who were in immediate attendance on the deceased shortly before their death.
Once the body is released for burial, two of the attendants will lay it out. The patient’s eyelids are closed and a bandage is applied to support the lower jaw, while the limbs are straightened with the arms placed neatly at the deceased’s sides. Further bandages bind the ankles and the toes; whatever clothes the patient was wearing are removed; the body is washed and then dressed in a clean sheet. This is how your friend or relative will be presented should you wish to reclaim their body for burial. That option is not without expense, as you will need to pay for collection and transport as well as the costs of a private interment, and for this reason most of our patient’s bodies are not reclaimed. There is no shame in this; many families find themselves obliged to invest their limited resources in the living, rather than the dead.
We can offer our deceased patients a peaceful plot in the parish churchyard some two miles from here, and within walking distance of the local railway station. Our original plan was to have a cemetery within the grounds of the asylum, but the Commissioners in Lunacy felt such an arrangement would be morbid.
The Norman church by our burial ground is very picturesque and lies a little way out from the centre of the village. The space reserved for the asylum burials is delineated from the rest of the burial ground, sited on a large and open, grassy space, containing iron grave markers. Headstones have been ruled out by the visitors on the grounds of cost. If your friend or relative is to be buried here then we expect that a memorial will not be a pressing concern for you.
The End of Your Relationship with the Asylum
So it is that every lunatic is called away, and the asylum gates are closed behind them. With death or discharge also comes the end of your relationship with our asylum. Any possessions belonging to the patient can be collected or disposed of as you wish.
We have done our best to improve the part of the patient’s life that they spent here, and offered compassion and security to every sufferer. We have employed the latest treatments in all our efforts for recovery.
One final word of caution: modern medicine is yet to reach a conclusion as to whether mental illness is infected with a hereditary taint passed within the blood. The risk to other family members may be greater if a relative spends time within our care. While it is unlikely that we will ever see you again, perhaps you might like to keep an eye on those within your close family for symptoms of similar afflictions. And please do ensure that someone keeps an eye on you.
This 1870s print shows Moulsford Asylum from the west, at its entrance along the Reading road. To the left of the central core is the north block for men; to the far right is the superintendent’s accommodation and between them, the north block for women. The women’s south block can be seen in the background. Reading Libraries.
The 1877 Ordnance Survey map shows the layout of the original asylum buildings and the extent of its estate, including ornamental and kitchen gardens. The south blocks are those facing the river, while the north blocks face the road. The chapel is seen to the south west and the farm to the north of the principal buildings; the gas works are a little distant.
This 1904 surveyor’s plan of Moulsford shows in more detail the different areas on the ground floor. The lightest shade also shows the buildings’ original extent in 1870; the darker colours show the extensions made between then and the beginning of the twentieth century. The Berkshire Record Office.
Brentwood Asylum, Essex, 1857: Although Moulsford was a typical county asylum, it was also one of the smaller ones. Those counties with large populations built on a grander scale. Here is the Brentwood Asylum, Essex, which opened in 1853 with beds for 450 patients. By the end of the century it had grown to accommodate 2,000 people. Wellcome Library, London.
The patient sleeping spaces at Broadmoor: similar to those found elsewhere in the public system. Dormitories, in which by far the greater number of county pauper lunatics found themselves, contained neat rows of beds and storage for patients’ night or day clothes. Single rooms might be used for patients at risk of harming others or, as here, approaching discharge. Reading Libraries.
Two images from the Illustrated London News depict convalescent spaces at the Royal Bethlem Hospital and Broadmoor respectively. The scene in the Broadmoor dayroom, drawn in 1867, was replicated throughout the public asylums of England and Wales. Patients talk, sit, read or play games in a sparsely furnished but light and airy room. The women’s gallery at Bethlem – including various caged birds – was drawn in 1869. Its décor is slightly grander than that of a public asylum. Reading Libraries.
This page from Moulsford’s annual report of 1875 shows superintendent Robert Gilland’s attempts to assign a cause for each of his patients’ illnesses. Just under a third of cases in this year were assigned no obvious trigger; in a further quarter only a vague attribution to ‘hereditary’ factors was made. The Berkshire Record Office.
