Mental Disability in Victorian England: The Earlswood Asylum 1847-1901

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OX F O R D H I S T O R I C A L M O N O G R A P H S EDITORS R . R . DAV I E S

R . J . W. E VA N S

J. H A R R I S

H . M . M AY R - H A RT I N G

A . J. N I C H O L L S

J . RO B E RT S O N P. A . S L AC K

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Mental Disability in Victorian England The Earlswood Asylum, –

DAVID WRIGHT

CLARENDON PRESS · OXFORD

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Great Clarendon Street, Oxford OX DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Athens Auckland Bangkok Bogotá Buenos Aires Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris São Paulo Singapore Taipei Tokyo Toronto Warsaw with associated companies in Berlin Ibadan Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © David Wright  The moral rights of the author have been asserted Database right Oxford University Press (maker) First published  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquiror British Library Cataloguing in Publication Data Data available Library of Congress Cataloging-in-Publication Data Wright, David, – Mental disability in Victorian England: the Earlswood Asylum, ‒/David Wright. p. cm.—(Oxford historical monographs) Includes bibliographical references and index. . Earlswood Asylum—History. . Mentally handicapped—Institutional care—England—History—th century. I. Series HV.G E  .¢¢—dc  ISBN ‒‒‒           Typeset in Ehrhardt by Cambrian Typesetters, Frimley, Surrey Printed in Great Britain on acid-free paper by Biddles Ltd, Guildford and King’s Lynn

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ACKNOWLEDGEMENTS So much of this work has profited from the favours of friends and the kindness of strangers, that I recoil at the task of recalling all. However, lest those who have been instrumental to my research and writing think for a moment that I am not appreciative, readers will pardon the following lengthy, but necessary, note of thanks. The genesis of this research dates from my years of working as a summer student in the s at the Children’s Psychiatric Research Institute (CPRI) in London, Canada. This residential facility for the ‘mentally retarded’ was, like most mental hospitals in the western world, in the process of downsizing and moving clients into the community. At the Behaviour Clinic, a short-term residential unit specializing in the treatment of severe self-injurious behaviour, I had my first experience with the issues associated with institutional confinement and discharge, with conflicts negotiated between families and health-care professionals. The question about the interface between the medical institution and society prompted my early interest in the history of medicine. I owe a great debt of gratitude to Dieter Blindert, Cheryl Hartridge, and Tannis Stewart of the Behaviour Clinic, and to successive research grants from the Ontario Ministry of Community and Social Services. In  I left Canada to begin doctoral research at the University of Oxford. During my time at Oxford I was grateful for the critical advice from individuals of the Faculty of Modern History and the Wellcome Unit for the History of Medicine. Several individuals read parts of this thesis at various stages of its development and commented both informally and formally on its contents. In particular I would like to mention Amanda Berry, John Clarke, Marguerite Dupree, Edward Higgs, and Richard Smith. Linacre College provided me with a friendly environment in which to work and row, and surprisingly for Oxford, a state-of-the-art computing centre which proved indispensable for the research below. Their Domus Scholarship and Junior Research Fellowship assured that I was well fed throughout that crucial stage in my academic life. I remember in particular the generosity of Russell Reid, the Bursar, and Sir Bryan Cartledge, the College Principal. I cannot look back at my years at Linacre and Oxford without recalling the intense happiness and academic satisfaction which informed my daily existence there. During my postgraduate studies I was very fortunate to join the

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Society for the Social History of Medicine (SSHM), an international society based in England devoted to interdisciplinary approaches to the history of health and medicine. Its Executive Committee members welcomed me with the friendliness and encouragement which I now associate with the British medical history community, and opened my eyes to the myriad of ideas in what was then still a relatively new historical field. In practical ways the Executive Committee of the SSHM helped advance my own research, first by supporting an autumn conference () on ‘mental deficiency’, and secondly by sponsoring a volume from the meeting which appeared under the title From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disability, published by Routledge in . My ideas have been much refined by my experience of working with those who contributed to that book, most particularly Jonathan Andrews, Mark Jackson, and Mathew Thomson. Staff at the following libraries were unfailing in their generosity and assistance: the Bodleian Library, the History Faculty, Radcliffe Science, Radcliffe Camera, and Wellcome Unit libraries, Oxford; the Essex Record Office, Colchester; the Buckinghamshire Record Office, Aylesbury; the British Library (both before and after its new site); the Census Office of the Public Record Office (PRO) on Chancery Lane, and the PRO at Kew; and the library of the Wellcome Institute for the History of Medicine. Special mention must go to Julian Pooley and the staff at the Surrey Record Office, Kingston-upon-Thames (now Surrey Record Centre, Woking), who made every effort to accommodate my research and weekly visits as a doctoral student. The privilege of using such a wonderful set of historical records was kindly granted by the Board of Directors of the Royal Earlswood Hospital (formerly the Earlswood Asylum) and Elizabeth Stapleton, the General Services Manager. For three years Ceri Dillon, and Melanie and Jonathan Ward, provided respite and blankets for a ‘Tuesday night’ traveller on his way from Oxford to the Surrey Record Office. It would be no overstatement to insist that the primary research upon which this thesis is based would not have been possible without their assistance, their couch, and moreover, their friendship. Like many young medical historians based in Britain, I was generously supported by the Wellcome Trust and its world-famous Institute for the History of Medicine. The Trust funded my post-doctoral research fellowship and my first academic post at the University of Nottingham. Many of the chapters were reworked during these two fellowships. David Allen, then the Director of the History of Medicine programme, encouraged me to hold the first ‘Asylums Conference’, which has since become

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an annual event held across Britain and Ireland. Although the number of researchers within this travelling band of lunatics has expanded greatly, I would like to pay special tribute to the many colleagues who shared their time and knowledge about the history of psychiatry and British academe more generally: Peter Bartlett, Cheryce Kramer, Elizabeth Malcolm, Hilary Marland, Joseph Melling, Pamela Michael, Anne Shepherd, Len Smith, Oonagh Walsh. I was privileged to work as a doctoral student under an academic whom I admired immensely. Those who are familiar with Anne Digby’s historical work will sense shortly the impact that her ideas have had upon my own research. Few, however, will know the immense debt I owe to her on a personal level during my apprenticeship as a doctoral student and as a young academic. Anne has seen this manuscript evolve from a doctoral proposal to monograph. As sub-editor she also read the entire manuscript before publication and gave me the final encouragement during the editing process. For this Anne, and much else, many thanks. Lastly, I am grateful for editorial assistance from Patricia Colton, Jean Wright, Sean Gouglas, and Janna Bordonaro. Many thanks also to Anne Gelling, Professor Robert Evans, and the staff at Oxford University Press. This book was, at times, given up for lost until I was persuaded to complete it by my wife, Mona Gupta. Without her love, encouragement, and editing there is no doubt that this book would never have seen the light of day. I dedicate this book to my parents who assisted me financially and emotionally through my doctoral years. Their sage advice to commence my doctoral work, despite considerable personal hesitancey on my part, proved life-changing.

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CONTENTS L I S T O F TA B L E S LIST OF FIGURES A B B R E V I AT I O N S

Introduction

x xi xii 

. The State and Mental Disability



. An Asylum for Idiots



. Care in the Community



. Institutionalizing Households



. Idiots by Election



. To Know No Weariness

99

. The Golden Chain of Charity



. The Educable Idiot



. Down’s Syndrome



. The Danger of the Feeble-minded



. Conclusion



SELECT BIBLIOGRAPHY



INDEX



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LIST OF TABLES . Licenses held by doctors certifying admissions to Earlswood Asylum, , ,  . Birthplace of fathers and mothers of families admitting children to the Earlswood Asylum, selected years, – . Size of towns in which families admitting children to the Earlswood Asylum were resident, selected years, – . Household structure of families admitting children to the Earlswood Asylum, selected years, – . Number of admissions and readmissions, Earlswood Asylum, – . Previous employment of female employees, Earlswood Asylum, – . County of birth of women workers at the Earlswood Asylum . Length of stay of women workers at the Earlswood Asylum . Previous employment of male employees, Earlswood Asylum, –, and Kent County Pauper Lunatic Asylum . Types of subscribers, new subscribers to the Earlswood Asylum,  . The Standing Drill

          

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LIST OF FIGURES .

Previous place of abode of patients admitted to the Earlswood Asylum in five-year intervals, - . Length of stay of Earlswood patients, including readmissions, all patients admitted between  and  . Number of patients resident, Earlswood Asylum, – . Admission status of patients, by year, Earlswood Asylum, – . Lengths of stay by status of first admission, first admissions to Earlswood Asylum, – . Lengths of stay of patients, excluding those who died in the asylum, admissions to Earlswood Asylum, – . Annual mortality rate, Earlswood Asylum, –, compared to the national asylum average . Mean length of stay of yearly cohorts of first admissions to Earlswood Asylum, – . Total subscription revenue and the number of patients resident, Earlswood Asylum, – . Type of income as a percentage of total donated income .a, b Place of abode, new subscribers to the Earlswood Asylum, , and admissions to Earlswood Asylum, 

      96    

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ABBREVIATIONS AGP ARCL AREA BHM BMJ C&C CDEC CEJ Cont. Rev. EJS EHR Hist. Psych. HWJ JFH JMS JPM&MP JSH LPS LRB Med. Hist. NHR PP PRO Psych. Med. RCFM Soc. Soc. Rev. SRO Soc. Hist. Med. T&S

Archives of General Psychiatry Annual Reports of the Commissioners in Lunacy Archives of the Royal Earlswood Asylum (Royal Earlswood Hospital) Bulletin of the History of Medicine British Medical Journal Continuity and Change (Parliamentary) Committee on Defective and Epileptic Children () Chambers’ Edinburgh Journal Contemporary Review European Journal Sociology Economic History Review History of Psychiatry History Workshop Journal Journal of Family History (Asylum) Journal of Mental Science Journal of Psychological Medicine and Mental Pathology Journal of Social History Local Population Studies London Review of Books Medical History Nursing History Review Parliamentary Papers Public Record Office Psychological Medicine Royal Commission on Care and Control of the Feebleminded (–) Sociology Sociological Review Surrey Record Office Social History of Medicine Theory and Society

All references to Parliamentary Papers will be given with two page numbers, the first representing the page number of the actual report—for instance, the page number of the Annual Report of the Commissioners in Lunacy (ARCL)—the second being the page of the sessional volume.

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Introduction This book is based on a doctoral thesis submitted to the Faculty of Modern History, University of Oxford. My aim was to write a history of the first asylum for ‘idiots’ in the English-speaking world and to construct my narrative ‘from below’—that is, placing emphasis on the experiences of the people whose lives intersected in the asylum world—patients, staff, subscribers, doctors. This approach to the history of medicine is not new. Henry Sigerist, in the s, called upon researchers to look beyond the ‘great men’ of medical history and locate our understanding of the history of health care in the social interaction between patient and doctor. His clarion call arose from the realization, now much more widely acknowledged than during his own time, that the vast majority of ill health, and the interactions between healer and sufferer, occurred outside of the traditional realms of the medical profession, the laboratory and the clinic. The advent of the ‘new’ social history in academe in the s and s gave impetus to Sigerist’s view of a medical history concerned with the cultural and social determinants of health, with lay as well as medical understandings of sickness and disease. It provided the intellectual groundwork for the creation of the social history of medicine as a discipline. A phalanx of historians and medical practitioners have now challenged the chimera of unfettered, unilinear progress in the history of health, and replaced an ageing medical historiography with new investigations of the experience of illness and health from an exciting interdisciplinary perspective. Within the history of Anglo-American ‘psychiatry’, the social history of medicine approach has been particularly pronounced with the publication in the s of several excellent monographs on individual mental  R. Porter, ‘The Patient’s View: Doing Medical History from Below’, T&S  (), –.  H. Sigerist, Civilization and Disease (Ithica, NY, ), and id. A History of Medicine (New York, ).  J. Woodward and D. Richards, ‘Towards a Social History of Medicine’, in Woodward and Richards (eds.), Health Care and Popular Medicine in Nineteenth Century England (London, ), –; C. Webster, ‘The Historiography of Medicine’, in P. Corsi and P. Weindling (eds.), Information Services in the History of Science and Medicine (London, ), –.  D. Porter, ‘The Mission of Social History of Medicine: An Historical Overview’, Soc. Hist. Med.,  (), –.

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hospitals. Promoted in particular by the generosity of the London-based Wellcome Trust, the examination of county lunatic asylums in England, Scotland, and Ireland has gathered pace, challenging many of the previously held views of the Victorian asylum. It would not be an exaggeration to suggest that the history of madness and psychiatry has been the most intensely studied area in the history of medicine during the last quarter-century, now boasting its own journal and several national and international societies. The history of psychiatry has also proved remarkably contentious. The historian Michael MacDonald once likened the din emanating from the community of scholars engaged in the history of psychiatry to the shouting of ‘contesting lineages at an African wedding’. The allusions to kinship and tribal ritual resonate well. Psychiatric history has indeed been governed by unbridled attacks, personal vendettas, and a gulf of misunderstanding between various academic and professional groups. Some scholars continue to misunderstand and misrepresent the opinions of those with whom they intellectually or ideologically disagree, or exaggerate the differences between positions that are not necessarily irreconcilable. Assessing the disagreement and diatribe within psychiatric historiography, Mark Micale and Roy Porter concluded that: ‘We believe that in no branch of the history of science or medicine has there been less interpretive consensus.’ It is thus fair to say that the history of psychiatry has become a contentious and challenging sub-discipline of historical research.  The literature on the history of psychiatric institutions is immense. Notable casestudies of asylums that examine the patient experience are: N. Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum Keeping, – (Cambridge, ); A. Digby, Madness, Morality and Medicine: A Study of the York Retreat, – (Cambridge, ); E. Dwyer, Homes For the Mad: Life Inside Two Nineteenth Century Asylums (New Brunswick, ); E. Malcolm, Swift’s Hospital: A Story of St. Patrick’s Hospital, Dublin, – (Dublin, ). See also n.  below.  For recent research, see J. Melling and W. Forsythe (eds.), Insanity, Institutions and Society: New Approaches to the Social History of Insanity (London, ); P. Bartlett and D. Wright (eds.), Outside the Walls of the Asylum: The History of Care in the Community, – (London, ).  See the range of articles in the journal Hist. Psych. (est. ).  M. MacDonald, ‘Madness, Suicide and the Computer’, in R. Porter and A. Wear (eds.), Problems and Methods in the History of Medicine (London, ), .  M. Micale and R. Porter, ‘Introduction’ to Micale and Porter (eds.), Discovering the History of Psychiatry (Oxford, ), .  For edited volumes on the history of psychiatry with particular reference to Britain, see A. Scull (ed.), Mad-Houses, Mad-Doctors and Madmen: The Social History of Psychiatry in the Victorian Era (London, ); W. F. Bynum, R. Porter, and M. Shepherd (eds.), The Anatomy of Madness: Essays in the History of Psychiatry,  vols. (London, –); Scull (ed.), Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective

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

Despite the intense attention now paid to the social dimensions of incarceration and asylum treatment, the history of those whom the British call the ‘learning disabled’ and North Americans the ‘developmentally disabled’ remains a relatively marginal topic. The two principal works devoted to the subject are still Leo Kanner’s A History of the Care and Treatment of the Mentally Retarded () and Richard Scheerenberger’s A History of Mental Retardation (). Despite the twenty years that separate these two monographs, the tone, content, and methodology are remarkably similar. Both approach their subject-matter from a perspective of the great chain of ideas, locating ‘idiocy’ in medical writings of Classical Greece and Rome, and charting a unilinear progression of medical ‘discoveries’ and ‘advances’ towards the present day. In both books pride of place is given to the ‘pioneers’ of mental retardation. Individuals or institutions are singled out for particular applause or opprobrium, for promoting or retarding the onward march of medical progress. Apart from these global histories, there was, until recently, very little serious historical discussion. Roy Porter has recently suggested that part of the lack of interest in the ‘idiots’ and ‘imbeciles’ of yesteryear emanates from the lack of attraction of the subject-matter: ‘Madness continues to exercise its magic, but mindlessness holds no mystique.’ Porter has something here. Western society places a premium on intelligence and tends to devalue those who could not, metaphorically or literally, make the grade. Madness, on the other hand, replete with its associations to disorder, disease, and distemper, continues to draw huge audiences. Thus mental disability, by contrast, has languished in the periphery of the new historiography. The anti-psychiatry movement has fuelled debate over the place of the mad within modern society. The great era of historical revisionism in the history of psychiatry, advanced by Michel Foucault, Thomas Szasz, and (London, ); T. Turner and R. Murray (eds.), Lectures on the History of Psychiatry (London, ); G. Berrios and H. Freeman (eds.),  Years of British Psychiatry, – (London, ); Micale and Porter (eds.), Discovering the History of Psychiatry; G. Berrios and R. Porter (eds.), A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders (London, ); H. Freeman and G. Berrios (eds.),  Years of British Psychiatry, –, vol. , The Aftermath (London, ); D. Tomlinson and J. Carrier (eds.), Asylum in the Community (London, ); and n.  above.  L. Kanner, A History of the Care and Study of the Mentally Retarded (Springfield, Ill., ); R. Scheerenberger, A History of Mental Retardation (Baltimore, ).  R. Porter, ‘Mother says it done me good’, LRB,  Apr. , p. .  A. Digby, ‘Contexts and Perspectives’, in D. Wright and A. Digby (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (London, ), .

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Andrew Scull, though directed primarily at the involuntary hospitalization of the mentally ill, did influence enormously approaches of the small number of researchers investigating the history of mental disability. By contesting the legitimacy of psychiatry’s claim for monopoly over the mad, they were also implicitly challenging the expertise of medical men over the ‘idiot’. However, the social dimensions, and determinants, of madness proved much more alluring than the question of mental disability. It was far more compelling for researchers to formulate critiques based on the social construction of ‘madness’ than on the social construction of disability. Although ‘idiots and imbeciles’—the medico-legal formulation of mental disability before the twentieth century—were mentioned as inmates of asylum wards, they receive little in the way of sustained analysis in most studies of the mental hospital. There has also been some ambivalence about whether idiots and lunatics should be studied together. The most recent edition of the standard history of the mental health services in Britain has dropped its chapter on ‘mental defectives’ (idiots and imbeciles) entirely, contending that the subject needs appropriate examination elsewhere. Fortunately this neglect is being redressed, if slowly. The publication in the last few years of several monographs on the history of mental disability has revealed that the subject-area is more contentious, challenging, and topical than some commentators previously have given it credit for. Researchers, for instance, have shown how discussions over the ‘danger of the feebleminded’ during the Edwardian period intersected with the most important debates about national degeneration. Those interested in race hygiene in the inter-war period know only too well that the mentally deficient were among the first victims of the Nazi sterilization programme, and that eugenic concerns about hereditarian transmission were realized in  M. Foucault, Madness and Civilisation: A History of Insanity in the Age of Reason (New York, ); T. Szasz, Age of Madness: The History of Involuntary Mental Hospitalization (New York, ); A. Scull, Museums of Madness: The Social Organisation of Insanity in Nineteenth-Century England (London, ); Scull, The Most Solitary of Afflictions: Madness and Society in Britain, – (London, ).  Monographs on individual institutions in Britain are too numerous to mention. Two significant works are R. Hunter, Psychiatry for the Poor.  Colney Hatch Asylum. Friern Hospital : A Medical and Social History (London, ); C. MacKenzie, Psychiatry for the Rich: A History of the Private Ticehurst Asylum, – (London, ). See also n.  above. The terms ‘idiot’ and ‘imbecile’ will hereafter no longer appear in quotation marks.  K. Jones, Asylums and After: A Revised History of the Mental Health Services (London, ).  M. Jackson, ‘Institutional Provision for the Feeble-minded in Edwardian England: Sandlebridge and the Scientific Morality of Permanent Care’, in Wright and Digby (eds.), From Idiocy to Mental Deficiency, –.

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

provincial and state jurisdictions across the United States and Canada both before and after the Second World War. In the United States in particular, scholarly books have appeared on the history of ‘mental retardation’. The emergence of ‘disability studies’ has helped to promote a gradual development of the history of idiocy as a unified area of study, distinct from the history of madness, spawning several excellent doctoral theses. The creation of a field of mental disability history has been more pronounced in the United States, which has been blessed with three major works looking more widely at ‘mental retardation’ and modern society. In Britain the history of idiocy has recently witnessed the publication of its first two edited volumes, and a spate of publications in medical history journals. The work on the ‘pre-institutional’ period has been particularly welcome, giving academics a longer time-line with which to assess the changes of the last  years. Yet, despite these positive developments,  H. Simmons, From Asylum to Welfare (Downsview, Ont., ); A. MacLaren, Our Own Master Race: Eugenics in Canada, – (Toronto, ); I. Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada (Ithica, NY, ).  P. Tyor and L. Bell, Caring for the Retarded in America (London, ); J. Trent, Inventing the Feeble-mind: A History of Mental Retardation in the United States (Berkeley, ); P. M. Ferguson, Abandoned to Their Fate: Social Policy and Practice Toward Severely Retarded People in America, – (Philadelphia, ); S. Noll, Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, – (Chapel Hill, ).  R. Neugebauer, ‘Social Class, Mental Illness and Government Policy in th and th Century England’, unpublished Ph.D. thesis, Columbia University (); H. Gelband, ‘Mental Retardation and Institutional Treatment in Nineteenth Century England, –’, unpublished Ph.D. thesis, University of Maryland (); J. Saunders, ‘Institutionalized Offenders—A Study of the Victorian Institution and its Inmates, With Special Reference to Late-Nineteenth-Century Warwickshire’, unpublished Ph.D. thesis, University of Warwick (); M. Barrett, ‘From Education to Segregation: An Inquiry into the Changing Character of Special Provision for the Retarded in England, c.–’, unpublished Ph.D. thesis, University of Lancaster (); L. Zihni, ‘A History of the Relationship Between the Concept and the Treatment of People with Down’s Syndrome in Britain and America, –’, unpublished Ph.D. thesis, University of London ().  See n.  above.  Wright and Digby (eds.), From Idiocy to Mental Deficiency; D. Atkinson, M. Jackson, and J. Walmsley (eds.), Forgotten Lives: Exploring the History of Learning Disability (Kidderminster, ).  R. Neugebauer, ‘A Doctor’s Dilemma: The Case of William Harvey’s Mentally Retarded Nephew’, Psych. Med.,  (), –; Neugebauer, ‘Medieval and Early Modern Theories of Mental Illness’, AGP,  (), –; Neugebauer, ‘Mental Handicap in Medieval and Early Modern England: Criteria, Measurement and Care’, in Wright and Digby (eds.), From Idiocy to Mental Deficiency, –; P. Rushton, ‘Lunatics and Idiots: Mental Disability, the Community, and the Poor Law in North East England, –’, Med. Hist.,  (), –; Rushton, ‘Idiocy, the Family and the Community in Early Modern North-east England’, in Wright and Digby (eds.), From Idiocy to Mental Deficiency, –; J. Andrews, ‘Identifying and Providing for the Mentally Disabled in Early

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huge gaps in our knowledge of the history of mental disability remain. Historians interested in the study of ‘idiocy’ in Britain before the twentieth century are faced with a fallow field of historiography within which to plant the seeds of their own research. We have no equivalent to Mathew Thomson’s seminal research on mental disability and social policy in Edwardian and inter-war Britain. This book contributes to this growing scholarly interest in disability and its history by investigating the emergence of idiot asylums in Victorian England. Using the Earlswood Asylum, the former National Asylum for Idiots, as a case study, it follows in the footsteps of Sigerist by investigating the social history of institutionalization, privileging the relationship between the medical institution and the society from whence its patients, staff, medical superintendents, and subscribers came. By concentrating on the importance of patient-centred admission documents, and emphasizing the benefits of nominal record linkage to other, non-medical sources, this book extends the analysis of confinement to the network of extramural care and control. This book contends that institutional confinement of mentally disabled and mentally ill individuals in the nineteenth century cannot be understood independently of an analysis of familial and community patterns of care which existed outside the walls of the asylum. In this account, the family plays a significant role in the history of the asylum, initiating the identification of mental disability, participating in the certification process, mediating the medical treatment, and facilitating discharge back into the community. In this respect the methodological approach of this book owes a great deal to the pioneering work of John Walton, Mark Finnane, Nancy Tomes, and Richard Fox, who all identified the family as central to our understanding of the rise of the mental hospital. This book constitutes the first substantial published history of an idiot asylum in England, a surprising fact considering the national network of institutions that developed in imitation of the Earlswood Asylum and the vast archives of these institutions that are extant. The records of the Earlswood Asylum, held by the Surrey History Centre, constitute an Modern England’, in Wright and Digby (eds.), From Idiocy to Mental Deficiency (London, ), –.  M. Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain, c– (Oxford, ).  See J. Walton, ‘Lunacy in the Industrial Revolution: A Study of Asylum Admissions in Lancashire, –’, JSH,  (), –; R. Fox, So Far Disordered in Mind: Insanity in California, – (Berkeley, ); M. Finnane, ‘Asylums, Families and the State’, HWJ,  (), –; Tomes, A Generous Confidence, ch. .

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

immense resource, and my research has only mined a small vein. I was drawn immediately to the remarkable array of primary sources on individual patients, family, staff, and subscribers. As will be discussed below, the medical superintendent of Earlswood (as of any asylum licensed under the  statutes) was required by law to ensure that all patients possessed detailed legal documents—from the ‘Reception Orders’ and ‘Certificates of the Insanity’ required before confinement, to the admission registers and case-book entries during their residence, to the discharge orders or death certificates involved at the end of their stay. With one or two exceptions, the Earlswood Archives have all these documents for the period under study. The scores of volumes pertaining to over , admissions persuaded me of the necessity of database analysis to impose an order upon what could have been an arbitrary and impressionistic reading of the documents. Much of my attention was therefore devoted to the construction and development of a large database of nominally linked records relating to the patients admitted to the asylum, supplemented by separate databases on staff, (charitable) subscribers, and financial records. The largest of these was a complete reconstruction of the admission register for the , patients admitted between  and . Greater detail ‘in depth’ was achieved by investigating the primary admission documents—the Certificates of Insanity and Reception Orders—for the patients admitted in , , , , , , and . The software also facilitated the extension of nominal record linkage to sources outside the asylum, in particular the household schedules of the decennial census of England and Wales. The addresses of the  patients admitted during , , and  census years were searched for, household by household, in the microfilm copies of the nineteenth-century decennial censuses, held by the Census Office of the Public Record Office. Working ‘backwards’ from the asylum to the familial context before committal allowed this study to explore the household dynamics that played an important role in the confinement process. By exploring the patterns of confinement to the Earlswood Asylum, this book hopes to reveal the diversity of the ‘insane’ population in Victorian England and the complexities of institutional committal in the nineteenth century. Because it was a ‘voluntary’, or philanthropic, asylum, the imperatives of identification, custody, confinement, and control were negotiated differently from those admissions to the more numerous pauper institutions. In particular, subscribers to the charity played an important role in the selection of patients; in this way, the operation and management of the Earlswood Asylum shared similarities to the

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voluntary hospital movement stretching back to the Georgian era of provincial infirmaries. As this book will show, most idiot asylums, like most provincial infirmaries, were predicated upon the notion that they would not accept pauper applicants and would place a time limit on residence. Moreover, the confinement of patients to the Earlswood Asylum required the sponsorship of a subscriber, in a manner modelled on the nomination of patients to voluntary hospitals. Thinking of the asylum in a dynamic with, rather than in isolation from, society, challenges a generation of thinking on the historical roles of hospitals for the mentally disabled. Wolf Wolfensberger was central to the characterization of all ‘mental retardation’ institutions as being inherently static and dehumanizing. In doing so, he was drawing on the antiinstitutional critiques of Russell Barton, Erving Goffman, and others. This book does not directly criticize these powerful and influential theses, but it does suggest that approaches that focus only on the institution distort as much as they illuminate. As this book will show, institutionalization, even during the so-called Victorian heyday of the asylum, was only one part of a lifelong strategy of families to care for and control their disabled family members. As Nancy Tomes has shown for the families sending relatives to the Pennsylvania Asylum during the same period, individuals and communities chose institutional solutions for a myriad of reasons—some from poverty, others from the hope of benefit for their kin, others, perhaps, from a desire to rid themselves of troublesome relatives. Motives and motivation are perennially difficult to decode from discrete actions, but there is no reason to believe that the plurality of views informing decisions over whether, or whether not, to institutionalize were any less contested and complex during the Victorian era than they are today. This book, therefore, does not seek either to validate or condemn the rise of large residential hospitals for the mentally disabled that figured so prominently in the provision of care and treatment in the first half of the twentieth century. Rather, it places the institution within the context of  As time evolved, however, two asylums—Starcross, near Devon (the Western Counties Idiot Asylum) and the Royal Albert, near Lancaster (the Northern Counties Idiot Asylum)—began to accept pauper idiot children. See J. Radford and A. Tipper, Starcross: Out of the Mainstream (Downsview, Ont., ); D. Gladstone , ‘The Changing Dynamic of Institutional Care: The Western Counties Idiot Asylum, –’, in Wright and Digby (eds.), From Idiocy to Mental Deficiency, –.  W. Wolfensberger, The Origin and Nature of Our Institutional Models (Syracuse, ).  R. Barton, Institutional Neurosis (London, ); E. Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (New York, ).  Tomes, A Generous Confidence, –.

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Victorian society, the economic pressures of industrialization, the emergence of a medicalized vocabulary for understanding disability, and the many other non-institutional forms of care and control which operated in tandem with the formal asylum. At the close of the twentieth century, when institutional and community care appear to have equal problems, there seems little to be gained from condemning the Victorians for their own imperfect responses to difficult social situations. Just as the rise of asylums did not herald a new era of progressive humanity, neither has the recent rapid closure of long-stay hospitals led to a smooth reintegration of the mentally disabled into society. Indeed, the perceived failure of community care to deliver the promises of its proponents in the s and s reminds historians of the failure of the optimistic expectations of a public asylum system in Victorian England. Fortunately, the more realistic approaches to familial, community, and institutional dimensions of care in operation today have spawned a scholarship which seems more willing to take a balanced look at the Victorian asylum system. As contemporary concerns and historical interests intermingle and inform each other, this book contributes to the ongoing debate and evaluation over care for people with mental disabilities at the dawn of the twenty-first century. A NOTE ON TERMINOLOGY

In  the Revd Andrew Reed recorded in his diary the spectacle in Wales and Cornwall of ‘a wretched idiot, chained, like a felon or a maniac, in the common pound or lock-up house of the village green, or chased hither and thither, the scoff and the outcast of the whole hamlet’. Following his observations, Reed apparently confided in his journal ‘that an Asylum is greatly wanted for indigent Idiots’. This book traces the history of the establishment and evolution of the first institution for ‘idiots’ in the English-speaking world, within a wider context of changing responses to mental disability in Victorian Britain. In doing so, the linguistic heritage of the Victorian era, the accuracy required by academic historians, and the sensitivities of people with disabilities must be considered. Faced with such a problem, explaining the contemporary meaning of terms remains paramount. The nineteenth-century term of ‘idiot’ referred to persons who were considered as suffering from mental disability from birth or an early age,  As quoted in A. and C. Reed (eds.), Memoirs of the Life and Philanthropic Labours of Andrew Reed, With A Selection From His Journals (London, ), .

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or what is now commonly referred to in Britain (though not in North America) as learning disability. It was packed with social, medical, and legal meanings. Commonly the term ‘idiot’ did not stand alone, and was associated with childhood—hence ‘idiot and imbecile children’, reflecting, in part, the life-expectancy at the time for those born with severe mental disabilities. Idiocy reflected a permanence of mental disability, as stated in statutes affecting property rights dating from the thirteenth century. ‘Lunatics’, by contrast, referred to all those who, though previously ‘sane’, suffered from a temporary or permanent impairment of mental ability. ‘Lunacy’ was considered more lofty than the terms ‘mad’ or ‘crazy’, which remained popular terms in lay and literary discourses. By its very definition ‘lunacy’ was not considered congenital, and in may cases held the promise of either cure or remission. It stood in contrast to ‘idiocy’. To use a common, if unkind, distinction made by the Victorians: ‘lunatics’ were individuals who had a mind and lost it; ‘idiots’ were individuals who never had a mind at all. The dominance of ‘lunacy’ over ‘idiocy’, reflected both in the priorities of asylum builders and, subsequently, in the historiography of asylums, led to appellation of ‘lunacy’ being attached to parliamentary statutes and state institutions—hence the  Lunacy Act and the county pauper lunatic asylums built throughout England and Wales in the nineteenth century. The term ‘insane’—though it is commonly used today as a synonym for the ‘mentally ill’—was, by contrast, used in the Victorian era to describe all those who were non compos mentis. Although it is true that, in the late twentieth century, the term ‘insane’ has become widely associated with ‘lunacy’ or ‘madness’, in the context of Victorian England insanity was a legal and medical term encompassing the whole range of individuals who were not capable of conducting their own affairs. The legislation, and the county asylums which the legislation regulated, defined and accommodated the ‘insane’, and thus, to borrow the phrase of the Victorian legislation included ‘idiots, lunatics and persons of unsound mind’. Language, and its uses, are an important component in our understanding of the rise of modern medicine and society’s changing response to disability. This book will use most often the terms ‘idiots’, ‘lunatics’, and the ‘insane’, all of which were used by Victorians in social discourse, legislative definitions, and medical nosologies, while acknowledging that they have now become unacceptable forms of current speech. Why and how ‘idiots’ became a term of derision is the very essence of the narrative that follows.

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

The State and Mental Disability The English state has a long history of providing welfare to, and regulating the property of, idiots and imbeciles of the Realm. Under the Elizabethan Poor Laws, parishes in England and Wales were responsible for providing relief to their destitute poor. Overseers of the Poor were obliged to support the indigent sick and disabled of their parish, put the able-bodied destitute to work, and apprentice pauper children. They discharged their duties by assessing rates (local taxes), and hiring Relieving Officers, who took responsibility for the dispensation of small cash payments, food, clothes, and, more rarely, medical care. Destitute individuals were entitled to petition parochial officials for relief provided they had settlement in the parish. Settlement was usually determined by birth, marriage, or duration of employment. The terms ‘idiot’ and ‘imbecile’ were widely accepted and used by Overseers of the Poor and magistrates adjudicating on cases of families petitioning for relief in the sixteenth, seventeenth, and eighteenth centuries. The Old Poor Law, as it is now known, did not function as a unitary system: its implementation varied according to the problems, priorities, and wealth of each of over , parishes. However, by the end of the eighteenth century certain patterns of parochial care and accommodation were beginning to emerge as officials dealt more frequently with the mentally disabled—those labelled idiot or imbecile. Peter Rushton has detailed how the Overseers of the Poor and local magistrates in the northeast of England were ‘experienced, if not enthusiastic, in dealing with cases of mental disability’, and adopted local solutions to resolve situations in which family- and kin-care had broken down. Akihito Suzuki and Jonathan Andrews confirm that parochial authorities in eighteenthcentury London also confronted cases of pauper ‘idiocy’ and ‘imbecility’,

 

P. Slack, The English Poor Law, – (London, ). J. Andrews, ‘Begging the Question of Idiocy: The Definition and Socio-Cultural Meaning of Idiocy in Early Modern Britain: Part ’, Hist. Psych.,  (), .  Rushton, ‘Lunatics and Idiots’, .

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though less often than ‘lunacy’. Under such circumstances, some parishes paid allowances to families to continue caring for dependent relatives within the household; others hired non-related individuals to care for idiots and imbeciles under a system known as ‘boarding-out’. Although boarding-out was a common occurrence in the late eighteenth and early nineteenth centuries, formal institutional solutions were also increasingly being sought, especially for those individuals considered dangerous to themselves or others. During the latter half of the eighteenth century Poor Law Overseers supplemented their general assistance by purchasing admissions to charitable (non-profit) ‘lunatic asylums’, such as Bethlem, St Luke’s Hospital, and the Manchester Asylum, a phenomenon reflecting the increasing use of hospital beds by pauper authorities. A further option open to parochial officials was the emerging for-profit ‘trade in lunacy’, where ‘madhouse keepers’ accepted pauper and private patients at different levels of payment. Parishes in Bedfordshire, for instance, used such institutions before the erection of their county asylum in , and the Hook Norton private home in Oxfordshire accepted thirty-seven paupers who were idiot and imbecile before . Other ‘madhouses’—or ‘licensed houses’ as they were officially known—like the Droitwich and Camberwell asylums, tailored their policies to accept pauper inmates from parishes at a reduced price. Having said that, admissions of idiots to these for-profit institutions were still quite rare. It seems that many parishes preferred to use the nearly , workhouses and almshouses scattered across the country to dispose of their pauper idiots. It was this growing demand for institutional accommodation amongst Poor Law parishes that led Parliament to pass the  Asylums Act,  A. Suzuki, ‘Lunacy in Seventeenth- and Eighteenth-century England: Analysis of Quarter Sessions Records: Part I’, Hist. Psych.,  (), –; ‘Part II’, Hist. Psych.,  (), –; Andrews, ‘Identifying and Providing for the Mentally Disabled’, –.  R. Houston, ‘“Not simple boarding”: Care of the Mentally Incapacitated in Scotland during the Long Eighteenth Century’, in Bartlett and Wright (eds.), Outside the Walls of the Asylum, –.  A. Berry, ‘Community Sponsorship and the Hospital Patient in Late EighteenthCentury England’, in P. Horden and R. Smith (eds.), The Locus of Care: Families, Communities, Institutions and the Provision of Welfare Since Antiquity (London, ), –.  B. Cashman, A Proper House: Bedford Lunatic Asylum: – (Bedford, ), –.  W. Ll. Parry-Jones, The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries (London, ), .  L. D. Smith, ‘Levelled to the Same Common Standard?: Social Class in the Lunatic Asylum, –’, in O. Ashton, R. Fyson, and S. Roberts (eds.), The Duty of Discontent: Essays for Dorothy Thompson (London, ), .

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which permitted magistrates to erect county institutions. Under the terms of this legislation, magistrates, with the support of parochial authorities, were empowered to establish a county asylum, where parishes could send ‘dangerous idiots and lunatics’ for special treatment and care at a weekly charge. Parishes still had to pay for the care of ‘their’ constituents, but Parliament’s intention was that these public institutions would be less expensive per patient than private for-profit care, and would protect against the abuses which were allegedly occurring in many private madhouses. Between  and  twelve county asylums were created under this system, which supplemented the traditional prerogative of the Poor Law with the legal authority of county magistrates. As Peter Bartlett has argued, these early nineteenth-century county asylums were, in some important respects, extensions of the traditional Poor Law system. Poor Law Relieving Officers acted as the gatekeepers to confinement, interviewing families, bringing the insane to the attention of magistrates, and co-ordinating the payment for patients. In other respects, however, the county asylums represented an enhancement of the power of the county magistrates, who oversaw the financing of the institutions, set the weekly fees charged to parishes, and hired and fired the medical superintendents of the institutions. Furthermore, all admissions and discharges required the approval of Justices of the Peace. Despite this new system of asylums erected at public expense, however, few idiots and imbeciles seem to have been sent to the county asylums in the first four decades of the nineteenth century. These institutions were, after all, still much more expensive per patient than workhouses, and Poor Law Guardians resisted the temptation of paying for asylum care for those not deemed ‘curable’. Instead, the workhouses began to dominate institutional provision for the mentally disabled. The movement towards workhouse provision was augmented by the Poor Law Amendment Act of . The ‘New’ Poor Law reorganized the ancient ecclesiastical and civil parishes into  ‘Unions’ of Poor Law parishes, and replaced the Overseers of the Poor with elected Poor Law Guardians. It continued the system of ‘settlement’, whereby Poor Law Unions were responsible only for destitute persons who had been born or who had  Jones, Asylums and After, ; Scull, The Most Solitary of Afflictions, . See also n. , below.  P. Bartlett, The Poor Law of Lunacy: The Administration of Pauper Lunatics in Midnineteenth Century England (Leicester, ).  L. D. Smith, ‘Cure, Comfort and Safe Custody’: Public Lunatic Asylums in Early Nineteenth-Century England (Leicester, ), –.

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‘settled’ in parishes within their jurisdiction. The New Poor Law, however, emphasized ‘relieving’ the poor in Poor Law Union workhouses, and doing so on the basis of ‘less eligibility’, whereby the provision of food and wages would be lower than that earned by the poorest ablebodied labourers of the local community. The workhouse, therefore, was supposed to act as a sharp deterrent to the poor and penalize those in receipt of its provisions. The operation of the New Poor Law did not, however, turn out the way its founders had intended. Three years after the implementation of the Poor Law Amendment Act, returns from the Poor Law Unions to the new national Poor Law Board indicate that the workhouses were relieving not the indolent able-bodied, but rather the aged, the sick, and the physically and mentally disabled. By , , idiots and , lunatics were under the care of parish officials. From the early years of the New Poor Law, therefore, idiots formed a large and important constituency for the Poor Law relieving officers and Poor Law medical practitioners. So how did Poor Law Guardians respond? The immediate post– period was characterized by an increasing range of possibilities for the newly formed Poor Law Unions. There emerged, as Len Smith has recently argued, a ‘mixed economy of care’ for the insane, in which Poor Law Unions and families negotiated an array of options. Poor Law Unions continued the tradition of sending selected inmates to private ‘madhouses’, that is, to licensed institutions for the ‘insane’ run by private proprietors, especially in areas where the county in which they resided had not erected a county asylum under the permissive  Act. Poor Law Guardians also continued the tradition of boarding-out, especially, it seems, in Victorian Wales. By far, however, the predominant institutional means of accommodating the mentally disabled became the Poor Law Union workhouses. Indeed, the rapid accumulation of idiots and imbeciles into the new workhouses prompted   

A. Digby, The Poor Law in Nineteenth-Century England (London, ). Annual Report of the Poor Law Board, PP [], xlviii, . L. Smith, ‘The County Asylum in the Mixed Economy of Care’, in Melling and Forsythe (eds.), Insanity, Institutions and Society, –.  D. Hirst and P. Michael, ‘Family, Community and the Lunatic in Mid-NineteenthCentury North Wales’, in Bartlett and Wright (eds.), Outside the Walls of the Asylum, — .  M. A. Crowther, The Workhouse System, –: A History of an English Social Institution (Athens Ga., ). The Poor Law Amendment Act (sec. ) stipulated that ‘dangerous lunatics and idiots’ should not be kept in the workhouse for longer than two weeks, before being transferred to a licensed institution. This legislative loophole provided Poor Law Unions with the excuse to retain harmless insane persons within the Union workhouses.

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

some Guardians to provide specialized care for these inmates in the years immediately following the advent of the New Poor Law. Birmingham, for instance, established ‘purpose-built’ wards in , separating over sixty ‘insane’ patients from the rest of the pauper inmates. The Leicester Union began segregating idiots and ‘lunatics’ within the workhouse in the early s, and by the mid-s provided specialized nursing attendants for the insane inmate population. By the end of the s  per cent of all Union workhouses in England and Wales provided separate wards of some description. In fact, the growth in the numbers of ‘chronics’ in workhouses—sometimes as many as  inmates in the large Metropolitan Unions—led the Lunacy Commissioners in  to comment that these huge wards were asylums ‘in everything but the attendance and appliances which insure . . . proper treatment’. However, these Poor Law ‘asylums’ were an exception: by  most of the workhouse insane remained in what the Victorians termed ‘general’ or ‘mixed’ workhouses, where few special arrangements appear to have been made for them. The accumulation of idiots and imbeciles coincided with the emergence of a specialized medical discourse on insanity. Medical practitioners writing on unsoundness of mind in the early nineteenth century differentiated consistently between lunacy and idiocy. John Haslam, in , divided ‘insanity’ into three divisions: idiotcy [sic], lunacy, and unsoundness of mind. For Haslam the key defining criteria was the commencement of the condition and its ability to be cured; idiocy began ex nativitate and was permanent (incurable); lunacy began at a late stage of life but could be temporary. Unsoundness of mind was ‘contradistinguished from idiotcy and lunacy’. His notes on idiocy were relatively straightforward: ‘[I]f in his career from infancy to manhood it is clearly ascertained that education is hopeless . . . that he is deficient in the capacity to attain the information requisite to pilot himself through the world and manage his concerns, such a person would be deemed an idiot . . .’ Thus, for Haslam, the key criteria was the idea of permanent impairment from a very early age. His attitudes were extended in  by Forbes  L. Smith, ‘Behind Closed Doors: Lunatic Asylum Keepers, –’, Soc. Hist. Med.,  (), .  Bartlett, The Poor Law of Lunacy, .  G. Ayers, England’s First State Hospitals and the Metropolitan Asylums Board, – (London, ), .  Eleventh Report, ARCL, PP,  session II, xvi,  ().  J. Haslam, A Letter to the Lord Chancellor on the Nature and Interpretation of Unsoundness of Mind and Imbecility of Intellect (London, ), , , , –.

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Winslow, the editor of the Foreign and Medical Review and future proponent of asylums for idiots, in one of the first textbooks on the criminal responsibility of the insane. Winslow defined three groups of non compos mentis that would form the basis for the landmark legislation in . According to Winslow, the three major groups of insanity were: Idiota, who from his nativity, by a perpetual infirmity, is non compos mentis; He that by sickness, grief or other accident, wholly loses his memory and understanding; is a person of unsound mind; A lunatic, that sometimes has understanding and sometimes not; aliquando gaudet lucidis intervallis; and therefore is called non compos as long as he hath not understanding.