A table from the annual report of 1880 shows the wide range of occupations within just one year’s worth of admissions to Moulsford. Although by far the greater number of new patients were eith
er labourers or their wives, middle class Victorian life was also represented. Note also the increase in the number of annual admissions from the annual report of five years earlier. The Berkshire Record Office.
Physiognomy – observing facial expressions – was one of the early tools used by Victorian doctors to diagnose mental illness. These sketches of real cases are taken from Sir Alexander Morison’s The Physiognomy of Mental Diseases, first published in 1840, when enthusiasm for the subject was at its height. Wellcome Library, London.
Sketches of patients in the Devon Asylum. Clockwise from top: mania caused by destitution in a young mother; an older man with acute melancholy; a demented patient suffering hallucinations of a past lover; a 27-year-old man described as a ‘congenital imbecile’; a 40-year-old woman with dementia; a middle-aged man with general paralysis. In the centre, the daughter of a customs officer, afflicted with monomania and convinced she was Queen Victoria. Wellcome Library, London.
John Conolly, first resident physician at the Hanwell Asylum, was very influential. He established the moral regime in public institutions and was one of the first to dispense with restraint and show that a humane approach could work. When he retired in 1852, Conolly was presented with this ‘testimonial’. The figures on its right depict mania and melancholia, while on the left those same figures are recovered. Reading Libraries.
(Above) The men’s Twelfth Night entertainments at Hanwell Asylum in January 1848. There was singing and dancing from 4.30pm until 8.00pm, when a supper of roast beef and vegetables was served with beer. (Below) Here the sexes are mixed for festivities at Colney Hatch on 4 January 1853. The officers staged a play, there were sung solos by selected patients, and finally the attendants and servants performed an ‘Ethiopian dance’. Reading Libraries.
At Moulsford, posters were created for some of the regular entertainments. The posters are full of private jokes – the ‘nobility and gentry of Star Terrace’, for example, were the married attendants. Here, head attendant Alfred Lockie is joined by medical officer John Barron, charge attendants Henry Kirby and Ellen Digby, attendants David Green, George Winter and Anne Hickman, and porter John Evans. The Berkshire Record Office.
Patients, staff and visitors at Brookwood Asylum’s New Year ‘observance’, 1881. The asylum band played from 7.30pm-9.00pm, wreaths and flags decorated the hall, and Chinese lanterns hung from the ceilings. Thomas Brushfield, the superintendent, is ‘The Ruling Spirit’ at the bottom of the image. Patients are drawn now in caricature: the sympathy of the earlier Victorian period is being lost. Reading Libraries.
The original Victorian view of the aim of asylum care: recovery. This image was published in the Medical Times and Gazette in October 1858 to illustrate an article by John Conolly on physiognomy. The patient presented with melancholia linked to feelings of religious guilt. She recovered after a summer spent in an asylum. Wellcome Library, London.
Part II
The History of the Victorian Asylums
Chapter 1
Moulsford Asylum: The Inspiration for this Book
The Victorian asylums were real places, and they existed in exactly the way I have just described. Public asylums opened across England and Wales throughout the nineteenth century, and any ordinary Victorian man or woman would have been familiar with them. These institutions were a remarkable monument to a belief in welfare, although they were not universally acclaimed; and ever since they opened, people have argued about the effectiveness and desirability of them.
I have sought to recreate the workings of a public asylum as it operated during the last three decades of Queen Victoria’s reign. My model was a rather small and insignificant county asylum but one that is very dear to my heart, because it is local to me. It still stands beside the A329 between Reading and Oxford, and is remembered now by the name of Fair Mile Hospital, though it was built as the Moulsford Asylum. Technically, it was the first (and only) Berkshire county lunatic asylum, though that latter name was seldom used.
Berkshire was a latecomer to the provision of public asylums. Although the local justices, who were responsible for county government, had considered a joint venture with Buckinghamshire and Oxfordshire after the 1808 Asylums Act, nothing came of it. When Berkshire, like all counties, was compelled by the 1845 Asylums Act to provide some sort of facility, the justices decided to contract out provision to Oxfordshire instead. This was because the neighbouring county was building its own asylum, Littlemore, at Iffley, on the southern outskirts of Oxford.
Soon after Littlemore opened on 1 August 1846, Berkshire concluded an agreement for the admission of its own patients. The county financed two wings at Iffley, one male and one female, to house the Berkshire lunatics.