Winslow refined Haslam’s views on idiocy by stating that anyone who suffered from a permanent intellectual deficit precipitated by an event after infancy should be categorized as a ‘person of unsound mind’. Naturally the boundaries demarcating idiocy, lunacy, and unsoundness of mind were vague and sometimes required court challenges when property and inheritance were involved. The Lunatics Act of , the defining piece of legislation during the Victorian era, adopted Haslam’s tripartite division by defining three subgroups of the insane: ‘lunatics, idiots, or persons of unsound mind,’ thereby maintaining the distinction between the conditions of lunacy and idiocy articulated in the first half of the nineteenth century: Every person whose mind from his birth by a perpetual infirmity is so deficient as to be incapable of directing him in any matter which requires thought or judgement, is in legal phraseology an idiot; Every person qui gaudet lucidis intervallis, and who sometimes is of good and sound memory, and sometimes non compos mentis, is in legal phraseology a lunatic; Every person who, by reason of a morbid condition of intellect is incapable of managing himself and his affairs, not being an idiot or lunatic, or a person merely of weak mind, is in legal phraseology a person of unsound mind; ‘Non Compos Mentis’ is the generic term which includes the three classes just mentioned.

 

F. Winslow, The Plea of Insanity in Criminal Cases (London, ), –. M. Jackson, ‘It Begins With the Goose and Ends With the Goose: Medical, Legal, and Lay Understanding of Imbecility in Ingram v. Wyatt, –’, Soc. Hist. Med.,  (), –.  C. Philips, The Law Concerning Lunatics, Idiots and Persons of Unsound Mind (London, ), –.

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

Thus, throughout the Victorian period there was a fairly widely acknowledged definition of ‘idiocy’ and a clearly understood demarcation between idiocy and lunacy. At the time of the Lunatics Act of  medical men and local authorities had a fairly uncomplicated attitude towards idiocy. Not a great deal of time was spent discussing the issue, simply because there was a perception that there was not a lot to discuss. Despite the distinction between idiots and lunatics, decisions over confinement to different types of formal institutions rested not on the medico-legal definitions, but on the perceived and observed ‘dangerousness’ and ‘curability’ of the person in question. For example, many clauses of the  Act emphasized the importance of sending the ‘dangerous insane’ immediately to the new county asylums, and removing recent ‘curable’ cases of insanity to institutions where they could receive medical treatment. The former impulse continued a tradition, established during the eighteenth century, of magistrates concentrating their attention on the dangerous insane ‘at large’. However, the therapeutic desire of treating and curing the ‘insane’ was a revolution in public attitudes to the insane promoted by lay and medical opinion which sought to inculcate a new regime dedicated to encouraging the insane to recover their senses, which the following chapter will address. In an asylum system that emphasized controlling the ‘dangerous’ and treating the ‘curable’, the vast majority of idiots and imbeciles, who were considered to be neither dangerous nor curable, occupied a conspicuously inferior place. They soon formed the largest component of a new mass of the ‘insane’, on whom Poor Law Guardians and county magistrates placed a low priority, preferring not to confine them in the new, expensive county institutions. In their second report to the Lord Chancellor (), the Lunacy Commissioners confirmed the Poor Law Board’s view that ‘most of the persons of unsound mind detained in Workhouses are incurable, harmless Idiots’. They were, however, unclear as to how to proceed. The  Act had proclaimed that all insane persons ought to be transported to county asylums, and idiots were clearly defined as a subgroup of the insane under the legislation. Yet the emphasis of the Acts on controlling the ‘dangerous’ and treating the ‘curable’, combined with the dwindling supply of available asylum beds, resulted in a rationing of  The control of dangerous lunatics ‘at large’ dates back to the Vagrancy Act of . See R. Porter, Mind Forg’d Manacles: A History of Madness in England from the Restoration to the Regency (London, ), esp. –.  As cited in the Further to the Second Report, ARCL, PP [–], xxxii,  ().

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asylum accommodation. Only two years after the passing of the legislation, the Lunacy Commissioners, sensing that the confinement of all insane persons was unworkable and perhaps undesirable, attacked only the retention of ‘curable’ or ‘disruptive’ cases of insanity in workhouses: We have invariably maintained that the permanent detention in a Workhouse of any person of unsound mind, whether apparently dangerous or not, whose case is of recent origin, or otherwise presents any hope of cure through the timely application of judicious treatment, or who is noisy, violent, and unmanageable, or filthy and disgusting in his habits, and must therefore be a nuisance to the other inmates, is an act of cruelty and injustice as well as of great impolicy; and we have, on all occasions endeavoured, so far as our authority extends, to procure the speedy removal of persons of that description to a Lunatic Asylum.

The emphasis on removing ‘curable’ cases of insanity and those ‘noisy, violent, and unmanageable’ left open the question of those thousands of persons with mental disabilities who were not considered ‘curable’ and who were relatively quiet and harmless. By , faced with unfriendly Poor Law Guardians and a staff of fewer than a dozen persons, the Lunacy Commissioners recognized that a strict interpretation of the  Acts was impractical, and began to divest themselves slowly of responsibility for the ‘harmless and incurable’ hundreds who continued to reside in workhouses. Moreover, they implicitly recognized insane wards in workhouses by prioritizing their inspection. The phraseology of the Commissioners’ report of  is instructive in recognizing the tension between the de facto and de jure situation: In these circumstances, and without agitating the question how far the maintenance of such wards, and the permanent detention of lunatics in them, is regular or valid in point of law (a question which seems extremely doubtful), and while carefully abstaining from giving sanction to their formation, the Commissioners have thought it right to visit and inspect them more frequently and systematically than the common workhouses.

The decision of the Lunacy Commissioners to downgrade the cause of the ‘harmless and incurable idiots’ (unless subject to neglect or cruelty) thus sprang from a fundamental tension between the ideology of ‘lunacy reform’, the imprecise framing of the  Acts, and the unanticipated demand for asylum accommodation the legislation would unleash. The lunacy reform movement was predicated upon advocating separate,  

Further to the Second Report, ARCL, PP [–], xxxii, –. Fifth Report, ARCL, , PP, xxiii,  ().

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

purpose-built institutions, under the control of medical practitioners. Under a progressive, medical and scientific regime, it was argued, ‘lunacy’ had the greatest chance of being cured. Asylums were to shed their notorious image as places of confinement, and usher in an era of curative medicine. The  Acts, however, were strikingly vague about the prerequisites of admission to the new institutions. Nowhere was it specified in these Acts that persons liable to be confined had to be ‘curable’ or ‘dangerous’. It merely stated that, in order for someone to be confined in an asylum, he or she had to be certifiable as ‘an idiot, lunatic or person of unsound mind’. This lack of specification of who should and should not be incarcerated left a great deal of discretion to county magistrates and Poor Law Guardians who, mindful of ratepayers’ pockets, placed greater priority on the violence and dangerousness of patients. Given this distinction, it is perhaps not surprising that most institutions did not admit large numbers of idiots and imbeciles. Marlene Arieno’s quantitative analysis of , patients sent to the Essex County Asylum, discovered that only  per cent were diagnosed as idiots or imbeciles. Of the , sample admissions to the Devon County Asylum between  and , a mere  admissions ( per cent of the sample) were registered as idiot or imbecile by the medical superintendent a return similar to that found in a more recent, but smaller, sampling of admissions to the Nottingham and Norfolk asylums. Indeed, there has yet to be a large-scale study of asylum patient populations to confirm whether those labelled ‘idiots’ or ‘imbeciles’ constituted over  per cent of admissions to a county institution during the mid-Victorian period. If one extrapolates these figures from small-scale studies to the entire asylum population in  (, in total), only about , persons with mental disabilities resided in county asylums at this time. By contrast, the returns of the Lunacy Commissioners suggested that there were , insane persons boarded-out and in workhouses across the country, the majority of  D. Mellett, The Prerogative of Asylumdom: Social, Cultural and Administrative Aspects of the Institutional Treatment of the Insane in Nineteenth Century Britain (London, ).  D. Wright, ‘The Certification of Insanity in Nineteenth-Century England’, Hist. Psych.,  (), –.  M. Arieno, Victorian Lunatics: A Social Epidemiology of Mental Illness in MidNineteenth-Century England (London, ), .  J. Melling, R. Adair, and W. Forsythe, ‘ “A Proper Lunatic for Two Years”: Pauper Lunatic Children in Victorian and Edwardian England: Child Admissions to the Devon County Asylum, –’, JSH  (), , , n. .  C. Aldiss, ‘Moral Treatment in the County Asylums: The case of Nottingham and Norfolk’, unpublished University of Nottingham MA thesis (), .

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whom were ‘idiots’ or imbeciles. Thus, by the s it is evident that the mentally disabled in workhouses and in the ‘community’ far outnumbered, in absolute terms, those similarly labelled in county asylums. Contrary to the characterization of the Victorian era as one in which asylums replaced families and communities as the locus of care, extramural solutions for the mentally disabled continued to predominate. In response to the accumulation of large numbers of the mentally disabled in workhouses, some Poor Law Guardians erected ‘idiot wards’ and ‘imbecile wards’ to separate and classify different types of inmates. Although the composition and structure must have varied between Poor Law Unions, the Lunacy Commissioners commented that those individuals in ‘idiot wards’ were the most disabled of a larger number of inmates who had varying degrees of disability: ‘Their [idiot and lunatic wards’] inmates are often numerous, and generally of a worse class (so far as their mental condition is concerned) than the imbecile or idiotic paupers who are usually found intermixed among the general body paupers, and are therefore kept entirely apart from them . . .’ Those not in ‘idiot wards’, but still mentally disabled, were often separated by age. Fragmentary evidence suggests that ‘idiot children’ who were not violent were often kept in the children’s wards, where they were sometimes supervised by pauper carers. In their special report in  on the provision for the ‘insane’ across England and Wales, the Lunacy Commissioners stated that ‘healthy’ idiots and imbeciles were placed indiscriminately among the able-bodied. Workhouse provision, however, did not preclude medical treatment of a kind very similar to that found in the county asylums. The Lunacy Commissioners stated that those in special wards had a ‘much more liberal and generous diet’ and were placed under the responsibility of specially selected attendants, whose ‘exclusive duties it [was] to wait upon them and minister to their wants’. Moreover, idiots requiring special attention were regularly visited by the Poor Law medical officer. By the end of the s the county asylums, many of which had been constructed immediately following the  Acts, were already experiencing severe overcrowding; the total asylum population had doubled to , patients. The numbers of reported ‘insane’ in Poor Law Union  D. Wright, ‘Familial Care of “Idiot” Children in Victorian England’, in Horden and Smith (eds.), The Locus of Care, –.  Smith, ‘Behind Closed Doors’, .  ARCL, , PP xxiii, – (–).  F. Crompton, Workhouse Children (Stroud, Glouc.; ), –.  ARCL, –, PP, xxxii, – (–).  Jones, Asylums and After, .

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

workhouses had also increased substantially: just over , resided in workhouses and with ‘friends’. Partly in response to this perceived crisis, Parliament established a Select Committee (–) to investigate the operation of the ‘lunacy laws’. Inevitably, they had to confront the chasm between the black letter of the law (which obliged magistrates to confine the insane who would benefit from institutional care) and the practice at county level (where Poor Law Guardians tended to send only their ‘dangerous’, ‘disruptive’, and ‘curable’ cases). The Select Committee attempted to solve this problem by recommending the construction of a new set of institutions specifically designed for the residence of ‘chronic’ and ‘harmless’ patients. ‘These auxiliary asylums,’ the committee explained, ‘would be intermediate between union workhouses and the principal curative asylums’. Faced with the persistent hostility of county magistrates over a central government’s attempted imposition of expensive lunatic asylums, Parliament resisted legislating the creation of another, overlapping set of institutions for the chronic insane. The opportunity for a publicly-funded system of idiot asylums had been lost. C O N C LU S I O N

The mentally disabled occupied an inferior position in the psyche of Victorian lunacy reform. After the  Poor Law Amendment Act idiots and imbeciles drifted into workhouse care, and were only sent on to the asylum if they became violent or unruly. Although the  Asylums and Lunatics Acts obliged Poor Law Guardians to send all pauper ‘insane’ to county asylums, the emphasis on the ‘dangerous’ and ‘curable’ patients permitted the Guardians to resist the widespread certification and incarceration of idiots and imbeciles. By retaining individuals in workhouses, they were saving enormously on the costs of formal institutional confinement. Magistrates, in charge of the county asylums, were more concerned with public order, and turned a blind eye to the retention of the mentally disabled in workhouses. Meanwhile, medical superintendents remained ambivalent about the appropriate locus of care. While ‘alienists’, the popular term for medical men specializing in mental disorder, campaigned for greater medical control of workhouse infirmaries, they were reluctant to see their ‘therapeutic’ asylums silting up with what they saw as ‘incurable’ cases. With no major constituency pushing for  

JMS (), . As cited in Ayers, England’s First State Hospitals, .

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confinement in county asylums, disproportionately few mentally disabled were admitted to state institutions in the Victorian era, and those that were had often been disruptive and violent at home or at the Poor Law Union workhouse. As overcrowding began to take its toll, alienists acceded to the return of their few ‘harmless and chronic’ patients back to the workhouses. For Poor Law Unions in London, the sheer size of some of the workhouses afforded the opportunity for ‘classification’, where special wards were established for idiot children. For higher-functioning imbeciles, it seems that workhouse masters were only too happy to employ them in rudimentary domestic tasks. For many smaller and rural Unions, however, informal boarding-out may well have continued to be used, even in contravention of the spirit of  which sought to eliminate ‘indiscriminate [out-door] relief ’. A confluence of cultural, medical, and charitable forces by the early Victorian period thus left idiot children as a constituency without a home. County lunatic asylums were concentrating their limited resources on violent and incurable adult lunatics, and were being increasingly seen as an inappropriate locus of care for idiot children. Meanwhile, the cultural status of children’s charities was on the rise. Orphan asylums had been established in the early decades of the nineteenth century, and childhood was becoming identified as central to new bourgeois configurations of family. Childhood was becoming something to be idealized, protected, and sanctified. Moreover, with the huge population explosion of the nineteenth century, children were everywhere to be seen. The time was right for a movement to establish a chain of philanthropic asylums devoted particularly to idiot children.  

Melling et al., ‘ “A Proper Lunatic for Two Years” ’, . L. Davidoff and C. Hall, Family Fortunes: Men and Women of the English Middle Class, – (Chicago, ).

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

An Asylum for Idiots Medical historians associate Georgian Britain with the growth of provincial hospitals. The new philanthropic and civic aspirations which these institutions embodied fuelled interest in the possibility of providing care to the insane whose families could not afford to pay for medical care. Charitable asylums such as St Luke’s Hospital (), the Manchester Lunatic Asylum (), the York County Asylum (), and the Liverpool Asylum () devoted themselves to the subsidized care and treatment of ‘those unhappy sufferers who are the objects of terror and compassion to all around them’. Recent work on the emergence of the nineteenth-century county asylums in England has emphasized the important role that philanthropic initiative played in the establishment of the rate-aided mental hospitals. As Len Smith has illustrated, some of the early county asylums were not purely institutions harbouring the pauperized population, but were also philanthropic institutions that accepted charitable patients. The Nottingham and Lincoln county asylums, for instance, represented such a partnership of philanthropy and the Poor Law at the county level. Charitable institutions played a crucial role in the development of new techniques for treating the insane. The York Retreat, an institution built by the Society of Friends, pioneered what is now famously known as the ‘moral treatment’ of insanity. The Retreat sought to eschew what it considered older and barbaric treatment of the mentally ill—typified by the use of mechanical restraint—and to promote the reintegration of the lunatic into a non-threatening milieu. Moral treatment thus constituted an effort to distance this new asylum from the perceived carceral role  

K. Jones, A History of the Mental Health Services (London, ), ch. . As quoted in A. Digby, ‘Changes in the Asylum: The Case of York, –’, EHR,  (), .  Rate-aided refers to institutions supported by the levying of poor rates under the Elizabethan Poor Laws. Those in receipt of poor law relief were designated as ‘paupers’ under the Poor Laws. Thus, the terms rate-aided institutions and pauper institutions will be used interchangeably in this book.  Smith, ‘Cure, Comfort and Safe Custody’, ch. .

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associated with older institutions for the insane. Systems of rewards and punishments provided the structural incentives for patients to proceed along a path of rational behaviour. Although the regime of moral treatment has come under attack by Michel Foucault as representing a more insidious system of coercion, the York Retreat, in the context of the early nineteenth century, achieved iconic status in its time as the embodiment of a progressive approach to mental illness. Although moral treatment was originally a lay initiative, it was soon co-opted by an emerging group of medical men claiming expert knowledge over diseases of the mind. In particular, medical superintendents of the new county pauper asylums, such as Robert Gardiner Hill, adopted the principle of moral treatment and refined it at his Lincoln County Asylum by proposing a system of treating the insane based on the abolition of restraint. More famously, John Conolly, the doyen of early Victorian alienists, implemented the non-restraint system at one of the largest asylums in the world—the Middlesex County Asylum at Hanwell. Although moral treatment and non-restraint were controversial at the time, voicing support for these principles became a mantra for the psychiatric profession, evidence of the scientific approach to madness which doctors hoped would increase the legitimacy of psychological medicine in the eyes of the public. With its emphasis on institutional care, moral treatment became the ideological prop for those proposing the construction of therapeutic lunatic asylums. Although these innovations did not go uncontested, men like Conolly argued that only a trained medical practitioner could attend to the physical problems often coexisting with madness. Many medical men were arguing that madness itself was merely a ‘disease of the mind’, and, as such, was the proper domain of medical practice. Around the articulation of madness as mental illness, and the lobbying of institutional care, the ‘lunacy reform’ movement emerged in the first decades of the nineteenth century. For many the quest for secure, humane, institutional care for the insane was analogous to the campaign for the abolition of slavery decades   

Digby, Madness, Morality and Medicine, ch. . Foucault, Madness and Civilization, ch. . L. Smith, ‘The “Great Experiment”: The Place of Lincoln in the History of Psychiatry’, Lincolnshire History and Archaeology,  (), .  A. Scull, ‘John Conolly: A Victorian Psychiatric Career’, in Scull, Social Order/Mental Disorder, –.  American superintendents in particular criticized what they considered the British obsession with non-restraint and suggested that the apparent abolition of chains was untrue and unachievable.

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earlier, or the reform of the prison system. Indeed, the involvement of many of the same individuals and religious denominations in these other causes illustrates the political nature of the lunacy reform movement. However, lunacy reform held many opportunities for a medical ‘profession’ which had found neither unity nor security by the onset of Victoria’s reign. Medical practitioners were struggling with the breakdown of the old tripartite Royal College system and a rapidly changing market for private, charitable, and public health care. The provision of health care was in a great state of flux, and huge discrepancies existed between the lowly provincial general practitioners and the honorary surgeons and physicians of the most famous London teaching hospitals. Within this context, the foundation of provincial infirmaries during the Georgian period and the emergence of specialist hospitals in London provided the most lucrative avenues for young and ambitious medical practitioners to foster connexions with wealthy subscribers and governors, that is, with potential private clients. Medical men of all backgrounds thus became intimately involved in the establishment of new medical institutions for an increasingly specialized list of diseases and disabilities as a means of advancing their own corporate and individual professional ambitions. Although it would be an exaggeration to suggest that the British medical profession was built solely on ‘bricks and mortar’, the identity, education, and increasing specialization of the emerging medical profession was forged within and betwixt these new hospitals. Thus, the advocacy of institutional treatment of the insane fulfilled a practical professional desire—the need for greater economic security. The rising optimism associated with the treatment of lunacy in the first decades of the nineteenth century gradually affected professional and lay attitudes to the plight of idiots, previously thought, by definition,  For a classic study of the prison reform movement, see M. Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution, – (New York, ).  I. Waddington, ‘General Practitioners and Consultants in Early Nineteenth Century England: The Sociology of an Intra-Professional Conflict,’ in J. Woodward and D. Richards (eds.), Health Care and Popular Medicine: Essays in the Social History of Medicine (), –.  M. J. Peterson, The Medical Profession in mid-Victorian London (Berkeley, ).  The standard survey of the history of British voluntary hospitals is J. Woodward, To Do the Sick No Harm: A Study of the British Voluntary Hospital System to  (London, ). For an excellent analysis of hospital development in an industrial city, see J. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region (Manchester, ).  A. Scull, ‘From Madness to Mental Illness: Medical Men as Moral Entrepreneurs’, EJS (), –.

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to be beyond education, training, or individual self-sufficiency. Like many of the medical innovations of the nineteenth century, revolutionary experiments began on the Continent. Édouard Séguin, a physician at the Bicêtre Hospital in Paris, experimented with methods of training idiot children in the early s, techniques which concentrated on the improvement of the mind through sensory experience and object association. Teaching began with discrimination, first of colours and numbers widely separated, and then, progressively, of finer discriminations. In  Séguin published a treatise on the treatment and education of idiots; four years later he published a second treatise, which was eventually translated into English. The apparent success of Séguin influenced a young Swiss medical student, Jacob Guggenbuehl. A medical graduate of Zurich, Guggenbuehl had been inspired by the writings of Séguin’s mentor, Jean Itard, whose experiment with the ‘wild boy’ of Averyon has been well documented. Guggenbuehl was primarily interested in cretinism, which was considered by medical opinion of the time to be an associated form of idiocy. Guggenbuehl persuaded the Swiss Association for the Advancement of Science to fund a demographic study of the prevalence of cretinism. His numerical findings of the prevalence of this condition, combined with his enthusiasm for the French school of training and education, sufficiently impressed the Swiss Association that they agreed to subsidize a Retreat. Guggenbuehl built his small institution on the side of Abendberg mountain, in the miasmatic belief that the ‘odours’ and bad air of the Swiss swamps were partly responsible for the high rate of Swiss cretinism. Once news of Guggenbuehl’s high-altitude experiment reached Britain, several progressively minded physicians travelled to see the ‘miracle’ at Abendberg. One such physician was William Twining, brother of the social reformer Louisa Twining, who visited during . Twining was suitably impressed by the spectacle of the mountain retreat: ‘Raising these poor creatures from their state of bodily disease and mental imbecility . . . it is a truth, a noble and exalted  M. Simpson, ‘The Moral Government of Idiots: Moral Treatment in the Work of Seguin’, Hist. Psych.,  (), .  É. Séguin, Traitement moral, hygiène et éducation des idiots et des autres enfants arrières (Paris, ), trans. as The Education of the Idiot by Moral Treatment (Edinburgh, ).  J. Itard, Rapport sur l’état actuel du Sauvage d’Averyon (Paris, ).  G. Blackie, Cretins and Cretinism (Edinburgh, ), .  Louisa Twining became famous for her involvement in the Workhouse Visiting Society and the campaign for better conditions for workhouse infirmaries. Ironically, Louisa Twining’s campaign to rid the Metropolitan Poor Law Union workhouses of the sick and disabled would lead to the first state institution devoted solely to idiot and imbecile children—the Darenth Colony for Idiot and Epileptic Children.

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idea, that, through human exertions, a mind may be awakened.’ Lauding the work of Guggenbuehl, he concluded that: ‘we may surely hail the philanthropic labours of Dr. Guggenbühl on the Abendberg, as laying down facts of high importance to the human race at large; inasmuch as they have a direct bearing upon those cases of mental imbecility which have hitherto been considered beyond the reach of cure’. Upon returning to England, Twining was so moved by his sojourn to the Swiss Alps that he became the self-appointed ‘English Advocate for the Committee Advocating the Claims of the Cretins’, inviting, and accompanying, Guggenbuehl on a Europe-wide speaking tour to proclaim the word. The early s thus witnessed an informal campaign for ‘idiocy reform’ analogous to that occurring for lunatics. Indeed, the appeal of the education of idiots (and cretins) seemed to have been particularly strong in those who were pioneering similar efforts of ‘reform’ for those suffering from madness. For instance, two years after Twining had travelled to Switzerland, and in the middle of the debate over the passing of the new Lunacy Acts, John Conolly himself journeyed across the Channel to visit the Bicêtre. Upon his return, the superintendent of Hanwell founded a pioneering, if little-noticed, programme of his own at his mammoth Middlesex Asylum, the results of which appeared in a medical journal of the time. A year later, in , Samuel Gaskell, then superintendent of the Lancaster Lunatic Asylum and a fellow Nonconformist lunacy reformer, followed in the wake of Conolly and travelled to learn from the famous physician of the Bicêtre. Gaskell, who had been credited with implementing certain elements of moral reform at the Lancaster Asylum, contributed three articles for Chambers’ Edinburgh Journal, in which he effused about the possibilities of the institutional education of idiot children. ‘Although apparently an unmoved spectator,’ wrote the future Lunacy Commissioner, ‘yet that strange mixture of feeling arising from sympathy with affliction, and rejoicing at its relief, was powerfully excited  W. Twining, Some Account of Cretinism and the Institution for Its Cure on the Abendberg (London, ), .  Ibid. . It was not without some embarrassment that Guggenbuehl’s apparent miraculous recoveries were found to be largely a hoax. Guggenbuehl, himself was arrested by the Swiss authorities. Scheerenberger, A History of Mental Retardation,   J. Conolly, ‘On the Management of Hanwell Lunatic Asylum’, JPM&MP  (), –.  Hugh Freeman and Digby Tantum, ‘Samuel Gaskell’, in Berrios and Freeman (eds.),  Years of British Psychiatry, –.  S. Gaskell, ‘Visit to the Bicetre’, CEJ  [ Jan. ], –; ‘Education of Idiots at the Bicetre’, CEJ  [ Jan. ], –; ‘Education of Idiots at the Bicetre, Part Three’, CEJ  [ Feb. ], –.

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within me. I could not avoid thinking’, he affirmed, ‘that if it were to serve no other purpose than that of illuminating, by a momentary consciousness of happiness, an existence otherwise dark, blank, and joyless, it would be desirable to institute such exercises.’ Consequently, when he returned to England in the autumn of  Gaskell began to institute a training scheme in a wing of Lancaster Asylum and carried out his own demographic study of idiocy in the county of Lancashire. Gaskell described, in two further articles, how he was transformed by the spectacle of ‘these forsaken members of the human family’ who, once wayward and uncontrollable, were taught to march in military order and who, once smeared their food, now ‘sat in an orderly and decorous manner.’ With such converts as Twining, Gaskell, and Conolly, the campaign for an English institution devoted to idiot children began to capture the imagination of the most reform-minded of Victorian medical practitioners. ‘Many essays have been lately published on the subject of the extraordinary strides which are being made towards the conversion of the idiot into the man fitted for the ordinary occupations of society’, opined Dr Henry Stubbs in the Journal of Psychological Medicine, who ‘earnestly hoped . . . that schools for the insane and idiotic may soon be instituted in our own asylums to rival those of [France]’. Philanthropic individuals were attracted to charitable projects of this nature as a way of bridging the social and religious divide so evident as a result of the process of industrialization. If even idiots could be educated, then the division that afflicted Victorian society, and the threat of an irredeemable working class, could be bridged. Yet a successful charitable enterprise required a convergence of propitious timing, wealthy patronage, and personal ambition. The genesis of the project came from an unexpected source. According to the popular accounts of the founding of Earlswood Asylum, Mrs Anne Serena Plumbe, a ‘lady residing in London, who was specially interested in the subject’, was so moved by Gaskell’s article that she contacted her pastor, the Revd Andrew Reed, to enquire of him the possibility of starting a home for the education of idiots. Reed’s sons, who penned his biography, remembered the  

Gaskell, ‘Visit to the Bicetre’, –. ‘Report of the Lancaster Asylum, Further to the Second Report, ARCL, PP [–], xxxii, – (– fn.); ‘Report of the Medical Officers of the Lunatic Asylum for the County of Lancaster, ’, JPM&MP  (), –.  Gaskell, ‘Visit to the Bicetre’, .  See e.g. G. G. Sigmond ‘The Idiots of the Bicêtre’, JPM&MP,  (), –.  H. H. Stubb, ‘Notes on the Parisian Lunatic Asylums’, JPM&MP  (), –.

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encounter thus: ‘But he [Reed] received her representations with his wonted quiet reserve and caution. The utmost she could obtain from him was the practical suggestion, “Go out some morning, and see how many destitute Idiots you can find in the neighbourhood”. She went and returned to him with a list of twenty-eight boys.’ This account, with its biblical allusions of bringing the lame to Christ for healing, was typical of the evangelically inspired accounts of the early days of the asylum. However, Plumbe’s own role seems to be rather mysterious, for, after alerting the appropriate individuals to the cause, she relinquished the project to Reed, whose male entourage of medical practitioners, bankers, and the well-to-do, glorified their own names in the pursuit of charity. Plumbe’s name receded into relative obscurity, save for a few signatures in the asylum’s Visitors’ Book; but nowhere does anyone describe what her own interest was in the subject. Her role might have remained a mystery, but in  the asylum admitted an Andrew Plumbe of Whitechapel. This could have been only a coincidence, save for the fact that the Subscribers’ Book of the asylum lists honorary subscribers, of whom Mrs Plumbe was one (presumably in recognition of her help in the initial stages of the charity). Her listing was also Whitechapel. Thus, Mrs Plumbe was, it seems likely, a parishioner of the Revd Reed and mother of an idiot child, who had read about, or had her attention brought to, the effects of training in France and elsewhere. Knowing of her pastor’s interest in asylums for the helpless, she no doubt asked him about the possibility that, given the recent developments in Europe, the same could be done in England. Reed’s sons, writing more than a decade after his death, downplayed the role of Mrs Plumbe and produced selected extracts of their father’s journal to support their contention that it was his idea all along to establish the first asylum for idiot children: ‘The idea of succouring the poor Idiot was not new to him: long had he pondered it; but a ceaseless round of public religious services consumed his time and obliged him to keep his project in abeyance.’ To support their contention, the sons make reference to an  entry in Reed’s personal journal in which he confided, ‘that an Asylum is greatly wanted for indigent Idiots’. In contrast, the biographers of John Conolly attested to his central role in  W. Millard, The Idiot and His Helpers; Including the History of Essex Hall; Together with Notices of the Rise of Progress of the Earlswood Asylum and Similar Institutions (London, ), .  Reed and Reed (eds.), The Life of Andrew Reed, –.  As quoted in ibid. .

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the pioneering of educative efforts for the idiotic and imbecilic. Sir James Clarke, the physician to Queen Victoria and a member of the original board of the Earlswood Charity, insisted in his memoir of Conolly that Plumbe had first written to Conolly, to ‘ask for advice and support’. Further, he quoted Dr Langdon Down, the famous superintendent of Earlswood, as to the importance of Conolly in the project: ‘Dr. Conolly’s name must for ever remain associated with the history of Earlswood Asylum . . . It may be safely said that Earlswood would not have attained its present position, but for the noble qualities of heart and mind possessed by Dr. Conolly.’ The precise contribution of these various figures may be forever lost to medical historians; but it is clear that Andrew Reed and John Conolly, far above the rest, provided the practical impetus behind Britain’s first asylum for idiots. Andrew Reed personified the rising prominence of Nonconformists in public affairs in the nineteenth century and the ways in which Dissenters combined evangelicalism and philanthropy to exert a powerful influence in its early decades. Reed’s family had a long history as itinerant Congregationalist preachers and watchmakers in Dorsetshire. Andrew Reed, senior, moved from the West Country to London, where he married the headmistress of a Dame School. Andrew and Mary Reed brought up Andrew junior, a sister, and a younger brother in a strictly religious environment, the family attending the New Road church in St George’s-in-the-East. Andrew Reed junior was sent to a school in Islington and returned as apprentice to his father, having turned down an offer from Cambridge University on account of the university’s observance of the rites of the Established Church. Reed, realizing that watchmaking was not his vocation, decided to formalize his family’s long-standing tradition of lay preaching by joining the ministry. Within a few years he became the principal preacher to the New Road church he had attended as a boy. As a popular preacher his congregation (and consequently his salary) grew, and he devoted his free time to charitable enterprises, especially those for orphan children. In early nineteenth-century towns and cities street urchins were a ubiquitous sight and ever-present problem. The increase in fertility in the late eighteenth and early nineteenth century, coupled with the ravages of war and a high maternal mortality rate, combined to create a situation in which thousands of  

As quoted by J. Clark, A Memoir of John Conolly (London, ), –. Andrew Reed’s concern for fatherless children was apparently inspired by his mother, who was herself an orphan. Reed and Reed (eds.), The Life of Andrew Reed, –.

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young children were left in the inhospitable environment of the Victorian city without parental control or authority. Although Dickens sentimentalized many of the characteristics of the deserted pauper child in Oliver Twist, the legion of fatherless and orphan children constituted a demographic reality in the early Victorian period. In response, charitable organizations sought to find appropriate education and housing for these children. In the forefront of this philanthropic impulse was Andrew Reed himself, who founded three subscription asylums for orphans in the Metropolitan area: the London Orphan Asylum (), the Infant Orphan Asylum (), and the Asylum for Fatherless Children (). Thus, when Mrs Plumbe approached the Revd Reed in  she knew well that she was petitioning a man who had become something of a hero in Nonconformist evangelical circles, and who was personally devoted to the plight of disadvantaged children. Indeed, Reed’s ambition in the field of charity was so unrestrained that it appears that he attracted some adverse publicity, to the effect that he was campaigning to promote asylums merely as a pretext for this own social ambitions. Only in this way can we understand the elliptical comments of his sons regarding his decision to help establish an asylum for idiot children: ‘Dr. Reed turned away from what he felt to be misconception of his motives, and even personal injury, to open up for himself a new course of benefaction by laying the foundation of an Asylum which now stands out as one of the crowning achievements in a long life of self-denying charity.’ Self-denying or not, Reed’s own conceptualization of the idiot asylum reflects a bizarre mixture of Nonconformist piety and explicit revulsion for mental disability. In  he wrote this strange passage in his journal explaining to posterity his decisions to undertake the project: ‘This one thing is left me, and I will do it. For discipline I will do it. I have naturally a love for the beautiful, and a shrinking, almost a loathing, of infirmity and deformity. The thing I would not do, is the very thing I am resolved to do. Alas! poor Idiot! while he is the great sufferer, I am the greater sinner.’ The Nonconformist minister became friends with an influential medical man who had himself undergone a fatherless upbringing as a young child— John Conolly. Born in Market Rasen, Lincolnshire, in , the orphaned son of an Irishman, Conolly attended a grammar school in Hedon until he was . In  his mother remarried a Frenchman who taught the young John Conolly French, a factor important in his later acquisition of the latest French research on medico-psychology. At the age of  Conolly joined 

Ibid. .



As quoted in ibid. .

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the militia, soon married, and lived in France for some time. In  or  he returned to Britain and entered medical school at the University of Edinburgh, completing his degree in . He set up a practice shortly thereafter in Chichester, and became friends with Dr (later Sir) John Forbes, subsequent editor of the British Foreign & Medical Review and the Cyclopaedia of Practical Medicine, to which Conolly would contribute. Historians of the medical profession have noted that the competition of provincial doctors for clients in the early nineteenth century was fierce; wages were often not sufficient to fulfil their gentlemanly ambitions. This seems to have been the case with the young Conolly who, without the connections to the elite of the profession in London or family networks in a community from which to draw a clientele, managed to scrape only a meagre living. Unsuccessful in his attempt to ingratiate himself with the London elite by teaching at the University of London Medical School, he returned despondent to Stratford. His financial position seems to have prompted him to seek a more stable source of income, and in  he applied and was rejected for the position of the resident superintendent of the Middlesex County Lunatic Asylum at Hanwell. However, apparently the governors’ first appointment did not work out, and in  Conolly reapplied and was this time accepted. As Andrew Scull has illustrated, acquiring the position at the Hanwell Lunatic Asylum was the turning-point in Conolly’s life. Hanwell was one of the largest lunatic asylums in the world at midcentury and, because it was situated in Middlesex, gave its medical superintendent a potential entrée to the medical elite of London. Conolly not only showed an ability to manage asylum affairs efficiently, he also had arrived at a point when the lunacy reform movement was gaining momentum. He converted to the movement advocating a new system of treating the insane and soon became the most vociferous champion of the system of ‘non-restraint’. Non-restraint—the system of controlling and treating the insane without resorting to chains and other mechanical means—was a topic of some contention within the Association of Medical Officers of Hospitals and Asylums for the Insane, the newly formed professional organization which would eventually evolve into the British Psychiatric Association. Eventually, however, non-restraint won the day, and Conolly, through his campaign, became the most celebrated asylum superintendent of his generation, a  

Clark, A Memoir of John Conolly, –. Scull, ‘John Conolly’, –.

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legacy he passed to his son-in-law, Henry Maudsley. Having also studied for and received his licence from the Royal College of Physicians, Conolly resigned his full-time post at Hanwell in , continuing as its Visiting and Consulting Physician while running his own private licensed homes. Three years later, and consistent with his initiatives to train idiot children at Hanwell, he agreed to act as honorary physician to a new charity devoted to the establishment of an English asylum for idiots, and even acted as honorary Secretary after the death of Andrew Reed in . In the wake of the Lunatics and Asylums Acts of , which established a national network of county pauper lunatic asylums, Andrew Reed and John Conolly began drafting the constitution for a new charity and organizing an inaugural meeting. In the politically charged years of the mid-s, so dominated as it was by the Chartist demonstrations, it is noteworthy that the provisional Board of the charity took on a decidedly Whig and Nonconformist complexion. Among the possibilities of guest speakers for the first fundraising meeting were Lord Palmerston and Lord John Russell, respectively the incoming Foreign Minister and Prime Minister of the new Whig government. In the end the Lord Mayor took the chair, and Lord Palmerston consented to become an honorary VicePresident. The inaugural meeting restated the aims of the charity, which was to be simply named the ‘ASYLUM FOR IDIOTS’. This was an unfortunate choice. After meeting at an office over which hung the sign ‘ASYLUM FOR IDIOTS’, the Provisional Committee thought better of it and changed the name to the ‘CHARITY FOR ASYLUM FOR IDIOTS’. Presumably any confusion was thus averted. The Charity formulated rules of admission reminiscent of the voluntary hospital system. However, in contrast to the charitable infirmaries, where patients were nominated directly by benefactors, the subscribers to the Earlswood charity would elect, by ballot, idiot children who would ‘most likely . . . profit by the course of treatment’. The period of residency was set at five years, subject to the discretion of the board, and in order to avoid the ‘dumping’ of unwanted  ‘Public Meeting,  Oct. —Minutes’, Minute Book, AREA, SRO ///, –; Annual Report, AREA, , SRO ///, . It is unclear when Conolly ceased his association with the Earlswood Asylum. In  he was listed as the Honorary Secretary after the death of Reed in February . This would suggest that Conolly was more or less active in the asylum’s affairs for at least fifteen years. See Sidney, A Lecture, back cover.  Voluntarism referred not to the agreement of patients to these institutions, but rather to the voluntary donation of monies for their maintenance. Hence asylums and hospitals built and financed on the voluntary principle stood in contrast to institutions established by the poor rates. In this book I will use the terms ‘voluntary’ and ‘charitable’ interchangeably.

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children upon the goodwill of the charity, all candidates needed to have the backing of two ‘respectable’ persons who would ensure that, at the end of the term, the child would be removed and returned to his or her home. Elections would be held twice yearly, and the number to be elected would be decided by the Board and subject to the financial position of the charity. Andrew Reed accepted the position of Secretary. The Georgian system of hospital patronage operated upon the principle of the ‘gift relation’—the immediate and personal reciprocity of patron and patient. Subscribers to provincial infirmaries could become members of a charity by donating certain amounts—usually one or two guineas. In return, the subscriber would receive the right to nominate a patient of his or her choice. The system worked reasonably well for the restricted clientele admitted into these institutions. Georgian infirmaries usually prohibited ‘chronic illnesses’, insanity, pregnant women, and people suffering from the morally unacceptable maladies, such as syphilis. Largely as a consequence of this, the average length of stay of patients at hospitals was short (at the Bath Infirmary it was only twenty days), thereby allowing for a sufficient number of nominations at any given time to compensate subscribers. But the proposed asylum for idiots was intended to accept children for a period of five years. With an estimated  patients at a purpose-built asylum, such a proposed duration of residence restricted the number of potential nominations to fewer than  a year. And yet the charity would need subscribers in the thousands rather than hundreds. Faced with the impossibility of direct subscriber nomination, Reed and his fellow Dissenters decided to base the charity for the asylum for idiots (later, the Earlswood Charity) on an ‘election system’ which Reed had refined at his three orphan asylums. The essence of this patronage, this election of idiots, was overtly democratic. Under the terms of the constitution, a subscription of one-half guinea gave individuals one ‘general’ vote and a right to participate in two yearly meetings. The first congregation of subscribers, usually held in April, comprised the annual general meeting. At this time subscribers  

Annual Report, , AREA, SRO ///, . R. Porter, ‘The Gift Relation’, in Porter and L. Granshaw (eds.), The Hospital in History (London, ), .  Woodward, To Do the Sick No Harm, ch. .  A. Borsay, ‘Cash and Convenience: Financing the General Hospital at Bath, c.–’, Soc. Hist. Med.,  (), –.  See N. Alvey, Education by Election: Reed’s School, Clapton and Watford (St Albans, ), ch. .

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elected a Board of Management. After the close of the general meeting subscribers could vote for a candidate-patient who had applied to be admitted into the asylum, an election which was repeated in October. The election system was not merely the example of a philanthropic exigency; it also represented a bold political statement of the Whig and Nonconformist Board members. In the context of the s and the calls for universal suffrage, the policy governing asylum admissions had political as well as philanthropic overtones. However, even liberal egalitarianism had its limits. Votes increased pro rata, thus bestowing multiple votes on more generous subscribers. And in order to maximize subscriptions, the charity bestowed one life vote on those who gave five guineas in one donation. As its name suggests, one life vote entitled subscribers to one vote at every election until they deceased. These life votes also increased pro rata. Having agreed upon the rules of admission, the Board set about advertising their intention to establish an asylum for idiots. Historians have shown how the construction of county asylums was followed by a surge of applications as county magistrates were swamped by patients. A similar phenomenon occurred in response to the construction of voluntary idiot asylums. Applicants from wealthy families, in particular, eagerly sought places for their ‘incurable’ idiot children. The minutes of the Inaugural Meeting of the Charity reflected the pressure for the admission of those whose care rather than education was the priority: It must be admitted that, after the utmost effort of skill and labour, there are cases which admit of little improvement; and many, while susceptible of much improvement, leaving the poor patient sadly disqualified to fulfil the duties of life, and to resist the trials and temptations of a bustling and selfish world. Are these to be abandoned because they inspire little hope, and need the most care? . . . [The Board] have learned, that the first desire of many an anxious friend or parent is to secure such a provision, for a helpless but beloved sufferer . . . They therefore earnestly hope that their Asylum may become both a School and a refuge, where  This method was a rejection of his earlier voluntary projects, which had preserved the older principle of allocating spots on the Managing Committees to those giving the largest subscriptions. Alvey, Education by Election, . In theory anyone could sit on the Board who had been a member of the charity for at least  months. Bylaw,  Apr. .  The Board also allowed for extraordinary Life Presentations whereby individuals could literally present a life case for  guineas. Clearly calculated to produce capital for investment, the Presentations, though few, preserve the older eighteenth-century aspect of individual subscriber-patient nomination. By  there were only six Presentations, two held by the Queen, one by the Prince Consort.  P. McCandless, ‘Build! Build! The Controversy over the Care of the Chronically Insane in England, –’, BHM,  (), –.

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the more hopeful may find beneficial training, and the hopeless and forlorn a quiet and grateful place of rest.

The eventual acceptance of ‘life’ cases, as they were to be called, would have financial implications and run counter to the asylum’s selfperception as primarily an educational institution. A later chapter will analyse the extent to which this occurred. The latter months of  were occupied in receiving applications, investigating cases, and searching for a temporary house for the new patients. After visiting houses in Stamford Hill, Holloway, and Enfield, the Board successfully negotiated a lease for Park House, Highgate, North London, an estate with a modest, but sufficient, sixteen acres. At Reed’s suggestion, William Millard, formerly the honorary superintendent of a ‘ragged’ school and an acquaintance of Mrs Plumbe’s, was appointed the first superintendent. Meanwhile the news of an English asylum for idiots excited interest in the capital and across the country. By February  the charity had received seventy-five applications for the first election, wherein the Board had decided to accept only six inmates. Even the Lunacy Commissioners commented on the ‘increasing number of applications for admission’ to the fledgling voluntary asylum. Within two years the charity had a waiting list of no fewer than  persons. ‘Not scores, but hundreds are craving admission’, boasted Reed in the first annual report. The first six elected inmates and two private patients were received in the last week of April . The seven boys and one girl aged from  to  years. Hasty arrangements were made for residence and educational instruction. It was not until June that the Board could announce that it had hired a full-time cook, maid, head nurse, two regular nurses, and two assistants. The remuneration of £ per annum for attendants was low, but not unusually so. Within the first month, however, one of the assistants had to be dismissed due to ‘harshness and violence of temper’, followed by another who had been seen striking a patient. To make matters worse, during the next year the Board resolved that Millard  

 See Chs.  and . [Annual] Report, , AREA, SRO ///, –. Millard later wrote of his earlier experience in the establishment of the asylum for idiots. See Millard, The Idiot and His Helpers.  Fifth Report, ARCL, PP [], xxiii,  [].  Reed and Reed (eds.), The Life of Andrew Reed, .  [Annual] Report, , AREA, SRO ///, .  Minute Book, AREA, SRO ///, –.  Ibid. .  Minutes of the House Committee,  Sept. , AREA, SRO ///, –.

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should ensure that a certain male attendant be withheld from any opportunities of ‘communicating with any of the female portion of the family’. As to the nature of the incident, the minutes did not elaborate. The Board subsequently raised the wage for attendants to £ per annum in the hope of attracting better candidates. Problems with the monies raised by the charity seemed to have added other minor embarrassments. Mr Bedford, a sub-secretary hired in October  to channel funds into the bank account of the charity, was dismissed due to his ‘unsatisfactory explanation of a missing seventy-two pounds’; Miss Cockburn, Park House’s first matron, was forced to resign when ‘deficiencies’ were found in the petty-cash accounts. These would be considered small incidents relative to the trials and tribulations of the next five years. The early and mid-Victorian periods were ones in which the British state was regulating more and more areas of professional and public life. Inspectors were established to scrutinize children working in factories, to impose vaccination upon a suspicious population, and to insist on public officers of health in high-mortality areas. With respect to asylums for the insane, government regulation dated from the  Madhouses Act, when Parliament gave the Royal College of Physicians the responsibility to inspect private madhouses in the Metropolis. Subsequent acts extended the control and inspection system over public and charitable institutions, culminating in the  Lunatics Act, which established a national inspectorate—the Lunacy Commission—to regulate all institutions accepting insane persons in England and Wales. Under this legislation, any asylum, hospital, or private licensed home receiving insane persons had to be licensed by the Commission and undergo annual inspections. Moreover, it had to abide by legal requirements of certification and institutional record-keeping. It seems, however, that Andrew Reed and his colleagues had not considered whether their charity would fall under the remit of the  Acts, even though the Lunatics Act of  had power over establishments receiving insane persons, and an insane person was clearly defined as ‘a lunatic, idiot or person of unsound mind’. Independent counsel seemed to confirm to Reed that the home  

Minutes of the Board,  Oct. ; Minute Book, AREA, SRO ///, . Minutes of the Board,  Feb. , Minute Book, AREA, SRO ///,; Ibid.  Feb. , AREA, .  For a recent book illustrating the extension of the state on the prerogative of the family, see G. Behlmer, Friends of the Family: The English Home and its Guardians, – (Stanford, ).  Separate legislation governed the licensing of institutions in Scotland and Ireland.  My italics.

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needed to be registered under the Act as a lunatic hospital. Reed sent a delegation to Lord Ashley, the powerful Secretary of the Lunacy Commissioners and himself a leading light in ‘lunacy reform’, to seek some sort of exemption on the basis that the institution was more a residential school than an asylum. At the conclusion of the meeting the Commissioners themselves stated that they were not decided as to whether the asylum came within their jurisdiction. The indecision, and later vacillation, of the Commissioners was understandable, for it was clear that the Lunatics Act of  was largely framed with lunatics in mind, rather than those suffering from permanent mental disability. Yet the problem of providing for idiots, with their numbers in workhouses growing rapidly, dogged the Commissioners. ‘The Commissioners’, lamented Lord Ashley in  in the Second Report of the Commissioners, ‘indeed believe that most of the persons of unsound mind detained in Workhouses are incurable, harmless Idiots.’ Because the Lunacy Commission was only in its second year, and judging from the hostile reception that the  Acts received from some provincial magistrates, the central inspectorate was hesitant to push Poor Law authorities too far on the subject of idiots, especially when those thus labelled often provided the manual labour in pauper institutions. ‘[A]lthough it might sometimes be a question whether on the whole the Workhouse was the best place for them, or whether it was right to detain them in it without their consent,’ concluded the Commissioners, ‘we never had a doubt that they were not proper persons to be confined in a Lunatic Asylum.’ Thus the Commissioners were willing to turn a blind eye to idiots and imbeciles scattered throughout the country in the workhouses, for lack of a better alternative. However, a dedicated asylum—one that accepted some private patients at a fee—posed different problems. The Commission sought to enforce compliance with the law, lest it allow its authority to be undermined and set a dangerous precedent for exceptions  

Minute Book, AREA, SRO ///, , . ‘To the Poor Law Commissioners for England and Wales’, Further to the Second Report, ARCL, PP [–], xxxii,  n. [ n.].  ‘In some of the smaller Workhouses where there are few or no able-bodied inmates, most of the garden and out-door labour is performed by males of this description [imbecile and weak of mind]; and females are very frequently employed in household work, in the kitchen and scullery, and in the washhouse, where, being under the eye of the Matron, they are active and obedient servants . . . .’. ‘Idiots in Workhouses’, Further to the Second Report, ARCL, PP [–], xxxii, – [–].  My italics. Ibid.

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to their prerogative. After a second meeting between Andrew Reed and Lord Ashley, the Chairman of the Commission informed the clergymanphilanthropist that, according to the provisions of the Act, the institution must submit to the Commission an application to be licensed as a ‘hospital’. In their official report the Commissioners gave as their reason the few private patients (some of whom were adults) received by the Highgate institution: Some doubt was at first entertained how far this establishment (which as yet is only in its infancy) fell within the jurisdiction of the Commissioners in Lunacy. But, having regard to its peculiar character and constitution, and more especially to the facts, that it admits persons above the age of puberty . . . that, for the purposes of discipline and instruction, an absolute right is necessarily asserted over the personal liberty of all its pupils; and that the profits from the boarders of the wealthier are applied towards the maintenance of those of the poorer class,— we came to the conclusion that it was substantially a hospital, within the meaning of the rd section . . . of the Statute, and decided that it ought to be registered.

As an act of good will, Lord Ashley gave the asylum ample time to implement the measures to which they were legally bound. Somewhat grudgingly, and in compliance with the Act, the Board hired Dr Foreman as the first consulting physician at £ per year. There is no evidence that he had a background in the care or treatment of idiot children; however, the advice of John Conolly must have been central to the educational philosophy of the institution. Foreman instituted a method of training, like Séguin’s earlier trials at the Bicêtre Hospital, that concentrated on improving the mind by bringing bodily movements under control. Drill, gymnastics, and exercises were used to stimulate dormant minds; academic classes concentrated on reading, writing, and arithmetic. The afternoons were devoted to industrial classes, where supervision was given in gardening, carpentry, shoemaking, and basket-making. This approach was sharply criticized by the Lunacy Commissioners, who believed that too little was being done in the way of industrial training. They were to

 Fourth Report, ARCL, PP [], xxiii,  []. It is worth remarking that the Commissioners came to a different conclusion in terms of the licensing of the Western Counties Asylum for Idiots, Starcross, near Devon. This institution, which admitted charitable as well as pauper idiot children, was considered outside the remit of the Lunacy Commissioners and, for the purposes of inspection, was considered under the jurisdiction of the Poor Law Board.  Minutes of the Board,  June , Minute Book, AREA, –.  Minutes of the Board, Minute Book, AREA, –.  Third [Annual] Report, Annual Report, AREA, , SRO ///, .

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voice the same objections to the system of education at the small Scottish institution at Baldovan in . By , just two years after the publication of the first advertisement for the asylum, Park House was full. In response to pleas from the Board, Samuel Morton Peto, a wealthy railway magnate and prominent Metropolitan Baptist, offered to lease Essex Hall, Colchester. Further, he bought an adjoining estate and loaned the charity the substantial sum of £,, free of interest, to furnish the new hall. The charity was hesitant to house the inmates in two separate institutions and divide the time of the Board between London and Colchester, but it was in no position to refuse such a generous offer. With Dr Foreman now firmly ensconced at Park House, Millard moved to supervise the smooth integration of patients into the newly refurbished Essex Hall. In the elections of  and  all went to this new home near Colchester. By the end of  it too was full, with  patients. The seemingly innocent issue of Essex Hall had managed to sour relations amongst the Board members. Samuel Peto, who had leased Essex Hall to the charity, had done so on the assumption that it would evolve into a separate voluntary institution serving the eastern counties. Reed concurred, actively seeking a corpus of benefactors who would form a governing board for an independent East Anglian institution. In his diary he recorded his own thoughts about Colchester, reflecting his insatiable ambition for recognition of his philanthropic works: ‘As to Colchester, I proposed that we should take the house, knowing, of course, the difficulty of distance; but I had another object. I have never allowed myself to regard it as a final step for us. My hope is, to nurse it up to independence, and, in the mean time, to teach the Eastern Counties their duty. My eye, too, is upon Edinburgh, Dublin, and Bristol, as other centres.’ Setting up competing charities constituted a divisive modus operandi, and a risky strategy, in the charity-saturated environment of Victorian London. Between  and  members of the Board had actively campaigned for funds by stressing that the charity was accepting cases from the eastern counties as well as the Metropolis and home counties. 

N. Anderson and A. Langa, ‘Institutional Care in Scotland’, Hist. Psych.,  (), . In , Peto forgave the loan of £,. Third [Annual] Report, , AREA, . As quoted in Reed and Reed (eds.), The Life of Andrew Reed, ; Reed was in communication with Dr John Coldstream of Edinburgh who, after a survey of idiot and imbecile children in Edinburgh, was central to the founding of the Scottish Society for the Education of Imbecile Youth which established the National Institution at Larbert. J. H. Balfour, Biography of the late John Coldstream (London, ), –.   

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Consequently, many of them feared that a separate institution would deprive what they considered the founding, and national, charity of scarce subscriptions. Reed, as persistent and single-minded as ever, pressed forward in his advocacy of not only an Eastern Counties Asylum but similar institutions across the country, in ‘the midst of difficulty and opposition’ which, in the words of Millard, ‘would have crushed a less noble spirit’. After two failed attempts to raise the requisite monies, the minister succeeded in February  in establishing the Eastern Counties Asylum for Idiots and Imbeciles, with an almost identical structure to Earlswood, but with elected patients strictly from Essex, Norfolk, Suffolk, and Cambridgeshire. The opposition, however, must have been bitter, as Millard, who left Highgate to take the superintendency of Essex Hall, recalled: It was a matter of much regret that [members of] the Earlswood Board deemed it right, by circulars and advertisements, to discourage the new Asylum; but the little sapling, planted under so many disadvantages, continued to grow and thrive; the streamlet became broader and deeper; so that the commencing capital soon increased sufficiently to give stability to the infant charity.

Despite its difficult birth, Essex Hall was to thrive after . It had a steady body of subscribers, a small estate which was largely paid for, and an agreement to keep numbers at a reasonably low level. It also represented the first of four regional idiot asylums. In  a Western Counties Asylum was built near Exeter and a northern counties institution near Lancaster. Two years later a much smaller Midlands asylum near Birmingham was also established. Each was constructed, more or less on the subscription and election system pioneered by Reed, though at least two, apparently for financial reasons, agreed to accept pauper idiot children in consultation with local Poor Law Guardians.  Having decided on a national asylum, Reed began to devise plans for a new, purpose-built institution which would outshine the idiot asylums on the Continent and act as a model of philanthropy and medical    

Millard, The Idiot and His Helpers, , –. Ibid. . Essex Hall was renamed the Eastern Counties Asylum for Idiots. For an excellent examination of the Northern Counties Asylum (also known as the Royal Albert Asylum), near Lancaster, see Barrett, ‘From Education to Segregation’. For case-studies of the other regional idiot asylums, see Radford and Tipper, Starcross; Gladstone, ‘The Changing Dynamic of Institutional Care’, –.  National in this sense meaning ‘England’. When the Larbert Asylum for the Education of Imbecile Children was founded in  near Falkirk, it was christened the ‘Scottish National Institution’ in contradistinction to Earlswood’s national appellation.

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progress. Many of the technical details were outlined in his early annual reports. Since the charity was based in London, the proposed new asylum had to be within a short distance of the metropolis, preferably near a major railway line. It needed sufficient grounds for a large institution of  patients, and room for gardens and possibly a farm. Lastly, it needed to be built on a hill with sufficient elevation. The cost, originally estimated at £,, reached close to £,, a sum which was about a middling range for an asylum at that time. The final architectural plans elicited respect as well as provoking criticism. Joseph Parkinson, one of the institutions many propagandists, described the building as ‘palatial’; others involved in the Board of Management tempered the rhetoric, guarding against attacks of gratuitous and lavish overspending. After the completion of the façade in , Andrew Reed, of course, was in no doubt as to its intrinsic beauty: It is sufficient to say that it [the new asylum] has met with general approbation. It stands well, on one of our principal lines of Railway[;] it commands attention and admiration; it is a home and not a prison; for looking well;—a substantial dwelling to accommodate  persons could not well cost less.

County and voluntary asylums were amongst the largest and most beautiful structures constructed during the nineteenth century. Provincial cities established holidays and marked the opening of county asylums with parades and fanfare. Local communities saw asylums as a tremendous boost to the local economy, providing direct and indirect employment and creating symbols of scientific progress and civic pride. For the launching of a philanthropic institution, dependent as it would be on the generosity of citizens both local and national, the opening day was crucial to its future viability. After months of careful preparation, the foundation stone of the asylum on Earlswood Common was laid in July . The Board invited all members of the charity and the local Redhill community to attend, at half-a-crown admission, all proceeds going to the charity

 Contemporary medical thought attributed mental as well as physical degeneration to the effects of living in damp, poorly ventilated, and low-lying urban areas. Consequently, professional treatises in the s on asylums for idiots and lunatics proposed the construction of asylums outside of cities on higher elevations in order to secure the maximum therapeutic benefit. See also the discussion on degeneration in Chs.  and .  Jones reports that the cost of county asylums between  and  ranged from £, to £,, and none of these was designed to accommodate over  inmates. Jones, Lunacy, Law and Conscience (London, ), .  Annual Report, AREA, , SRO ///, .

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itself. Trains were donated by the railway companies to transport the guests of honour from London, including the Prince Consort, who performed the ceremonial turning of the soil, and the Bishop of Oxford, who blessed the institution. As Andrew Reed and John Conolly watched with pride, they may not have known that the clouds were already gathering on the horizon of this philanthropic enterprise. Charitable causes came and went, and by the mid-s the cause of ‘educating the idiot’ no longer captured the public imagination in quite the same way it had in the mid-s. Other charities, most notably those championing widows and orphans of soldiers of the Crimean War, diverted funds from the fledgling Asylum for Idiots. William Millard admitted that, in the aftermath of the soil-turning, ‘the contributions were, comparatively speaking, inconsiderable, and the enthusiasm diminished . . .’ Reed’s own sons recall that the charity seemed to be on the brink of financial collapse. Subscriptions slumped and the Secretary had to report to the Board that the charity was £, pounds in debt. Millard commented that ‘much discouragement’ was felt by members of the Board. The Lunacy Commission reported that the Board was having problems reaching quorum. The problems of the Earlswood Board illustrate the capriciousness of many Victorian philanthropic enterprises. Reed, it would seem, had based his prediction of financial viability more on faith than on prudent financial calculations. By , burdened by the expense of a new asylum, the Board decided to transfer patients prematurely from Park House and Essex Hall to Earlswood, even though the construction of the asylum was only partly completed. This exodus, carried out without the knowledge of the Lunacy Commission, provoked a confrontation with the national inspectorate which, up to this point, had been relatively supportive of the Park House experiment. No fewer than three special reports, each printed in embarrassing detail in Parliamentary Papers, were conducted by the lay and medical commissioners in London. Each one condemned the action of the Earlswood Board: As no intimation of the intended removal of the patients had been previously given to the Board, and as the new Building at Earlswood had not been duly registered  

Millard, The Idiot and His Helpers, –. Annual Report, AREA, , SRO ///, ; [Annual] Report, , SRO ///, .  Millard, The Idiot and His Helpers, .  Reed and Reed (eds.), The Life of Andrew Reed, .  Twelfth Report, ARCL, PP [–], xxiii,  [].

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as a Hospital, and was consequently not a legally-constituted receptacle for Insane Patients, a letter was directed to Drs. Reed and Conolly, Joint Secretaries to the Institution, inquiring by whose direction, and under what legal authority and medical adviser, the patients were removed, and whether the premises at Earlswood had been duly ascertained to be in a fit state for their reception.

In the next report the Commissioners concluded that the patients were removed hastily, without ‘legal sanction’, and transported to an asylum that was ‘unfinished, unfurnished, and totally unfit to receive them’. Further, in a damning passage in their yearly report to the Lord Chancellor, one Lunacy Commissioner opined that the Board, instead of making the internal arrangements complete, directed their attention ‘to produc[ing] a pleasing and finished exterior, while many material requirements, essential to the health and training of the inmates, remained unaccomplished’. The Report continued to list, in embarrassing detail, the shortcomings of the charity’s preparations: There were not bedstuffs sufficient for half the patients, and so scanty was the supply of bedding, that it was found necessary to borrow from the neighbouring union workhouse  blankets, by means of which beds were made on the floor . . . The male day-rooms are almost without furniture, and the tables consist merely of boards laid on tressels. There are no blinds or curtains in any of the rooms. Everything, indeed, is in a rough and unfinished state and the disorder and confusion which surround them, must, I think, be injurious to the patients.’

Despite the embarrassment of Shaftesbury’s stinging critique, the impasse reflected the extent to which the Lunacy Commission was a toothless lion. There was little the Lunacy Commissioners could do except to bully the Earlswood Board to comply with the law by shaming them in a public forum. Legally, the Lunacy Commissioners could have ordered the closure of the new institution; but if they contemplated this radical option in private, the Commissioners did not threaten it openly. With powerful allies, many of whom now held prominent positions in Parliament or, in the case of Sir James Clarke, as physician to Her  

Tenth Report, ARCL, PP [] xviii,  []. ‘Reports Made by Visiting Commissioners upon the State and Condition of the Idiot Asylum at Earlswood Reigate,  Oct. ’, Eleventh Report, ARCL, PP [], xvi,  []. His sons recalled the situation thus: ‘On the last day of this eventful year [], Dr. Reed looked with delight on an entire family in the full possession of a building perfectly furnished and pleading daily to thousands of travellers on the Brighton Railway.’ Reed and Reed (eds.), The Life of Andrew Reed, . My italics.  N. Hervey, ‘A Slavish Bowing Down: The Lunacy Commission and the Psychiatric Profession, –’, in Bynum et al. (eds.), The Anatomy of Madness, ii. –.

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Majesty, both Andrew Reed and John Conolly must have been cognizant that it was unlikely that the Commissioners would close them down. Consequently, the charity’s Board chose to put on a brave face (through its annual reports) and pray that the controversy would not affect the reputation of the new institution. Apparently it did not. Timely bequests and a new, aggressive, sermon-driven campaign for funds kept the charity afloat, and by  its worst years had passed. While there was no dramatic turning-point, several factors marked a new beginning. By October  Essex Hall ceased to be a branch asylum of the London charity and was transferred to subscribers from the eastern counties. In  the asylum was completed (ten years after the first soil was turned and eight years after it started admitting patients) and received its Royal Charter. Soon its new medical superintendent, the unknown John Langdon Down, would emerge from the shadows of his mentor, John Conolly, and establish himself as the most-recognized and bestremembered expert on idiocy of the Victorian period. In  the Revd Andrew Reed, pronounced by David Owen to be one of the most important philanthropists of the entire nineteenth century, died in a house that he had built on the grounds of the Earlswood Asylum. He could rest soundly, knowing that the asylum which he contemplated as ‘the last golden link in the chain of charity’ was securely established.

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Care in the Community The history of society’s response to mental disorder has been characterized primarily as a debate over the emergence of asylums and the rise of institutional psychiatry. Institutional histories have focused on what happened within the mental hospital; thus, implicit associations between treatment, care and institutional confinement have occurred. In the minds of historians, treatment became synonymous with institutional treatment, progress was reflected in institutional construction. Further, sociological critiques of mental hospitals have emphasized the experience of inmates in ‘total institutions’. The movement to community care in the last quarter of the twentieth century, however, has precipitated a reevaluation of the asylum era. Mark Finnane, whose case study of confinement in post-famine Ireland remains one of the classic works in the history of psychiatry, stated, in a prescient essay, that the family was the key to understanding the institutional committal of the insane in the nineteenth century: ‘The asylum operated as a particular type of intervention in family life and the lives of those without familial context.’ Recent research has revealed that community and familial networks were not only important to the confinement process; they persisted throughout the asylum era, in parallel to formal medical institutions. Thus the reevaluation of the institution, the community, and the family have been interwoven in the changing historiography. The ‘locus of care’ has been moved to the forefront of the history of public welfare. The persistence of community and household care and control of idiots and lunatics was not unknown to the authorities responsible for regulating the asylum system. From the first decades of the nineteenth century, the lunacy laws empowered county magistrates to conduct informal censuses of insane persons under their jurisdiction, in order to predict the need for institutional provision and to ensure that the laws regarding licensing were being properly respected. Although there is   

Goffman, Asylums, passim. Finnane, ‘Asylums, Families and the State,’ . See Horden and Smith (eds.), The Locus of Care.

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every reason to believe that the Poor Law Guardians, and families, widely under-reported the number of insane persons in the community, the cornucopia of statistics generated by the Lunacy Commission nonetheless reflects a substantial number of the insane kept, in delicate Victorian parlance, ‘at home’ or ‘with friends’. In , for instance, the national returns indicated , insane persons ‘residing with relatives or others’, a number which, the Lunacy Commissioners readily acknowledged, was a gross underestimation. Census returns, which after  required households to list whether their household members were ‘idiots or imbeciles’ or ‘lunatics’, reveal the thousands of mentally disordered and disabled people who remained outside of formal institutional care and control and yet who were often not listed in the Poor Law returns sent to the Lunacy Commissioners. This informal market for the care and control of the insane outside of medical institutions has profound implications for our understanding of the primacy of the asylum in the nineteenth century. Since legal papers were not required by law for individuals kept with relatives, there are no documents with which to judge the care, diet, treatment, and use of mechanical restraint in the community. Thus, a fair comparison of community and institutional care, at least for those who remained outside the criminal system, remains elusive. Bearing in mind the difficulties of evidence, there are extant institutionally generated sources which illuminate hitherto hidden dimensions of the care of idiots and lunatics in the community. Indeed, as will be shown, two admission documents may be used to uncover informal networks of care and supervision prior to institutional committal. The laws governing the confinement of the insane were influenced by the popular and political concern over wrongful confinement dating back to the late eighteenth century. Thus, from  Parliament enshrined a system of inspecting homes receiving paying patients, known hereafter as private patients. By the time of the  Asylums Act, regulations over admissions had extended to the medical certification of inmates sent to charitable, as well as private, institutions. From  all patients, paupers  

Fifty-fourth Report, ARCL, PP [], xxxvii, . For those who committed a crime, the details of the court proceedings provide a fascinating insight into the situation of the insane outside the institutional system, see R. Smith, Trial by Medicine: Insanity and Responsibility in Victorian Trails (Edinburgh, ).  All the medical Certificates of Insanity and Orders for the Reception of a Private Patient for the Earlswood Asylum are located in the Surrey Record Office (SRO) under the title of ‘Admission Papers’, SRO /, and are bundled by year of admission. Hereafter, references for individual certificates of insanity and reception orders will list the name of the inmate and the year of admission.

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included, were required to be certified by a medical practitioner before confinement. As has been shown elsewhere, the certification of insanity evolved in the first half of the nineteenth century so as to exclude asylum superintendents from the certifying process, placing the onus on local medical practitioners and families. The revised Certificate of Insanity, as constituted in the  Lunatics Amendment Act, was a single sheet of paper with explicit instructions for local medical practitioners. After stating the date, his qualification, type of medical practice, and address, the doctor was obliged to classify the person as ‘a lunatic, idiot or person of unsound mind’, and then state his ‘facts indicating insanity’. Below, he was obliged to fill out ‘other facts indicating insanity communicated to me [the doctor] by others’, and state by whom. Notably, then, the Certificates of Insanity allocated as much space to the comments of household members and lay observers as they did to medical practitioners. The format of the certificates remained unchanged until . A second legal document required for all admissions to asylums was an ‘Order for the Reception of a Private Patient’ (hereafter Reception Order). These Reception Orders, signed both by a clergyman or magistrate and the guardian of the patient, included brief descriptions of the social and medical characteristics of patients at the time of admission. The data was then transferred by the clerk of the institution, or the medical officer himself, into the admission register of the asylum. Four questions of the ‘Statement’ section, in particular, provide a window through which to view pre-institutional care of idiot children during the Victorian era. These questions asked the ‘previous place of abode’ of the patients, ‘when and where [they were] previously under treatment’, the ‘duration of their attack [of insanity]’, and ‘whether [they were] suicidal, dangerous or epileptic’. In the case of idiot children, the Reception Orders were invariably signed jointly by a local clergyman, doctor, or magistrate and by a guardian (usually the father). Since the address of the inmates at the committal was given on their respective Certificates of Insanity and Reception Orders, record linkage between these asylum admission documents of , , and  and the family entries in  

Wright, ‘The Certification of Insanity’, –. Certificate Sched. (A) No. , Sects. , , , , , , . From  the Idiots Act of  required only one medical signature for the certification of idiots.  Order for the Reception of a Private Patient, Schedule (A) No. , Secs. , . There were separate forms for the Pauper Reception Orders and Private Reception Orders.  The rows for whether patients were epileptic, suicidal, or dangerous were separate, rather than grouped as a single question.

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

the enumerators’ schedules of the same year was also possible. Of the  families or kin admitting children to the Earlswood Asylum in these census years,  ( per cent) of household schedules were located, giving additional information about the composition of the household, and specific detailed information about those who testified in the certification process. This technique of nominal record linkage, therefore, offers the best of both worlds—comprehensive quantitative data on the composition of households, and rich, qualitative material revealing some affective and dependent relationships between household members and non-co-residing kin. An analysis of the families successfully located in the decennial census household enumerators’ schedules strongly suggests that the pre-institutional environment of caring for idiot children was the household of the parents. Eighty-four per cent of children were present in their household on census night prior to confinement. The type of household seems to be overwhelmingly that of the ‘nuclear’ family:  per cent of these linked households were primary co-residing families without kin. These snapshots of residential patterns are complemented by information from the Reception Orders indicating the duration of co-residence: the overwhelming majority of idiot children had been indicated as ‘always at home’ or ‘always lived with parents’. Previous institutional stay for any child of the sample years was rare: apart from the  per cent of all  The author is grateful to Richard Smith for suggesting this technique. For a similar exercise in the linkage of hospital admission records and the census enumerators’ schedules, see M. Dupree, ‘Family Care and Hospital Care: The ‘Sick Poor’ in Nineteenth-century Glasgow’, Soc. Hist. Med.,  (), –.  When ‘linked’ households are being cited, the reference will include the Reception Order and the Certificate of Insanity and then the Public Record Office reference number (RG) for the enumerator’s schedule of that household.  Of the  households located:  children were present,  were not present, and  were families whose children were admitted before census night and therefore excluded from this calculation.  Out of the  linked households, the numbers are:  (%) Primary Co-residing Families (PCRF);  (%) PCRF with at least one non-relative present;  (%) Extended Co-residing Families (ECF);  (%), two non-related coresiding families. Taken from those admitted to Earlswood between the day of the census and the end of that calendar year regardless of whether the child was present or not. Households were defined, in line with common demographic practice, by including all individuals between respective ‘heads’ of households, excluding visitors. The similarity to Anderson’s % sample of  census is striking: Anderson found (for ) % PCRF, .% PCRF with at least one non-relative of the head present, .% ECF. M. Anderson, ‘Households, Families and Individuals in : Some Preliminary Results From the National Sample From the  Census of Great Britain’, C&C  (), –.

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sample children who were readmissions to Earlswood, only  per cent were indicated as having ever stayed in an hospital or another asylum. This reinforces evidence of other ‘national’ or ‘regional’ studies which suggests that the insane, including idiots, were most likely to be integrated members of a primary family prior to institutional committal. What of the ‘missing’  per cent of children—those not in their households on census night? One might logically assume some sort of Poor Law supervision; however, the Earlswood Asylum did not accept any pauper patients. These absent children, consequently, must have been boarded out or out-nursed in the informal economy of care and supervision which so vexed the Commissioners in Lunacy. ‘There is the strongest ground’, they admitted in , ‘for believing that a much larger number of persons of unsound mind are, in point of fact, deprived of their personal liberty, and kept under care and control as single patients for hire or profit, than the returns made to this office would otherwise indicate . . .’ Here, the ‘previous treatment’ category of the Reception Order fills in some missing information. Henry Markley had been boarded out by his father, a Hackney butcher, with ‘friends’ in the ‘recent past’. Similarly, Fleming Brook, a shopkeeper in Castleford, Yorkshire, had his -year-old daughter, Kate, ‘out-nursed’ for three years before her admission to the asylum, despite the fact that Fleming Brook had a ‘general servant’ enumerated in his household. These twenty-one families with ‘missing’ children range across the occupational spectrum. There also does not appear to be any gender-specificity to boarding out.  A proportion of % of admissions as readmissions was consistent with county pauper lunatic asylums where % of admissions in the Victorian period were ‘first admissions’. See Tomlinson and Carrier (eds.), Asylum in the Community, Fig. ..  Mark Finnane’s case study of  Admission Warrants for the Omagh district asylum in Ireland revealed that % were living with their nearest relative in a ‘nuclear family’. Finnane, Insanity and the Insane, . See also J. Saunders, ‘Quarantining the Weak-minded: Psychiatric Definitions of Degeneracy and the Late-Victorian Asylum’, in Bynum et al. (eds.), The Anatomy of Madness, iii. .  Fourth Report, ARCL, PP, , ,  ().  Certificate of Insanity and Reception Order for Henry Markley, , AREA, SRO /; PRO RG/, a–. See, however, for skilled artisans, the example of Alfred Wilden, the son of a blacksmith, who was boarded out prior to his admission to Earlswood in .  Certificate of Insanity and Reception Order for Kate Brook, , AREA, SRO /; PRO RG/, .  The numbers are:  from families of unskilled labourers,  from skilled labourers,  from clerks and small shopkeepers,  from the professional classes,  from a widow family, and  from families where the father’s occupation was not listed;  boys and  girls were ‘missing’, reflecting the larger number of boys admitted to the asylum.

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

It is widely known that the wealthier families in Victorian England chose to care for their sick and disabled within the household. Formal medical institutions were still associated with the Poor Law, and prosperous families had greater opportunity to hire in nursing assistance. Nursing, in these pre-Nightingale times, still represented a wide range of services incorporating those receiving formal training in medical institutions as well as those who had earned a local reputation for caring for the sick and for infants. Brian Abel Smith suggested that there was some overlap between domestic service and household nursing, and this is clearly seen in the evidence of pre-institutional care of idiot children. Henry Frayling, who, as a Clerk to the Lord Chief Justice, would have been firmly in the middle ranks of society, admitted his son after the death of his wife in . Prior to his wife’s demise two ‘temporary nurses’ were enumerated in his household, presumably with responsibility for the boy. The Fraylings were one of fifteen families with servants who were also listed as ‘nurses’ in the occupation column of the census. Not surprisingly, these nurses were the preserve of prosperous families headed by clergymen and merchants. More problematic is the role in the caring complex of a further forty-three ( per cent) of households with domestic servants listed as ‘general servants’ in the occupation column. These individuals were mostly single or pairs of servants in families headed by small shopkeepers and clerks. Michael Anderson has suggested that these individual servants, as well as ‘unoccupied’ female residents and lodgers, would have been available for caring responsibilities, but their precise duties, in the case of these institutionalizing households, is unclear. The picture which emerges, then, is of an environment of caring which centres on the primary co-residing family, with the responsibility for caring responding to life-cycle changes. If this is accurate, then how can we more firmly determine who was doing the caring within the household, and what dimensions this caring took? In line with most general surveys of women’s unpaid work within the household, the primary responsibility of caring for idiot children in the Victorian era seems to  

a.

B. Abel-Smith, A History of the Nursing Profession (London, ), . Certificate of Insanity and Reception Order for Henry Frayling, , RG/,

 M. Anderson, Family Structure in Nineteenth Century Lancashire (London, ), ; E. Higgs, ‘The Tabulation of Occupations in the Nineteenth Century Census with Special Reference to Domestic Servants’, LPS (), –.  E. Roberts, Women’s Work, ch. ; Jane Rendall, Women in an Industrializing Society, ch. .

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have fallen disproportionately on mothers and elder daughters. The first set of evidence for this derives from the testimony given to the local medical practitioners. While the father tended to sign the Reception Order, it was disproportionately mothers and sisters of the patient who retold stories of household dependence, disruption, and deviance in the certificates of insanity. Of the certificates where the informant is given, doctors attributed testimony as coming from the mother in  per cent of cases, compared to  per cent as from the father. Similarly, sisters outnumbered brothers nearly three to one. This does not mean, however, that caring was exclusively a female domain: there are many examples in the certificates of brothers and fathers intervening to control violence or aggression. Caring was, however, disproportionately the prerogative of mothers and daughters. Ellen Ross has argued that the years of between  and  were ‘caretaker’ years for children, when the daughter or son was responsible for running errands, child-minding, and ancillary domestic assistance. The contribution of siblings to caring patterns was overt and explicit in the Earlswood Certificates of Insanity, the frequency of interventions depending often upon the nature of the employment of the mother. If she was required to be out at certain times of the day or of the year, then the other children were expected to step in and fulfil the caring duties. As Diana Gittins has demonstrated, caring often fell on the shoulders of elder daughters who had not married or had not been released into the ‘formal economy’. Hence we have the example of Emma Offer, a year-old unmarried governess still living with her parents, who told a certifying practitioner how her -year-old sister, Adele, was ‘not able to dress herself, [or] able to cut up her own food [and] incapable of taking care of herself ’. This may well be an example of how even grown women, if still unmarried and co-residing with their parents, owed ‘allegiance’ as carers for members of their ‘biological’ household.  The testimony by either grandparents or neighbours or ‘friends’ occurs in less than % of all certificates where an informant’s relationship to the idiot child is given.  E. Ross, ‘Labour and Love: Rediscovering London’s Working Class Mothers, –’, in J. Lewis (ed.), Labour and Love: Women’s Experience of Home and Family, – (Oxford, ), .  For an example of how caring duties of daughters in a rural setting could vary seasonally, see P. Horn, Victorian Countrywomen (Oxford, ), .  D. Gittins, ‘Marital Status, Work and Kinship, –’, in Lewis (ed.), Labour and Love, .  Certificate of Insanity for Adele Offer, , AREA, SRO /; PRO RG/, a–.  Gittins, ‘Marital Status’, .

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The certificates of insanity provide clues to the way in which Victorians responded to, and identified, idiocy. Sarah Roberts of Notting Hill acknowledged her son’s inability to dress himself and his being ‘entirely dependent on the help of other persons’. His two older brothers may have assisted; but as they were employed outside the household as clerks, it is more likely that the mother attended to most of his needs. Many children unable to dress themselves would have been subsumed under the more general category, often described as ‘not being able to care for themselves’. Toileting and general ‘hygiene’ represented a further area around which the onerous duties of caring had to be directed. The brother of Henry Brooks informed the local practitioner that Henry had been unable to ‘hold his urine or faeces for going on eight years’, and others complained of the constant ‘soiling of bed & dress’ requiring extra laundering duties. Some idiot children ‘made known their wants by screaming’, at which time certain unnamed family members had to render assistance. Families of the middle classes spoke delicately of their son’s or daughter’s ‘inattention to the calls of nature’. One mother recounted the problems of toileting by saying that her daughter, when requiring ‘relief of the bladder or bowels’, would in the street ask persons to ‘unfasten her drawers’. Families could do little but improvise. Stephen Wand, a chemist from Leicester, stated that because his son had a tendency to ‘pass urine involuntarily’ a ‘receptacle’ was kept constantly at hand. Assistance in feeding, dressing, and toileting represented direct intervention of family members, often at specific times of the day, and was, no doubt, hindered by the incapability of many of these children to ‘make known their wants’ or ‘understand any question’. Caring, however, often included an informal supervisory role. The danger of open fireplaces in the homes of all social classes presented a challenge to families needing to keep a watch over the erratic and, at times, unpredictable behaviour of a child. Some toddlers were guilty of ‘playing with fire’ or ‘putting things into the fire’; others had a habit of injuring themselves by either setting

 Certificate of Insanity and Reception Order for William Roberts, ; PRO RG/, .  Certificate of Insanity for Henry Brooks, .  Certificate of Insanity for Wilfred Bucknall, .  Certificates of Insanity for John Evington and William Feesey, .  Certificate of Insanity for Mary White, .  Certificate of Insanity for Alfred Wand, ; PRO RG /, a.

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fire to their clothes or directly burning themselves. Mary Blagrove seems to have suffered from the stresses of such supervision. A ‘glazier’s wife’ in Reading, Mrs Blagrove had to watch over her daughter, who was ‘constantly getting into the fire and coal’. This required family members to keep idiot children away from the hearth or, in another case, from laying their hands on Lucifer matches. The possibility of the child’s carrying the fire to different parts of the home had other obviously dangerous implications beyond self-injury. Clare Banner testified to the doctor that her sister once took a lighted branch from the fire up into her bedroom and crawled under the bed. Even the habit of lighting paper, ostensibly for amusement, would be enough to cause families grave concern. As with -year-old Louisa Adams, the daughter of a farm bailiff in Fletching, Sussex, such an indifference to the danger of fire could require ‘constant care & watching’ by one or more members of the family. These issues, however, were not entirely novel: as Akihito Suzuki illustrates in his analysis of institutional committal in early modern London, concern over fire, arson, or self-injury revealed by families petitioning Quarter Sessions animated discussion about insanity and family care for hundreds of years. Uncontrollable ‘excitability’ could also pose specific challenges to families. Mrs Barker stated that Edward was ‘of a very excitable temperament’, and that she was ‘obliged to keep knives and other instruments out of his way’. Children tore clothes, ripped the bindings off books, spilled boiling water on others or on themselves, threw knifes randomly, upset chairs, broke furniture, hid under beds with burning articles, and did ‘all sorts of mischief ’ not further defined in the certificates. The complete certificate for James Cox gives one the impression of the range of ‘mischief ’ detailed to the first local medical practitioner consulted:  Certificate of Insanity for Thomas Woodcock, , Clamida Smalls, , or Frederick Everitt, . ‘Mary Ann Ashfield of  Russell St Bermondsey says that Emily Lewis had several times burned herself, ‘yet will go and burn herself [again]’. Certificate of Insanity for Emily Lewis, .  The  Census did not ask for the enumeration of idiots or imbeciles, or lunatics. This began in  in response partly to the belief, as witnessed above, that idiot children were being returned as ‘dumb’. My own research of future inmates of Earlswood suggests, however, that the labelling of idiot children as ‘dumb’ was relatively uncommon. This research uncovered only  such cases out of a possible .  Certificate of Insanity for Ethel Watkins, .  Ibid.  Certificate of Insanity for Amy Banner, .  Certificate of Insanity for Louisa Adams, .  Suzuki, ‘Lunacy in Seventeenth- and Eighteenth-century England’, –.  Certificate of Insanity for Edward Barker, .

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. He is never quiet, he is always crowing like a Cock or barking as a dog . He tears his clothes to pieces, cuts up all the apron strings & boot laces he can get . He has thrown the school keys, hammer and hard bill down the privy . He throws anything he can get at at any person or thing to which he takes a disliking

and to the second practitioner: ‘He runs away all day without his clothes if he can get away. He strangled a rabbit . . . because it bit him when feeding it. Requires constant care to prevent his doing improbable acts of mischief.’ As many mothers and fathers testified, vigilance was the only recourse. With such demands on family resources, it is not surprising that many, like George Wheeler, a gardener from Hammersmith, complained to medical practitioners that the rest of the family were obliged to keep watch constantly over his daughter. Mothers lamented to their doctors that their idiot children would eat anything—rotten apples, dirt, coal—or that they would feed turpentine to unsuspecting baby siblings. Lucy Pinchard, a widow from Exeter, admitted to the certifying medical practitioner that her year-old son ‘requires constant watching, giving more trouble than a baby’. Social disorder in the household also merited comment in Certificates of Insanity. Behaviour usually described as ‘spiteful’ or ‘passionate’ included biting, slapping, and pushing other children or the mother. In these cases, those charged with caring were also prime targets for injury. When Alfred Curters, a ‘clerk in Holy Orders’, presented his -year-old daughter Ellen to his local medical practitioner in Dover, he testified that she had ‘shown a strong propensity to injure her own brothers & sisters’. Notably, Ellen was the eldest of the four siblings in the enumerator’s schedule, suggesting a possible problem for families with violent or aggressive children but with no older child in the household to intervene. Even ‘occasional’ or ‘threatened’ violence could force families to take pre-emptive action such as restraint or sequestration within the home. Although historians tend to associate restraint with institutional treatment, fragmentary evidence suggests that such expediencies were   

Certificate of Insanity for James Cox, . Certificate of Insanity for Alice Wheeler, . ‘His mother informs me that he puts everything which is given him into his mouth.’ Certificate of Insanity for William Figg, .  Certificate of Insanity for George Pinchard, .  Certificate of Insanity for Ellen Curters, , RG/, .

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resorted to frequently in the community as well. A quotation from one case of inspection of a Commission in Lunacy gives an example: The cottage, externally and internally, was in a state of great dilapidation, and presented an aspect of extreme poverty. The Idiot is about six years of age; and of the other children living with their parents, five in number, the youngest is now only eight months old. The parents appeared to be very respectable and kindly disposed, but obviously not in a position properly to maintain and take care of their poor Idiot Child, who, on account of her restlessness and violent agitation, and for her own protection, had been during the past two years kept in restraint day and night. . . . When seen by the Visiting Commissioner she was lying in a cradle crying out and beating her head and face, and with her arms, legs, and body confined by bands.

Exceptional investigations like these tend to suggest, as Mark Finnane has illustrated in his work on post-famine Ireland, that restraint constituted a common response to self-injury and aggressive behaviour in the nineteenth century, and was not the sole prerogative of formal mental institutions. Medical assistance for the co-morbid symptoms experienced by idiot children was also reported in admission papers. Approximately one-tenth of the Reception Orders allude to epileptic fits. Caroline Diplock of Southampton testified to the local practitioner that her ‘Deaf & Dumb’ son Henry remained in a ‘disturbed’ state after ‘constant’ fits and would slap his elder sister afterward. The seizures themselves varied enormously in frequency and severity—‘four or five times a day’, ‘twice a day’, ‘daily’, ‘frequent’, ‘once a week’. The ‘prostration of mind’, ‘falling’, or general state of ‘mental torpor’ which followed in the aftermath of a seizure necessitated watching day and night. One mother alluded to the injuries sustained by her child because of losing consciousness and falling  ‘Report of the Visiting Commissioner to the house of a village shoemaker at Haracott, near Barnstaple, Barnstaple Union’, Nineteenth Report, ARCL, PP, , .  Finnane, Insanity and the Insane, , –.  This figure is lower than one might expect and is due to a policy of the Asylum Board of Governors to limit the numbers with high rates of epileptic fits because of the extra demands these placed on staff.  Certificate of Insanity and Reception Order for Henry Diplock, ; PRO RG/, a–.  The Commissioners in Lunacy recommended night attendants for all lunatic asylums because of the number of deaths of epileptics who, after having a seizure in the middle of the night, had suffocated themselves. Twenty-eighth Report of the Commissioners in Lunacy, PP, , xxvii, . See also Certificate of Insanity for Frederick Timbers, ; William Jacobs, .