Along with every other English county in the Victorian period, Berkshire then experienced an unplanned increase in its number of admissions. Before twenty years had passed, the growing pressure on the space at Littlemore forced the justices to board out patients in other places, including at the Dorset Asylum and a private house in Camberwell, neither of which were close at hand for the families of those transferred. It was also very expensive to manage contracts with so many different providers; and the unexpected complexity of these arrangements led the Berkshire justices to conclude that it might be simpler to create their own facilities.
Building Moulsford
In the spring of 1866, an advertisement was placed in the Reading newspapers, requesting offers of land for sale which would make an appropriate site for a new asylum. The justices received just two, which was not so much a case of local antipathy but a reflection of market forces. There was little money to be had from selling land to the county, and unless a landowner needed the money quickly, he would be better advised to sit tight. Nor was it guaranteed that an offer would be deemed suitable, as the county was obliged by statute to look for that ‘airy and healthy situation’ prescribed by Parliament.
Fortunately, one of the two sites offered was almost entirely suitable. It cost the justices the princely sum of £8,000 to acquire, and comprised around eighty acres in a rural area on the edge of the Berkshire Downs. This estate was located nearly twenty miles north-west of the county town of Reading, about a mile from the small village of Cholsey and the same distance from the nearest Great Western Railway stop. Its proximity to the latter gave the new venture its name. Indeed, the Railway Hotel at Moulsford hosted lunch for the Berkshire justices after they had viewed the fields they were about to purchase. While they dined, these county men decided to plan an asylum for 300 patients.
The project was a partnership. The county joined with the boroughs of Reading and Newbury and the costs were apportioned according to how many beds each party required. The Gothic designs for Moulsford were drawn up by Charles Henry Howell, a well-known architect of Victorian asylums and later a consultant to the Commissioners in Lunacy. Howell had just finished work on Surrey’s Brookwood Asylum, near Woking. The principal contractors were Mansfield and Price of Holborn, London, and they were given a little under £50,000 to complete the work – comparable to around £20 million today.
Some other facts and figures about the initial building at Moulsford give an insight into the size of a Victorian asylum. The first delivery of materials alone consisted of 900,000 red bricks, 9,000 feet of ‘Baltic timber’ (beech, ash or pine), and 1000 individual sections of iron rainwater goods. The scale of the enterprise was immense. Rather than use the railway for delivery – which would have necessitated an additional short journey by road – a miniature tramway was laid between the construction site and the River Thames, which formed the eastern boundary of the site. All the materials were delivered by barge and then dragged by horse along the rails.
A team of 230 labourers were permanently engaged on the project, with another 50 or so joining for the spring and summer months before leaving for the harvest. Even with such a large workforce, it took around a year to get the main building watertight, and another year to complete its internal fitting out, which
demonstrates how much work went into the fixtures, joinery and decoration and suggests that the quality of these institutions did not end at their elegant façades.
The building thus created was the one on which the description in Part One of this book is based. Once complete, it had capacity for 285 patients – slightly below the original estimate – with 222 of those sleeping in dormitories and 63 in single rooms. It was divided up as I have outlined, by sex and by block.
Inside, £9,000 was spent on fitting out the wards to reflect the latest in Victorian conveniences. The grounds too were carefully designed for their purpose. Robert Marnock, an experienced landscaper, was briefed to provide a calm and restful space. His blueprint placed specimen trees and shrubs within a wide lawn.
Moulsford opened on 30 September 1870, and was immediately tested. As the initial batch of patient transfers were concluded, it was discovered that the group from the Dorset Asylum came complete with head lice, which they duly transferred to everyone else. Then, within two months of opening, a more serious predicament arose: virtually all the plaster ceilings in the main block gave way, and large parts of the building were evacuated. Mansfield and Price were called upon to rectify the situation and the remedial work bankrupted them.
Six months later the re-plastered asylum was able to recommence admissions, and the rest of its early years were free from similar disasters. Moulsford was comparatively set fair for a trouble-free existence: not only was it relatively small for a late Victorian asylum, but the rules and regulations for the management of such places were by now well established. All the staff had to do was stick to the rulebook and things were likely to run efficiently.