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during an ‘attack’. It was the treatment of epilepsy, not the general mental disability of the child, for which local medical practitioners were sometimes called in periodically to prescribe medicines or special diets. For instance, Stephen Ward, a chemist and druggist from Leicester, had his epileptic son treated at home by a Dr Jackson. In these cases of medical assistance, names and addresses of individual practitioners were listed under the ‘previous treatment’ column of the Reception Orders. Included are local surgeons and surgeon-apothecaries and parish doctors. Sometimes a visit to the home was followed by out-patient ‘treatment’ at a local infirmary or dispensary—the Cheltenham, Bristol, Wrexham, and Clapham dispensaries all treating future inmates of Earlswood when the patients were younger. More specialized treatment at the London Epileptic Hospital or the Children’s Hospital on Great Ormond Street was rarer and tended to be relatively short, often no more than a few months. The vast majority of responses to the question of whether the prospective inmate had ever been under ‘previous treatment’, however, was simply ‘never’ or ‘only under parents’, reinforcing the argument made earlier that the household was the primary locus of care. So far this chapter has detailed caring, control, and supervision of idiot children within the physical dimensions of the household—but what of the division between household and neighbourhood? It has often been implied that, in the absence of asylum treatment, the insane were free to wander about the community unchecked. This depiction seems to have been constructed by historians as a rhetorical foil against which to show the incarceration of the insane in purpose-built institutions, rather than as an accurate description of the liberty experienced by the mentally disabled in Victorian England. Testimony from the certificates illustrates that many relatives saw the household as a place of confinement from which the child was not supposed to escape. Henry Markwick, a carpenter from Brighton, stated that his -year-old daughter ‘cannot be left alone; if left alone would stray away and could not find way back again’, and there are a few testimonies of children straying or getting lost, and   

Certificate of Insanity for Alfred Wand, . See also James Baker, . Reception Orders for John Lees,  and Stephen Ward, . See e.g. Reception Orders for Ellen Curters/Curtis, , William Cooke, , Gertrude Harding, ,  Reception Orders for Emily Lewis, Mary Shee, Willliam Taplin, ; Robert Campbell, ; Charles Wallis, ; Louisa Wheeler, ; Mary White, ; John Jones, .  Certificate of Insanity for Henry Markwick, ,

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staying out overnight. John Twiddy had a habit of wandering into other peoples houses; so too did Walter Price, who was often found in a neighbour’s bed. Twelve-year-old Thomas Carney, if left to his own devices, would run naked through the street of St Pancras, London, ‘without evincing any shame’. On a more serious note, family members feared that the child was not capable of perceiving danger. Besides being ‘unable to be left alone for any time’, John Evington, according to his father, ‘has always evinced a strong desire to run into the Humber’. One young woman told the doctor that, ‘if a Horse, Carriage or Cart was coming quickly along the road she [her sister] would not draw to one side to get out of danger’, while another boy actively endeavoured to ‘throw himself under the wheels of carriages’ passing by. As a consequence, one infers from the Certificates of Insanity that houses themselves became informal ‘asylums’ outside of which the child was not allowed to go unattended. The dependent clauses of ‘if let outside’ or ‘if not properly controlled’ imply that, for some of these children, there were prescribed territories of movement. On the other hand, there are some cases of children being sent to a parish, ‘ragged’, or national school (and often being sent back home as helpless cases). Some certifying medical practitioners alluded to instances of coming into contact with the idiot children in the local neighbourhood. One such child, James Cox, seemed to have been a frequent caller at his local doctor’s home: ‘Frequently following after me and telling me to go and see persons, saying they have sent [him] when such is not the case, coming to my door and asking for victuals, after he has had sufficient at home.’ And in only one of six instances of neighbours testifying in the Certificates of Insanity, community members of Shrivenham confirmed the ‘strange occurrences’ witnessed by the local medical practitioner of one local idiot wandering about in the neighbourhood. As stated earlier, the permanence of mental disability was a crucial factor in differentiating it from lunacy. This developmental stasis,        

Certificate of Insanity for Ephraim Day, . Certificate of Insanity for Walter Price, . Certificate of Insanity for Thomas Carner, . Certificate of Insanity for John Evington, . Certificate of Insanity for Benjamin Harrow, . Certificate of Insanity for James Cox, . Certificate of Insanity for Ephraim Day, . The  Lunatics Act defined an idiot in the following manner: ‘Every person whose mind from his birth by a perpetual infirmity is so deficient as to be incapable of directing him in any matter which requires thought or judgement, is in legal phraseology an idiot.’ Philips, The Law Concerning Lunatics, –.

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therefore, had important implications for the patterns of caring within the household. The Reception Orders queried the ‘duration of attack’, a question which was conceived, presumably, with lunatics in mind. Nevertheless, parents interpreted it in one of two ways: the duration of epileptic fits or the duration of the disability. In the latter cases, most parents simply said the child had ‘always been an idiot’ or was an ‘idiot from birth’. Some Certificates of Insanity allude to a deteriorating condition—‘been worse of late’—but the fragmentary nature of these descriptions precludes any conclusion that in many of these cases things were getting worse. In fact, parents were frustrated by the stasis and the dayin, day-out caring while their other children, and their neighbours’ children, grew up and assumed their responsibilities in the natural life-cycle of their respective families. The implications of permanent dependence was noted by contemporaries. John Conolly alluded to the changing nature of care over the life-cycle of the family, when describing the ‘typical’ poor family seeking admission for their child at the Earlswood Asylum: You will find it [the idiot child] in winter placed by the fire, and in summer by the door, seated in a little chair, or lying in a little bed . . . It cannot dress itself, nor feed itself, nor help itself in any way . . . The matter of admiration is, that this imperfect little creature, which only entails privations upon them, is still to them an object of even peculiarly tender solicitude . . . [they] seem to love their afflicted brother or sister more than they love each other. They watch it, they protect it from danger, they try to amuse it, they draw it about, and they give it some of their own little portions of food. With increased stature and strength, however, the necessity of labour comes upon them. One by one they go from home, and support themselves. The poor imbecile also remains and becomes an even heavier burden to its father and mother when years are gathering over them.

Conolly’s sentimental portrayal of the typical family petitioning the Earlswood Board was designed as much to elicit contributions to the asylum as to depict the crisis of caring within the household. Yet it does raise the issue of caring over the lifespan of the family, and of how responsibilities changed as siblings grew older. The importance of the family life-cycle to the problems of caring will be discussed in the next chapter; suffice to say, however, that a crisis of care in the family could  John Conolly, lecture to a Cambridge meeting, as quoted in Clark, A Memoir of John Conolly, –. Note that Conolly uses a dehumanized ‘it’ rather than the traditional gendered ‘he/him’ to described the archetypal idiot children. I am grateful to Anne Digby for pointing this out.  Gittins, ‘Marital Status’, .

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well be predicated upon certain demographic features such as the absence of elder children in the household. It is also likely that, as the family aged and as daughters and sons left the household to marry or take up paid employment, the duties and responsibilities of caring may well have been transferred from one sibling to another. This, naturally, raises the question Conolly alluded to above, of what the ageing parents did with an adult idiot still dependent on them. The importance of life-course transitions, and the ability of households to adapt to changing economic circumstances, need to be investigated more fully in order to answer these questions, especially with respect to two national developments: the decline in fertility and the rise of compulsory elementary education. Both of these factors must have had a profound impact on the availability of children during their ‘caretaker’ years and, hence, the ability of children and adolescents to assist in caring for dependent members. Following the Lunacy Act of , the household became a place for the formal certification of idiot children, a process that provided crucial information for the medical superintendents at the time of a child’s admission. The process of confinement, in which local doctors were required by law to describe insane behaviour, created a situation whereby medical practitioners were faced with the problem of certifying insanity as part of an increasingly disparate range of activities. Contemporary evidence suggests that they were not always entirely comfortable with this new responsibility. Medical textbooks and articles in medical journals provided examples of ‘satisfactory and unsatisfactory’ Certificates of Insanity in textbooks, such as Charles Philips’s Hints on Insanity, published in , in order to assist local practitioners. There were also legal texts to which medical men, if they knew of them could turn for guidance. Philips, a lawyer who sat as a lay member of the Lunacy Commission, drew on legal precedents to formulate his definition of what constituted insanity in his textbook The Law Concerning Lunatics, Idiots, and Persons of Unsound Mind. As Michael MacDonald has argued, any analysis of the changing approaches to the history of mental disorders must start by understanding the ‘role of the observers as well as the observed’. And the medical  D. Gittins, Fair Sex: Family Size and Structure – (London, ), ; J. Lewis, ‘Introduction’, in Lewis (ed.), Labour and Love, –.  As cited in P. McCandless, ‘Liberty and Lunacy: The Victorians and Wrongful Confinement’, JSH,  (), .  Philips, The Law Concerning Lunatics, –.  MacDonald, ‘Madness, Suicide and the Computer’, .

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observers of idiocy represented the breadth of the Victorian medical profession. The Certificates of Insanity asked for the name, address, qualifications, and type of practice engaged in by the certifying medical practitioner. The details of medical men for the years , , and , representing  certificates, produced profiles of  medical practitioners in the period of  and , as listed in Table .. The certifying doctors were most commonly surgeons by licence, being either licentiates, members, or fellows of the Royal Colleges of Surgeons of London, England, or Edinburgh. Over half of these surgeons had added a licence in apothecary from the London Society of Apothecaries, the Apothecaries Hall, or the Company of Apothecaries. Inevitably, if they had such a dual qualification they listed themselves as practising ‘surgeon-apothecaries’ or, less commonly, ‘general practitioners’. Licentiates or Fellows of the Royal College of Physicians, and those who listed only their graduation from Oxford or Cambridge, made up  per cent or fewer of the examining doctors in each year. The stereotypical hierarchy of professional designation did not necessarily correspond to the status of the family approaching them for certification. Physicians certified children of families across the socio-economic spectrum, from rich private clergy families to families headed by clerks, brass-finishers, and coachmen, whose children were accepted as charitable cases to the asylum. There were also many surgeons and surgeon-apothecaries certifying children of professional or manufacturing families who were willing to pay Earlswood’s minimum annual fee of  guineas. This supports the thesis of a certain ‘fluidity’ of medical roles in the competitive medical market of the nineteenth century. A comparison of the addresses of the certifying doctors compared to the places of abode of the inmates’ family (derived from Reception Orders) shows that these medical practitioners were overwhelmingly from the local area in which the inmate lived prior to confinement;  Certificates of Insanity for non-pauper admissions required two signing medical practitioners, but a few doctors signed more than one medical certificate. Therefore the total number of individual doctors does not correspond to exactly twice as many admissions.  A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, –, esp. ch. .  In contrast to MacKenzie’s findings for the certification of patients to Ticehurst, the practice of certifying admissions at the asylum or in the local neighbourhood of the institution was not common for patients destined for the Earlswood Asylum. Fewer than , or  per cent of cases, may be considered to have fallen into this category and, in the cases certified at the asylum, this was usually so if the child was transferred from another asylum prior to admission to Earlswood or if the parents lived abroad.

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T A B L E .  Licenses held by doctors certifying admissions to Earlswood Asylum, , ,  License(s) listed by certifying doctors Physician (only) Physician and surgeon Surgeon (only) Surgeon-apothecary Apothecary only Physician, surgeon and apothecary MD alone MD and physician MD and surgeon MD, surgeon and apothecary MB Not listed/not known T O TA L







           

           





Total

(%)

           

           

           





many could be assumed to have known the child in question. In some instances the doctor used his familiarity with the prospective patient as a justification for his authority in the certification process: ‘I have known the child in question for many years,’ commented one practitioner, ‘and have no doubt as to his being idiotic.’ Charles Ray, a ‘general practitioner’ licensed in surgery and apothecary, stated that he had attended Edith Little on three or four occasions, and that she was ‘obviously an idiot’. A local medical practitioner briefly described his past interactions with a -year-old boy as part of his reasons for medical certification: Have seen the child from time to time for  years past when visiting other patients at the house. He has an imbecile manner & expression, mutters unintelligibly to himself. When asked to put out his tongue e.g. he takes no notice beyond making some grimaces & walks off to the other side of the room—shewn a penny & asked what it is, he cannot tell. Makes known his desires in an imbecile fashion . . .

 Certificate for Edward Barker, , SRO //. All certificates are listed under the series SRO /, and henceforth the person and the year will only be listed.  Certificate for Edith Little, .  Certificate for Thomas Pritchard, .

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

Unlike the medieval lunatico inquirendo, a public occasion encouraging the participation and testimony of neighbours, the certification of idiot children appears to have been a more private matter, conducted in the midst, and with the testimony, of co-residents and family members, and completed in the household of the family or the surgery of the medical practitioner. References in the certificates to people outside the nuclear family usually occurred only in the case of the death of a breadwinner, or when ‘nurses’ had helped with pre-institutional caring. Fathers tended to sign the Reception Orders, but the facts communicated to the medical practitioners in the certificates rely heavily on the testimony of women— hence entries such as ‘her grandmother says she cannot be taught’, or ‘she is at times violent—her sister’, indicating that those primarily responsible for care in the household also took the lead in giving evidence to the doctors. The medical ‘indications’ of insanity described many of the same social or intellectual deficits, but incorporated lay testimony into an older legal tradition of ‘interrogation’ and a new medical approach to ‘seeing the idiot’. The legal examination of idiocy dates back to medieval statutes governing property rites. The Prerogativa Regis outlined the requirements of the crown to persons idiot or lunatic, and prompted ‘inquisitions’ by royal officials to determine the validity of the allegation of lunacy or idiocy. An early seventeenth-century legal dictionary listed several practical methods of evaluating idiocy: ‘Idiot is he that is a fool natural from his birth and knows not how to account or number  pence, nor cannot name his father or mother, nor of what age himself is, or such like easy and common matters; so that it appears he has no manner of understanding or reason, nor government of himself, what is for his profit or disprofit.’ Peter Rushton has shown that these basic tests—counting to twenty, knowing the name of one’s parents or neighbours, knowing the seasons or coinage—persisted into the early modern period as practical tests for idiocy in north-east England. This inquisition or interrogation of the person did not disappear with the emergence of a ‘modern’ medical profession. Quite the contrary. Medical practitioners borrowed heavily from these centuries-old prescriptions. Many wrote, in the Victorian certificates, that the idiot children were unable to state their names, places of abode, and days of the week. ‘Unable to recollect her   

R. Neugebauer, ‘Mental Handicap in Medieval and Early Modern England’. As quoted in Neugebauer, . Rushton, ‘Idiocy, the Family and the Community’, –.

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own Christian name or age,’ wrote William Wilson, a physician from Cheltenham, ‘or name the number of brothers & sisters in her family.’ There was also the well-known use of coins for testing counting: ‘He is quite unable to tell the sum of three or four coins,’ wrote the Exeter physician Samuel Budd in , ‘[he] told me that there were six pences [sic] to make a shilling.’ Asking the child the correct month, year, and the name of the queen were all common. With children who answered these preliminary questions correctly, the doctors usually went on to present them with simple problems of arithmetic, reading, or writing, reflecting a process of rudimentary mental testing decades before the emergence of compulsory education and the filtering of backward children into separate schools. Built into the doctors’ evaluation was a consideration of age and developmental ability: ‘Though [about]  years age—[he] does not know the season of the year or the day of the week.’ It has been argued that families testified in medical certificates of the social skills deficits of the child from a perspective of household activities, such as the inability to care for themselves, fulfil age- and sex-specific responsibilities, or the presence of violent and uncontrollable behaviour. The brief medical examinations of children tended not to dwell on deficits of self-care; rather, they highlighted the ‘peculiarity of manner’, ‘excited, repetitive behaviour’, or ‘grovelling on the floor’ exhibited during the certification examination. By necessity, the testimony of the medical practitioners mention the ‘inability’ or ‘disinclination’ of the child to respond when spoken to. ‘Inability to speak distinctly and childishness of manner’, wrote George Harrison, a surgeon from Brixton Hill, in the medical certificate for Walter White in . Other children were described as speaking ‘clumsily’ or ‘incoherently’, or ‘humming’ and ‘laughing’ without notice of those around them. In  John Bucknill, then President of the Medico-Psychological Association, wrote an article complaining about the poor standards of medical Certificates of Insanity. He stressed that medical men should place first consideration on the appearance of the patient. By doing so  

Certificate for William Pitts, . G. Sutherland, Ability, Merit and Measurement: Mental Testing and English Education, – (Oxford, ).  Certificate, patient .  This was not simply a case of conflating idiocy with deaf and dumb children: ‘Although he can hear[,] he cannot speak he has no intelligence & does not understand when spoken to’, concluded Thomas Edgeworth, a Bristol surgeon of the idiot child, Henry Lee, in . Certificate for Henry Lee, .  J. Bucknill, ‘On Medical Certificates of Insanity’, JMS  (), .

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he was highlighting the importance of representing the insane in a new and normalizing way. As Sander Gilman has argued, modern medical observers have found it necessary to ‘see the insane’ by compartmentalizing them into coherent and identifiable types, thereby demarcating the boundaries between the sane and the insane, and in this case between the idiot and the ‘normal’. This visualization was obsessed with the countenance of the idiot. The ‘wandering eye’, ‘imbecilic expression’, ‘unmeaning grimace’, and the ‘fixed and unmeaning stare’ are phrases representative of the new medical descriptions of what an idiot ‘looked like’. Common words recur. One-quarter of all medical certificates noted the ‘vacancy’ of the child. Many doctors used phrases such as ‘a typical vacant look of an idiot’, implying the shared cultural understanding with the undefined audience about how an idiot appeared. As noted earlier, there was no requirement for medical practitioners to refer to ‘textbooks’ on insanity or to call upon expert authority to validate their determination of insanity. Considering how infrequently some medical practitioners may have certified insanity, however, one would have thought that they would have felt safer invoking the opinions of experts in the field. But there is not one certificate in the  studied which mentions a medical treatise, the thoughts of a distinguished alienist, or gives references to any medical article. Nor can one see a reflection of the themes of heredity, consanguinity, or degeneration which were beginning to preoccupy the theorizing of alienists. This suggests a chasm between the local certification of insanity and the medical specialization occurring in mid-Victorian medical journals of the time. Rather, there was a local interplay of lay and medical ideas that informed each other. C O N C LU S I O N

Within the history of medicine two debates persist about the care of the insane in general, and the care of dependent family members in particular: to what extent did formal medical institutions replace the family as society’s response to the problem of insanity; and to what extent was caring for dependent family members outside of formal institutions restricted to the ‘autonomous’ nuclear family. In the light of parliamentary returns,  Sander Gilman, Disease and Representation: Images of Illness From Madness to Aids (London, ), .  For two recent contributions to these two debates see, respectively, A. Scull, ‘Museums of Madness Revisited’, Soc. Hist. Med.,  (), –, and B. Reay, ‘Kinship and

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lunacy statistics, and the pre-institutional experience of patients admitted to the Earlswood Asylum, Victorian households constituted the primary locus of care for idiots both prior to, and in lieu of, institutional confinement. Previous institutional confinement was rare and long-stay confinement even rarer. Boarding out and out-nursing did occur, across class divides, but the Earlswood Asylum records suggest that they represented a minority of cases. Widowed families tended to combine with kin in the household to fulfil the role of the dead parent: caring by kin when primary families were intact seems the exception rather than the rule. A common criticism about any analysis that relies in part on enumerators’ schedules is that it overemphasizes the importance of household members at the expense of kin and neighbourhood networks. Similarly, it is a possibility that the process of testifying during the certification of idiocy (and insanity) downplayed the role of local caring networks, and that the admission documents discussed in this chapter, like the census schedules, exaggerate the importance of the household members in the ‘informal economy of care’. On the other hand, there were no restrictions or specifications as to who testified to the local medical practitioner. Nowhere on the Certificate of Insanity does it state that the informant had to be the guardian or even a member of the household. Indeed, recent research on the certification of lunatics reveals a significant participation of Poor Law officials, most often when the patient had been housed in a workhouse. Considering the overwhelming preponderance of household members in the process of certification and committal of idiot children, it is possible, therefore, that the idyll of the benevolent working- class neighbour sharing in the burden of care, which has been highlighted by recent oral histories, may be somewhat exaggerated. A second qualification about using Certificates of Insanity, Reception Orders, and census schedules to illuminate the complex matrix of care in an industrializing society is that the admission records testify to the problems of families who would eventually seek an institutional solution to their problem. Thus, these records are biased in favour of the failures of family care, rather than the successes. Consequently, it is possible to speculate that those families seeking institutional confinement may be biased towards those household units who had few kinship supports. Lastly, the nature of the certificates is such that problems of the Neighbourhood in Nineteenth-Century Rural England: The Myth of the Autonomous Nuclear Family’, JFH  (), –.  G. Levi, ‘Family and Kin—a Few Thoughts’, JFH  (), –.  Melling et al., ‘A Proper Lunatic for Two Years’, –.

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

care are intermixed with ‘indications of insanity’ required by law. Thus, they are not intended explicitly to describe the patterns of care and supervision in the past. Notwithstanding these caveats, it is clear that the decision to institutionalize children was one of an array of options in, often, a life-time struggle to cope with dependent children under the social dislocation associated with industrialization and urbanization. The next chapter will explore in greater detail what factors may have influenced some families to choose the institutional over the familial in the complex nexus of caring.

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

Institutionalizing Households The admission procedure to the Earlswood Asylum enshrined the principle that the family sought and negotiated the application for a place in the asylum. Often applications were endorsed by a prominent and respectable member of the local community—the vicar, a medical man, or county magistrate. Those prospective patients who had been inspected and had completed vaccinations and medical inspections were then officially inscribed on the next election list of applicants. The medical superintendent sent papers to the clerk in London, who typed an election card with the relevant details of the case and wrote to the parents to inform them of their successful candidacy. Cards were sent out to all subscribers to the charity in time for proxies for the semiannual elections. After the biannual meeting and elections the families of successful candidates were required to comply with the  Acts by having the child certified as insane and by completing a Reception Order. These documents, described in the previous chapter, were kept at the asylum, and relevant information was transferred into the admission register alongside the date of admission. The exploration of these asylum records, through record linkage to census enumerators’ schedules of their families, permits an investigation of many aspects of household structure, occupation, place of residence, and length of stay. This chapter will analyse households grouped by paying status—the private paying families, the partial paying families, and the charitable cases. Tables included in the chapter allow for comparisons of different ‘status’ families within categories such as occupation or place of abode.

 ‘Dear Mother, I am requested to state that the Board have accepted the Case of your Child, Harry H., for Election, and you are at liberty to canvass the Subscribers for votes,’ ‘Letter Copying Book’, no. . (Jan.  to Apr. ), AREA, SRO ///, .  The total number of admissions depended not only on the financial position of the Society, but also on the numbers who may have died or been discharged in a particular year. Thus, the extraordinarily large number of admissions in  reflected not only the relatively prosperous condition of the charity, but also the fact that several inmates had died from an outbreak of scarlatina.

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

P R I VAT E PAT I E N T S

Until recently it has been taken as axiomatic that the swelling of the number of admissions to public asylums meant that it was the very poor who were disproportionately incarcerated. There is now abundant evidence to suggest that this was not entirely true. The private ‘trade in lunacy’ in madhouses persisted throughout the Victorian period. Although the proportion of patients resident in private licensed homes declined over the course of the nineteenth century, there remained no fewer than ninety-nine provincial licensed homes and forty-seven Metropolitan licensed homes by the s. Moreover, there were significant numbers of fee-paying patients in charitable asylums and even in county pauper lunatic asylums. Indeed, many medical superintendents, after having spent years in pauper or charitable institutions gathering experience in insanity (and cultivating connections with potential clients), left the public institutions for lucrative private practices. The private sector of provision for the insane remained buoyant, and charitable trustees, like the Earlswood Board of Management, had to resist the temptation to be swamped by private applicants. As we shall see, the demand for private institutional provision lured many medical men away from public and charitable institutions, including the famous superintendent of the Earlswood Asylum, John Langdon Down. The pressure to accept private patients occurred almost as soon as the Earlswood Charity was established. Originally intended for the ‘respectable poor’, enquiries from wealthy families forced the Earlswood Board to debate a policy of allowing a limited number of fee-paying clients. Eventually it was agreed to follow this course, based on the expedient reason that the private patients would subsidize the charitable cases. Subsequently, over the thirty-three-year period under study the Board of Management of Earlswood admitted  private patients, and refused more than twice that number. The annual charge for private care    

Scull, The Most Solitary of Afflictions, . Parry-Jones, The Trade in Lunacy, passim; MacKenzie, Psychiatry for the Rich, ch. . MacKenzie, Psychiatry for the Rich, . Smith, ‘Levelled to the Same Common Standard?’, –; Digby, Madness, Morality and Medicine, –, and Tables .–..  The prevalence of private patients varied from county to county, depending upon the availability of private and charitable accommodation. Peter Bartlett, ‘The Poor Law of Lunacy: The Administration of Pauper Lunatics in Mid-Nineteenth-Century England, With Special Reference to Leicestershire and Rutland’, unpublished Ph.D. thesis, UCL (), , .  See Ch. .  Annual Report, , AREA, SRO ///, .

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Institutionalizing Households 1856

1861

23 patients in Metropolitan region –2 in Guernsey

19 patients in Metropolitan region

Earlswood Asylum 100 km

Earlswood Asylum 100 km

1866

1871

24 patients in Metropolitan region

28 patients in Metropolitan region

Earlswood Asylum 100 km

Earlswood Asylum 100 km

F I G . .. Previous place of abode of patients admitted to the Earlswood Asylum in five-year intervals, ‒

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Institutionalizing Households 1876

1881

33 patients in Metropolitan region –1 in Dublin

19 patients in Metropolitan region

Earlswood Asylum

Earlswood Asylum

100 km

1886 23 patients in Metropolitan region

Earlswood Asylum 100 km

F I G . .. (continued)

100 km

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was set at £, although families could negotiate special service, and even individual attendants, for higher annual sums. The minimum level of payment seems to have been set with competing private homes in mind. The Ticehurst Asylum in neighbouring Sussex, for instance, also set its minimum charge at £ per annum and welcomed idiot as well as lunatic private patients. The occupations of fathers, as listed in the Reception Orders, indicate that the families sending children to Earlswood as private patients were representatives of the professional and manufacturing classes, including surgeons, solicitors, merchants, shipbrokers, and manufacturers. The families showed a predisposition to live in and around London, suggesting upwardly mobile members of the new urban middle class rather than traditional landed interests. Although these professional and manufacturing families were predominantly urban-based, an analysis of the places of birth suggests that they were rather mobile, with twothirds of mothers and over one-half of fathers being born outside their county of enumeration (see Tables . and .). Unlike many admissions to county pauper lunatic asylums, which were often precipitated by household violence, the threat of suicide, or delusional behaviour, the admission of idiot children does not seem to have been typically triggered by a specific sequence of events. In the absence of a precipitating incident, the decision of wealthy families to seek institutional care, therefore, offers a fascinating case study in the slow evolution from private domestic nursing of mental disorders to formal institutional treatment. When one scrutinizes the household schedules of these wealthy families, every household had servants, some of whom were listed as ‘nurses’ in the occupation column of the census. This strongly suggests that these domestics fulfilled the role of nurse-carers in the home prior to institutional committal, an assumption borne out by their testimony in some of the Certificates of Insanity. For instance, Annie Coates, one of two domestic servants to a   

Some families paid as much as £ p.a. MacKenzie, Psychiatry for the Rich, . Migration, of course, is notoriously difficult to gauge, and I will be using only the crudest of indicators—namely, a comparison of the county of birth of parents versus the county of their census enumeration. D. E. Baines, ‘The Use of Published Census Data in Migration Studies’, in E. A. Wrigley (ed.), Nineteenth Century Society: Essays in the Use of Quantitative Methods for the Study of Social Data (Cambridge, ), –. There have been several studies to suggest that individuals giving birthplace information to census enumerators were not always consistent in their identification of town of birth. Both Anderson and Dupree found approximately % of cases in their respective samples gave different birthplaces from the previous census. This does not hold true for the identification of county of birth. As cited in M. Dupree, ‘Family Structure in the Staffordshire Potteries, –’, unpublished Oxford D.Phil. thesis (), .

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T A B L E .  Birthplace of fathers and mothers of families admitting children to the Earlswood Asylum, selected years, – Parents (%) of private (feepaying) patients

Villages/ small towns Mediumsized towns Large towns Cities Subtotal n/a T O TA L

Parents (%) of subsidized (partial fee-paying) patients

Parents (%) n/a of charitable patients (those receiving free care)

Total (%)





































 

 

 

 

 

 

 

 

 

  

  

  

  

  

Sources: Admission Papers, Earlswood Asylum, AREA, SRO, ⁄⁄-; Registers of Names, residences, etc. of Cases, Earlswood Asylum, SRO ⁄⁄; Population tables, Census of England and Wales, ‒: for , PP  LIII Pt.  [], for , PP LXXI Pt.  [‒I], for , PP  LXXX [c.].

-year-old banker’s clerk in Wandsworth, told the certifying medical practitioner that her charge, a future private inmate of the Earlswood Asylum, ‘cannot dress or feed himself, that he eats ravenously & bolts his food; that he is inattentive to the calls of nature; that he is restless and destructive’. Annie Coates, though listed as a housekeeper in the census of , is referred to in the medical certificate as ‘the boy’s nurse’. Institutional confinement, in these cases, could not have occurred for reasons of financial gain, since the lowest private rate of £ per annum was the equivalent cost to a family of two full-time domestic servants.  Certificate of Insanity for James Allan, ; Census for England and Wales, , RG/, a.  A private domestic servant in the south-east of England at the time might cost £–£ p.a. in wages and the same again in room and board. P. Horn, The Rise and Fall of the Domestic Servant (Gloucester, ), , Table .

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T A B L E .  Size of towns in which families admitting children to the Earlswood Asylum were resident, selected years, ‒ Birthplace

Parents (%) of private (feepaying) patients

(a) Fathers Within county  Outside of county  Subtotal n/a T O TA L

 

  

T O TA L

  

Parents (%) n/a of charitable patients (those receiving free care)



















  

(b) Mothers Within county  Outside of county  Subtotal n/a

Parents (%) of subsidized (partial fee-paying) patients

  

Total (%)











 

  

































 

  

  

  

Sources: Admission Papers, Earlswood Asylum, AREA, SRO AREA, ⁄⁄-; Registers of Names, residences, etc. of Cases, Earlswood Asylum, SRO ⁄⁄; Population tables, Census of England and Wales, ‒: for , PP  LIII Pt.  [], for , PP LXXI Pt.  [‒I], for , PP  LXXX [c.].

If prosperous families did not gain financially from the decision to incarcerate a disabled member, one must turn to more elusive social and cultural reasons behind institutional confinement. It is widely accepted that hospitals established in Georgian and Victorian times were created for the ‘respectable poor’, with a lower level of institutional pauper provision for the indigent. Historians have detailed how wealthy families sought private domiciliary treatment for most illnesses, rather than subject themselves to formal medical institutions. Attitudes to institutional treatment, however, 

Woodward, To Do the Sick No Harm, ch. .

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were changing, and the potential beneficial effect of the treatment of mental disorders in purpose-built institutions seems to be one of the leading areas in which families were prepared to try out the reputed benefits of segregated treatment.  This transformation in attitudes may have been promoted by the lunacy reform movement, in which mad-doctors campaigned claiming miraculous cures for the mentally disordered, and the apparently remarkable advances in the education of idiot children recalled earlier in this book. Although propagandists refrained from claiming that idiocy could be ‘cured’, they did make exaggerated predictions of the effectiveness of separate, specialized institutional treatment. Moreover, the attempts of asylum proprietors to tailor the comforts of private patients to meet the expectations of the family may also have lessened the reluctance of some well-heeled families to use charitable or private institutions. For instance, paying patients at Earlswood slept in private rooms, dined separately (with silver service), and, although they attended classes with the other children, did not engage in any manual pursuits in the workshops. The increasing demand for private care may have thus reflected the impact of some of these ideas as the ‘therapeutic’ asylum distanced itself from the prison and the Poor Law workhouse. Without detailed financial records of the household concerned, it is impossible to say precisely what proportion of their income private families were willing to spend on asylum care. One stray letter to the Board, however, suggests that in certain cases it represented a significant amount of a household’s annual income. Mr Ben Stoha wrote to the Board in  setting out his financial predicament: Dear Sir, My average income I compute at from £ to £ per annum—on which I have a wife and five children (including the applicant for admission to the asylum) to maintain, and out of which all expenses have to be met . . . I would feel obliged if he could for the present be received into the Asylum . . . as soon as possible into the lowest [private] rate—which would be a considerable relief in the expense— with my limited means . . . I remain, Sir, yours, most respectfully, B. Stoha.

After receiving letters testifying to the good character of the father, the Board agreed to admit his child as a private patient at £ per annum, a sum equal to nearly one-third of Stoha’s annual income. Some of Stoha’s   

Tomes, A Generous Confidence, ch. . Scull, ‘From Madness to Mental Illness’, –. Letter to the Board, //; AREA, SRO ///, .

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money to pay for private care may have come from accumulated savings, but it is perhaps not surprising that the child stayed for only two years before being discharged by order of the father. It would be facile, however, to conclude that ‘respectable families’ happily resorted to institutional confinement to conceal embarrassing relatives. When one analyses the length of stay from the admission registers, one does not see the unequivocal ‘dumping’ of unwanted household members. The database study from the admission register shows that families opted for a variety of lengths of stay: one-third of private admissions stayed for two years or less, and only a quarter of admissions stayed for very long periods of time (Fig. .). The distribution of duration was relatively unaffected if disaggregated by death or by sex. It is thus perhaps more compelling to speculate that prosperous families tried out the asylum and, unconvinced of the results, or unwilling to pay such a price for institutional care which did not meet expectations, decided to revert to care within the domicile, or alternative private care in the ‘community’. S U B S I D I Z E D PAT I E N T S

Families further down the socio-economic hierarchy of Victorian society also experimented with asylum treatment. The bulk of subsidized care, for instance, went to families of the emerging ‘lower middle class’, families of limited means whose heads of household were employed as shopkeepers, clerks, or prosperous artisans. Those families eligible for subsidized care contributed between £ and £ per annum depending upon their ability to pay. As stated above, the reports on the financial position of the family made by the Board are no longer extant, but fragmentary evidence suggests that family members haggled with members of the Board in order to secure admission at a reduced fee. One father was told that with an income of £ per annum and four children, he would be expected to offer to pay at least £ per annum towards his son’s fees if he wanted to be included on the Charity’s election roll. Moreover, the mean household size of non-private families (.), taken, as Anderson instructs, by beginning with the head of the house and continuing until the next ‘head’ occurs, suggests larger household sizes than those found in a study of the Staffordshire Potteries (mean of .) or



Minutes of the Case Committee, AREA, SRO ///, .

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Institutionalizing Households 60% Private Subsidized Charitable

40%

20%

>2 0y ea rs

10 <2 0y ea rs

10 ye ar s 5<

2< 5y ea rs

1< 2y ea rs

0%

<1 2m on th s

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F I G . .. Length of stay of Earlswood patients, including readmissions, all patients admitted between  and  (n = ). Sources: Admission Papers, AREA, SRO, ⁄⁄‒; Registers of Names, Residences, etc. of Cases, AREA, SRO ⁄⁄; Population tables, Census of England and Wales, -‒; for , PP , liii, Pt. I [], for , PP lxxi, Pt. II [‒], for , PP, , lxxx [c.].

the Lancashire city of Preston (mean of .). Table . lists the household structure of families located in the decennial census enumerators’ schedules. Almost exactly the same proportion of primary co-residing domestic groups were found in the Earlswood sample as in the published sample of the national () census. Fifteen per cent of non-private households contained one non-conjugal relative compared to the national () figure of  per cent. Those households with three or more generations, with lodgers, or headed by widows also did not vary markedly from national averages. Of the few extended families found, these appeared most often in cases where one of the parents of the child had died. Thus, Thomas Kendrick, a -year-old ‘Cigar Maker’, lived  The mean household size for England and Wales ( census) was .. One would expect larger-than-normal household sizes, since households including Earlswood families would have, by definition, at least one parent and at least one child. This, however, does not detract from the point about life-cycle poverty made below.  Anderson, ‘Households, Families and Individuals in ’, –; M. Dupree, Family Structure in the Staffordshire Potteries, – (Oxford, ), ch. .  R. Wall, ‘Regional and Temporal Variations in the Structure of the British Household Since ’, in T. Barker and M. Drake (eds.), Population and Society in Britain, – (London, ), . Precise figures for the residence of non-conjugal kin are extremely difficult, considering the inconsistency of census enumerators who returned some kin as servants under the ‘relationship to head of household column’ of the Census for England and Wales.

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with his widowed sister who had, according to the  census schedule, two ‘imbecile sons’, one of whom had a habit of setting his clothes on fire. Jane Aldridge, a widow ‘housekeeper’ in the Horsham census of , had to cope with Eva, her -year-old daughter, who could not, according to the Certificate of Insanity, feed or dress herself, and two thirty-something brothers, one of whom was ‘deaf & dumb from birth’. These extended families imply, as has been suggested elsewhere, that widows and widowers adopted strategies of household formation in ‘critical life situations’, specifically the integration of an unmarried kin of the opposite sex. John Walton, in his study of the provision for pauper lunatics in Lancashire, suggested that the families of those sending relatives to the asylum came disproportionately from urban centres. This phenomenon was certainly not replicated with non-private families admitting children to the Earlswood Asylum in the period under study. As we have seen in Table .,  per cent of subsidized and  per cent of charitable children in the sample group came from small towns which, in the population indexes of the censuses,  were listed as having fewer than , inhabitants. Those living in small market towns make up a consistent onequarter of all families, such as the Morgells, who lived in Hindon, Wiltshire ( pop. ), or the Bennetts, a family who, in , lived in St Giles, Devon (pop. approx. ). Since the  census marked the turning-point at which more than  per cent of English society was living in towns in excess of , inhabitants, one cannot find evidence of an urban bias which seems to have been shown for the private patients to the same institution. In conclusion then, decisive evidence cannot be marshalled to justify isolating household size, household type, or urban living as contributing factors in the confinement of idiot children. But as the discussion of the sizeable charitable population will reveal, there were peculiarities in the household composition of poor families which may lend 

.



–.  

Certificate of Insanity and Reception Order for Frederick Everitt, , RG/, Certificate of Insanity and Reception Order for Eva Aldridge, , RG/,

Anderson, Family Structure, –, Table . Walton, ‘Lunacy in the Industrial Revolution’, –. Though Walton’s findings are, as he concedes, ambiguous, inasmuch as in addition to the statistically significant number of families coming from the most urban areas, the predominantly rural districts in his sample contributed more than the ‘smaller industrial centres’. Ibid. .  Town size was calculated using the population tables in the Census Reports. For the years , , , the population given for the census five years before and five years after the year in question were averaged.

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

weight to the hypothesis that there were demographic factors which made certain families more likely to seek confinement. C H A R I TA B L E A D M I S S I O N S

The Earlswood Asylum was founded upon the desire to provide institutional treatment to families who could not afford to pay for private care. Despite the acceptance of some private admissions, and the innovation of reduced-fee paying families, the Board of the asylum were fervent in their advocacy of this original goal. Of the , patients admitted during the period, over half were from families who paid nothing towards the care and treatment of their children. The families of these charitable patients were not paupers, or they would have been rendered ineligible for election by the rules of the Management Board. Rather, they were part of the ‘respectable’ or ‘deserving’ poor who motivated philanthropic organizations throughout the Georgian and Victorian periods. The fathers of these , children were employed as gardeners, stablemen, shepherds, agricultural labourers, railway labourers, policemen, butlers, coachmen, painters, ropemakers, wire-drawers, sawyers, plate-layers, carpenters, silversmiths, upholsterers, and tanners—a remarkable diversity of occupations. There was even a significant minority who were members of what would gradually be termed the ‘lower middle class’, including clerks, bakers, shopkeepers, schoolmasters, grocers, agents, and tailors. Many of these families, it may be assumed, were not destitute but were ‘cash poor’, unable to marshal the funds needed for private care or domiciliary nursing of a disabled family member. Most charitable families did not have the resources of servants to assist in the responsibility of caring within the family itself. Thus, anomalies in family composition or occupation may have rendered some poor families incapable of maintaining the precarious balance between productive and caring resources within the household. In a household without resources to pay for a domestic ‘carer’ or for private medical treatment, poor families would have become reliant on informal networks of reciprocal caring within the household or between non-co-residing kin. An examination of the household schedules of charitable families suggests that families which sought institutional treatment may have inadvertently distanced themselves from such resources through migration. While one might expect a low percentage of parents of mobile professional families to have been born in the same county of enumeration, those of elected and subsidised families fluctuated between

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TABLE . Household structures of families admitting children to the Earlswood Asylum, selected years, ‒ Parents (w) of private (feepaying) patients

Nuclear familya Stem Familyb Two CRFc Subtotal n/a T O TA L

Parents (w) of subsidized (partial fee-paying) patients

Parents (w) of charitable patients (those receiving free care)

Total

(w)

















  

  

  

  

  

  

  

  

 

a Nuclear family—no cousins, grandparents, nieces, nephews; bStem Family (two or more lineally related ever-married persons and their families, if any); cTwo co-residing families not related; (w) widow/widower-headed households

Sources: Admission Papers, Earlswood Asylum, Surrey Record Office (SRO), ⁄⁄-; Registers of Names, residences, etc. of Cases, Earlswood Asylum, SRO ⁄⁄; Population tables, Census of England and Wales, ‒: for , PP  LIII Pt. I [], for , PP LXXI Pt. II [–I], for , PP  LXXX [c.].

only  and  per cent. Comparisons with local studies suggest that this amount of family ‘life-time’ migration is high. Most published studies found that between  and  per cent of (male) heads of household were born in the same county of enumeration. These findings do not necessarily mean that the families of charitable patients were rootless; indeed, the nature of the system of ‘election’ would have necessitated that the  B. Wojciechowska, ‘Brenchley: A Study in Migratory Movements in a MidNineteenth-Century Rural parish’, LPS  (), .  The relationship between migration and confinement in medical institutions is now a matter of some dispute. For a study of a voluntary hospital which suggests that patients were well rooted in local communities, see M. Dupree, ‘Family Care and Hospital Care’, esp. . For a study of the confinement of idiot children, see D. Wright, ‘Family Strategies and the Institutional Committal of “Idiot” Children in Victorian England’, JFH  (), –. For a contrary view, see R. Adair, J. Melling, and W. Forsythe, ‘Migration, Family Structure and Pauper Lunacy in Victorian England: Admissions to the Devon County Pauper Lunatic Asylum, –’, C&C  (), –.

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

family be well enough known to be considered ‘respectable’ by a local figure. Rather, the result of the extensive nominal record linkage with census schedules suggests that kin-availability was lower than in ‘average’ families, thus possibly adding to the household crisis of care. In his study of Iowa families committing ‘exceptional children’ to a ‘mental retardation’ institute in , Mark Friedberger found unusual ranking orders in the children confined. In particular, he concluded that firstborn male children with (only) younger sisters were sent to the institutions much earlier than idiot boys with younger brothers. A similar anomaly was found in the Earlswood household schedules. The first- or second-eldest children in their respective households comprised twothirds of all charitable admissions. This does not mean that these children were the first or second children of their respective families: it is possible that older brothers or sisters may have left home or that other children may have died. Rather, they are the first- or second-oldest children in the census schedule. When compared against a random selection of children from the same families, both the eldest children, and the eldest and second-eldest children together, were statistically significant. This suggests that there was an unusual absence of older brothers and sisters in the household, pointing to a crisis of supervision and care. For caring, amongst the poorest families, though primarily the responsibility of mothers, often devolved onto older siblings. Thus, the absence of older brothers and sisters to care, control, and feed a disabled sibling, coupled with a higher-than-normal migration pattern (thus distancing the families from relations) may well have made these poor families vulnerable to seeking confinement. That is, it may have tipped the scale in favour of asylum rather than community care.  Unfortunately, there is no systematic and detailed information on the number of families who may have wanted to confine children but did not know any subscribers of the institution, nor information on who applied but were never elected.  M. Friedberger, ‘The Decision to Institutionalize: Families with Exceptional Children in ’, JFH  (), .  Given the distribution of children, one would expect a random selection of the children to be weighted towards the higher ranks. For example, the probability of the rankings first, second, and third, of three families with  child,  children, and  children, would be /, /, and / respectively. Thus, to evaluate properly the ranking data one must set up a probability of the respective ranks and compare the data found with it.  The first ranked children were significant at the % level using a two sample t-test and an f-test, and significant to a .% level using a z-test (the NH assumed the proportions of families in category  (random) and category  (ranks found) were equal in the two samples). The combined first and second rank are significant to a .% level. The first and second eldest children of charitable families were also significant using the Kolgomorov–Smirnov test.

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Institutionalizing Households C O N C LU S I O N

Historical research has underlined the importance of life-cycle poverty to the pressures of household economies. In particular, published work has emphasized the relative surpluses and deficits accrued by families during different life-cycle stages. According to this argument, families suffered the greatest financial stress when their child-bearing years had ended, but before the children had begun to contribute more to the household than they took out of it. The relative deficits of children tended to hit families when the parents were between the ages of  and  (assuming three or more children). This ‘critical’ period seems to correspond well to the distribution of ages of mothers of charitable admissions at the time of institutionalization: their interquartile age range was  to  years old. As Wall and Henderson have shown in a recent edited volume, poor families in the past sought to alleviate financial crises by manipulating welfare provision as a strategic means of overcoming crises of short-term duration. Thus, the confinement of idiot children for two to five years echoes the findings of Hunecke, who detailed the ‘misuse’ of foundling hospitals in early nineteenth-century France by poor families eager to relieve themselves of a ‘consuming child’ for a few years before returning to reclaim them. Here one sees similar strategic uses of the voluntary English idiot asylum by poor families in the nineteenth century faced by economic crises and, distanced by kin resources, turning to institutional provision as a way of reducing the number of dependants. Instead of the ‘strategic abandonment’ of children in foundling hospitals, one sees ‘strategic confinement’ of idiot children in Victorian idiot asylums. The argument in favour of reconceptualizing the admission of idiot children as a process of strategic confinement, rather than the ‘dumping’ of unwanted family members, is reinforced by the lengths of stay of these inmates. Earlswood was dominated by medium-term admissions. This was partly due to the asylum policy, designed to incorporate a training and educational rather than strictly curative or custodial function. Consequently, the length of stay for charitable cases was clustered around  R. M. Smith, ‘ Some Issues Concerning Families and their Property in Rural England, –’, in Smith (ed.) Land, Kinship and Life-Cycle (London, ), – and Table ..  J. Henderson and R. Wall (eds.), Poor Women and Children in the European Past (London, ).  V. Hunecke, ‘The Abandonment of Legitimate Children in Nineteenth-Century Milan and the European Context’, in R. Wall and J. Henderson (eds.), Poor Women and Children in the European Past (London, ), –.

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

the five-year period of training. The reduction in length of stay and the decrease in institutional mortality meant that the proportion of those being discharged actually increased during the period under consideration. The chances of an inmate dying in the asylum decreased rapidly over this period, from a high of  per cent in the s to well under  per cent in the s. Since most inmates were only marginally improved by their stay at the Earlswood Asylum, it is possible that the problem of care and control reoccurred once they returned to their household after discharge. Nevertheless, numerous letters from grateful parents attest to the relief the intervening years had given to the family. The confinement of the insane and the explosion in the accommodation for idiots, lunatics, and persons of unsound mind in nineteenthcentury Europe and America was driven by families of all social and geographical backgrounds. As has been shown in this chapter, many upwardly mobile members of the middle class were willing, under certain circumstances, to seek asylum care for their children rather than domiciliary care and treatment. Some, as we have seen, were even willing to pay considerable sums for this privilege. This represents, if not a dramatic conversion to medical approaches to insanity, then at least a signal of the decline in the stigma attached to certification and confinement. But poor families were faced with a narrower range of options. Families sought aid from kin or neighbours, colleagues, voluntary societies, or parochial authorities to overcome periods of crisis or the death of key members of the family. With the proliferation of medical institutions in the late eighteenth and nineteenth centuries, families had a new and free option for care. Not all families with idiot children petitioned for and received relief in a charitable asylum. This chapter, therefore, has focused on what factors may have contributed to the decision to institutionalize. Migration, and the resultant distancing from kin resources, was only one of a range of contributing household factors which may have made certain poor families vulnerable to seeking confinement. When this was coupled with a larger-than-usual family size, coinciding at a point in the family’s lifecycle when the greatest strains were put upon the household, it seems that these families were liable to send out a disabled child to an institution. The lack of elder siblings might well have compounded this situation by causing a crisis of caring within the household. In the case of disruptive adolescent boys, there may have been few to control them within the household. This diminution in the number of siblings would have been exacerbated by the turn of the century, when older children,

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traditional carers of the old and dependent, were forced into formal, fulltime elementary education in England and other western countries. Whatever the precise reasons for confinement, families turned in their hundreds to seek institutional confinement of their idiot children, first in the Earlswood Asylum and later in the regional asylums built on the Earlswood model. The following chapter will explore in detail the characteristics of the patients who successfully navigated through the selection process.

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

Idiots by Election The Victorian period was marked by the rapid increase in the number and size of county lunatic asylums. The average size of these institutions rose from  in  to  by the end of Victoria’s reign. The sheer scale of these institutions made them some of the largest and most imposing buildings in the country at that time. A similar pattern of growth marked some of the principal idiot asylums during the same period. The Northern Counties (Royal Albert) Asylum and the Western Counties (Starcross) both experienced rapid expansion after they were constructed in the s. Similarly, the Earlswood Asylum, built originally for  occupants, was full in , and after it had expanded its facilities in  reached its full capacity of  residents in  (see Fig. .). As mentioned in the Introduction, the socio-demographic characteristics of patients admitted to lunatic asylums has received intense academic scrutiny. The analysis of patients admitted to idiot asylums, by contrast, is practically non-existent. Relating the charitable dimensions of admission to voluntary hospitals to the legislation of the lunacy laws, one can see that admission to these asylums poses fascinating questions about the nature of institutional confinement in the nineteenth century. Within this context, this chapter explores some aspects of the admission and length of stay of patients. The steady rise in the number of inmates at Earlswood reflected the explicit policy by the Board and the financial position of the charity as a whole. As the charity’s constitution stated, the Board had control over the number of elections per year and were to set them on the basis of the asylum’s financial position. The number of annual admissions varied, but the asylum could expect to admit between sixty and eighty new cases every year (Fig. .). The flow of new entries depended not only on the financial position of the Society, but also on the numbers of inmates who may have died or been discharged in a particular year. Thus, the extraordinarily high number of admissions in  reflected not only the relatively  

Radford and Tipper, Starcross, ch. ; Barrett, ‘From Education to Segregation’, passim. Minute Book,  Oct. , AREA, SRO ///, .

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Idiots by Election

700 600

Boys Girls

500 400 300 200 100 0

18 55 18 57 18 59 18 61 18 63 18 65 18 67 18 69 18 71 18 73 18 75 18 77 18 79 18 81 18 83 18 85 18 87 18 89

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F I G . .. Number of patients resident, Earlswood Asylum, ‒ Source: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄⁄‒.

prosperous condition of the charity, but also the fact that several inmates had died following a Scarlatina (scarlet fever) epidemic. As a charitable asylum, the Earlswood Board sought to aid the ‘respectable’ poor of Victorian Britain, who were defined as those who had never received relief from the poor rates and who were too poor to pay for private care. Thus, throughout this period the subscribers of the asylum elected candidates (charitable patients) from a general polling ballot. These patients paid no fees and were elected to a five-year term, once renewable. A time-limited period of admission was not unusual for charitable hospitals or even some charitable asylums: the famous Bethlem Hospital, for instance, placed a limit of twelve months on all charitable patients during this time. As mentioned in Chapter , the Earlswood Board also realized that there was a large demand for asylum care for idiot children of the wealthier classes. They thus allowed for a limited number of private patients who paid £ per annum or more for treatment, and justified this on the expedient grounds that the expensive fees would subsidize the charitable cases. Because of certain financial stresses which all charities underwent in the nineteenth century, the Board, within the first five years of its existence, decided to allow for the admission of patients whose families were willing to pay a token amount per year, but could not pay full fees. Consequently, these families paid between £ and 

J. Andrews et al., A History of Bethlem (London, ).

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Idiots by Election Subsidized

Charitable

Unknown

Private

100% 80% 60% 40% 20% 86

84

18

82 18

18

80

78

76

74

72

70

18

18

18

18

18

18

66

64

62

60

68 18

18

18

18

18

58

0% 18

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F I G . .. Admission status of patients, by year, Earlswood Asylum, ‒ ( not available). Total number of patients = , Source: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄⁄‒.

£ per annum for treatment. The care of these subsidized (fee-paying) patients was not limited to any specific time period, although the Board tried to enforce a five-year maximum. It was not uncommon, however, for patients to switch status during the time of their stay in the asylum. Although the existence of patients admitted on the basis of three different payment levels contributed to some confusion in terms of institutional policy, it was not at all unusual for Victorian asylums. Indeed, most asylums in the nineteenth century operated a flexible system of payment and quasi-charitable provision. The York Retreat had at least five different payment levels based on a family’s ability to pay. The early nineteenth-century county pauper lunatic asylums operated a policy of accepting both pauper and private patients (private being those who paid their own way). Some of the county asylums were, in fact, jointly operated by  There were also three rarer categories of patients: Life Elections, i.e., candidates from poor, usually widowed, families who were elected for the whole of their lifetime; Presentations, who were life admissions purchased for  Guineas; and Life Payments, who paid a lump some for permanent care. For the purposes of this chapter and Ch. , Life Elections will be included with regular elections; Life Payments and Presentations will be included with the regular Private Patients.  It is clear from the records that some inmates moved between categories. There was no bar to families who sought to secure for children already admitted to the asylum election as reduced-fee paying cases. Similarly, families could seek re-election for another five year term for patients who were in the asylum or since discharged. In addition, some patients moved from private to reduced-fee paying or vice-versa or between election and, at the end of the term, reduced-fee paying. These changes were not systematically recorded, and so only the status of first admissions will be used.  Digby, Madness, Morality and Medicine, ch. .

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county magistrates (in charge of the pauper side) and charitable trustees (administering the philanthropic admissions). In these cases, complicated situations arose whereby the county magistrates approved the admission of private and pauper patients to the same institution where charitable governors accepted partial- or no-fee paying patients. The Nottinghamshire and Lincoln county asylums, the first ‘jointly run’ county institutions, operated on this basis; so too did the Leicestershire and Rutland County Asylum. Even the infamous private madhouses— licensed institutions inspected by the state but run for profit—had a flexible and ever-changing system of payment. There also was no great consistency in the asylums which were ostensibly constructed on the Earlswood model. The Western Counties (Starcross) Asylum for Idiots, near Exeter, which admitted pauper idiot children from Devon Unions, and the Northern Counties (Royal Albert) Asylum for Idiots in Lancaster both accepted pauper and private patients in addition to their charitable admissions. Seen in the context of the times, the approach of the Earlswood Board of Governors was less capricious than it appears. And, to the credit of its members, the desire to accommodate the increasing demand for private patients did not obscure the central mission of providing relief to the respectable poor. Table . lists the status of all admissions to Earlswood Asylum. Taken as a whole, three-fifths of patients were elected, the vast majority for regular five-year periods. Onefifth were accepted as reduced-fee paying and another one-fifth as private patients. Patients admitted to any asylum constitute those who were ‘successful’ in passing the various hurdles on the way to institutional confinement, but what of those who were not successful? What types of patient were rejected outright by the Earlswood Board as unsuitable? The impetus for the construction of the asylum was to ‘educate the idiot’, to provide a symbol of progress in an age of improvement. There was a moral imperative, therefore, for the Board of Management to give priority to inmates deemed to be ‘improvable’ or ‘educable’. In practice, this meant that the asylum, in the s and s, tended to reject idiots whose epileptic fits, prior to or at the time of admission, were frequent or severe enough to cause disruption, require intense supervision by staff, or result in rapid mental deterioration. Similarly, violent children who were perceived as   

Smith, Cure, Comfort and Safe Custody, ch. . Bartlett, The Poor Law of Lunacy, passim. Radford and Tipper, Starcross; M. Barrett, ‘From Education to Segregation’.

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being uncontrollable were dismissed as too disruptive to what was, in part at least, conceived of as an educative institution. If children were so physically weak as not to be expected to live for the intended period of training, the Board tended to reject them before they reached the polling papers. The procedure of selection and rejection was formalized in , when the Earlswood Board created a Case Committee which screened applicants. The Committee was surprisingly small—three members met bi-monthly at the charity’s office in London. The members vetted applicants and rejected any children who had ever been, or were currently, on parish (Poor Law) relief. Unfortunately, the Case Committee minutes are fragmentary. Thus, one can only reconstruct the rejection of candidates by random inscriptions. Cases younger than  were deferred; pauper cases were rejected outright. Some children were refused because they had serious physical disabilities. Sometimes the recommendations involved haggling over reduced payment levels. ‘F.F.’, an applicant for reduced admission, was recommended for full payment. ‘Radbrooke Crescent’, retorted one member sarcastically, ‘is not inhabited by poor people.’ Those who had been inspected and had completed vaccinations and medical inspections were then officially inscribed on the next election list of applicants. The medical superintendent would send the admission papers to the Secretary of the Asylum in London, who would type an appropriate election card with the relevant details of the case. Cards were sent out to all subscribers in time for proxies for the semi-annual elections. An election card from  remains in the records of the Earlswood Asylum. Presumably written by one of the applicants’ advocates listed at the bottom of the card, it gives the salient details of the candidate Charles Spencer, aged , an orphan from Lutterworth. The details of his plight are mentioned in a short, six-sentence summary. However, equally important were the influential recommenders, two of whom took responsibility for accepting proxies. Much has been made of the apparently disproportionate incarceration  It is worth remarking that the Board believed that violent idiots should be sent to lunatic asylums, where the means of control and surveillance were more comprehensive than at charitable asylums such as Earlswood.  There was, however, a reference to a ‘deaf & dumb’ applicant where Dr Grabham, who replaced Dr Langdon Down as medical superintendent, did not consider it a disqualification.  Case Committee Book, AREA, SRO ///, .  See Ch. , n. .

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of women in nineteenth-century asylums. Notwithstanding the debate over this controversial thesis, it is clear that the confinement of idiot children was directed disproportionately at adolescent boys rather than girls. Indeed, twice as many idiot boys were admitted as idiot girls. Victorian commentators found this unusual and speculated on the possible causes. Some opined that idiocy was more prevalent in boys than girls. The general reports of the  and  censuses, for instance, estimated that congenital idiocy was  per cent more likely in male offspring than in female. However, it is likely that this ratio may have reflected in part the petitions by families and the selection process itself. As stated in Chapter , the household problems of idiot boys may have been more intractable and difficult than those of girls. The selection of boys may also have reflected the general bias of Victorian society towards the need to produce self-sufficient young men, whereby the selection of boys for training may have been reinforced. Without counterfactual data on families and applicants who were never admitted, the question of the gendering of idiocy remains in need of further research. The Earlswood Asylum was designed as an institution for children and adolescents. This principle was enshrined in the constitution, and underlined the educational nature of the institution. It also reflected the belief that, if progress were to be made in training, it must be commenced at an early but educable age. Thus the asylum tended to look unfavourably on any applicants below the age of  and rejected outright any under the age of . As a result of this policy, the mean age was lower than that found in county lunatic asylums, remaining between  and  years of age over the Victorian period. Ninety per cent of all admissions were between the ages of  and . However, the violent nature of some of the adolescents and the mixed success of their training prompted the Board to suggest that perhaps younger admissions would be more amenable to education: ‘Whenever practicable, the training and education of feeble and imperfect  E. Showalter, The Female Malady: Women, Madness and English Culture, – (New York, ) and id., ‘Victorian Women and Insanity’, in Scull (ed.) Madhouses, Maddoctors and Madmen, –.  For the critiques of Showalter’s conclusions, see J. Busfield, ‘Sexism and Psychiatry’, Soc.  (), –; and Busfield, ‘The Female Malady?: Men, Women and Madness in Nineteenth-Century Britain’, Soc.  (), –.  General Report, Census of England and Wales, , PP [] , . The disproportionate admission rate may have been a direct policy of the Board of Management, although the annual reports do not reveal any stated ratios or ‘goals’.  Unfortunately, the lack of any polling lists denies one the opportunity of testing whether the admissions corresponded to the ratio of applicants.

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intellect should be commenced at a very early age, and not deferred to the age of seven or even five years. When such young children have been received at Earlswood their progress has generally been satisfactory.’ Consequently, the Board began to encourage even younger admissions, especially those under the age of , and the mean age of admission dropped below  years of age in the s, s, and s. In  the Board, taking a seemingly contradictory stance, extended the upper limit of admissions to include those over the age of . Despite the apparent inconsistency in policy, the trend on age of admission, however, remained relatively constant for the period under study. A common theme in the history of Victorian asylums contends that asylums evolved from therapeutic and educative institutions to become primarily custodial institutions. Statistics used in support of this view draw on the changing length of stay of residents in the institutions, rather than exploring the career of new admissions. Substantial database studies involving thousands of records of patients admitted to county lunatic asylums in England and Wales now seem to show that substantial proportions of new admissions stayed less than twelve months in the institution. However, a minority of long-stay patients, combined with a constant rate of admissions, simultaneously made the resident population appear increasingly custodial. Figure . summarizes the lengths of stay of , inmates admitted to the Earlswood Asylum between  and , regardless of status upon admission or status upon death, discharge, or removal. Not surprisingly, considering that  per cent of all inmates were elected for a five-year term, the class interval of two to five years looms above the rest. The very long-stay patients, judged by those who stayed in excess of ten years, comprised only  patients, or  per cent of the total patients admitted. Unlike lunatic asylums, Earlswood was dominated by medium-term (two to ten years) not short-term admissions. This was largely due to the asylum’s percevied role as a training, rather than a ‘curative’, institution. Figure . reveals that this medium-term length of stay was largely due to the elected admissions. This chart, expressed as a percentage of    

[Annual] Report, , AREA, SRO ///, . [Annual] Report, , AREA, SRO ///, . See e.g. Barrett, ‘From Education to Segregation’, passim. For a survey of literature until , see D. Wright, ‘Getting Out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Soc. Hist. Med.,  (), –. For recent publications, see chapters in Melling and Forsythe (eds.), Insanity, Institutions and Society.

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60% 50% 40% 30%

Charitable Subsidized Private

>2 0y ea rs

10 <2 0y ea rs

5< 10 ye ar s

2< 5y ea rs

1< 2y ea rs

20% 10% 0%

<1 2m on th s

F I G . .. Lengths of stay by status of first admission, first admissions to Earlswood Asylum, ‒ Source: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄⁄‒; Register of Names, Residences, and Payment of Patients, AREA, SRO ⁄⁄⁄‒.

>2 0y ea rs

10 <2 0y ea rs

5< 10 ye ar s

Charitable Subsidized Private

2< 5y ea rs

60% 50% 40% 30% 20% 10% 0%

1< 2y ea rs

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F I G . .. Lengths of stay of patients, excluding those who died in the asylum, admissions to Earlswood Asylum, ‒ Source: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄⁄‒; Register of Names, Residences, and Payment of Patients, AREA, SRO ⁄⁄⁄‒.

each class, indicates that the reduced-fee-paying and the private patients were more evenly spread amongst the class intervals. Although some short-term stays in Figure . were due to deaths, the number of surviving patients who had short- and medium-term lengths of stay remains quite substantial. Interestingly, the length of stay did not vary significantly by gender, either as an aggregate or within a status sub-group. Figure . details the length of stay by status, demonstrating that the duration did not vary by ‘outcome’ (death or discharge). These aggregate figures suggest that the use of the asylum for short and medium terms predominated as a percentage of overall admissions. Figure . shows the

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

average length of stay of yearly cohorts ‘smoothed’ by the use of a threeyear moving average. The trend is unmistakably downward, from a yearly mean of eleven to below eight years. Although these lengths of stay do reflect a considerable amount of time spent in the institution, they challenge the widespread contention that asylums degenerated into merely custodial institutions during the Victorian era. The length of stay and the nature of institutional experience for patients reflect a number of contributing factors, including institutional mortality. The annual returns sent to the Commissioners in Lunacy reveal that annual mortality at the Earlswood Asylum compared well with the national average. After the epidemics in the early s, the mortality rate of the institution did not change dramatically one way or the other. If anything, it actually decreased slightly between the mid-s and , thus increasing the likelihood that potential long-term patients would stay for a long period of time. This would tend to underline the importance of the downward trend in the length of stay. Put another way, the decrease in length of stay and the decrease in institutional mortality meant that the chances of being discharged actually increased during the period under consideration. The chances of an inmate dying in the asylum decreased rapidly over this period, from a high of  per cent to well under  per cent. This quantitative analysis of over , patients has revealed three significant things: the number of discharges was larger than the number of deaths; the length of stay inside the Earlswood Asylum decreased for patient cohorts during the period under study; and, there was an equal distribution across the length-of-stay axis for private and reduced-fee paying inmates. There were certainly patients who might, if one were to be uncharitable, be interpreted as having been ‘dumped’ upon the asylum with little else than an aim of long-term permanent supervision. The categories of Life-Elections and Life-Payments could mean little else. However, there were also the majority of patients, who would, over the course of the Victorian period, be likely to stay for increasingly shorter lengths of time. This touches on the central paradox of asylum development over the Victorian period. As Laurence Ray suggested in , if an institution admitted a constant number of patients, and a fraction of those patients remained for a long stay while the majority remained for a short duration, and if these ratios remained constant, the asylum would inevitably fill up with chronic cases. 

L. Ray, ‘Models of Madness in Victorian Asylum Practice’, EJS  (), .

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As the asylum reached capacity and, consequently, the number of beds available decreased, the authorities who ran the institution would be forced either to admit fewer patients, discharge patients earlier than normal, or discharge long-term patients. Each of these options would tend to decrease the length of stay of new admissions, and change the function of the asylum, vis-à-vis new admissions, to more of a centre for respite care. The authorities could also increase accommodation by building new blocks or a new asylum, but this only postponed the transformation rather than reversing it. Thus, there was a natural life-cycle to the residential medical institution. Its early years could be characterized by relatively longer periods of stay and a liberal attitude towards readmissions on behalf of those who ran it. As it filled up, however, the authorities would be less likely to readmit, or in the Earlswood case re-elect, patients, and those admitted would stay for shorter periods. What happened to the patients discharged from the asylum during its first thirty years? A small number of cases ‘removed’ directly to another institution (forty-six cases, or  per cent of all discharges). Seven patients, for instance, were conveyed to Peckham House Asylum and two to Camberwell House Asylum. Six of these nine were private admissions; the other three were reduced-fee paying patients. Invariably, the majority of those elected patients who were removed to other asylums ended up in the workhouse or county lunatic asylum of their settlement. Thus, William Jones was transferred to Abergavenny County Asylum and Catherine Spicer to the Three Counties Lunatic Asylum. Removal to a county lunatic asylum could be precipitated by the family’s inability to pay; however, it is clear that in the case of inmates who became extremely violent, the superintendent instructed the inmate to be removed for ‘medical reasons’. An additional  patients ( per cent of discharges) were re-elected or readmitted to the institution, a figure lower than that found in county lunatic asylums at the time. Of those inmates who were readmitted, the majority had returned home for a period of six months to two years before returning to Earlswood. A scattering of letters, cross-referenced with the computerized record of several inmates, illustrates this resumption of household care and the desire of some households to write to the asylum authorities seeking  

Register of Patients, AREA, SRO ///–. The readmission rate of county lunatic asylums, for the mid-Victorian period, was about % of discharges. See D. Wright, ‘The Discharge of Pauper Lunatics in MidVictorian England’, in Melling and Forsythe (eds.), Insanity, Institutions and Society, –.

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T A B L E .  Number of admissions and readmissions, Earlswood Asylum, ‒ Admissions

Number

(%)

Only once Readmitted once Readmitted for a second time Readmitted for a third time

,  

  





Sources: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄‒

readmission. Joseph Pollard, for example, wrote to the asylum secretary in  about the future of his daughter Anne, who had just been discharged from the asylum: ‘She [Anne] is more harmless than before, more cleanly in her habits and in every respect more manageable, under proper superintendence she can wash up pots and attend to one or two other little domestic duties better than formerly.’ Even so, Joseph desired re-election for his daughter, but complained that the expenses of another election might be too much for him. As it turned out, Anne was re-elected three years later and remained in the asylum until she died in , at the age of . Mrs King, after visiting her son in the asylum close to the end of his five-year term, wrote diplomatically to the asylum that ‘the improvement both in Edward’s person and manners far exceeds my most sanguine expectations and although I love him dearly and wish to have him home, yet I feel that my utmost endeavours should prove but fruitless in comparison with the Benefit he would receive at the Asylum’. She then asked for a re-election. Edward, according to the database, was re-elected in  and discharged again in . Some parents, if illiterate, secured the services of the local clergyman to write on their behalf, such as the mother of Sarah Hatfield in : ‘Mrs. Humphrey, the mother of Sarah Hatfield, who has recently been discharged from your excellent Institution, has called upon me this morning desired me to write to the Board of Management to thank them for the benefit which her child has received under their kind protection.’ The Revd Heap went on to describe the improvement in Sarah’s ability to dress herself, and feed herself and described in some detail her reintegration in the community:  

Letters Copying Book, AREA, SRO ///, . Mrs King to the Asylum, //, AREA, SRO ///, 

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 Deaths per hundred inmates (resident)

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Earlswood

National

10 8 6 4 2 0

18 58 18 60 18 62 18 64 18 66 18 68 18 70 18 72 18 74 18 76 18 78 18 80 18 82 18 84 18 86

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F I G . .. Annual mortality rate, Earlswood Asylum, ‒ (-year moving average) compared to the national asylum average Source: Annual Reports of the Commissioners in Lunacy, ‒.

We allow her to attend my Sunday day School & I do not hear that she behaves badly. I have not heard that she is teased or molested by the roughs of the Village; but I am glad to say that at present she does not show a disposition to mix with them . . . I do not think that we could undertake another election & if she should relapse, I think her Mother must put her under the protection of the Board of Guardians for the Poor, instead of your charitable & benevolent Board.

Sarah was not elected to or readmitted to the asylum, due to a lack of financial support. Charlotte MacKenzie has argued that, in the case of the private Ticehurst Asylum, some patients were discharged because their families could not afford to continue the cost of care. This seems also to be the case for some families requesting the discharge of family members from Earlswood Asylum. James Ashford, whose daughter Catherine was accepted in  as a reduced-fee paying candidate, wrote to the Board asking for her discharge since, because of his large family, he was unable to maintain the annual payment of £. The lay Board of Management, which ran the asylum, remained flexible and often renegotiated fees in response to the pleas of parents. But, the asylum’s finances only afforded so much generosity. Families found themselves making difficult decisions over the allocation of scarce household resources.  

Robert Heap to the Secretary of the Asylum, //, AREA, SRO ///, . James Ashford to the Secretary of the Asylum, Letter Copying Book, AREA, SRO ///, .

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Length of stay (years)

25



Charitable Subsidized Private

20 15 10 5

18 58 18 60 18 62 18 64 18 66 18 68 18 70 18 72 18 74 19 76 18 78 18 80 18 82 18 84 18 86

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Year of first admission

F I G . .. Mean length of stay of yearly cohorts, first admissions to Earlswood Asylum, ‒ (-year moving average) Source: Register of Patients, Earlswood Asylum, AREA, SRO ⁄⁄⁄‒. C O N C LU S I O N

Recently historians have identified those with mental disability as being one of the most silent, or voiceless, of all historical groups. Indeed, it is immensely difficult to conceptualize the social impact of incarceration upon the lives of these children. One may assume that to be taken from one’s household and thrust among a crowd of several hundred strangers must have been distressing. Some patients clearly had a difficult time settling into the routine. Others, it seems, developed an attachment to the inmates and staff of the asylum which outweighed familial bonds. Many of these children, it should be remembered, came from extremely impoverished backgrounds and were received into an institution which many outsiders felt was overly lavish. The Lunacy Commissioners commented on the high quality of the food; inmates were provided with new clothes, opportunities for sports and leisure, and probably a greater degree of attention than many of their family members were able to devote to them. For better or worse, fragmentary evidence suggests that after a time many of the children identified closely with the staff: It is a common thing for the children to speak of their Attendants as though they were on the best of terms with them; indeed, it is not at all the fashion for them 

Atkinson et al., Forgotten Lives, ch. .

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to accept the position for being controlled, without asserting opinion as to how they should be treated. In many cases they can speak for themselves when occasion requires it, frequently taking the part of one who is not able to do it for himself.

This quotation alludes to the multidimensionality and interdependence of asylum life. There was also, no doubt, the regimentation of asylum life, famously observed by the sociologist Erving Goffman. The asylum’s sheer size determined that rising, eating, and recreation were all arranged at prescribed times. Within such an atmosphere individual desires and peculiarities may often have been suppressed rather than encouraged. On the other hand, the monotony of the patients’ existence was mediated by their relationships with a group of individuals perhaps less well understood even than the patients—the staff themselves. As many contemporaries observed, the fate of asylum patients was entrusted to the asylum attendants and nurses. It is to this poorly understood group of young men and women that this book will now turn.  

Report of the Schoolmaster, [Annual] Report, AREA, SRO, ///, . Goffman, Asylums.

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To Know No Weariness Large, purpose-built institutions dominated the geographical and political landscape of Victorian England. The  Poor Law Amendment Act, directed as it was to indoor poor relief, obliged Poor Law Guardians to construct hundreds of workhouses throughout the country. As has been well documented, workhouses built for the able-bodied became filled with the sick, elderly, and insane, prompting Guardians to build separate infirmaries or convert existing buildings into makeshift local hospitals. In addition to this variegated state-supported hospital system, Victorian England also witnessed a virtual explosion of charitable hospitals for sick children, epileptics, foundlings, orphans, and the incurable, heirs to the tradition of medical philanthropy pioneered by the Georgian infirmaries. The expansion of in-patient treatment was so extensive that, by , there were , beds in the voluntary sector and approximately , in Poor Law infirmaries or workhouse sick wards. Within this emerging institutional sector asylums featured prominently. Following the Lunatics and Asylums Acts of , which obliged all counties and boroughs to erect institutions for their pauper insane, the numbers of insane resident in licensed asylums, hospitals, or private homes rose from , in  to , in . By the turn of the century the number of beds in mental hospitals outnumbered those found in general hospitals. The growth in the number and size of asylums meant that, by , there were approximately , female attendants working in institutions licensed by the Lunacy Commissioners. Indeed, between  and  asylum attendance represented the largest sector of institutional nursing in England.     

Crowther, The Workhouse System, ch. . Woodward, To Do the Sick No Harm, ch. . R. Pinker, English Hospital Statistics, – (London, ),  and Table ix. Fifty-fourth Report, ARCL, PP [], xxxvii,  (), App. A. According to Christopher Maggs, there were , ‘general’ hospital beds in England and Wales in . C. Maggs, ‘A General History of Nursing; –, in W. F. Bynum and R. Porter (eds.), Companion Encyclopedia of the History of Medicine (London, ), ii. .

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The Earlswood Asylum stood within a matrix of institutional employers eager to attract workers in the south-east of England. In addition to the asylum for idiots, there were two Surrey County Pauper lunatic asylums, one at Wandsworth near Tooting, and the other at Brookwood, built in the aftermath of the  Metropolitan Poor Act. Though these Surrey pauper asylums were very large institutions, they were merely half the size of the two neighbouring Middlesex county asylums (Hanwell and Colney Hatch), which had burgeoned to hold almost , patients each. In addition, the Metropolitan Asylums Board, established in , erected three mammoth, purpose-built institutions for ‘harmless and incurable lunatics’ of Metropolitan Poor Law unions. Lastly, there were forty-two Metropolitan (private licensed) homes, six of which had in excess of  inmates, and eight private ‘provincial’ homes in the neighbouring counties of Kent, Surrey, Sussex, and Hampshire. In Surrey there were sixteen Poor Law workhouses containing over  reported insane persons. There were also the charitable hospitals of St Luke’s and Bethlem, both of which had over  patients. A number of other nonmedical institutions, such as prisons and reformatory boys’ schools, gave workers still other institutional options. The potential demand for nurses, therefore, was very high, and it will be shown below that different institutions competed with each other to recruit and retain skilled staff. By the late s two medical men, John Langdon Down and George Shuttleworth, were responsible for supervising the treatment of  inmates in the Earlswood Asylum. Within this context, treatment inevitably devolved upon a small army of faceless institutional attendants, a phenomenon much commented upon by Victorian contemporaries. As John Conolly himself acknowledged when he was medical superintendent of the Middlesex (Hanwell) Pauper Lunatic Asylum: ‘[t]he character of particular patients, and of all the patients of a ward, takes its colour from the character of the attendants placed in it.’ The Commissioners in Lunacy, the national inspectorate charged with regulating licensed institutions after the  Acts, endlessly wrung their hands over the diminution in the power of medical superintendents vis-à-vis their attendants, and tried to redress this by pressuring magistrates and philanthropic boards of governors into hiring more medical men. Inevitably, however, the Lunacy Commission realized that the success or failure of large  They were situated in Caterham, Surrey, in Leavesden, Hertfordshire, and in Darenth, Kent. Ayers, England’s First State Hospitals, –.  Twenty-third Report, ARCL, PP [–], xxvii, App. A,  ().  J. Conolly, On the Construction . . . of Lunatic Asylums (London, ), .

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asylums rested on the quality of staff: ‘The condition of a Patient is materially promoted or retarded by the activity or supineness of the Attendant, who exercises great powers of control over him during the greater portion of the day, and during the whole day is his only sole companion.’ Unfortunately, historians know little about the staff to whom the bulk of the asylum care was left. The staffing of asylums, some researchers have suggested, was predicated upon local economic circumstances, the wages offered by individual institutions, and the conditions of work. Yet the fragmentary nature of most staff records remains a major barrier to our understanding of nursing in Victorian psychiatric institutions. Much of what we know about the history of psychiatric nursing is based on evidence drawn from annual reports of institutions, the propaganda of reforming organizations, or the investigations of government inspectors. Though valuable for sketching a general outline of the rise of psychiatric nursing, these sources cannot reveal precise patterns of occupational change or allow us to divine the relative importance of institutional nursing within the broader, lifelong work patterns of individual women and men. The decades between  and , the period during which the greatest expansion of the asylum system took place, still remain poorly researched. Some historians have accepted uncritically the verdict of W. A. F. Browne, a Scottish asylum superintendent and lunacy reformer, who dismissed asylum nurses in the s as the ‘unemployable of other professions’. Fortunately, extensive staff wages books are extant for the Earlswood Asylum, affording an opportunity to examine this important dimension of asylum life. A separate page was devoted to each new employee, and included the individual’s name, age, ‘previous employment’, ‘date of  

Thirteenth Report, ARCL, PP [, nd Session], xiv,  []. For useful case-studies on asylum and hospital staff in Victorian England, see J. Walton, ‘The Treatment of Pauper Lunatics in Victorian England: The Case of Lancaster Asylum, –’, in Scull (ed.), Madhouses, Mad-Doctors and Madmen, –; Digby, Madness, Morality and Medicine, –; R. Russell, ‘The Lunacy Profession and its Staff in the Second Half of the Nineteenth Century, With Special Reference to the West Riding Lunatic Asylum’, in Bynum et al. (eds.). The Anatomy of Madness, iii. –; Smith, ‘Behind Closed Doors’, –.  W. A. F. Browne, What Asylums Were, Are, and Ought To Be (Edinburgh, ), ; Jones, Asylums and After, ; Scull, Museums of Madness, , and id., The Most Solitary of Afflictions, , ; M. Carpenter, ‘Asylum Nursing Before : A Chapter in the History of Labour’, in Celia Davies (ed.) Rewriting Nursing History, ; Dingwall et al., An Introduction to the Social History of Nursing, ; Nolan, A History of Mental Health Nursing, .

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engagement’, ‘nature of duties’, ‘rate of wages’, ‘date of leaving’, ‘where to be found’, ‘reason for leaving’, ‘remarks’, and ‘address for correspondence’. This information was supplemented by the institutional returns of Earlswood in the census enumerations of  and . The results of this database analysis offer a systematic investigation into an important aspect of women’s and men’s work—that of the ‘prehistory’ of psychiatric nursing. More importantly, however, it also sheds light on the occupational mobility of nurses in the mid-Victorian period. As this chapter will demonstrate, women moved from domestic service to institutional nursing, were promoted within hospitals, and graduated to more lucrative or higher-status jobs in other related institutional work. Women often stayed for short periods of time in the asylum, gaining experience and accumulating funds before moving on to another institutional job or to be married. This pattern of short-term institutional work and mobility was common in mid-Victorian England and pronounced in the south-east of England, where there was the greatest concentration of hospitals. For men, asylum work offered transitional employment for those recently discharged from the army, navy, or militia. Men moved on after brief stays in asylums to take up positions in the expanding county constabularies or to reintegrate themselves more fully into civilian life. Although the precise reasons for leaving or taking up institutional employment will never be known, this chapter contends that the high turnover rate of staff appears to owe less to the incompetence or neglect of asylum workers, than to the volatile market for skilled institutional workers. Magistrates, guardians, governing bodies, and medical superintendents were looking for single women and men experienced in the rigours of service. In particular, the shortage of women with an accumulated knowledge of attending and nursing within an institutional setting meant that new positions at higher-status or better-paid institutions were easily acquired by women motivated to advance their own careers. Mid-nineteenth-century asylum nursing, thus, offered unparalleled opportunities for workingclass British women. WO M E N WO R K E R S

Most English asylums hired single women as ‘domestics’ for the service of the entire institution, and ‘attendants’ for specific female wards. Servants were differentiated into dormitory, laundry, and kitchen maids, and needlewomen. In return for their labour, needlewomen, housemaids, and dormitory maids at the Earlswood Asylum received £ per annum;

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kitchen-maids started at £ per annum. The duties of female attendants were less clearly defined. Female attendants were responsible for groups of inmates: waking them, assisting with dressing and grooming, escorting them to the dining hall for meals, and supervising them during work and leisure hours. Attending comprised periods of physical exertion and other points of relative leisure—accompanying inmates on walks, engaging in sports, and even participating in asylum bands. ‘Nurses’, so described, were assigned to either asylum infirmaries or duty as night nurses. Here they could acquire skills in the administration of medicines, the treatment of fevers, or the attending of chronic ailments. Nurses received the same salary as female attendants—starting at £ per annum or, in the case of night nurses, £ per annum. In addition to these wage rates, free room and board, washing, and fuel were provided, which would have made these positions more attractive than they at first appear. The absence of individuals due to resignation, sickness, vacation, or the exigencies of institutional life resulted in an interdependence amongst staff. If an inmate was unruly, a dormitory maid might be asked to assist an attendant. If an epidemic broke out, as many did in the s, female attendants might be enlisted temporarily as nurses. Thus, it should occasion little surprise that women hired as maids should gain experience as attendants, and attendants as nurses. The acquisition of skills was formalized in promotion practices, whereby the Earlswood Board hired women as maids and then promoted them to positions as female attendants, and later to the highest status of nurse. Individual cases reveal this pattern. Maria Howard, previously a housemaid, was hired in  at the age of  as a linen-room maid; in  she was transferred to the Nursery for Infants. Regular nurses could likewise opt for night nursing or eventually the position of head nurse. Elizabeth Taylor, hired as an infirmary nurse in , was promoted two years later to head female attendant, with a resultant wage increase of £ per annum. Consequently, service of one or two years could give young women enough experience to be promoted within the ranks of the institution, with a commensurate increase in base salary. Women could also rise in rank and then move to other institutions at a graduated scale of pay. There was no formal qualification until , so promotion was strictly at the discretion of the governing body or medical superintendent.  

 Ibid.  Staff Wages Book, AREA, SRO ///. In the s most asylums appointed at least one night nurse to keep a watch over  Ibid. . epileptic patients. Ibid.  Nolan, A History of Mental Health Nursing, .

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As stated earlier, the Earlswood staff wage books included ‘age at time of engagement’ and ‘previous occupation’, providing useful information on the occupation patterns of women hired at this unusual institution. One-quarter of maids and needlewomen were hired for the first time, and had an interquartile age rangeof  to . None was hired under the age of . Half of the maids and needlewomen had formerly worked in domestic service, and, although previous addresses were not systematically recorded, fragmentary evidence suggests that these previous positions were situated in the south-east of England. These ex-domestic servants were slightly older, having an interquartile age range of  to . If one combines findings for an average length of stay of domestics in private homes, and research on the age of leaving home, one may infer that many of these women had been employed by two or three households before starting asylum work. The fact that most were listed as ‘general’ servants in their previous place of occupation also implies that they were maids-of-all-work with few specialist skills. The Register of Servants of the nearby Brookwood Asylum did not include age at time of engagement, yet the modal class of – (derived from the enumeration returns of ) confirms this general age grouping. The census returns on ages listed in the Earlswood census enumerators’ schedules reflect a population slightly older than that of the census returns of domestic servants in England as a whole, reinforcing the database results, where a movement from domestic service as a first job to institutional service as a second or third position was apparent. Forty-two per cent of female attendants and nurses hired at Earlswood were listed as previously working in other hospitals or asylums (see Table .); as a consequence, they were older than the maids, with a large interquartile age range of  to . They tended to come from ‘lower status’ institutions—Poor Law infirmaries in Surrey, such as Croydon and Wandsworth, Metropolitan Asylums at Leavesden and Caterham, or Middlesex county pauper asylums, such Colney Hatch and Barning  

The interquartile range includes the middle % of a population. M. Ebery and B. Preston, Domestic Service in Late Victorian and Edwardian England, – (Reading, ), .  This pattern reflects similar results from the Kent County Lunatic Asylum, although Hervey does not discriminate between different types of employment in the asylum. Nicholas B. Hervey, ‘The Lunacy Commission, –, With Special Reference to the Implementation of Policy in Kent and Surrey’, unpublished Ph.D. thesis, Bristol University (), ii. , Table .  Between % and % of all servants enumerated between  and  were under the age of . As quoted in T. McBride, The Domestic Revolution: The Modernisation of Household Service in England and France, – (London, ), , Table ..

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T A B L E .  Previous employment of female employees, Earlswood Asylum, ‒ Maids and (%) needlewomen

No previous work experience Private domestic service Other institutiona Nurseb Other Subtotal n/a T O TA L

Female (%) attendants and nurses

n/a Total (%)





























  

  

  

  

  

  

  

  

  

  

  

Notes: aIncluding other country or voluntary asylums, hospitals, private homes, and residential schools; bNurses who were not defined as either private (domestic) servants or institutional nurses. Source: Earlswood Staff Wages Books, SRO ⁄⁄⁄‒

Heath. Transfer for promotion, moreover, is well illustrated in the case of Julia Goodwin. Hired as a housekeeper at the Surrey County Asylum at Brookwood in December , she resigned in April  to take the position of matron at Earlswood. Results of research for the Kent County Pauper Lunatic Asylum, which found that upwards of  per cent of new recruits in the s had previously worked in another institution, suggest that the Surrey asylums were not singular and that the south-east experienced a fluid movement of women workers between institutions. The inevitable conclusion is that staff hired at asylums from the s onwards were more experienced than has been previously  

Register of Officers, Attendants and Servants, AREA, SRO Acc  //, . Hervey found that, from the women hired at the Kent Asylum between  and ,  out of the  (%) where previous employment was listed had worked at other asylums. Hervey, ‘Lunacy Commission’, , Table .

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assumed, and that women were willing to transfer between institutions for a better salary or working conditions. This phenomenon of occupational mobility was not limited to asylums. Institutional histories abound with references to the problem of retaining nurses once they had acquired experience. As Poor Law historians have previously shown, women gained experience in Poor Law infirmaries and moved on to ‘more lucrative’ areas of nursing. Even the matron of St Mark’s Hospital, a prestigious charitable institution, complained that ‘when a Nurse perfects herself in dealing with the special cases treated here, she is anxious to leave and take a higher position elsewhere’. Hiring from domestic service or from other institutions (whether Poor Law infirmaries, lunatic asylums, or hospitals) presumably ensured that the prospective candidate was aware of the duties of institutional life. Letters of reference from previous employers could also offer asylum boards a method of judging the fitness of applicants. Another possibility, as Anne Digby has illustrated, was hiring from the local area. Although the last position held by ex-domestic servants seems most often to have been located in the south-east, the ‘place of birth’ column of the decennial censuses reveals that only half of women workers of Earlswood and Brookwood resident on census night were born within Surrey or contiguous counties (see Table . ). While previous research has underlined the high level of migration of domestic servants, the mobility of these institutional servants was greater still. Edward Higgs, for instance, in his study of servants in the Rochdale (Lancashire) censuses of –, found that between  and  per cent—twice as many as these Surrey asylum workers—were living in their county of birth. Thus, even by the standards of the mobile domestic servants, asylum staff stand out as particularly migrant. The places of birth in this study support the work of researchers who have drawn historians’ attention to the migration of young women from poor rural backgrounds to employment in domestic service in or around metropolitan areas. Of the one-half of the Earlswood women who were born outside the south-east, more than half of them came from towns with a population of fewer than , persons, such as Woburn, in  

Crowther, The Workhouse System, . As quoted in L. Granshaw, St. Luke’s Hospital, London: A Social History of a Specialist Hospital (London, ), .  Digby, Madness, Morality and Medicine, .  E. Higgs, Domestic Servants and Households in Rochdale, – (New York, ), –, Table .  McBride, The Domestic Revolution, ch. .

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T A B L E .  County of birth of women workers at the Earlswood Asylum 

(%)



(%)

Surrey Middlesex Rest of South-Easta Other

   

   

   

   

Subtotal n/a

  

T O TA L

  

Note: aRest of South-East = Hampshire, Sussex, Kent, and Berkshire. Sources: Census of England and Wales, , RG//–a; Census of England and Wales, , RG//–a.

Buckinghamshire, Cossington in Somerset, and Brockdish in Norfolk. Apart from the half-dozen Irish female workers, the overwhelming majority of these women, born in agricultural areas, came from southern English counties. One should take care not to exaggerate the rural background of these women workers, as ‘lifetime’ migration patterns tend to hide familial relocation. Women could well have moved at a young age with their families to Middlesex or Surrey. However, it does reflect an established pattern of movement of young women off the land and into modern urban ‘service’ industries. The transfer of women out of domestic service and into institutional nursing may be partly understood within the context of wage levels. As stated earlier, the pay scale at Earlswood was revised in  and stayed in place until the mid-s. During this time housemaids and kitchenmaids at Earlswood earned £ per annum and £ per annum respectively; a female attendant or nurse started at £ per annum. Annual increments of £ per annum (to a maximum of £ above the base rate) also helped to formalize remuneration. These wage levels were better than those for maids in private service cited in a popular book on household management, which shows that wages at selected homes ranged between £ and £ per annum, without any guaranteed increase. Thus, domestics in the south-east might well have chosen to look elsewhere after a year  Though servants’ wages were supplemented by gratuities. Horn, The Rise and Fall of the Victorian Servant, , Table .

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or two in private employment. By contrast, work in voluntary hospitals could be more lucrative than that found in these Surrey asylums. St Mark’s Hospital in London paid probationary nurses £ per annum in the early s, with a similar £ per annum increase (to a maximum of £ per annum); the Royal Berkshire Hospital offered as much as £ per annum immediately after (non-probationary) engagement as a fulltime nurse. St Mary’s, Paddington, revised its own pay scales upwards in  and started nurses at £ per annum. This very generous remuneration was matched by the prestigious private licensed homes in the south-east, such as the Ticehurst Asylum. These competing salary scales suggest that women may well have been drawn from domestic service to the asylums, but could also be poached by better-endowed voluntary institutions or private licensed homes. This situation prompted the Lunacy Commissioners in  to berate the Board of Governors of the Earlswood Asylum for allowing their remuneration to slip below that which existed in other institutions: This constant change [of attendants] must be disadvantageous to the children, and we desire strongly to express our opinion that one of the grounds of the nurses leaving the [Earlswood] Asylum is the lowness of the wages on commencement, viz. £ only. The result is, that as soon as a nurse here begins to know her work she leaves, and readily obtains a situation in one of the Asylums in the neighbourhood at an advance in wages.

The Commissioners’ recognition of occupational mobility is reflected in the database study of lengths of stay (Table .). Forty-four per cent of new women workers stayed for six months or less. The median length of stay at Earlswood was seven months, as compared to thirteen months at the nearby Brookwood Asylum. Comparison with the lengths of stay of domestic servants in England is very difficult and is biased towards the more detailed records remaining from the ‘great houses’. Ebery and  

.

Granshaw, St. Luke’s Hospital, . M. Railton and M. Barr, The Royal Berkshire Hospital, – (Berkshire, ),

 Cope, A Hundred Years of Nursing at St. Mary’s, Paddington, as cited in Abel-Smith, A History of the Nursing Profession, App. III, , n. .  MacKenzie, Psychiatry for the Rich, . MacKenzie also notes that female attendants in private asylums could also reap the benefits of cast-off clothing and gratuities from kin of wealthy inmates. Ibid.  Thirty-seventh Report, ARCL, PP [], xxx,  [].  D. Wright, ‘Asylum Nurses and Institutional Service in Mid-Victorian England’, NHR  (), –; Hervey found the average length of stay at the Kent County Asylum was  months. Hervey, ‘Lunacy Commissioners’, ii. , Table .

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To Know No Weariness T A B L E .  Length of stay of women workers at the Earlswood Asylum Duration Less than  months – months – years – years Over  years Subtotal n/a T O TA L

Number    8 

(%)     

  

Sources: Earlswood Staff Wages Books, AREA, SRO //–

Preston estimate that servants remained in Englefield House in Berkshire for an average of just under two years.  Higgs calculates that three years was the average turnover rate for Rochdale servants in the mid-Victorian period. In the light of the previous occupation data, a picture emerges of women moving through a volatile labour market. Women entered private domestic service in the south-east from rural backgrounds and stayed for two or three years, moving to an institution where they gained attending and nursing skills and an advancement of wages, and finally graduating to a more lucrative nursing position elsewhere or leaving to marry. In response to the one-in-two women who left within the first six months, asylums slowly adopted more flexible hiring policies and strove to make institutional work more attractive. It was not uncommon for siblings to work together, nor for married couples to provide partnerships of attendants and nurses. The latter became a policy which the Earlswood Asylum began in earnest from  onwards, hiring twenty-two couples between  and . The Earlswood Asylum also had a ‘married wage’ which was equal to the combined wages of a male and female attendant, giving women a relatively rare opportunity to integrate married life within their place of full employment. Though these twenty-two married women only represented  per cent of all women hired at Earlswood, the practices were created to ensure better character profiles and longer time  

Ebery and Preston, Domestic Service in Late Victorian and Edwardian England, . Higgs, Domestic Servants and Households in Rochdale, .

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commitments, and seem to have had some impact. The median length of stay of married women was six months longer than that of single women. Earlswood, therefore, seems to have responded in a creative manner to persistent problems of staff retention. It would be simplistic to ascribe all the movement out of the asylum to occupational mobility based upon a simple calculation of wages. Many women apparently did not like asylum life and quickly looked for institutional work with better conditions of employment. Caring for ten to twenty disabled children, some with behavioural problems, could take its toll on even dedicated staff. Working conditions may have been one factor prompting individuals to move between Surrey asylums. Caroline Cunningham, a nd Class Attendant at Brookwood, which had a patient : staff ratio twice as high as that which existed in Earlswood, resigned on  February  after one year’s employment to join Earlswood as a regular female attendant. Since the wages for female attendants at both asylums were identical, it seems likely that Caroline, and the other women who transferred from Brookwood to Earlswood, were attracted to more agreeable working conditions in a better-funded voluntary, rather than pauper, institution. For dedicated female nurses, who had acquired experience in institutional work, moving between institutions had distinct perquisites. For instance, if a female attendant were fortunate enough to secure employment in the private Ticehurst Asylum, she would receive not only an advance in wages, but also a dramatically reduced inmate : staff ratio of less than one patient per staff member. The precipitating factor behind most women’s decisions to leave the employment of one of the two asylums is impossible to determine from the brief and often ambiguous inscriptions in the ‘reasons for leaving’  This method of hiring married attendants could prove counter-productive, since the firing of a married worker would necessitate the leaving of the spouse. There were at least two instances of this at the Earlswood Asylum, Staff Wages Book, AREA, SRO //, , .  Most county asylums had patient-to-staff ratios of  :  to  : . In Colney Hatch, one of the huge Middlesex asylums, there were  ‘ordinary’ female attendants for , female inmates in —a ratio of approximately  : . Hunter, Psychiatry for the Poor, .  The Brookwood Asylum, like many other county asylums, followed the st and nd class Attendant hierarchy, where the st class Attendants, also called ‘Charge Attendants’, acted roughly as ward-supervisors and were intermediaries between regular ward attendants (nd class attendants) and Head Attendants. Brookwood Asylum, Rules for the Guidance of the Attendants, Servants, and all Persons Engaged in the Service of the Surrey County Asylum, at Brookwood (), SRO Acc. ///.  MacKenzie, Psychiatry for the Rich, . The calculation of patient-to-staff ratios is complicated by the work of patients as staff ‘assistants’ or as part of their therapy.

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T A B L E .  Previous employment of male employees, Earlswood Asylum, –, and Kent County Pauper Lunatic Asylum Earlswood

(%)

Army, navy, militia Attendants Artisans Labourers Service Other

     

     

T O TA L



Kent County      

(%)      



Sources: Staff Wages Books of the Earlswood Asylum, AREA, SRO //; N. Hervey, ‘The Lunacy Commission, –, With Special Reference to the Implementation of Policy in Kent and Surrey’, unpublished Bristol Ph.D. thesis (), ii. , Table .

entry of the Earlswood Asylum records. The records often included only a ‘resigned’ entry, with no other explanation as to whether the resignation was precipitated by an incident, was through mutual agreement between the institution and the woman, or was in fact ‘requested’ by the asylum management. The under-enumeration of dismissals seems unlikely, as there are cases where the asylum clerk explicitly inscribes the dismissal of women workers. Only one in ten women were fired from these institutions, for a range of offences such as theft, illicit sexual relations, and neglect of patients. As one might expect, there was also a loss of women workers due to marriage, though these records, albeit imprecise and fragmentary, suggest that as few as  per cent of women departed for this reason. Twice as many resigned because they felt that the duties were too arduous. Institutional attendants laboured approximately for fourteen hours—from . a.m. to . p.m.—six-and-a-half days a week, and despite exhortations to ‘know no weariness and refuse to be discouraged’, one-third of those who left found the work ‘too hard’ or retired because of ‘ill-health’. Having illustrated the dominant pattern of women transferring out of domestic service into institutional work, and between different institutions, before married life made such work either impossible, undesirable, or unnecessary, it is important also to acknowledge the exceptions to these 

First (Annual) Report, AREA, SRO //, .

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patterns. Some young women remained loyal to an individual institution and stayed for very long periods. There was also a small group of widows over the age of  who, it seems, had taken up institutional employment late in life. These women pose many interesting questions about the future work patterns of attendants and nurses who left institutions to marry. Did they continue private nursing on a part-time or casual basis while raising a family? Did they pursue nursing after their children had left home or after the death of their spouse? The fragmented occupational history of these women, without the benefit of complementary primary sources is, sadly, impossible to reconstruct fully. M A L E AT T E N DA N T S

A central theme in the historiography of medicine in the nineteenth century has been the sexual division of the marketplace for health care. The medical profession was closed to women; general practitioners attempted to ostracize and professionally isolate midwives, and the largely female nursing occupation was placed in a subservient position to the medical profession. One exception to this sexual segregation of the medical marketplace occurred in the realm of psychiatric nursing. Victorians believed that only men could properly control violent male patients. Similarly, for cultural as well as practical reasons it was considered most appropriate for female employees to attend and supervise female patients. The particular vulnerability of the mentally ill placed an onus on administrators to prevent any infiltration of male and female wards by the opposite sex. As a consequence of these practical, medical, and moral considerations, asylum nursing has always had a significant number of male attendants. The Earlswood Asylum hired  male attendants between  and , men whose career trajectories were very different from those of the asylum nurses. One hundred and twenty-two ( per cent) of new male employees came directly from the armed services, listing their regiment in the previous occupation column of the staff books. These men, overwhelmingly soldiers, took up positions as ‘ordinary’ attendants, with responsibility for feeding, washing, and attending patients of particular wards. The standard lengths of service in the ‘reformed’ Victorian army were six and twelve years, so it is not surprising that almost one-half of  See J. Donneson, Midwives and Medical Men: A History of Inter-Professional Rivalries and Women’s Rights (London, ).  Nolan, A History of Mental Health Nursing, passim.

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ex-soldiers were over  years of age before they started employment in the asylum. The presence of members of the armed forces has often been interpreted as fulfilling the need for strong-armed men to control violent patients. Certainly this cannot be discounted, especially in the case of county pauper lunatic asylums, but it hardly accounts for the number of ex-soldiers hired at the Earlswood Asylum, where the majority of new inmates were children below the age of . It seems that recruiting from the armed services was a natural and logical strategy of asylum boards based upon the labour supply available. Ex-soldiers represented a reserve of unmarried men who had been disciplined to long hours and monotonous work. The weekly wages of infantry soldiers in  was reportedly £. s. d. per annum for basic infantry men, suggesting a modest increase in wages for those who left the armed service to accept the starting regular (male) attendant’s wage of £ per annum at Earlswood. We have already noted that annual wages at the institution increased by £ per annum above the base wage rate, and asylums had no ‘stoppages’ (army payments for food, uniform, etc.), making the difference between the two occupational wage rates greater than it first appears. Nicholas Hervey examined the staff books of the Kent County Pauper Lunatic Asylum for the four years between  and , and concluded that approximately  per cent of Kent’s new male employees were also from the army, navy, or militia. When one considers that between , and , soldiers were discharged every year in the s, asylums had a vast reservoir of men from which to choose. The second-largest occupational category of new male recruits to Earlswood was skilled artisans ( per cent of new male employees), especially men previously employed as carpenters, shoemakers, tailors, and basketmakers. They accepted positions as ‘trades attendants’, working for half-days as master tradesmen in the asylum’s workshops and half-days as regular ward attendants. As has been noted elsewhere, vocational training occupied a central role in the therapeutic regime of Victorian asylums, so hiring skilled artisans partly reflects new therapeutic interventions. There was, however, also a more pragmatic impetus behind the engagement of skilled workmen: vocational training occupied patients  ‘Army—Weekly Wages’, PP [], xxxix, (); Staff Wages Book, AREA, SRO //.  Hervey, ‘Lunacy Commission’, ii. , Table .  E. Spiers, The Late-Victorian Army, – (Manchester, ), Table .  A. Digby, ‘Moral Treatment at the Retreat, –’, in Bynum et al. (eds.), The Anatomy of Madness, ii. –.

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and, by producing goods of use within the institution or for sale outside the asylum, their productive labour reduced annual institutional costs. Earlswood paid trades attendants a starting salary of £ per annum (s. d. a week plus room, board, and uniform), which increased by £ per annum per year employed. Robert Gray, in his study of the labour ‘aristocracy’ in Victorian Britain, estimated the range of wages for skilled workers as –s. per week, but wages were extremely variable and subject to seasonal and other short-term fluctuations. Comparisons of wages is difficult, because one must try to account for the costs of living for artisans residing outside institutions, in particular the costs of food, fuel, and accommodation which could easily account for  per cent of earnings. When one takes into consideration other incidental costs of living, it is not surprising that J. T. Arlidge, a Victorian asylum superintendent, concluded that artisans who sought asylum employment were ‘tempted by higher wages’. The importance of having attendants with skills useful for training inmates and adding to the value of the institution seems to have been well recognized by county magistrates and asylum management committees, who recruited them eagerly. Peter Nolan identifies Worcester County Asylum as an example of an institution which hired almost exclusively skilled artisans. In his study of asylum ‘keepers’ in the years before , L. D. Smith has concluded that very few, if any, asylum attendants had had previous institutional experience. However, the growth in the number of asylums—well over fifty by the late s—created a pool of experienced asylum attendants from which asylum superintendents in the later Victorian period could draw. Twenty-seven men ( per cent) hired at Earlswood came from other asylums in England, including the three other Surrey county asylums (Wandsworth, Brookwood, and Brentwood), county asylums in Lancashire and County Durham, provincial asylums in Northamptonshire and Gloucestershire, and private licensed homes such as Camberwell House, Peckham House, and Chartwell House. Two former attendants of the Leavesden Asylum for the ‘chronic and harmless insane’ also joined the Earlswood Asylum during this period. This movement of male attendants between institutions seems to represent a broader pattern in the south-east, as Hervey found that a full  per cent  

R. Gray, The Labour Aristocracy in Victorian Edinburgh (Oxford, ), . J. T. Arlidge, On the State of Lunacy, as quoted in Walton, ‘Treatment of Pauper Lunatics’, .  Nolan, A History of Mental Health Nursing, .  Smith, ‘Behind Closed Doors’, .

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of new male attendants had worked previously in another asylum before taking up employment at the Kent County Asylum. Although unions and certification of qualified attendants did not appear until the s, this phenomenon of experienced asylum attendants moving between different institutions reflects the recognition by asylum boards of the advantage of having a nucleus of skilled, experienced attendants. The prevalence of agricultural labourers working in asylums depended on the economic profile of the county. These farmworkers were less important to urbanizing Surrey. Fewer than one in ten of new male employees to the Earlswood Asylum listed their previous occupation as agricultural labourers. Those who did formed the bulk of the farm and garden attendants, though some became ordinary ward attendants. A Royal Commission on Agriculture investigating employment patterns was compiling evidence shortly after Earlswood was revising its own wages scale, providing a useful index of wages for the south-east in the late s. The level of wages of male agricultural labourers seems to have been –s. per week during non-harvest periods. This, however, does not take into account the s. per week estimated by the Commission for food, rent, and fuel. It is highly likely, therefore, that the asylum’s guaranteed wage of s. d. per week, with free meals and living arrangements, and long but not physically demanding duties, had definite attractions. In spite of the financial incentives, occupational allegiance was variable. The median length of stay for new male employees was . months at Earlswood. The asylum was plagued by a rapid turnover in its lowest ranks, although relative loyalty was found amongst a minority of new recruits. Since some attendants were still employed when the Earlswood staff wages books ended, it is impossible to calculate precisely the mean length of stay, but it would not be appreciably different from Hervey’s findings of twelve months for the Kent County Asylum. When the results were broken down by previous occupation there was no statistical difference between the length of stay of former soldiers and the rest of the male employees, so that this turnover rate cannot be associated with one identifiable cluster of men. A  per cent loss in six months presented difficulties in staffing levels, but  

Hervey, ‘Lunacy Commission’, ii. , Table . Royal Commission on the Employment of Women and Children in Agriculture, , evidence for Surrey, PP [–], xiii, – (–).  Asylum work had the advantage of job security and a security of wages. However, it was possible for attendants to be fined for breaking the asylum rules or allowing a patient to escape.

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these staff fluctuations were not disproportionately severe when one examines comparable occupations. Carolyn Steedman’s study of county constabularies during the mid-Victorian period concluded that approximately  per cent of new recruits left within two years. Therefore it is unlikely that the employment patterns in Victorian asylums were unique. Rather, they seem to share similarities with many other sectors of the rapidly changing Victorian economy. Of the remainder of those discharged, eleven men at Earlswood were fired for drunkenness, eight for undefined ‘misconduct’, and three for being absent without permission. Only two attendants—James Humphrey and William Taylor—were fired for striking patients. Ten men left because of their own ill health, and eighty-nine simply resigned with no further information given. Although one must always be wary of accepting uncritically the reasons given for leaving, the overwhelming impression is that the vast majority of staff did leave voluntarily to begin a new phase of their life elsewhere. The evidence of post-asylum occupation is fragmentary, and only general comments can be made. A common route for ex-soldiers seems to have been from the asylum to the county constabularies. The constabularies, which were also seeking young men accustomed to discipline and authority, were expanding in size during the s and s, and a thirdclass constable in Surrey in , for instance, was paid s. per week, although this did not include room or board. The constabularies drew their new employees from a similar labour source, and offered the advantage of allowing ex-soldiers to work outside the confines of an institution. Another, reason for change was that employment in the asylum was not compatible with married life, except in cases where the asylum hired a couple already married as ‘joint’ attendants. Apart from these rare cases, the impending nuptials of an attendant precipitated his leaving the institution. Again, other men left to open their own businesses. Since everything was provided for by the institutions, men employed there had few opportunities to spend money, thus facilitating the saving of modest amounts enabling possible career changes or marriage. C O N C LU S I O N

Some historians of medicine have represented the asylum attendant as the ‘unemployable’ of Victorian society. This chapter has provided evidence  

Ebery and Preston, Domestic Service in late Victorian and Edwardian England, . C. Steedman, Policing the Victorian Community: The Formation of English Police Forces, – (London, ), –; Tables .–..  Register of Staff, Surrey Constabulary, SRO Acc. CC/.

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which suggests otherwise. It seems that the problem facing asylum superintendents was that these workers, particularly the women, were highly employable and moved fluidly between different jobs in an open Victorian labour market. The pattern uncovered from the investigation of asylums in Surrey suggests that these institutions represented important sources of employment for men previously employed as soldiers, artisans, and agricultural labourers. Competitive wages, decent food, and secure employment made attending attractive to a range of unskilled and semiskilled workers. In turn, the previous experience of these workers could be used by the institutions, which may well have realized the value of their work-skills. Thus, the growing importance of movement between asylums could be evidence which points to ‘transferable skills’ within the emerging market for domestic and institutional service in the two decades before the ‘professional’ demarcations of psychiatric nursing became more established. Asylums would have to compete increasingly with the outside world and with other asylums to recruit and keep good attendants. This chapter has taken a largely quantitative approach to the study of female and male asylum attendants and attempted to place the occupation within a wider context of the Victorian labour market. Historians of nursing must examine the attitudes of the attendants themselves before a more nuanced picture may be drawn of asylum nursing in the Victorian period. To this end the case studies of individual attendants by Anne Digby and Peter Nolan have added immenssely to our understanding. Historians must also extract the reality of attending as an occupation in Victorian England from the rhetoric of asylum reformers. It is unrealistic to expect asylum attendants to have been the standard-bearers of a new, enlightened and individualistic style of treatment when there were between ten and twenty patients per staff member, and when attendants received little in the way of formal training. On the other hand, high staff : patient ratios and individual cases of dismissal are not conclusive evidence that attendants were forced to become faceless instruments of social control. Attendants were ordinary Victorians making occupational choices between the available alternatives based on rational decision-making. Asylum nursing represents an important case study in the history of women’s work, standing as it does at the crossroads between Victorian domestic service and the twentieth-century ‘caring professions’. This chapter has identified the overlap of domestic service and the nascent  Digby, Madness, Morality and Medicine, ch. ; Nolan, A History of Mental Nursing, chs.  and .

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nursing profession by showing the movement of groups of women from private homes in the south of England to a large asylum in the county of Surrey in the s and s. The prevalence of domestic servants and other institutional staff, and the short length of stay, all characteristics discovered by Maggs, prevailed in the asylum sector at least a decade before the period studied in his seminal work on the origins of general nursing. The short-term nature of women’s employment was only partly due to women leaving to marry. Some of the volatility in the domestic and institutional service sector was a function of the demand for the labour of experienced young, predominantly single, women. This labour shortage, coupled with a degree of specialization of skills within large institutions, meant that there were distinct opportunities for young women to acquire expertise and ‘trade-up’ in the labour market, accumulating capital and experience before marrying. It also provided a vehicle for a limited rise in social status for women from rural, and often deprived, backgrounds. The frequency with which asylums recruited women from other ‘medical’ establishments suggests that, in the decades before formal registration, asylum managers recognized the skills of institutional attendants. Historians have too readily accepted that asylum attending was an ‘occupation of last resort’. This chapter argues that the picture was not so bleak as that recorded in inquiries and special commissions drawn up to investigate individual cases of abuse, neglect, or cruelty. Indeed, the study suggests that patterns of asylum recruitment mimicked that of recruitment to the general hospitals. For the period – pay was more than competitive with that for most domestic service, and much better than the paltry amounts doled out to unskilled women workers in the metropolis. As we have seen, the benefits of asylum attending were attractive enough to draw many young women out of domestic service. Although many left asylums because they did not like the work, the turnover of the staff was not dissimilar to that in other trades. Indeed, medical superintendents (who had a habit of complaining about a lot of  

C. Maggs, The Origins of General Nursing (London, ), passim. Jones, Asylums and After, ; Scull, Museums of Madness, ; id., The Most Solitary of Afflictions, ; Mick Carpenter ‘Asylum Nursing Before : A Chapter in the History of Labour’, in Celia Davies (ed.), Rewriting Nursing History, ; Robert Dingwall et al., An Introduction to the Social History of Nursing, ; Nolan, A History of Mental Health Nursing, .  S. Alexander, ‘Women’s Work in Nineteenth-Century London: A Study of the Years –’, in J. Mitchell and A. Oakley (eds.), The Rights and Wrongs of Women (London, ), –.

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things) rarely believed that they could not find adequate numbers of recruits. Local communities also appreciated asylums as a source of employment and trade, and were often the most bitter opponents when local authorities began to close down long-stay hospitals in the last third of the twentieth century. Anne Digby once described psychiatric attending as the ‘hidden dimension’ of asylum history. This still remains true. Asylum attending has often been relegated as the poor cousin of the history of medicine, receiving less historical scrutiny than general or district nursing. This neglect has been due partly to a perception that it has a ‘distinct’ history and that it was an occupational backwater. This chapter has argued, however, that for the mid-Victorian period there was no sharp divide between ‘general’ and ‘psychiatric’ nursing, as some women moved freely between different types of medical institutions. It has argued that women were not ghettoized in county asylums, but rather could often graduate to more prestigious institutions. Victorian asylums were not, as Andrew Scull has mocked, institutions where the staff were ‘scarcely better’ than the inmates themselves. Rather, these novel institutions represented new opportunities for working-class women to work independently and achieve modest social advancement, and afforded them relative job security and empowerment in a volatile economic marketplace. It seems from these case studies that women and men made use of these facilities for economic opportunity and empowerment in a manner that has been little recognized.  

Digby, Madness, Morality and Medicine, . Scull, The Most Solitary of Afflictions, .

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7

The Golden Chain of Charity Andrew Reed and his fellow Dissenters chose to establish a charity which ran on an election system which the clergyman-philanthropist had refined at his three orphan asylums. Under the terms of the Earlswood constitution, a subscription of half-a-guinea gave individuals one ‘general’ vote and a right to participate in two yearly meetings. At the first meeting subscribers elected a Board of Management from the general body of subscribers and voted for the candidates approved for the semiannual elections. This represented a break from the Georgian tradition of buying direct influence on a hospital Board. However, democratic egalitarianism was tempered by financial considerations. In order to maximize subscriptions, the charity gave one life vote to those who gave  guineas. As its name suggests, one life vote entitled subscribers to one vote at every election until they deceased. Moreover, regular and life votes increased pro rata, thereby giving wealthier subscribers a greater democratic voice. Democracy with a nod to the power of the wealthy and propertied. The Earlswood Asylum was a charity for a society in democratic transition. During the s and s the election system proved to be remarkably popular. Thousands of subscribers flocked to the fledgling charity, and by  patients were being elected with over , votes each. Over the course of the same period the charity saw its annual income rise to nearly £,. This is all the more impressive, when one considers that the Earlswood Charity was more vulnerable than other medical charities to the volatility of annual subscriptions. As Figure . shows, subscriptions accounted for over  per cent of charitable revenue until the s. Unlike many of the new Metropolitan hospitals, Earlswood did not have recourse to students’ fees as a source of income, it had almost no stock, and it specifically excluded pauper admissions, a source of Poor   

See Alvey, Education by Election, ch. . See Ch. , n. . This method was a break from Reed’s earlier voluntary projects, which had preserved the older principle of allocating spots on the Managing Committees to those giving the largest subscriptions. Alvey, Education by Election, . In theory, anyone could sit on the Board who had been a member of the charity for at least  months. By-law,  Apr. .  Of the  patients elected in  the vote ranged from , to ,. Annual Report for , AREA, SRO //.

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Total subscriptions Inmates

700 600

10,000

500

8,000

400

6,000

300

4,000

200

2,000

100 0

18 60 18 62 18 64 18 66 18 68 18 70 18 72 18 74 18 76 18 78 18 80 18 82 18 84

0

Number of patients resident

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F I G . .. Total subscription revenue and the number of patients resident, Earlswood Asylum, ‒ Sources: Annual Expenditure Books [‒], AREA, SRO ⁄⁄⁄. ( is no longer extant.)

Law revenue which underpinned some philanthropic and private institutions. Moreover, because the asylum was located in Surrey, it did not receive supplementary subventions from the Metropolitan Hospital Sunday Fund, a collective philanthropic initiative which provided essential revenue for London Hospitals. Despite, or maybe because of, these handicaps, the number of both general and life voters had passed , by the s, making the Earlswood Charity one of the largest philanthropic organizations in Victorian England. In fact, out of the  charities sampled by Frank Prochaska in his seminal work on philanthropy in the nineteenth century, only one, the Society for Promoting Christian Knowledge, was larger

 For financial reasons, two of the voluntary idiot asylums—the Western Counties Asylum and the Northern Counties Asylum—belatedly allowed in pauper patients. Many voluntary hospitals in London took the ‘unpopular’ decision of doing the same. K. Waddington, ‘Grasping Gratitude: Charity and Hospital Finance in Late-Victorian London’, in M. Daunton (ed.), Charity, Self-Interest and Welfare in the English Past (London, ), –.  Keir Waddington, ‘ “Bastard Benevolence”: Centralisation, Voluntarism and the Sunday Fund –’, London Journal,  (), –.  The Subscribers List did not detail the exact number of subscribers. Since, however, the Subscribers Lists were typed and each subscriber took up one line, calculating the approximate number of total subscribers is fairly easy.

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The Golden Chain of Charity General subscriptions

Special donations

Legacies

Life subscriptions

100% 80% 60% 40% 20%

84 18

82 18

80 18

78 18

76 18

74 18

72 18

70 18

68 18

66 18

64 18

18

62

0% 60

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F I G . .. Type of income as a percentage of total donated income Source: Annual Expenditure Books, Earlswood Asylum [‒], AREA SRO ⁄⁄⁄.

than the Earlswood Charity. So who were these benefactors, and what motivated their participation in this charitable endeavour? The Subscribers’ Books listed the names of all members who were eligible to vote in the semi-annual elections, their number of votes, addresses, and the year of first subscription. Since those who gave  guineas or more remained on the Subscription Book for life, the total list of subscribers for any one year may be a misleading indicator of the number of active members of charity—that is, those who regularly participated in voting. Thus, in order to analyse various aspects of who gave to the charity at a particular time, this chapter will concentrate on all new subscribers for , since that year lies approximately in the middle of the period under study and allows for comparisons with the characteristics of the inmates admitted in the same year. Of the  new subscribers to Earlswood for the year , over  per cent were individuals,  per cent were companies, and  per cent were groups of individuals (e.g. ‘the Misses Brown’). Four per cent remained anonymous by the listing of only their initials, but may be assumed also to have been individuals (see Table .). All of  The Society for Promoting Christian Knowledge (SPCK) had a subscribers’ list of , names in . Prochaska estimates that there were close to , charities in London alone by the close of the century. F. Prochaska, Women and Philanthropy in Nineteenth Century England (Oxford, ), pp. i–iv, . Coincidentally, the SPCK regularly donated toys and religious books to the Earlswood Asylum. See [Annual] Report, , AREA, SRO ///, .

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T A B L E .  Types of subscribers, new subscribers to the Earlswood Asylum, 

Individual men Individual women Group of individuals Subtotal Anonymous Corporate T O TA L

Number

(%)

   

  

 

 



Sources: Subscribers’ Book, Earlswood Asylum, SRO ⁄⁄⁄.

the twenty-nine organizations represented in the  new sample were businesses, and all were located in London, such as Freeman & Sons of Fenchurch Street, or Spicer Brothers of London. Additionally, the charity received regular donations in other years from the Fishmongers, Goldsmiths, Mercers, Skinners, Cordwainers, Girdlers, Salters, Drapers, Vintners, Saddlers, Haberdashers, Cutters, the London Assurance Company, and the Corporation of the City of London. It seems, however, that a more common type of support from companies was that of free goods and services, a factor to be discussed below. Most subscribers contributed small amounts to the charity—half-aguinea ( per cent) and  guinea ( per cent), for one or two regular votes, or  guineas ( per cent) or  guineas ( per cent) for one or two life votes. In order to determine the ‘loyalty’ of a subscriber, the names taken from the  sample were cross-referenced with the  and  subscription lists. Of twenty-six general subscribers randomly selected from new  subscribers, twenty-three gave again to the charity in the following year. Ten years later, however, the number had dwindled to ten. Notably, the levels of subscriptions remained remarkably consistent. Of those twenty-three general subscribers who reappeared a year later,  The  Subscription list has not survived to show medium-term subscriber loyalty. These figures also do not imply continuous subscriptions, but merely those who were on the lists in , , and . Thus those who appeared on the  list may have only subscribed in  and  and stopped for an undisclosed period before beginning again in .

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twenty contributed the same amount. Similarly, of the ten who remained ten years later, seven were still subscribing at the same level. This suggests that some subscribers, who gave more modest amounts, had a fixed idea of how much they wanted to give and remained loyal to the charity for relatively long periods. On the other hand, of the twenty-one life members selected in the sample, only five had, by , given additional money to the charity (indicated by an increased number of life votes), implying, perhaps, that larger benefactors were less consistent in their donations. A summary of the titles prefixing the names of the male subscribers gives a very imprecise indication of their social and occupational status. Of the new subscribers for ,  per cent were ‘esquires’,  per cent ‘Mr’,  per cent ‘Revd’, and  per cent ‘Dr’. A further  per cent had titles which would place them in the gentry or aristocracy (Baron, His Excellency, etc.). These findings might imply a group of subscribers that was skewed towards the upper classes with addresses in London rather than the new urban middle class, though the tendency for grateful charities to ‘inflate’ the status of subscribers should not be discounted. This contrasts with studies of provincial voluntary hospitals in the eighteenth and early nineteenth century, which show a more pronounced representation of local merchants of the middle and upper middle class. Forty per cent of the Earlswood subscribers were women, a high proportion since the Board of Management was entirely comprised of men. The number of unmarried women subscribers nearly equalled the number of those married ( per cent and  per cent respectively). Whilst the asylum seems to have been supported by the elite of English philanthropic circles, the charity was not beholden to a handful  The identification of subscribers can be given with a high degree of accuracy, since not only were the name and address given, but also the year of first subscription remained constant, thereby precluding the confusion of one John Smith subscribing in  and another John Smith subscribing in . It cannot be estimated, however, how many subscribers had died.  There are two contrasting views as to the social compositions of the funding of Georgian infirmaries. Roy Porter argues that the gentry gave the ‘lion’s share of donations’, whereas Anne Borsay believes that the new urban middle class was central to the financing of these civic institutions. See Porter, ‘The Gift Relation’, –. See Borsay, ‘Cash and Convenience’, –.  Prochaska argues that women were less likely to subscribe to charities with all-male boards, than to mixed or all-female boards. The marital status of women subscribers, derived from ‘Miss’ or ‘Mrs’ in subscription lists, may underestimate the proportion of unmarried women because of the practice of older unmarried women of adopting the title `Mrs’. Prochaska, Women and Philanthropy, , .

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of powerful patrons. The largest new donation in  was thirty-four life votes ( guineas) and only  per cent of the new members in  subscribed more than  guineas. Of all the , individuals listed in the Subscribers’ Book for , only seven had rights to  or more votes. The largest subscriber, Samuel Morton Peto, had only  life votes. Since successful candidates regularly received in excess of , votes per election, Peto possessed a meagre  per cent of votes for a potential candidate. With such a large subscription list, the ‘stacking’ of votes was counter-productive, for if any of the wealthiest subscribers wanted to secure an asylum place for a ‘friend’, they could merely pay £ per annum for a private admission. Thus, notwithstanding the advantage of wealthier subscribers, the election process proved, for its time, relatively meritocratic. With the emergence of regional idiot asylums, the Board scrambled to reposition itself as the national asylum: They [the Board] call particular attention to this, as since the opening of the Albert Asylum for [idiot] children in the Northern Counties, several [people] have withdrawn their subscriptions from Earlswood, understanding it would no longer receive cases from those counties; but, the Board wish it to be distinctly understood that as ‘the National’ and ‘Model Asylum’, Earlswood will always be open to cases from all parts of the United Kingdom and to children of British subjects all over the world.

The Earlswood Charity was only partly successful in its bid to maintain the ‘national’ scope of subscribers. The presentation of a one-in-ten stratified sample, shows a predominance of the south-east and a strip of subscribers farther north. If one superimposes the map of admissions for , this pattern of the south-east and midlands is reinforced (Fig. .). This pattern is suggestive, since it shows that Earlswood exploited areas where other regional asylums were not strongly represented, such as the area surrounding the Severn Estuary, through the midlands counties, to  Subscriptions Book, , AREA, SRO ///, . Samuel Morton Peto had made his fortune through investment and construction of the Southern and South-Western Railway lines in the s and s. He was a committed Quaker who almost single-handedly funded the establishment of two chapels in London. Besides being enormously wealthy Peto was also well connected in Whig circles, elected as an MP in , and serving in government under Lord Palmerston. Indeed, the fact that Reed spoke optimistically that he would be able to secure the services of Lord Palmerston (by then Prime Minister) at an Inaugural Meeting may well owe a great deal to Peto’s influence.  [Annual] Report, , AREA, SRO ///, –.  One-in-ten sample, stratified between the new general voters and the new life voters of , randomly started.

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(b)

(a)

New Subscriber New Admission

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100 km

F I G . .(a). Place of abode, new subscribers to the Earlswood Asylum,  (b) Place of abode, new subscribers to the Earlswood Asylum,  and admissions to Earlswood Asylum, 

100 km

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the Wash and Lincolnshire. The paucity of subscribers in the eastern and western counties also suggests that fears of losing subscribers to the newer, regional idiot asylums were not without justification. Initially, the duration and level of subscriptions were vulnerable to the more general rise and fall of income or the sudden rise in taxation, and the supporters repeatedly complained of the extent to which downturns in trade affected revenue by hundreds of pounds. However, once the Crimean War had passed, the period of – was marked by a relative stability of prices and the general increase in the prosperity of the nation. As the economy suffered through periods of economic recession starting in , the entreaties of the Board began again, as they saw subscriptions levels declining with the economic fortunes of the nation in general. Unfortunately, the Board, after the downturn of the mid-s, chose to borrow instead of reducing costs, predicting, incorrectly, that the recession would be relatively short-lived and that the relentless rise of subscriptions of the pre-s would resume. When the depression in trade continued in fits and starts throughout the s and s the Board resorted to reducing the number of charitable patients. In this way, the financing of the asylum had a direct impact on the number of patients. The Board of the Earlswood Asylum had justified the admission of private patients on the basis that the excess of fees over the ‘real’ cost of annual accommodation and treatment would help to subsidize the charitable cases. However, there does not seem to be much evidence that this actually occurred. The asylum’s own figures for the cost per inmate fluctuated between £ and £ per annum. Since the number of private patients never exceeded  per cent of the total inmate population, the likely subsidy of an elected patient by the admission of a private patient would have been in the order of £ per annum, or  per cent of his or her cost of maintenance. It is more likely, therefore, that the Board cherished private fees as a stable and consistent source of income which could offset the fluctuations of annual subscriptions. Moreover, it seems clear that the medical men involved in the institution favoured the admission of private patients as a useful method of establishing contacts for when they made  The Midland Counties’ Asylum for Idiots at Knowle, near Birmingham, remained very small and thus did not have the financial demands or the subscribers’ base that the other regional asylums required.  E. Grove, A Beam for Mental Darkness: For the Benefit of the Idiot and his Institution (London, ), .  [Annual] Report, , AREA, SRO ///, .

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the inevitable professional transition from public superintendent to private proprietor. The Board thus had a delicate balancing act to perform. It needed income from fees, but did not want to compromise its appeal as a charity for idiot children of poor families. With the establishment of ‘regional’ idiot asylums, and the founding in  of the Hospital for Sick Children on Great Ormond Street, London, the danger of losing subscribers was real. Amidst the intense competition for limited charitable resources, proponents engaged in an intensive marketing campaign to attract new members and moderate the attrition of contributors. This competition for hearts and minds led proponents of the asylum to demonstrate that the affliction of idiocy was worse (and therefore more deserving) than those of other competing recipients of charity. At the beginning of her ‘penny plea’ on behalf of one candidate, Eliza Grove affirmed that: ‘It cannot be denied that idiocy is, of all afflictions, the greatest and most deplorable.’ Andrew Reed concurred, by adding that idiocy was ‘the lowest of all objects of Christian sympathy.’ Reinforcing the need for both charity and institutional provision, partisans wrote pamphlets alleging widespread neglect at home, or the abuse suffered at the hands of other children in the community. Medical men took up this theme with fervour. Detailing the life-cycle of a family with an idiot child, John Conolly explained clinically that: The poor imbecile alone remains, and becomes even a heavier bur[d]en to its father and mother when years are gathering over them. With all that they can do, the child grows only a stronger animal; learns to walk about, but is uninstructed, uncontrolled, helpless; if possessed of much energy, the dread of neighbours; and if quiet and timid, hunted from street to street, and exposed to every kind of wanton cruelty.

This was a view with which John Langdon Down, the second superintendent of the asylum, readily agreed. ‘Very many boys,’ he explained, ‘whose lives had heretofore been passed in neglected seclusion at their homes, or who, in their native villages, were the subjects of cruel tyranny or pitiless scorn from their fellows, may now be seen working in joyous

  

 Grove, A Beam for Mental Darkness, . See Ch. . Reed and Reed (eds.), The Life of Andrew Reed, . Propagandists were careful never to mention the abuse of the child by family members lest potential subscribers should feel that they were lending relief to less-than-respectable families.  As quoted in Clark, A Memoir of John Conolly, .

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mirth.’ The implication was clear: institutional confinement was better for the child, for the parents, and for society. Yet relieving suffering was not enough for some Victorians: appeals to Christian philanthropy had to be supplemented by a Victorian call for progress, self-help, and improvement. ‘We ask that he [the idiot] may be elevated from existence to life—from animal being to manhood—from vacancy and unconsciousness to reason and reflection’, exhorted Andrew Reed in one of his spiritual annual reports sent to every subscriber. The education of the idiot and the improvement of his moral, intellectual, and vocational powers thus reinforced the Victorian ethos that all individuals, through hard work and the application of the scientific method, could be improved. As Eliza Grove rhymed in her poem, ‘The Idiot’: Yet not upon him we gaze With cold and despairing eye, ’Tis not decreed that idiot born Must a poor idiot die. For those who may not have been sufficiently motivated to give money to a ‘hopeless’ cause or a grand social experiment, the Board marshalled microeconomic arguments to justify the endeavours of the asylum. The institution, they proposed, was alleviating the circumstances of the industrious, but poor labourer, struggling in hard times to feed a family which had been further burdened by an idiot child. According to this set of propositions, resources were being directed to the care and supervision of a disabled member, pushing the family to the brink of poor relief. Thus, by institutionalizing the child the charity supposedly prevented an extra burden on the Poor Law rates, an argumentative sleight of hand used more general by London voluntary institutions, such as Guy’s Hospital. As local infirmaries appealed to civic pride, so too did the National Asylum for Idiots tug on the heartstrings of British patriotism. ‘Something must be done for the Idiot,’ declared Reed, ‘unless we would allow other nations to outrun us in the noblest cause of man—that of benevolence.’ The Great Exhibition of  was often used as a      

Medical Superintendent’s Report, in the [Annual] Report, , AREA, SRO, . AREA, SRO ///, . Grove, ‘The Idiot’, in A Beam for Mental Darkness, . Reed’s Inaugural Address, quoted in the Minute Book, AREA, SRO ///, . Waddington, ‘Grasping Gratitude’, . Minute Book, AREA, SRO ///, .

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metaphor for the Earlswood Asylum. Lord Carlisle’s assertion that the ‘glories of the Crystal Palace would be dim by the side of an adequate house of shelter and of cure for all the idiots of our land’, was hyperbolic, but not atypical. The annual reports often described excursions to similar institutions for the training of idiot children in the United States and France, and concluded, for the edification of all friends of the institution, that the English national asylum was ‘unsurpassed’ in the world. The Earlswood Asylum thus simultaneously appealed to a wide variety of religious convictions, social aspirations, and economic beliefs of the Victorian age. For those motivated by a simple desire for Christian philanthropy, the proponents could emphasize the motif of helpless sufferers, the chrétiens of the modern world. For those interested in alleviating the plight of the working-class families, the Board could stress the benefit accrued to industrious households living on the edge of subsistence. For members with a scientific interest, the education of the idiot represented a novel post-Enlightenment experiment in the rejuvenation and progress of the mind. And for members of the medical profession, the creation of an asylum epitomized the triumph of modern medicine over mental disorder. Playing upon Eliza Grove’s metaphor of ‘A Beam for Mental Darkness’, the Revd Edwin Sidney summed up the multiple appeal of the asylum thus: The phrenologist will find opportunities of observation of the most instructive kind; the psychologist may study the development of mind, as the corporeal feebleness which overshadowed it approaches to strength; and the Christian philanthropist may note the efficacy of the plain and verifying truths of the Gospel, as it causes light to beam forth from Darkness.

Marketing the ‘product’ of the idiot child was thus of fundamental importance to the financial viability of any charity running a medical institution. The annual donations were the most visible and tangible results of the philanthropic effort. There were also levels of honorary positions and individual actions, however, which loaned necessary nonpecuniary aid to the charity. Earlswood received the support of the Queen in  and secured the official patronage of the Prince Consort, who laid the ceremonial first stone on Earlswood Common. In  the Prince   

As quoted in Reed and Reed (eds.), The Life of Andrew Reed, . Sidney, A Second Visit, –. [Annual] Report, , AREA, SRO ///, . The Prince Consort became the patron of many of the idiot asylums, including the first Scottish asylum at Baldovan, and

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and Princess of Wales performed the same task for the extension to the main building, whilst Prince Leopold celebrated the building of the detached infirmary in . After securing a suitable patron, a charity could do worse than build up a list of Honorary Presidents and VicePresidents who agreed to become large benefactors. Rarely would any of these individuals take a day-to-day role in the running of the asylum, and none of those listed in the  Presidential List sat on the Board of Management. They were, rather, grandees who were called upon to preside over fund-raising dinners, lend a supportive word or two on behalf of the institution, and perhaps come to the aid of the charity in times of financial crisis. In  the Duke of Cambridge presided over the Annual Festival Dinner which, in later years, boasted Lord Dufferin and Charles Buxton, MP. Honorary physicians, dental surgeons, surgeons, accountants, and bankers had important professional contributions to make. John Conolly, by then the most famous asylum superintendent of his era, acted as Consulting Physician from the founding of the charity in  until his death in . He was thus responsible for advising on medical matters and recruiting and hiring new medical officers. When John Langdon Down was engaged in , he would acknowledge in later papers that his entire training in asylum practice was due to the ‘counsel’ of Conolly in the first years at Earlswood. Though devoting his time freely, Conolly could court a huge potential clientele from the thousands of wealthy subscribers, especially after he resigned from his position as superintendent at Hanwell and founded his own private clinic. The role of honorary positions underscores the importance of nonpecuniary aid to the management and running of voluntary institutions. For instance, although the minimum subscription of half-a-guinea may have been too dear for some benevolent-minded individuals, gifts of food, clothing, books, and sundries were welcomed and rewarded with honorary votes by the Board and noted in precise detail in the annual reports. Similarly, less wealthy individuals could also post collection boxes the Northern Counties in England, to which he lent his name when it was established in . See Anderson and Langa ‘Institutional Care in Scotland’, –; Barrett, ‘From Education to Segregation’, passim.  [Annual] Report, , AREA, SRO ///, ; [Annual] Report, , ibid. .  [Annual] Report, , AREA, SRO ///, ; [Annual] Report, , ibid. ; [Annual] Report, , ibid. ; [Annual] Report, , AREA, SRO ///, .  Clark, A Memoir of John Conolly, –.  A. Scull, ‘A Victorian Alienist: John Conolly’, in Bynum et al. (eds.), The Anatomy of Madness, i. –.

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in their stores or advertise on behalf of the asylum. When the inmates went on a day trip to the Crystal Palace, the railway organized a special train at no cost, and the Crystal Palace waived the entrance fee. At the summer fête of , Schweppe & Co. provided the lemonade, soda water, and ginger beer. In  a printing press was donated, as well as toys, dolls, scrapbooks, engravings, and three cases of oranges, while other friends of the asylum distributed children’s periodicals such as Chatterbox and the Children’s Friend. Women played a central role in fund-raising for Earlswood, as they did in Victorian charitable activity generally. The summer fête and bazaars were the product of and were organized by the ‘Ladies’ of the charity, and raised between £, and £, annually. This largely anonymous group of the wives of Board members, individual female subscribers, and other ‘interested’ women organized games, sold inmates’ crafts (boys’ carpets and girls’ sewn articles), and provided entertainment, often in the form of general concerts for ‘inmates, staff, and subscribers’. When the bazaar was held at the ‘Dome of the Pavilion’ in Brighton, it was chaired by the Mayoress of Brighton, with the assistance of several ‘prominent ladies of the town’. The importance of women’s groups within the subscribers was formalized in  when the Board consented to the creation of an ‘Association of Ladies’, charged with raising money from individuals unable to become full subscribers. The annual fête was also symbolically important, for it allowed for the congregation of the staff, inmates, subscribers, officers, and Board members in the grounds of the asylum itself. All subscribers, and potential subscribers, were invited for a day of games and a tour of the institution, situated near Redhill Station, in Surrey. The fêtes brought the subscribers down to the asylum itself, in the hope that, seeing the progress of the inmates and possibly the need for some new items, they would be more likely to give above and beyond their regular subscriptions. Visiting and touring asylums represented an important way of educating the public and reminding subscribers of the importance of continual financial support. The charity rewarded clergymen who preached on behalf of the asylum with the right to membership with a life vote. This was not merely a polite gesture. The Board of Management realized that clergymen were the most important link to the local communities of the country, and fret  

[Annual] Report, , AREA, SRO ///, . [Annual] Report, , AREA, SRO ///, . [Annual] Report, , AREA, SRO ///, –.

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ted constantly about the poor support of local churches: ‘The Board perceive, with great regret, that the income from this source has been declining for some years, and desire most earnestly to commend the claims of this truly National Institution to the kind consideration of the Ministers of Religion of all denominations.’ Despite these incentives, the Board actually received little directly from congregational donations. The annual reports indicate that fewer than ten churches made regular collections on behalf of the charity, amounting to little more than £ per annum. In part this was due to an anomaly in the creation of the ‘Sunday Hospital Fund’, an attempt to pool all the proceeds given to hospitals in the Metropolis by the designation of a particular day for preaching on behalf of hospitals. The Fund was then to be divided among the London hospitals, with a disproportionate amount going to the smaller, poorer infirmaries. The Earlswood Charity apparently did not receive anything from the Sunday Fund, since it was located outside London, but was doubly handicapped in that many churches declined to raise monies for the asylum itself in order not to undermine the purpose of that centralized and co-ordinated philanthropic enterprise. Preaching, however, could benefit the institution indirectly: ‘Many legacies,’ pronounced the Annual Report of , ‘it is believed have resulted from sermons’. Legacies to Earlswood ranged from several guineas to several thousand pounds. Year to year the Board could rely on several in excess of £, and the Board tended to budget on the assumption that they would receive a certain amount from this source. In  the Annual Report regretfully stated that it had to borrow £,, and commented that the deficiency was due solely to an unexpected decrease in bequests. Conversely, in  the Board announced that, because of ‘exceptional’ legacies, the charity was able to pay off the entirety of its accumulated debt, a sum in excess of £,. While there were variations in the amounts bequeathed, the proportion of bequests to overall revenue of the charity was one-fifth, a figure comparable to Amanda

  

[Annual] Report, , AREA, SRO ///, . D. Owen, English Philanthropy – (Cambridge, Mass., ), –. [Annual] Report, , AREA, SRO ///, . It is unclear whether the Earlswood Charity was barred because it was (a) an asylum, (b) not technically in the Metropolis, or (c) its revenue exceeded the maximum allowed for hospitals to benefit from the Sunday Fund. Again, the fact that the asylum was a nationally oriented institution, and not a locally based one, may have worked against its raising revenue from church donations.  [Annual] Report, , AREA, SRO ///, –.  [Annual] Report, , AREA, SRO ///, ; , ibid. .

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Berry’s findings for the voluntary hospitals in Bristol and Northampton. Prochaska has argued that, although women were often outnumbered in the subscription lists, they were more likely to bequeath to the asylum and leave legacies which were larger fractions of their accumulated wealth. An analysis of the legacies to  indicates that women did outnumber men, but not by an overwhelming amount. Not surprisingly, legacies most often came from those deeply involved in the management of the asylum or from individuals who had been generous subscribers. When Andrew Reed died he left the asylum £,, but Mrs Plumbe, whose idea had initiated the entire asylum project, bequeathed only a modest £. s. Similarly, prominent members of the Board of Management also remembered the institution in their wills. Sir George Carroll, who had acted as Treasurer since the original Provisional Committee, bequeathed £. To facilitate such benefactions, the Board was even kind enough to publish, with the Subscriptions Book, a ‘typical’ bequest. And to add to the public recognition of the gift, the Board started a list of benefactors on the walls of the main dining hall in . While most of these had some connection to the asylum, there were exceptions. A possibly apocryphal story, circulated by advocates of the asylum, spoke of a Mr Dickenson who, apparently with no relation to the charity, read the report of the founding of the asylum on his deathbed and immediately changed his will in order to give the charity £,. Sermons were not restricted to the pulpit; certain clergymen took the ‘plight of the idiot’ to the people, lecturing in halls across the country. The Revd Edwin Sidney, rector of Cornard Parva, Suffolk, for example, toured the country giving lectures, such as one of the series of Lectures in connection with the Educational Exhibition of the Society of Arts, Manufacturers, and Commerce in . His engagements were encour Amanda Berry, ‘Patterns of Patronage: English Provincial Voluntary Hospitals in the Eighteenth Century’, an unpublished paper read at the Wellcome Unit for the History of Medicine, Oxford,  May . Berry found .% and .% for Bristol and Northampton respectively; however, the figure for the Devon and Exeter Hospital was lower, averaging .% of total revenue.  Prochaska, Women and Philanthropy, –.  Respectively, [Annual] Report, , AREA, SRO ///, ; [Annual] Report, , AREA, SRO ///, –.  [Annual] Report, , AREA, SRO ///, .  [Annual] Report, , AREA, . Unfortunately, these lists were painted over some time after the hospital came under National Health Service control.  Reed and Reed (eds.), The Life of Andrew Reed, .  (Anon.), The Education of Imbecile Children, .

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aged and co-ordinated by the Secretary of the charity, Mr William Nicholas, who himself spoke to at least two public meetings a year. The purpose of these lectures was threefold: to elicit donations, to enrol new subscribers, and to generate an interest in the charity’s affairs which would lead to new applicants. ‘Public Meetings . . . are not only immediately profitable,’ suggested Reed, ‘but increase the number of Annual Supporters and are the means of bringing forward fresh candidates for admission, both as private and election cases . . . and have happily led to the establishment of local institutions.’ During the years between  and  Nicholas collected donations at Torquay (£), Eastbourne (£), Banbury (£), Leighton (£), Canterbury (£), Luton (£), and Swansea (£). When the Revd Edwin Sidney travelled to Newcastle and Liverpool, he was congratulated by the Board for increasing the number of subscribers by . C O N C LU S I O N

Despite the best intentions of its supporters, the Earlswood Asylum, like many other Victorian charitable institutions, lurched from financial crisis to financial crisis. It is a particularly apt commentary on the viability of the Earlswood Charity, that with all the exertion put into annual subscriptions, with the patronage of the Queen, the support of extremely wealthy patrons like Samuel Morton Peto, and in a general period of prosperity and low inflation, the Board continued barely to break even, relying on special appeals for any major renovation or expansion, or even for the extinction of an accumulated debt. For instance, the devastating effect of infectious diseases and the subsequent danger to institutional populations prompted many asylums, both rate-aided and voluntary, to build separate detached infirmaries. The Lunacy Commission itself began a campaign to initiate their construction in the s. Yet, although the idea was raised in the Earlswood annual reports from , it was not until  that the asylum, with an extraordinary donation from the Freemasons of London, was able to construct the building, and even then it was still unfurnished in  for want of funds. After fairly buoyant years of the  

[Annual] Report, , AREA, SRO ///, . [Annual] Reports, –, AREA, SRO ///, , , , ; SRO ///, .  [Annual] Report, , AREA, SRO ///, .  [Annual] Report, , AREA, SRO ///, ; [Annual] Report, , AREA, SRO ///, .

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s, the revenue plateaued and even declined slightly. The asylum turned to deficit-financing, borrowing sums of £,, £,, and £, in the economically depressed years of –. In addition, it began to reduce elections after . Accordingly, the asylum, which had peaked at  inmates, declined to  as the Board cut costs by slowly reducing the numbers of readmissions and new admissions. Part of the Board’s reluctance to keep pace with the wages of attendants at other asylums, outlined in the previous chapter, may be a result of these hard financial times. Public opinion also began to turn against the voluntary management of medical institutions, including criticisms of the election system in particular. Figures of no less stature than William Gladstone, Lord Shaftesbury, and Florence Nightingale lashed out against the arbitrariness of election. Lord Salisbury himself wrote that the election system ‘selects the objects of charity in the very worst possible way, befriending those who have many friends, and sending back those who have few friends unrelieved; and it induces people to waste time and money in charitable electioneering’. Salisbury was thus identifying the underlying ideological fault-line which was to play itself out in the first half of the twentieth century. On the one hand there were individuals, such as Shaftesbury himself, arguing in favour of a comprehensive statesupported asylum system for all classes; on the other hand there were philanthropic institutions which wanted to preserve the prerogative of voluntarism and the sharp distinction between the deserving and undeserving poor. The spirit of collectivism and state intervention was slowly overwhelming the well-intentioned efforts of charity. In addition, the inflated educational goals of those who advocated separate asylums for idiot children failed to materialize. The education of idiots had proved to be less revolutionary than had at first been hoped. 

As quoted in Alvey, Reed’s School, .

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

The Educable Idiot The Victorian period witnessed a dramatic change in the education of the mentally disabled. Before the early nineteenth century, professional and popular discourse emphasized the ineducability of idiots. Indeed, the very definition of idiocy revolved around the inability of idiots to be ‘improved’. As previous chapters have illustrated, institutions such as Earlswood represented a grand experiment in education that owed its origins to the post-Enlightenment experiments in France. However, the social significance of ‘helping those who cannot help themselves’ went beyond Christian piety. Philanthropic schools, such as Earlswood, held special significance within the class-torn environment of Victorian England. Within the laboratory of the asylum, idiot children were being recreated in a bourgeois, middle-class image. If even idiots could be incorporated and educated into civilized society, then there were no barriers to the education of the working classes and the civilization of ‘underdeveloped’ cultures of the emerging British Empire. The idiot asylum was thus a strange admixture of social engineering and radical educational experimentation, reflecting deep class and cultural preoccupations of Victorian social commentators. Discerning what actually happened within asylums, however, has proved extremely difficult for medical historians, especially when confronted with the ‘official’ self-portrayal of asylums in annual reports. In addition, institutional medical superintendents proved ambivalent about opening the doors of mental hospitals to the outside world—torn between the desire for a degree of public transparency and the fear that visitors would disrupt the improvement of patients. For a philanthropic institution, however, the need for publicity tended to outweigh considerations of intrusion or impropriety. The Earlswood Board treated visiting by ‘interested observers’ as a necessary evil and even, at times, invited sympathetic publicists into the asylum to write about their experiences. No less a figure than Charles Dickens visited the Earlswood Asylum on more than one occasion in order to draw inspiration for his novels. Another writer, the pamphleteer Joseph Parkinson, remarked, ‘the ordinary inner life of this remarkable place is as little known as that of a man

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who conceals a secret pride, or ambition, or scorn beneath a frivolous or jocular exterior’. A prolific clergyman, the Revd Edwin Sidney, published no fewer than three accounts of his visits to Earlswood, each with the approval and support of the Board. These first-hand accounts provide us with insights into the inner world of a Victorian idiot asylum and the social significance of their educational activities. The moral education of idiots incorporated traditional classroom teaching, workshop apprenticeship, and the inculcation of accepted norms of social behaviour. All three were to be incorporated within the therapeutic milieu of the asylum, itself a self-contained laboratory of social, medical, and educational experimentation. It is worth reflecting how little discussion there was in the early years of the Board as to the appropriate locus of care and medium for this dispensation of charity. From  to  the Board ran homes in London and Colchester, converted into residential ‘retreats’. Park House, in Highgate, North London, and Essex Hall in Colchester would have borne similarities to the intimacy of other private licensed homes in the metropolis and surrounding region. However, the decision to build a large institution along lines similar to the county pauper lunatic asylums left a legacy for future ‘mental deficiency’ institutions in Britain. The charity could, theoretically, have continued its specialized form of training in a small home or series of day schools in the metropolis specifically tailored to the training of idiots. It could also have sent nurses into the homes of poor families to provide relief or train families in the management and care of the idiot child, in a manner similar to the ubiquitous lady visitors of the Victorian era. Instead, the Earlswood Charity chose to find an institutional medium through which to dispense its philanthropy. Thus it reinforced ideas of the otherness of the asylum patients, rather than promoting an integration of the children into their respective communities. It also presented one of the many ironies of asylum treatment for idiots—in order to facilitate the integration of idiot children into society as ‘useful’ and productive members, it was deemed necessary first to segregate and isolate them. Andrew Scull has argued that large asylums for the insane were most fervently promoted by medical men who were eager to extend their own professional domain and establish a monopoly over the formal treatment of mental disorder and disability. This ‘moral entrepreneurialism’  was  

Parkinson, A Day at the Earlswood Asylum, . Scull, ‘From Madness to Mental Illness’, –.

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pronounced in the development of the Earlswood Asylum. Medical men on the Board of Management were central to the articulation of the idea of large, isolated institutions for the treatment of mental disability. Indeed, the Revd Andrew Reed, writing the first Annual Report of the charity, directly alluded to the determination of its medical advisors to secure a large asylum isolated from urban influences: ‘In concurrence with the Medical Officers, we were of the opinion, that they [the idiots under treatment] would require a house of ample accommodations; that its site should be elevated; that there should be sufficient land to secure exercise and free ventilation . . . and readily accessible from the Metropolis.’ Identifying a location for a new asylum thus became a priority, and the Board could turn to the then national expert on asylum construction and Earlswood honorary physician, John Conolly. In his influential  treatise On the Construction and Government of Asylums and Hospitals for the Insane, the bible of asylum construction in midVictorian England, Conolly outlined the physical dimensions and geographical location of asylums in the Victorian era. ‘There can be no doubt’, he asserted, ‘that the best site for an asylum is a gentle eminence, of which the soil is naturally dry, and in a fertile and agreeable country, near enough to high roads, a railway, or a canal, and a town, to facilitate the supply of stores, and the occasional visits of the friends of the patients, and to diversify the scene without occasioning disturbance.’ His advice was well-heeded. Many provincial county asylums built in the late s were constructed along ‘gentle eminences’ near provincial capitals. Following the tradition of the times, the Earlswood Board secured land in  on Earlswood Common, near Redhill in the county of Surrey,  miles south of the River Thames. It was, by the standards of the time, an ideal location for an asylum. The land towered above the Southern (London to Brighton) Railway line, boasted  acres (ninety-four acres for future expansion and farm work), and was only two hours by train from Victoria Station. Thus the location balanced the necessary isolation emphasized by alienists and the proximity to the metropolis for transportation of patients, visitors, subscribers, and supplies.

  

[First] Annual Report, , AREA, SRO ///, –. Conolly, On the Construction . . . of Lunatic Asylums, . Small parts of adjacent lands were purchased between  and  to bring the total acreage to . Twenty-third Report, ARCL, PP [–], xxvii,  [].  Cf. to Thomas Kirkbride’s similar comments on the ideal spot for the Pennsylvania Lunatic Asylum as described in Tomes, A Generous Confidence, –.

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Although in the s there would be a backlash against the construction of larger and larger institutions for the insane, Andrew Reed and his medical advisers seem to have been convinced in the early s of the need for the asylum to consist of a single institution, rather than a group of small homes located on a common property. The medical report, signed by John Conolly, William Little, and Thomas Callaway, the ‘gratuitous’ medical officers of the asylum, emphasized the need for classification within a large institution: ‘. . . seeing the great variety exhibited in their [the inmates’] intellectual, moral, and physical character, we cannot conclude without expressing our great anxiety that they should before long, be collected in one large and systematically arranged building, affording facilities which no private house can be made to possess, for this very essential object.’ The construction of a large institution divided into wings or wards, in contradistinction to converted homes or rural estates, constituted a rejection of the ‘retreat’ style of asylum accommodation which, until then, had dominated the arena of private care of idiots and lunatics in the eighteenth and nineteenth centuries. The ‘institutional’ structure adopted for construction on Earlswood Common also stood in contrast to the Philanthropic Boys School, Reigate, a residential reformatory school a mere  yards away, that occupied roughly the same acreage but whose residents were accommodated in six independent cottages. This belief in a unitary building, and the centralization which it engendered, informed the culture of the asylum experience. Centralization had the obvious advantage of economy; yet it also structured power within the institution, particularly that of the medical men vis-à-vis the matrons or other senior domestic servants. Whereas in the two homes in Highgate the medical officer was a visiting physician, at Earlswood the chief medical officer, in compliance with the Asylums Act of , was also a resident superintendent. Here the gendering of the medical marketplace operated on a subtle level, since all the medical superintendents of asylums were men, whereas many of the matrons and

 The cottage system would re-emerge in many guises by the Edwardian era, as the public turned once again against the prison-like appearance of huge institutions. In particular, those advocating separate colonies for the feeble-minded, epileptics, and the tubercular proposed cottages as a way of maintaining a homelike environment within an asylum framework.  [Annual] Report, , AREA, SRO ///, .  Parry-Jones, The Trade in Lunacy; Digby, Madness, Morality and Medicine; C. MacKenzie, ‘Social Factors in the Admission, Discharge and Continued Stay of Inmates of the Ticehurst Asylum’, in Bynum et al. (eds.), Anatomy of Madness, ii. –.

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heads of small voluntary homes for idiots, such as the ones in Bath and Belvedere, were women. Large institutions for the insane, however, were not without their critics, even in the ten years of rapid asylum construction following the Asylums Act of . The rapid establishment of such large institutions provoked debate within the medical community, which saw some of them as appearing custodial, ugly, and too closely resembling prisons rather than hospitals. Conolly, writing in , acknowledged these criticisms: In most of the old asylums the architects appear to have had regard solely to the safe keeping of the inmates, and the buildings resemble prisons rather than hospitals for the cure of insanity. Even now, high and gloomy walls, narrow and inaccessible windows, heavy and immovable tables and benches, and prison regulations applied to officers and attendants, attest the prevalence of mistaken and limited views.

One of Conolly’s responses to these misgivings about the ‘prison-like’ appearance of the new institutions was to encourage the beautification of the exterior and interior environments of asylums. Reed and Conolly took pains to present an admirable edifice, pleasing exterior, and handsome decor for the new National Idiot Asylum. The result, depicted in a drawing in the Illustrated London News, revealed a majestic building of the ‘Elizabethan style’, costing close to £,. Notwithstanding the criticisms of the Lunacy Commissioners in , over the next generation there was a gradual bourgeoisification of the Earlswood Asylum. Despite the striking façade, the internal structure of the Earlswood Asylum was premised upon the ‘moral architecture’ of Victorian asylum construction, whereby the symmetry of the wards would impart a similar orderliness in the minds of its inmates. While the original architectural plans have not survived, there is a layout of the asylum extant, showing the installation of a new set of lights sometime in the late s, which reveal its essential internal structure. The portico beneath the central  Anon., The Education of the Imbecile and the Improvement of Invalid Youth (Edinburgh, ), ; Millard, The Idiot and His Helpers, .  Conolly, On the Construction . . . of Lunatic Asylums, .  Appendix to the Eleventh Report, ARCL, PP [],  []. The artist’s creation of the asylum was in fact an interpretation of the final structure, since this article was published three years before the building itself was fully finished. The drawing, however, is a very accurate representation of what the building looks like today, although the waterfall does not grace the entrance, is not referred to in any sources, and does not appear in the Ordinance Survey map of . A watercolour made from this drawing (also with the waterfall) currently stands in the front portico of the institution, now the Royal Earlswood Hospital. The building is listed under English Heritage.

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water tower led into the front hall, with the reception room on the left, adorned with the artwork of gifted inmates, and, to the right, a drawingroom for the use of the medical superintendent. Behind the front staircase lay the main corridor connecting the two main wings of the front of the building. On the left-hand side lay the female ‘division’, on the right, the male. Like most lunatic asylums and schools of the Victorian era, separation by gender was essential: ‘The entrance to the female division of the asylum is quite distinct,’ commented the Revd Edwin Sidney approvingly, ‘as it ought to be.’ Hence, there were separate girls’ wards, a female side of the dining hall, and only female attendants worked on the girls’ wards. Behind the grand central staircase was a large dining hall which occupied the symbolic centre of the asylum and doubled as a chapel and music hall. The only fundamental structural changes to the asylum during the Victorian period were the extension of the dining hall, the construction of a separate infirmary for ‘the lame, epileptic, and the impotent, unable to feed or dress themselves’, and an adjacent building for workshops. One should not be overly deceived by the rigidity of the asylum’s internal structure. The building allowed for some degree of flexibility. Each ward could operate as a relatively separate unit, having its own entrances and staircases to the lawns, and its own bedrooms. Since children were divided by intellectual ability, tailoring wards to specific abilities afforded the type of classification and specialized training the medical officers considered essential for individual development. These units also fostered an interdependence between staff and inmates within the ward. Indeed, long-stay patients sometimes acted as ‘attendants’ under the supervision of ‘regular’ staff. Although Conolly might lament the prison-like appearance of some lunatic asylums, he fretted little about the regimentation of asylum life. Indeed, he and his contemporaries believed such regimentation was essential to the amelioration of disabled and disordered minds. Duncan and Millard, in their first textbook on the training of idiot and imbecile   

Sidney, A Visit to Earlswood Asylum (London, ), . Ibid. ; Tomes, A Generous Confidence, –, and J. Crammer, Asylum History, . Sidney, A Second Visit, ; Parkinson, A Day at the Earlswood Asylum, . In  a separate outside entrance to the dining hall was built so that the girls and boys could enter by separate doors. Twenty-eighth Report, ARCL, PP [], xxvii,  [].  Sidney, A Second Visit, –; Seventeenth Report, ARCL, PP [], xx,  [].  Twenty-fifth Report, ARCL, PP [], xxvi,  [].  ‘On the way, I met a youth who has been long in the Asylum, and is now elected for life . . . he told me his office was to “mind the little boys”.’ Sidney, A Second Visit, . See also Duncan and Millard, A Manual, .

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children, suggested that the first step towards prevention of offensive habits was the establishment of a regular routine which was ‘clock-work’ in its regularity. Idiot asylums, not unlike other institutions, worked on a ritualized day. Staff rose at . a.m. and prepared themselves for ward work. They entered rooms of six to twelve patients to wake them for breakfast. Although large shared sleeping rooms lacked privacy, when one considers the living conditions of poor rural labourers in the Victorian era—where many families occupied tiny, unsanitary hovels—the living arrangements could not be considered squalid relative to the times. As the charity became more financially secure, venetian blinds were placed on all front windows in  to add some privacy for the patients. Attendants working in classrooms encouraged ward staff to display an inmate’s artwork on the wall above his or her bed, to add a degree of individuality. At the foot of the bed hung the (medical) cards indicating for the attendants the inmate’s name, type of ‘disease’, and special dietary requirements. One visitor observed, rather mawkishly, that each of the little girls’ beds had a doll reclining on its pillow. More able inmates and attendants helped the younger and less capable children to dress and make beds. Attendants ushered the inmates through the front hallway, beneath hanging ‘ornamental cages’ with birds and past windows ‘decorated with flowers and ferns’, to the dining hall for prayers and breakfast at . a.m. Mealtime brought the whole inmate population—commonly called ‘the family’ in most Victorian asylums—together within the confines of the dining hall. For many medical practitioners in Victorian Britain the choice of diet was considered essential for ameliorating unbalanced or deficient minds, so the quality and quantity of the food was carefully considered. Attendants sat at the head of each table and watched over the behaviour of the pupils. Dining was also an event during which values of order and self-discipline were inculcated. ‘Except for their odd sayings now and then, and the singularities of manner incident to their condition,’   

Duncan and Millard, A Manual, . Twenty-third Report, ARCL, PP [–], xxvii,  []. These cards were introduced in . Additional Bylaws,  January , addendum to the General Rules and Regulations; Eleventh Report, ARCL, .  Parkinson, A Day at the Earlswood Asylum, .  ‘Bare walls and vacant galleries are opportunities lost for conveying knowledge and awakening emotions of pleasure. Bearing this in view, the corridors have been partially decorated with singing birds in ornamental cages . . . and many of the windows enlivened by baskets of flowers and ferns.’ Sidney, Earlswood Asylum and its Inmates (Croydon, ), ; See also [Annual] Report, , AREA, SRO ///, .

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observed the Revd Edwin Sidney, ‘the spectator might fancy himself looking at the pupil’s dinner of some well-conducted superior girls’ school.’ This may have been a slight exaggeration, since the throwing of food, screaming, and violence amongst inmates were frequently mentioned in the medical case-books. Despite this, the management of the asylum saw every daily ritual as an opportunity for the acquisition of skills for self-sufficiency and training of self-discipline. ‘The due use of a knife and fork’, one visitor observed, ‘is a step in the idiot’s education; it helps on other advances.’ At the termination of breakfast the dining hall transformed itself into a chapel, as one of the schoolmasters read prayers. Formal training began when the pupils proceeded outside into the gymnasium and assembled in squads of no more than ten for ‘drills and gymnastics’. The Victorian approach to the education of idiots, as outlined in Millard and Duncan’s manual, emphasized the importance of controlling the involuntary and irregular movements of the body which, to many observers, typified idiocy. This physical dimension to the education of the idiot was premissed on the inviolability and perfection of the mind operating within an imperfect physical constitution. Reed described the theoretical underpinnings of this philosophy: [The Board] have acted on the principle; that always there is a mind, and that in itself it is perfect; and that it has imperfect and defective expression or imperfect or deranged organisation. Their education therefore, has been principally physical . . . They have sought for the particular defect, and begun with it. They have educated the eye, the mouth, the muscle, the limb; and have endeavoured to reach the better portion of our nature, that it also might be trained to moral and spiritual exercise.

In this organicist perspective, the training of the body and the training of the mind were inextricably linked. The flailing arms or repetitive, ‘purposeless’ action of idiots was seen as merely representing defective bodily organization, improperly subject to the individual’s will. Thus, before any success could be achieved in academic work the body had to be brought under control. And the most popular manner to achieve this    

Sidney, A Second Visit, . Ibid. . Twenty-sixth Report, ARCL, PP [], xxvii,  []. On rainy days the drill would have been conducted in part of the dining hall, or, more likely, in the classrooms. In  the gymnasium was covered.  [Annual] Report, , AREA, SRO ///, , italics original; see also [Annual] Report, , AREA, SRO ///, .

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The Educable Idiot T A B L E .  The Standing Drill

‘Place each pupil a yard apart, see that the heels touch, the toes turn out, the knees are straight, and the head erect.’ . . . . . . . . .

Up Hand Down Hand Repeat Hands on Hips Hands Down Hands on hips, head turned right Hands on hips, head turned left Hands down, head front Clap Hands

. . . . . . . .

Clap, , ,  Arms Front Arms Back Arms Down Repeat Arms Up Arms Down Repeat

Source: Martin Duncan, The Method of Drill for Idiots, Simpletons, Feeble-minded Children (London, ), .

result was the ‘drill’. In  Martin Duncan published a manual for teaching idiots which detailed the various drills useful for idiots (see Table .). As well as those shown in the Table, the manual recommended several other drills, including the Step Drill, Walking Drill, Hopping Drill, Running Drill, Two Pole Drill, Ward Drill, and Club Drill, as well as a variety of gymnastic exercises including the parallel bars and the balancing plank. The very first Annual Report indicates that a ‘gymnastice’ was hired specifically for this purpose, and a visitor in  made reference in  to the ‘drilling and imitation rooms’. Drill was, it seems, also used to help ‘correct’ self-injury: one boy, known for slapping and punching himself, ‘[is] drilled daily, made to stand in one position for sometime, is put on an inclined plane, and by resting on his hands is trained to bear the weight of his body’. Down wrote of the extension of gymnastics to speech, where the defective speech of imbeciles could be overcome by a well-arranged plan of ‘tongue gymnastics’. Physical exercise was thus directed at subjecting body and mind to the will. Following ‘drill’, each pupil—they were referred to as pupils when  P. M. Duncan, The Method of Drill, The Gymnastic Exercises, and the Manner of Teaching Speaking, used at Essex Hall, Colchester, for Idiots, Simpletons, and Feeble-minded Children (London, ), –.  [Annual] Report, , AREA, SRO ///, ; Sidney, A Second Visit, .  ‘Case Study no.’, [Annual] Report, AREA, SRO ///, .

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regarded in their capacity as schoolchildren—was assigned to one of six classes according to his or her ability. In the lower classes the teachers tended to concentrate on basic life skills, such as self-feeding, self-dressing, and speech. Classroom training concentrated on association, imitation and repetition: ‘The pupils, especially at the commencement of their training, are chiefly taught through the eye, objects being presented to them again and again until they have become familiar and at once recognised. Speech is acquired by the same sound and word being continually repeated and pronounced.’ After ‘graduating’ from the probationary class, the schoolmaster and schoolmistress divided new admissions into one of six regular classes, where the average student spent ten hours a week under instruction in half-hour lessons. The separation into classes reflected the perceived educational level of the child. Beginning in the sixth class, pupils were described as only knowing one or two sounds, knowing no letters, and as sometimes coming when they were called. Each higher class represented a progression in each of the separate skills. In fourth class the pupils knew six or seven letters, could make rudimentary strokes on their slates, and could count above twenty. Students of the first class, according to the schedule, could read the New Testament ‘with tolerable correctness’, write sentences in copybooks, and do simple sums. The methods used to teach basic educational and self-help skills reflected a pragmatic approach. Teachers set counting to music: ‘By this means much is retained in their minds which could not be learned in any other way.’ Others tried to impart the understanding of letters through the ‘aid of bits of wood constructed for the purpose’. Duncan and Millard suggested specialized devices for the acquisition of motor skills: ‘It will be found useful to have garments specially constructed, which shall form a series of graduated exercises in buttoning and unbuttoning, tying and untying, lacing and unlacing, buckling and unbuckling, fastening and unfastening with hooks and eyes . . . At first, large buttons and button-holes should be tried, and afterwards smaller ones.’ Wooden cabinets in the classrooms included objects of ‘common use’ of all shapes and colours, whereby ‘habit of observation is strengthened and remarks are drawn out on their form, colour, taste, smell, size, weights and use’,     

[Annual] Report, , AREA, SRO ///, . [Annual] Report, , AREA, SRO ///, . [Annual] Report, AREA, SRO ///, . Parkinson, A Day at the Earlswood Asylum, . M. Duncan and W. Millard, A Manual for the Classification, Training, and Education of the Feeble-minded, Imbecile, and Idiotic (London, ), .

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while the utterance of their names ‘includes all the sounds of the English language.’ One visitor observed the teaching of letters and sounds in full: The present mode is ingenious. A number of familiar objects are provided, generally three for each elementary sound, shewing it in three different positions. For example, if the sounds were those of the letter t, the teacher would first hold up a top which the pupils are made to name collectively; then a letter, and lastly a pot. For d, he would shew a dog, a ladder and some object coloured red . . . The result has been that many who could scarcely articulate a sound can now peak intelligently and with tolerable correctness.

When being taught shopkeeping, the pupils took turns weighing and selling fictitious goods, paying, and giving change. This taught them the value of money, reading (through the lists of goods), and the differentiation of coins. After a morning break some of the inmates returned to a second half-hour lesson; others (generally those who had been re-elected or elected for life) helped with the preparation of dinner or with domestic chores. A typical dinner, according to one observer, consisted of ‘boiled and roast beef and mutton, Yorkshire puddings, treacle pudding, rice pudding, and bread puddings’, with water and, for the few adult inmates, beer as the beverage. Food was served by large ‘hand-wagons’ with food taken from heated air cupboards. For those with difficulty eating, minced meat and mashed potatoes were provided so that ‘injury from defective mastication’ would be as unlikely as possible. After dinner the pupils sang grace. Children too young or needing special assistance ate in a small nursery dining room. Following dinner the pupils adopted working roles commensurate with their gender, class, and mental ability. The girls and young women of charitable status retreated to the wards, to clean the linen, perform needlework, and sweep the wards under the supervision and assistance, if necessary, of the female attendants. This, the asylum concluded conveniently, was useful ‘training for future housemaids’. The Annual Report of  estimated that nearly , pieces of laundry were required per week, and all were successfully completed by the inmates and staff of the

  

[Annual] Report, AREA, SRO, ///, –. Sidney, A Lecture, . After  the bulk of the attendants ate in a separate dining halls for the men and the women, in shifts.  [Annual] Report, , AREA, SRO ///, .

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institution. At any time during the period under study between onethird and one-half of the male inmates worked in the workshops. Manufacturing was seen as an important source of income and therapy for the inmates. ‘The common matshop supplies the whole house,’ wrote Edwin Sidney, ‘and the boys may be said to earn at least a good portion of their living.’ The tailor’s room, which in  occupied eleven boys, supplied, according to one propagandist, the clothes for all the charitable boys and uniforms for the attendants, the master-tailor cutting the pieces to be sewn by the worker-pupils. In  a separate building for the workshops was erected, and contained separate rooms for basket-making, mattress-making, unpicking, and renewing: ‘The row of boot-cleaners in red flannel jackets and black aprons, like Lord Shaftesbury’s shoeblack brigade, are hard at it with brush and blacking-pot. The menders, sewers and welters are all doing useful work, under the superintendence of the master tradesmen . . .’ The Victorian preoccupation with the therapeutic and spiritual value of work affected the operation of different types of institutions—workhouses, lunatic asylums, and prisons. Few Boards of Guardians, magistrates, and lay managers tried to conceal the fact that employment within the institutions was also an important element in reducing institutional expenses. Things were no different at the Earlswood Asylum. In fact it is difficult to discern what activities of daily life were not supplemented by the labour of the inmates thinly disguised as vocational training. The carpenter’s shop constructed furniture for the asylum. In  the farm was equipped with twelve cows, seven sheep, and fifty-two lambs and, by , encompassed  acres. The cows were milked by the patients. In the kitchen, ‘several of the largest boys dressed as cooks, with white sleeves, aprons, and caps, helping to take up the dinner’, while another commentator seemed amused at ‘several of the idiot friends we have already made. They have put on brown holland suits over their attire, and are doing brave work in weighing, carving, and apportioning out the meat, vegetables, and pudding for the approaching meal.’ Meanwhile, other boys conveyed the clothes to the rooms, while the girls made linen apparel  [Annual] Report, , AREA, SRO ///, . The training of idiot or feebleminded girls would become more pronounced in the Edwardian period, when it was common for young girls of weak intellect and ‘morals’ to be placed in homes where they would be trained as domestic servants.  Clark, A Memoir of John Conolly, .  Sidney, A Second Visit, –.  Parkinson, A Day at the Earlswood Asylum, .  Clark, A Memoir of John Conolly, .  Sidney, A Visit, .  Parkinson, A Day at the Earlswood Asylum, .

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with the help of a ‘treddle’-aided sewing machine. ‘Improved’ idiots helped make the beds. Even the mail was carried by an inmate: ‘[O]ne of the first persons we saw on our way through the village, was a pupil of the Idiot Asylum, who acts as postman, and is most proud of the trust, with letter-bag over his shoulders.’ He received his mail from the letter carrier, who drove to the railway station every day on his donkey-cart to pick up the postage. When, in , a printing press was donated, the Annual Report boasted that all the printing of the establishment, including the Annual Report itself, was executed by inmates. Vocational employment lessened the financial burden of the asylum, taught trades to the inmates, and kept the pupils busy. However, as stated earlier, there was something ideologically important about the role of work in the asylum. The religious terms in which work was described, as if the devil would make use of idle hands, revealed an ethic which, although broadly bourgeois, may also have had with it strong Nonconformist roots. After tea at . p.m. the inmates were often free to engage in sports or leisure activities under the supervision, or with the active participation, of the attendants. The conviviality and camaraderie of sports broke the monotony of asylum life and lifted the spirits of staff as well as patients. As Sir James Clark perceptively commented: ‘Amusements of various kinds take place at weekly intervals, which not only interest the inmates, but prove beneficial to the staff, on whose mental freshness and vigour the progress and happiness of the patients in a great measure depend.’ From the mid-s there was an outdoor gymnasium behind the dining hall, with athletic equipment. The asylum grounds had a cricket oval where attendants umpired. After dinner, commentators mentioned the walks, of which there were reputedly no fewer than  to  miles across the property. An asylum brass band, comprised mostly of officers and attendants, but including ‘a few patients’, played once a week on the terrace, witnessed by ‘as many as ’. Less frequently there were magic lanterns and shadow pantomimes, Japanese jugglers, and performing dogs. Once a month a concert of vocal and instrumental music was held, the performers being solely composed of the officers and attendants of       

 Parkinson, A Day at the Earlswood Asylum, . Sidney, A Second Visit, .  See Ch. . [Annual] Report, , AREA, SRO ///, . Cf. Digby, Madness, Morality and Medicine, .  Sidney, A Second Visit, . Clark, A Memoir of John Conolly, . [Annual] Report, , AREA, SRO ///, . Parkinson, A Day at the Earlswood Asylum, . Thirty-second Report, ARCL, PP [], xxxix, – [].

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Earlswood. For the Christmas pageant of  Dr Down wrote the dialogues, Mrs Down designed the costumes, and attendants were expected to take leading roles. Punch and Judy shows seemed the most popular for the inmates, perhaps because the characters were depicted as attendants. In the late s an aviary was added to the asylum to which subscribers sometimes donated birds, as with the pair of cockatoos given in . By  the attendants had two mess-rooms, a billiards table, and a skittles alley shared by both staff and pupils. Some preferred to retire to the semi-privacy of the ward, where boys played draughts and the girls did ‘fancy work’. Patients’ ‘lights out’ was at . p.m.; the attendants were allowed one more hour before their curfew took effect. At night, separate attendants, two for each division, took responsibility for the night watch, and were monitored by Dent’s ‘Tell Tale’ clocks that had been installed to motivate somnolent workers. Daily routine varied weekly and seasonally; on holidays and weekends there appear to have been frequent excursions outside the grounds of the asylum. The Lunacy Commissioners reported that  inmates attended a special children’s afternoon service at Warwick Town church, while thirty travelled regularly into neighbourhood churches in the Reigate area. The annual reports allude to regular trips into Redhill, and at times further afield. By the s the asylum was regularly renting a seaside cottage near Brighton, where inmates and staff would travel for the day on the Southern Railway line. A yearly trip to the Crystal Palace was also very popular. One sojourn to Littlehampton was described by a local Redhill reporter in July : We were astonished at the magnitude of the undertaking [w]hen we saw upwards of  put into the special train awaiting them, and wondered how in the common order of things they could all be attended to. Many of them seemed to us helpless crip[p]les, and must have needed a large share of the watchful care of their attendants and nurses, besides any amount of patience on a hot-summer day. We could not follow them, only in thought, to Littlehampton, where, we heard they were      

[Annual] Report, AREA, SRO ///, . Sidney, A Second Visit, . [Annual] Report, , AREA, SRO ///, ; Sidney, A Lecture, . [Annual] Report, AREA, SRO ///, . Twenty-fifth Report, ARCL, PP [], xxvi,  []. Night nurses were installed in most asylums in the s in response to suicidal attempts and epileptic fits during the night.  Twenty-seventh Report, ARCL, PP [], xxx,  []. This was discontinued during the period of smallpox epidemics. Twenty-sixth Report, ARCL, PP [], xxvii,  [].

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going to spend the day, but contented ourselves by going up again in the evening to see them return ‘all safe’ as we were told, about  o’clock.

The tone of this article implies that the local community took an almost paternalistic outlook towards the asylum, as if it was a source of amusement, curiosity, and pride. Many local people would have had relatives working in the asylum or commercial dealings with the institution. Linda Bryder has spoken of the fear that local communities had of the tuberculosis sanatoria; however, it seems that few felt threatened by the presence of idiot or imbecile children. John Langdon Down, the medical superintendent of the asylum from  to , also developed his own ‘moral treatment of idiots’, an educational system based on a self-conscious system of rewards and punishments. Corporal punishment was strictly prohibited; but there were more subtle means of punishment and persuasion within the confines of everyday life. While Dr Down counselled not to deprive patients of food, he did imply that privileges, such as the advancement to higher classes, and access to sports and trips, be used as a means of reinforcing appropriate behaviour. In a forerunner to the principles of behaviourism in the twentieth century, Down wrote in one of his textbooks on idiocy that ‘[the idiot] has to learn obedience; that doing right is productive of pleasure and that wrong is followed by deprivation thereof ’. On his visit to Earlswood the Reverend Sidney commented favourably on the use of persuasion and punishment in a short incident he witnessed between attendant and patient: ‘Then turning away, he [the inmate] attacked a door and broke it all to pieces. On coming to himself, he was told as he had certain resources for pocket money, it must be stopped to pay for it, to which he assented. Afterwards, however, on behaving well, he was offered a sum towards excursion to Brighton . . .’ Even the level of class which a child attended was used as a reward: ‘Such a classification [into six classes] has an excellent effect on those higher in the scale [of intelligence], and nothing is more felt by them than a threat of removal to a lower class.’ The inmates could have rights to games, excursions, and sports all terminated in response to poor behaviour.  

‘Earlswood Asylum, Sea-Side Excursion’, Reigate and Redhill Express,  July . Linda Bryder, Below The Magic Mountain: A Social History of Tuberculosis in Twentieth-Century Britain (Oxford, ).  J. L. Down, On the Education and Training of the Feeble in Mind (London, ), –.  Sidney, A Second Visit to Earlswood, .  Sidney, A Lecture, .  Sidney, Earlswood and its Inmates, .

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Within such a culture of conformity, one sees the manifestation of Goffman’s principles of life in a ‘total institution’, whereby inmates become vulnerable to the arbitrary power of asylum attendants. To what extent the power over inmates was used for good or ill will never be precisely known. Many of the patients would scarcely be capable of voicing complaints to visiting Lunacy Commissioners. Only the threat of scandal, much more feared in philanthropic institutions than pauper institutions, may have kept the behaviour of attendants in check. Each annual report of the Board to subscribers included several case studies of dramatic improvement; however, staff and medical officers reconciled themselves to the fact that most improvements were measured in small degrees. An example of the progress can be gleaned from the complete case notes of one pupil, Sarah Doel. Admitted in June , Sarah apparently could read all the letters , count ‘a little’, ‘partially’ dress herself, and ‘partially’ take care of herself. In general she was described as having ‘clean’ habits. The following notes are her case-book entries for her entire stay:  October,   March,   October,   March,   November,   June, 

 April, 

 August,   November, 

Can partially dress herself. No other improvement. Exercises & sings. Counts to . Spells words of one syllable but cannot pronounce them. Slight general improvement. Speaks distinctly. Reads easy words of  or  letters. Counts to . Knows some figures. Assists a little at house work, knows one coin. No improvement. Improvement in habits; speaks better; reads simple words by spelling; writes a c g; counts to ; [marks] on slate the figures to ; can spell go, no; knows blue & green; works nicely sometimes; drills carelessly, more intelligent, but very restless, & incessantly talking. Can say anything; knows all the letters; writes any letter; counts to ; spells a few simple words & answers various questions; knows nearly all the colours; makes a bed & sets the tea-table; hems fairly; drills, sings & can dress herself & others. Is rather more quiet. Occasionally very excitable: to be employed in Dormitories half-time. Is getting worse generally. Says words but cannot read alone, writes small words, counts to  without aid, makes a few figures, spells some easy words, answers very well at times, knows

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 May,   June, 



colours, assists in all industrial lessons, hums well, catches easy tunes, fond of dancing, not quite so boisterous but still very excitable. Somewhat less troublesome than formerly. Discharged, Improved.

In many ways Sarah was a successful case. In her five years at the asylum she had apparently learned to dress herself, make her own bed, and name a few letters and colours. Notably, like many inmates, after a couple years of full-time school she was moved into the capacity of assisting the newer or less able inmates in dressing and also helped the attendants by making beds. There were, however, moments when she seemed as if she was not improving, or even regressing. In the end, however, the medical officer concluded that she had ‘improved’. Thus, after five years at the asylum Sarah had learned how to dress and feed herself and make beds—far from the claims of early propagandists of the asylum to transform idiots into ‘self-sufficient’ members of the community. It was in part this lowering of goals which led many members of the charity to stress the caring rather than educative aspects of the asylum, and to emphasize the advantage of lessening the burden on poor families rather than imparting novel skills to the mentally disabled. C O N C LU S I O N

The systematic institutional training of idiot children represented a watershed in modern educational theory, decades before the more famous theories of Marie Montessori became indelibly associated with child development. The philosophical underpinnings of education at the Earlswood Asylum were based on a post-Enlightenment belief in the perfectibility of humankind, a Victorian faith in the improvement of individuals, and a Nonconformist desire to see spiritual improvement through employment and self-help. Educating the idiot at the Earlswood Asylum thus constituted an important affirmation of a new industrial society, where intellectual ability proved more and more culturally important. Yet the very notion of a unitary structure at Earlswood Common, the large size of the asylum, and its inherent ‘institutional’ routine undermined one of its fundamental purposes—namely, to educate idiot and imbecile children in domestic and vocational skills in order to return them to their communities and family environments. Surely no adolescents would find in the institutional life anything comparable to that which they could reasonably expect back in the household of an artisan or

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small shopkeeper. Moreover, the asylum seems to have made no attempt to evaluate whether the teaching of a specific trade to an individual would in fact be useful once he or she was returned to his community. Educational achievements of individual patients continued to adorn annual reports sent to subscribers, but the propaganda of the institution progressively emphasized its own caring role. Education at the asylum was also based on a Victorian belief in the organicist origins of mental disability. Physical improvement could foster intellectual attainment. This organicist understanding of mental handicap was central to the medical model of idiocy—that physical defects of unknown origin were preventing the true expression of the idiot mind. Idiocy was being recast as a disease of the mind. As the final chapters will show, the medical model of idiocy would fall easily under a Social Darwinist belief in the hereditary nature of disability. As the Earlswood Asylum begot similar institutions for idiot children, a small coterie of medical men specializing in idiocy began to develop slowly a corpus of professional knowledge that would seek to place idiocy firmly under the aegis of psychiatry and lay the groundwork for the emergence of eugenic approaches to what was later called feeble-mindedness.

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

Down’s Syndrome With the success of the social history of medicine, scholars who now emphasize the great figures and discoveries of psychiatric history have come under attack, if not ridicule. It is true that much of what passed as biographical work in the history of psychiatry was often Whiggish, descriptive, and hagiographical. But scholars have recently suggested that the pendulum has swung too far away from biographical studies. Even historical sociologists, such as Andrew Scull, are arguing that social history needs to be rescued from mindless icon-toppling. Both he and Edward Shorter have been forging new and sophisticated reinterpretations of important psychiatrists and their impact on society. John Langdon Down is just such an individual who is deserving of reconsideration. Within traditional medical history he is seen as a physician who was ‘in advance of his time’ in the treatment and classification of persons with mental disabilities. Scheerenberger and Kanner classify him as one of the outstanding lights in the history of ‘mental retardation’. He is clearly seen, in the words of his most recent biographer, as a ‘pioneer’, comparable in impact in his field to Lister or Pasteur. By contrast, Down has also proved extremely controversial, as the inventor of an overtly ‘racist’ taxonomy of mental disability that stigmatized those with trisomy  for the next century. Stephen Jay Gould, for one, attacked Down’s ethnic classification as typifying the racism of the Victorian era, a theme recently taken up by other scholars. This chapter seeks to re-examine the social history and intellectual legacy of John Langdon Down, charting his rise from near obscurity to  A. Scull, C. MacKenzie, and N. Hervey, Masters of Bedlam: The Transformation of the Mad-Doctoring Trade (Princeton, ), esp. Introduction; E. Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York, ).  C. A. Birch, ‘Down’s Syndrome: John Langdon Haydon Langdon-Down, –’, The Practitioner,  (), .  Kanner, A History of the Care and Study of the Mentally Retarded, –; Scheerenberger, A History of Mental Retardation, –.  O. C. Ward, John Langdon Down: A Caring Pioneer (London, ).  S. J. Gould, The Panda’s Thumb (London, ), –; C. Borthwick, ‘Racism, IQ and Down’s Syndrome’, Disability and Society,  (), –.

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the hallowed halls of the Royal College of Physicians, from a bright if unknown resident medical tutor to an acclaimed Victorian alienist whose atypical anthropological theories would forever associate his name with the archetype of mental disability. It will locate Down’s formulation of Mongolism within the context of the s anthropological debates over race, and contextualize his ideas within the articulation of degeneration theory that was slowly gaining a foothold in intellectual circles in Europe, Britain, and North America. Lastly, it will reveal the alacrity with which Mongolism was accepted as a useful classification of idiocy, even when many contemporaries disputed or challenged the theoretical basis for Down’s original ethnic classification. In the mid-Victorian period there were no easily distinguishable national borders of professional discourse. Alienists travelled widely, consulted with colleagues on both sides of the Atlantic, and read other national professional periodicals. Down’s ideas of Mongolism, published in British medical treaties and medical periodicals, quickly infiltrated the small but growing body of professional literature in North America and the colonies. In  the British Parliament passed the Medical Registration Act, which established a General Medical Council empowered with overseeing a profession that was unified in theory if not in practice. Appearing on the first national medical register was the newly hired medical superintendent of the Earlswood Asylum, a recent graduate of London University Medical School named John Langdon Down. Down must have been fortunate in securing a position at a voluntary hospital at so young an age, even if it was an idiot asylum. Born in  in Torpoint, Cornwall, Down was part of a modest family of Irish lineage, the son of a West Country apothecary. As a young man he worked under the supervision of his father, before moving to London to apprentice to a surgeon in Whitechapel. Later, in , he joined the Pharmaceutical Society. For the next three years he was employed as a chemist, allegedly assisting Faraday in some of his now famous experiments, before travelling to Devon to recover from an undisclosed illness. In  Down returned to London and enrolled as a medical student at the London Hospital. As a student, Down had been fortuitously assigned to William J. Little, Physician to the London Hospital. Clearly a very gifted student, Down completed his MB, receiving the gold medal in physiology, and passed the



See Peterson, The Medical Profession in Mid-Victorian London.

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examination of the Royal College of Surgeons in April , and his Licentiate of the Worshipful Society of Apothecaries in November of the same year. At the  London University examinations he won the three hospital gold medals and was voted best clinical student of his year. Down’s accumulation of academic prizes during these years as a student clearly impressed Little, to the extent that the influential consultant offered him the opportunity to stay on at the London Hospital, acting as a tutor to other medical students, as ‘resident accoucheur’, and as lecturer in comparative anatomy. With the rapid establishment of provincial infirmaries in the latter half of the eighteenth century, the emergence of teaching schools in the early nineteenth century, and the development of more specialized medical knowledge during the first decades of the Victorian era, the medical profession became divided more and more between those receiving elevated prestige and salaries within the voluntary hospitals, and those engaged in the more volatile and precarious field of community practice—the consultant–general practitioner divide that still dominates British medicine today. Sensing that he might end up on the wrong side of the widening disparity in medical livelihoods, Down continued his seemingly relentless pursuit of qualifications. Whilst performing the onerous tasks of supervising attending medical students, tutoring, lecturing, and assisting hundreds of births, he began to work towards his MD. Like any young medical practitioner of his generation, he eagerly awaited a vacant hospital position. In  Dr Maxwell, the resident medical superintendent at the Earlswood Asylum, resigned, leaving the position vacant. The patronage of William Little, a consulting physician to Earlswood, proved crucial for Down. Little lobbied John Conolly, former medical superintendent of the Middlesex County Pauper Lunatic Asylum (Hanwell), and Sir James Clark, Physician-in-Ordinary to the Royal Household, on Down’s behalf, securing his appointment in the autumn of . Both Little and Conolly shared professional interests in mental and physical disabilities in children. William Little is remembered for his research into spastic paralysis and credited as the ‘discoverer’ of a form of cerebral palsy. John

 

 Ward, John Langdon Down, . Birch, ‘Down’s Syndrome’, . Obituary, John Langdon Haydon Down, BMJ [ Oct., ] (, ii), –; Lancet, [ Oct. ] (, ii), –.  Hunter and MacAlpine, Three Hundred Years of Psychiatry, ; Scheerenberger, A History of Mental Retardation, –.

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Conolly, as we have seen in previous chapters, was the most celebrated alienist of his generation, the champion of the non-restraint movement. His brilliant, if somewhat inconsistent, life has been examined thoroughly elsewhere. The appointment of medical men to asylum positions in the Victorian era was often mired in controversy, with critics contending that connections, rather than experience, usually won out. Down still had to complete his MD during his first year of residency at Earlswood, and he had no experience in the institutional treatment of the insane, let alone practical experience in treating and educating idiot children (though the fact that he was then a Dissenter may have helped with the Nonconformist Board). In addition, he was entering a position that was only modestly remunerated (£ per annum), in an institution that was not completely finished, and under the authority of an asylum Board that had fallen out with the Lunacy Commissioners. It was not the most auspicious way to begin a career, but it could have been much worse. He could have been scraping a living in the overcrowded medical market of the mid-Victorian period or continuing to try to achieve middle-class respectability from the irregular earnings of a medical school lecturer. Instead, Down had something valuable and rare at the time—a guaranteed income, a degree of job security, and the potential to develop specialist skills. Although he would at first show signs of regret over his decision—having arrived at the asylum to experience life within a Victorian mental hospital for the first time—his accession to the position of resident medical superintendent would prove to be a turning-point in his life. Under Conolly’s mentorship Down quickly familiarized himself with the practical aspects of asylum management. Reputedly a handsome and charming man, he revealed an ability to align himself strategically within the asylum community and amongst members of the Earlswood Board, a committee made up of lay as well as medical representatives. Within the first year of his superintendence he persuaded the Board to include for the first time a separate Report of the Medical Superintendent describing the medical and educational advances of the asylum as an appendix to

 A. Scull, ‘John Conolly: A Victorian Psychiatric Career’, in Scull, Social Order/Mental Disorder, –.  T. Turner, ‘Not Worth Powder or Shot’, in Berrios and Freeman (eds.),  Years of British Psychiatry, .  Ward, John Langdon Down, ch. .

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

the charity’s Annual Report. The -year-old medical superintendent appreciated that the annual reports were sent to over , subscribers, a certain way to elevate the medical profile of the institution and to spread his reputation to potential clientele of the south-east of England. Further, Down convinced the Board to permit him to continue lecturing pupils and staff at the London Hospital, travelling north into the Metropolis periodically to wax eloquent on ‘childhood diseases of the mind’. Shortly thereafter he was elected assistant visiting physician to the hospital, thereby maintaining important links with the medical elite of London. John Langdon Down’s evident lack of asylum experience did not prevent him from converting to the cause of segregated treatment of the insane, soon proving a more effective proponent than even the elderly Andrew Reed, the asylum’s founder. Through his annual reports and London Hospital lectures, Down used his position as a pulpit from which to preach the advantages of separate institutional care and education of idiot children. ‘In but few homes’, he affirmed, ‘is it possible to have the appliances for physical and intellectual training adapted for the duration of the feeble in mind.’ Down distanced the idiot asylums from the tide of criticism concerning the overcrowded conditions of county lunatic asylums, and emphasized the lack of ‘scientific’ education available to idiot children in those pauper institutions. In county asylums, Down contended, ‘the entire machinery is adapted for another class of patients, and the idiot residents forming but a small proportion, they are for the most part overlooked in the general routine of the establishment’. By advocating idiot institutions separate from lunatic asylums, Down contributed to a prominent tendency of the mid-Victorian medical profession: a desire to seek increasing specialization of knowledge and practice. Larger and clearly differentiated hospitals afforded the opportunity, in the mindset of mid-Victorian proponents, for the benefit of classification and specialized treatment. Thus Down welcomed, rather than lamented, the steady growth of the Earlswood Asylum from  to  patients under his stewardship. He sought not only separate institutions for idiot children, but also to classify and separate idiot children by intellectual ability within idiot asylums:

   

[Annual] Report, , AREA, SRO, . Peterson, The Medical Profession in Mid-Victorian London, passim.  Ibid. [Annual] Report, , AREA, SRO, . See R. Stevens, Medical Practice in Modern England: The Impact of Specialisation on State Medicine (New Haven, ).

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In small Institutions there must necessarily be commingling of the inmates, and the consequent danger of disadvantage resulting from the influence of the least intelligent upon those who are higher in scale. With our greatly increased family we have been enabled, by classification, to obviate this evil, and to supply them in their several rooms with the kinds of amusement and occupation suited to their various capacities.

In the autumn of  Down completed his informal asylum apprenticeship. In what had by then become something of a rite of passage, he secured leave from the Board to travel to the birthplace of idiot asylums, Paris, to observe the practices of the successors of Jean-Étienne Esquirol and Édouard Séguin. He returned to England confident that Earlswood held a ‘prominent position of superiority’ compared to its Continental counterparts. Although Down sought to shield his voluntary idiot asylum from unflattering associations with county pauper lunatic institutions, he faced many of the administrative burdens inherent in being an asylum superintendent in the mid-Victorian period. Under the lunacy laws, he had to provide a history for all new admissions, complete with approximately forty separate findings. Discharge orders were completed upon the end of a stay; death notices pronounced upon the decease of a patient. The medical superintendent was required by law to visit all patients every day, and to minister in particular to those who were infirm. Considering the number of patients who suffered through epileptic fits, or who had contracted infectious diseases, this was no small burden. Abstracts of all deaths, discharges, and admissions were to be sent to the national inspectorate, the Lunacy Commission. Further, Down reported to the monthly meeting of the Earlswood Board, and wrote biannual reports to the Lunacy Commissioners and annual reports to the subscribers of the institution. He was also the administrative head of an institution of fifty attendants, nurses, and domestic staff, responsible for attendants’ moral behaviour and their treatment of the inmates. Although being an asylum superintendent afforded some opportunity for research and public lectures, and a modest degree of professional status, the drudgery of routine and repetitive administrative requirements burdened the overwhelming majority of the time of these alienists.

  

[Annual] Report, , AREA, SRO, . [Annual] Report, , AREA SRO. Turner, ‘Not Worth Powder and Shot’, .

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

Faced with considerable administrative responsibilities and an asylum of over  patients, Down convinced the Board to hire a young assistant medical officer, George Shuttleworth, who would later accept the position of medical superintendent of the Northern Counties (Royal Albert) Asylum for Idiots, near Lancaster, where he established a reputation in England second only to Down himself. Down elevated the medical dimensions of care and treatment within the quotidian experience of asylum life. His medical case-books reveal that he relied on a multiplicity of chemical interventions for sedating excitable patients and stimulating melancholic inmates. In a manner similar to the treatment conducted in lunatic asylums at the time, Down regularly employed potassium bromide, chloral hydrate, and opium to ‘calm’ patients. Cold showers were also used to quiet violent and ‘maniacal patients’. In order to counter the outbreaks of scarlatina (scarlet fever) and cholera, he insisted on the construction of a detached infirmary, though it was not fully complete until after his departure. In most respects, the administration of daily medicines to patients and the strategies Down utilized to deal with the management of violent or aggressive behaviour do not seem to have differed from those described by most asylum medical superintendents in the pages of the Journal of Mental Science or those recommended by the Lunacy Commissioners in their annual reports. As would be natural for any person in his position, Down joined the Association of Medical Officers of Hospitals and Asylums for the Insane, the forerunner to the British Psychiatric Association. Founded in , the association changed its cumbersome name in  to the MedicoPsychological Society, so as to give the body a more medical and less administrative tone. The association members, who jovially referred to themselves as the ‘wandering lunatics’, followed the predictable path of professionalization, establishing a journal—the Asylum Journal (from , the Journal of Mental Science)—soliciting original articles and case studies on the aetiology, treatment, and pathology of insanity, and organizing meetings where a sense of identity and common interest could be forged. Although the society self-consciously dropped reference to ‘Asylum’ from both its organization’s name and from the title of its journal, members of the society were overwhelmingly drawn from purposebuilt institutions for the insane, and the size of the society grew in proportion to the number of asylums in Great Britain. In  there were nine lunatic and idiot asylums, with an average size of  inmates each. By  there were fifty-one such asylums, employing  medical practitioners, with an average size of  inmates. The psychiatric profession

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thus developed in response to the rising tide of the confinement of idiots and lunatics during the nineteenth century. Throughout the first half of the nineteenth century medical thinking on idiocy and imbecility, as on insanity more generally, had been deeply influenced by phrenology. Franz Joseph Gall and his followers had advanced the idea that faculties of the mind could be localized cerebrally. Intelligence, affections, even religious observance could be measured through a careful examination of cranial size, structure, and topography. Although phrenology is now considered a ‘pseudo-science’, many aspects of its philosophy were embraced by alienists in the decades leading up to the Lunatics Act of . Phrenology appealed to asylum medical superintendents in various ways. It offered a coherent ‘scientific’ explanation for understanding mental disorder as a ‘disease of the mind’, and thus legitimated medical hegemony over mental disorder and disability. By suggesting that innate faculties could be modified and improved, it also offered an optimistic impetus that appealed to reform-minded medical practitioners. Although researchers have identified the mid-Victorian period as one in which the attractiveness of phrenology waned, both due to the death of the original prophets and to the decline in the visible benefits of moral treatment, the adherence to phrenological tenets persisted amongst the sub-group of asylum superintendents associated with the idiot asylums established in the s and s. Idiocy, it is important to emphasize, had been held in special regard by phrenologists, and treatises such as George Blackie’s on cretinism in  continued the fascination with cranial malformation and intellectual impairment. Gall, as William Ireland, superintendent of the Scottish National Institute for the Training of Imbecile Children, would recall in his  textbook, had identified idiot children as one clear proof that intellectual faculties were associated with cranial anomalies. The continued association of John Conolly with the Earlswood Asylum (until his death in ) may have also influenced the young Langdon Down. Conolly took no measures to hide the influence of phrenology upon his own thinking, active as he was in the Warwick and Leamington Phrenological Association, as committee member of the [National] Phrenological Association in , and as  

Scull, Museums of Madness, . R. Cooter, ‘Phrenology and the British Alienists circa –’, Med. Hist.,   Ibid. (), –.  Blackie, Cretins and Cretinism, –, Tables I–III.  See reference in Ireland, On Idiocy and Imbecility, .

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

President of the Ethnology Society in –. Shortly before his death the famous alienist acknowledged that, ‘no person not altogether void of the power of observation can affect to overlook the general importance of the shape and even the size of the brain in relation to the development of the mental faculties’. The influence of Conolly’s ideas about cranial localization was not lost on Earlswood’s new medical superintendent. In the early s Down began publishing articles in the British Medical Journal and the Journal of Mental Science on cerebral abnormalities, such as the imperfect formation of the corpus callosum, as well as describing the malformation of the mouth and tongue in idiot children. In the wake of Darwin’s Origins of the Species, Down became drawn to the implications of evolutionary theory to ethnology, joining the Anthropological Society of London some time in the early s. Several papers read before the society in – attest to its members’ fascination with the relationship between racial development, intellectual ability, and cranial physiognomy. Anthropological circles in s London were gripped by contests between an older school of ethnology that believed in the essential ‘unity of mankind’, the mongenists, and a new radical group, led by Dr James Hunt, who asserted the aetiological separateness of racial ‘types’, the polygenists. Amidst this debate, Down speculated about the racial dimensions of idiocy, proposing in one address that arrested racial development could result in idiocy. In a now-famous paper delivered to the London Hospital, Down described the racial grouping of some of the patients he had encountered: ‘I have been able to find among the large number of idiots and imbeciles which came under my observation, both at Earlswood and the out-patient department of the [London H]ospital  R. Cooter, Phrenology in the British Isles: An Annotated Historical Bibliography and Index (London, ), –.  J. Conolly, Lecture on Mental Disease to the Royal Institution, as cited in Clark, A Memoire of John Conolly, .  J. L. Down, ‘Account of a Case in which the Corpus Callosum and Fornix were Imperfectly Formed and the Septum and Commission were Absent’, Trans. Royal Medical and Chirurgical Society (); ‘On the Condition of the Mouth in Idiocy’, Lancet, vol. i []; ‘An Account of a Second Case in which the Corpus Callosum was Defective’, Trans. Royal Medical and Chirurgical Society, .  Lancet, Obit., [ Oct. ], () .  See inter alia, J. B. Davis, ‘The Neanderthal Skull: Its Peculiar Conformation Explained Anatomically’, J. Thurnam, ‘On the Two Principal Forms of Ancient British and Gaulish Skulls’, and J. Hunt, ‘On the Negro’s Place in Nature’, Memoirs Read Before the Anthropological Society of London, – (London, ).  G. W. Stocking, Victorian Anthropology (London, ), –.

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that a considerable portion can be fairly referred to one of the great divisions of the human family other than the class from which they have sprung.’ He described the facial and cranial stigmata of a specific group of similar-looking idiot children: ‘The face is flat and broad, and destitute of prominence. Cheeks are roundish, and extended laterally. The eyes are obliquely placed, and the internal canthi more than normally distant from one another. The palpebral fissue is very narrow . . . The lips are large and thick with transverse fissures. The tongue is long, thick, and much roughened. The nose is very small.’ Drawing on the flood of ideas in the s about racial characteristics, he hypothesized that a possible explanation for the attributes was atavism, the spontaneous reversion of individuals to earlier ‘pre-modern’ races of humans. Down postulated that certain types of mental disease could ‘break down’ the racial barrier so as to ‘simulate features of the members of another [race]’. Thus the ‘great Mongolian family’ represented, to him, the reversion of Caucasian children to an earlier, ‘less developed’ race. ‘So marked is this [racial imprinting] that when placed side by side’, Down affirmed, ‘it is difficult to believe that the specimens compared are not children of the same parents.’ He then proceeded to categorize the population of the Earlswood Asylum into ‘Mongolian’, ‘Malay’, ‘Ethiopian’, ‘Aztec’, and ‘Caucasian’ idiots, attempting to incorporate each into his new anthropological hierarchy. But the Mongolian ‘family’ was the most numerous—as many as  per cent of his asylum could be grouped into this category, he conjectured. His paper, published the following year in the Journal of Mental Science, sought to advance his contention that idiocy proved important to the anthropological debates of the s by illustrating that individuals could ‘revert’ between racial types. This, according to Down, disproved the polygenist belief that the races came from different sources. Down’s ‘ethnic classification’ of idiocy has been attacked historically by those who see it as an inherently ‘racist’ ideology. To do so is to decontextualize the anthropological debates of the mid-Victorian period. Anthropologists and ethnologists in the s were attempting to come to grips with the impact of Darwin’s revolutionary theory of evolution, published most famously in his  treatise, The Origin of the Species. Aligning himself with the more traditional and embattled school of humanitarian anthropology, Down asserted the ethnological relevance of his classification explicitly:   

J. Down, ‘Observations on an Ethnic Classification of Idiots’, JMS  (), . Ibid. –. Borthwick, ‘Racism, IQ and Down’s Syndrome’, –.

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

Apart from the practical bearing of this attempt at an ethnic classification, considerable philosophical interest attaches to it. The tendency today is to reject the opinion that the various races are merely variety of the human family having a common origin, and to insist that climatic or other influences are sufficient to account for the different types of man. Here, however, we have examples of retrogression, or at all events, of departure from one type and the assumption of the characteristics of another . . . These examples of the result of degeneracy among mankind appear to me to furnish some arguments in favour of the unity of the human species.

To our ears, although Down’s suggestion that Caucasians were more ‘developed’ (in evolutionary terms) than ‘Mongols’ is offensive, his views actually placed him in the ‘liberal’ camp of thought, that is, with those who believed that all races stood on the same continuum and shared a common ancestry. The alternate view, to which Down alluded, contended that other non-Caucasian and ‘inferior’ races were derived from separate origins (and, by implication, that Caucasians were of a superior racial type). This alternate school of ethnology had been used to assert the ‘natural state’ of slavery, a question of some importance, especially considering that slavery was one of the central points of contention in the devastating American Civil War that had just ended. The degree to which Down’s Nonconformist faith and Liberal politics made him a natural ally of mongenism requires further research. By the time his publication of the new ethnic classification had appeared in the Journal of Mental Science in , John Langdon Down had built up a devoted audience of students attending his lectures on ‘Medicine, Materia Medica and Comparative Anatomy’ at the London Hospital. The restrictions of an institutional post led to an incident that was all too common in public medical institutions, and that reveals the fault-lines between the ambitions of talented medical practitioners, increasing specialization in Victorian medicine, the status of superintendents’ wives within medical institutions, and an older tension of lay versus medical authority. Earlswood placed a limit on the number of private patients it would admit in any given year. It was, after all, a charitable asylum built for the poorer classes with only a few beds for private   

–. 

page.

Down, ‘Ethnic Classification of Idiots’, . Kevles, In the Name of Eugenics, . N. J. Stepan, The Idea of Race in Science: Britain, – (London, ), , , J. L. Down, On the Education and Training of the Feeble in Mind (London, ), title-

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(paying) patients, not a large private (for profit) licensed home. As a consequence, there were numbers of wealthy families willing to pay significant sums to have an idiot child accepted who had been refused for lack of space. By December  there were fifty-one Payment Cases on the waiting list alone. In that month the Earlswood Board was alerted to the fact that patients were being kept in the local community, and suspected that Down was taking payments in addition to his contract. In the monthly meeting of the Board they requested that the House Committee ‘inquire if any children other than their own are kept in the cottages of the attendants or servants of the institution’. The subsequent story of Down’s sudden departure can only be gleaned from the minutes of the board, but several facts appeared uncontested. Some time during  or earlier, the wives of at least two attendants, Everett and Walker, had started to receive private patients in their cottages. Mrs Everitt had three patients, Mrs Walker one. In return for their ‘services to the asylum’, the husbands had received ‘increased’ remuneration under the authority of Down. None of this, it appears, had been brought to the attention of the Board. On being summoned to explain his actions, Langdon Down was prickly and evasive, saying that there were indeed private patients being kept for a fee in attendants’ cottages, but that they were under the care of attendants’ wives and that the whole arrangement was being supervised by Mary Langdon Down, his wife (who, he implied, was not bound by his contract with the Board). Further, Down admitted that there were ‘a few other [additional] patients’ lodged similarly who were also under Mrs Down’s care and supervision. But ‘she alone’, he insisted’, ‘is responsible’. He also argued that he was doing the Board a favour by ‘preserving’ excellent private candidates for future vacancies. Mary Langdon Down, throughout her husband’s tenure at the institution, played a central role in the smooth operation of the Earlswood Asylum. She was often seen counselling mothers of children who had recently been admitted, conferring with the matron of the institution regarding the behaviour of the female attendants, and taking a leading role in the preparation of special events. Her activities appeared, thus, to conform to the accepted rituals of the wife of a superintendent without stepping outside the boundaries of the defined sex-roles of middle-class women of her generation. Within the context of mid-Victorian concep 

Agenda of the Board, AREA, SRO ///. General and By-Laws for the Regulation of the Idiot Asylum (), AREA, SRO //, , article no. .  Minutes of the Board,  Jan. , AREA, SRO ///, .

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

tualization of marital contracts and the legal status of women more generally, the contract John Langdon Down had signed—that he must devote all his time to the patients at Earlswood and take no private patients—would have applied also to his wife by default. Down contended, however, that wives should be able to care for, and receive, private patients outside of institutions, ‘as Mrs Down would be to engage in literature, Mrs Walker to keep a shop, or Mrs Everett to take in dressmaking’. Down’s retort was not as self-serving as it first appeared, inasmuch as there were several wives of asylum medical superintendents in England who were paid formally as matrons to the same institution in which their husband worked. However, Down’s case was not assisted by the fact that he had never formally requested remuneration for his wife, and that all patients kept in private homes for a fee had to be legally registered with the Lunacy Commissioners, from whom neither he nor Mary had received approval. A man of Down’s intelligence must have known that his actions were technically illegal. At the brink of what could have been a rather fascinating legal discussion, the dispute spun out of control. The Board proposed to convene a ‘special Board Meeting’ to be held on  February . Before the Board could meet Down penned his resignation letter on  February, departing from the position he had held for just under ten years, and for reasons which he described, in a pregnant way, as ‘cumulative’. The Board unanimously agreed to accept his resignation, assuring him ‘that he was quite in error in assuming that the Committee had come to foregone conclusions in relation to the questions contained in their letter to him’. So what were the ‘cumulative’ reasons that lay behind Down’s apparently premature exit from the Earlswood Asylum? By  he had become the nationally respected leader of a movement for the care and treatment of idiot children. The demand from wealthy clients was so intense that, he must have realized that his ten years at the Earlswood Asylum had served their purpose and that he could do better as the proprietor of a private institution of his own. Shortly after his resignation in  he took up a Harley Street private practice and received a licence to found a private idiot establishment at White House, Hampton  Letter from Down to the Board,  Feb. , as transcribed in the Minutes of the Board, ibid. –.  E. Burrows, ‘Alienists’ Wives: The Unusual Case of Mrs John Conolly’, Hist. Psych.,  (), –.  Minutes of the Board, AREA, SRO ///, –.  Birch, ‘Down’s Syndrome’, .

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Wick, later renamed Normansfield Training Institution for Imbeciles. There he exploited the demand for asylum accommodation from the wealthier segments of the upper middle classes, charging £ to £ per annum, with a licence for  patients. Revealingly, the Lunacy Commissioners listed Normansfield as a Metropolitan Licensed House under the guidance of Dr and Mrs Down, and stated that ‘Mrs Down devotes her whole time to the management of the Institution’. Destined to be one of the largest private licensed homes in the country, Normansfield grew from eighty ‘students’ in  to its maximum of  in , the year of Down’s death. By this time he was a national and international expert on the mental diseases of childhood and youth, and a prominent and respected member of the British medical establishment, having founded and presided over the Thames Valley Branch of the British Medical Association, and remaining a Consulting Physician to the London Hospital until his death. Down was also involved in local politics and administration, being appointed a Justice of the Peace for Westminster and Middlesex (), a County Alderman in , and remaining to his death a ‘pronounced’ Liberal. In  he was invited to deliver the prestigious Lettsomian Lectures, which formed the basis of his last major work. By then this son of a West Country apothecary had crowned his career by his election as Fellow of the Royal College of Physicians. The continued prominence of his two surviving sons, Reginald and Perceval, who both read medicine at Cambridge and took over the operation of Normansfield upon the death of their father, maintained the Langdon Down name within the British medical establishment. Reginald, in particular, would be an important witness in the Royal Commission on Care and Control of the Feebleminded. Langdon Down died in , receiving glowing tributes in the Lancet and the British Medical Journal. It had been a long journey from Torpoint, Devon. In the generation after Down’s death, the clinical term Mongolism became separated from the ethnic classification that gave birth to it. It should be remembered that Down’s novel classification of idiocy coincided with a flurry of publications on the taxonomy and education of  Thirty-sixth report, Annual Report of the Commissioners in Lunacy (ARCL), Parliamentary Papers (PP), [], xxxiii,  ().  Obituary, ‘John L. H. Langdon-Down, FRCP, JP’, BMJ [ Oct. ] (, ii), –.  L. Zihni, ‘A History of . . . Down’s Syndrome’, .  BMJ [ Oct. ] (, ii), –; Lancet [ Oct. ] (, ii), –.

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

idiot children, all published by the medical superintendents of the principal idiot asylums in Britain and North America. Until  there were only a handful of books on the training and classification of idiot children. The first, appearing in French, was written by the famous Édouard Séguin and translated into English, in the same year as Down’s London Hospital report, as the Treatment and Training of Idiots by the Physiological Method. Séguin, a physician at the Bicêtre Hospital in Paris, experimented with methods of training idiot children, techniques that concentrated on the improvement of the mind through sensory experience and object association. Teaching began with discrimination, first of colours and numbers widely separated, and then, progressively, to finer discriminations. In  Séguin published a treatise in French on the treatment and education of idiots, followed by a second four years later. Both works were reviewed widely in the British press, and inspired the French-speaking John Conolly to visit Séguin and study his techniques in . Séguin had also inspired the first major American study of idiocy, that of Samuel Gridley Howe and his inquiry in the Commonwealth of Massachusetts, published under the title On the Causes of Idiocy. In England,  also witnessed the publication of A Manual for the Classification, Training, and Education of the Feeble-minded, Imbecile, & Idiotic by William Millard, the lay superintendent of Park House, who had helped found the Eastern Counties Asylum for Idiots at Colchester, and by the Eastern Counties Asylum’s visiting physician P. Martin Duncan. When Down’s ethnic classification was published in the Journal of Mental Science, it was part of a torrent of new professional literature on idiocy, including his first major book—A Treatise on Idiocy and its Cognate Affections (). The proliferation of ideas about idiocy had been partly promulgated by the expansion of asylums for idiots and, by extension, medical superintendents’ eagerness to stake their claim in this new medical sub-discipline. In , John Langdon Down, Fletcher Beach, William Ireland, and George Shuttleworth held the first-ever medical conference on idiocy  

Séguin, Treatment of Idiots by the Physiological Method. M. Simpson, ‘The Moral Government of Idiots: Moral Treatment in the work of Séguin’, Hist. Psych.,  (), .  E. Séguin, Traitement moral, hygiène et éducation des idiots et des autres enfants arrières (Paris, ), trans. as The Education of the Idiot by Moral Treatment (Edinburgh, ).  S. G. Howe, Report Made to the Legislature of Massachusetts (Boston, ); Howe, On the Causes of Idiocy (Edinburgh, ).  Duncan and Millard, A Manual.  J. L. Down, A Treatise on Idiocy and its Cognate Affectations (London, ).

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in Belfast. The quartet represented the most influential idiocy alienists in Britain at the time. Fletcher Beach, the medical superintendent of the Metropolitan Asylums Board Darenth Colony for Idiot and Imbecile Children, was to have a long and successful career studying idiocy and epilepsy in children, and represented the Royal College of Physicians before the Royal Commission on Care and Control of the Feeble-minded in . William Wetherspoon Ireland graduated from medical school in  and became the medical superintendent of the new Scottish National Institute for Imbecile Children at Larbert in . His textbook appeared in . George Shuttleworth, briefly Down’s assistant at the Earlswood Asylum in the late s, enjoyed a reputation as medical superintendent of the Royal Albert Asylum at Lancaster and published widely in the s on the aetiology and training of idiot children, culminating in Mentally Defective Children, the standard textbook for the remainder of the century, which saw five editions. The establishment of idiot asylums had thus created a unique medical expertise that found its fruition in treatises on idiocy in the last third of the nineteenth century. Shuttleworth had been initially the most supportive of Down’s new formulation. After he left the Earlswood Asylum in  to take up the superintendent’s position at the Northern Counties (Royal Albert) Asylum near Lancaster, he regularly employed the term ‘Mongolian’ to describe patients fashioned after Down’s new descriptive taxonomy, although, unlike Down, he believed the aetiology of Mongolism was related to intemperance in the parents rather than, as Down hypothesized, to the degenerative influences of phthisis (tuberculosis). Like Down, however, he continued the interest in the cranial characteristics of idiocy, referring to the measurements of a ‘Mongolian idiot’ in the Journal of Mental Science in . Ireland, however, was more sceptical, having been present at the Medico-Psychological Association meeting in Scotland, where Sir Arthur Mitchell and Robert Fraser had presented their paper on ‘Kalmuc Idiocy’, a formulation very similar to that of Down ten years earlier. Sir Arthur had spent several years as a Scottish Lunacy Commissioner inspecting the insane in private care, and had made a strikingly similar observation to Langdon Down, namely, that  Evidence, Royal Commission on Care and Control of the Feebleminded (RCFM), PP [], viii, .  Ireland, On Idiocy and Imbecility.  G. Shuttleworth, Mentally Defective Children: Their Treatment (London, ).  G. Shuttleworth, ‘Cranial Characteristics of Idiocy’, JMS (), as reprinted in M. Rosen et al. (eds.), The History of Mental Retardation, .

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there was a group of similar-looking idiot children whom he believed bore facial stigmata reminiscent of the ‘Kalmuc’ race. Also like Down, Mitchell regarded the Kalmuc idiot as representing a state of incomplete physiological development. It is unlikely, though not impossible, that Mitchell and Fraser had not seen Down’s earlier paper. Nevertheless, and perhaps in a fit of national pride, Ireland avoided Down’s English appellation of Mongolism in his  treatise, preferring instead the reference to ‘Scottish’ Kalmuc idiocy. Even here, however, Ireland thought that the importance of this group, whatever the label, was being exaggerated, as he believed that only  per cent of his own patients at the Scottish National Institution were thus affected. Indeed, in On Idiocy and Imbecility he advanced an entirely new system of classifying idiocy based on comorbidity and supposed aetiology. A recent biographer of Down suggests that the omission of Down’s ethnic classification in Mitchell and Ireland’s paper may explain the reprinting and reassertion of his famous ‘Ethnic Classification of Idiocy’ London Hospital report, and other early papers, along with his  Lettsomian Lectures in his final treatise, On Some of the Mental Affections of Childhood and Youth. Certainly, Down conspicuously placed his ethnic classification at the very beginning of his first Lettsomian Lecture. Notwithstanding the influence of Séguin’s idea of ‘Mongolism’ as a form of cretinism on the American discourse on idiocy, the terms ‘Mongolism’ and ‘Kalmuc’ idiocy appeared almost immediately in American medical journals in the late s. Part of the speed of acquisition may have been due to the influence of Shuttleworth and Fletcher Beach, who attended the first meeting of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons in . At the meeting Hervey Wilbur, a colleague of Séguin, read a paper on ‘that modified form of cretinism quite common in this country [America] and Great Britain, which has been called the Mongolian or Kalmuc type of idiocy’. Wilbur, while accepting the utility of the term Mongolism, rejected Down’s underlying theory and instead, like Séguin, placed the condition in the realm of cretinism. ‘I find little constant resemblance’, he concluded, ‘to the Mongolian race in these degenerate     

A. Mitchell and R. Fraser, ‘Kalmuc Idiocy’, JMS  (), . L. Zihni, ‘A History of . . . Down’s Syndrome’, –. Ireland, On Idiocy and Imbecility. J. L. Down, On Some of the Mental Affections of Childhood and Youth (London, ). J. L. Down, ‘The Lettsomian Lectures on Some of the Mental Affections of Youth’, BMJ (, ii), .

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human beings.’ His contemporary, Albert Wilmarth, Assistant Physician at the Elwyn Training School in Pennsylvania, was similarly sceptical of Down’s anthropological theorizing. He nevertheless was intrigued by the idea of degeneration, and had been influenced by Dugdale’s study of the Jukes. J. L. Dugdale, in , published an account of the Juke family, from whom New York state had incurred ‘over a million and a quarter dollars of loss in  years, caused by a single family of , strong’. Over the course of the next two decades similar stories of huge degenerate families appeared also in the English medical press, such as a case ‘in which an imbecile man and woman had over  descendants, all of whom were defective in some way or another’. Amidst the incipient Social Darwinism, Wilmarth, at the  conference of the Association of Medical Officers of American Institutions for Idiotic and Feeble-Minded Persons, read a paper entitled ‘Mongolian Idiocy’. In keeping with hereditarian ideas at the time, he suggested that a hereditary taint caused by arrested brain development, or brain damage, could be passed down to later generations, resulting in what was being called Mongolism. The utility of the term Mongolism had thus taken hold, even though the underlying theoretical framework was unanimously discarded (the Kalmuc variation faded into obscurity). What had caused the greatest difficulty in the American acceptance of the underlying anthropological implications of Down’s ethnic classification was, ironically, the question of race in post-emancipation United States. For Down’s theory to hold, it would be counter-intuitive that black Americans could give birth to Mongoloid children since, in Down’s theorizing, ‘Ethiopians’ were less developed (racially) than even ‘Mongols’. But American alienists began to  H. B. Wilbur, ‘The Classification of Idiocy’, Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-Minded Persons (), –. Wellcome Trust Contemporary Medical Archives (WTCMA).  J. L. Dugdale, The Jukes: A Study in Crime, Pauperism, Disease and Heredity (New York, ), . Dugdale’s account of the Juke family was used to buttress many developing ideas about hereditary criminality and feeble-mindedness, including Francis Galton’s Inquiry into Human Faculty and its Development [] (London, ), . Later, scarestories would be recycled, as when H. H. Goddard followed with a similar study of the Kallikak family which purported to detail the creation of several generations of crime, pauperism, and physical and mental degeneration. H. Goddard, The Kallikak Family (nd edn., London, ).  Anon. ‘Imbecile and Epileptic Children in the Workhouses’, BMJ [ Apr., ] (, ii), .  A. W. Wilmarth, ‘Mongolian Idiocy’, Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-Minded Persons (); –. WTCMA.

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observe the same ‘racial’ features in children of African Americans. An American physician, Adrien Bleyer, for instance, found two ‘negro infants’ whom he diagnosed as ‘negro Mongoloid idiots’. His publications suggested that mongolism could occur in any race, and his interest in genetics would contribute to the first articulation of a chromosomal abnormality long before its actual discovery in . In the early twentieth century the terms ‘Mongolian Idiocy’, ‘Mongoloid Idiocy’, or more popularly ‘Mongolism’ survived, even though the underlying theoretical premiss had been attacked by most experts. However, Down’s racial theorizing would undergo one last renaissance of sorts before it would be thoroughly discredited by Lionel Penrose in the s. Dr P. W. Hunter, who succeeded Shuttleworth at the Royal Albert Asylum in , began to postulate that the reversion was not back to a primitive race but in fact to primates. ‘These morphological aspects of the condition’, he opined, ‘suggested that the orangutan possibly approached much nearer the lines of human ancestry than either the gorilla or the chimpanzee.’ Francis Crookshank, a London physician who had had previous experience as an asylum medical officer, continued Hunter’s argument, with modification. Crookshank hypothesized that children with features of ‘primitive races’ were not fully developed in utero. Rather than being ‘Mongoloid’, in Langdon Down’s sense, they were in fact more like primates who preceded even the ‘inferior’ Mongol race. In The Mongol in Our Midst he brought these views to a popular audience. In this manner, Mongoloid idiots were a unique remembrance, the Missing Link. In a final ironical moment, Langdon Down’s own son Reginald, who, with his brother Perceval, had taken over the administration of the Normansfield training institution after their father’s death in , agreed with Crookshank. Reginald stated that ‘it would appear . . . that the characters which at first sight strikingly suggest Mongolian features are in no way characteristic of the race’, and if it were a reversion, ‘it must be a reversion to a type even further back than the Mongol stock’. Reginald is now best known as the individual who identified the peculiar handprints of individuals with Down’s Syndrome—the ‘presence of one, rather than two, transverse lines’—the so-called Simian crease. But here     

Zihni, ‘A History of . . . Down’s Syndrome’, ch. . As quoted in Zihini, ‘A History of . . . Down’s Syndrome’, . F. G. Crookshank, The Mongol in Our Midst (London, ). R. L. Langdon-Down, ‘Discussion’, JMS  (), . R. L. Langdon-Down, ‘Handprints’, BMJ (), ; See also F. G. Crookshank,

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he was competing with his father in hypothesizing how far back ‘Mongoloid idiots’ had regressed. Whilst it is true that Crookshank’s and the younger Down’s work was highly criticized (even the eugenicist Alfred Tredgold rejected Crookshank, and by implication the senior Down’s theories, by stating that it was self-evident that the vast majority of individuals of Mongol ethnicity were not mentally deficient), the appeal of the empirical observation of Mongoloid idiots would prove so useful that use of the term would continue well after the World Health Organization voted overwhelmingly in  to replace the name with ‘Down’s Syndrome’. C O N C LU S I O N

Mongolism thus occupied a highly significant place within the deluge of ideas unleashed by Darwin’s revolutionary theories of the origins of humankind. Within this intellectual milieu stood Langdon Down, a medical practitioner whose intellect, powers of observation, and aptitude for self-promotion ensured him a place in the annals of medical history. His role, however, as both a champion of special institutional provision for the mentally disabled and a promoter of ‘racialized’ views of Caucasian superiority put him in an awkward category for present-day historians and biographers, eager to praise or pillory his reputation in medical history. As a medical professional he followed a remarkable path upwards through the medical hierarchy, apprenticing as a young man, achieving the relevant qualifications in apothecary, surgery, and later physic. He slowly insinuated himself into the London elite, first as a lowly lecturer and later as a member and fellow of the Royal College of Physicians, a career and upward progression culminating in his Harley Street private practice. He rode the wave of possibilities for the new medical specialization occurring during his lifetime. His decision to leave Earlswood after ten years replicated the path of many successful alienists of his generation. His mentor, John Conolly, though he is famously associated with the Hanwell Asylum, resigned his position in order to establish his own private licensed homes in the metropolis. Similarly, his ‘Hand-prints of Mongolian and other Imbeciles’, Trans. Medical Society of London,  (), .  Zihni, ‘ A History of . . . Down’s Syndrome’, .  F. Miller, ‘The Perseverance of “Mongolism”: The Old and the New in Medical Cytogenetics, c.–’, unpublished paper read before the Annual Conference of the American Association for the History of Medicine,  May .

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Scottish colleague and competitor William Ireland would retire from the Scottish National Institution to establish three private residential schools. Whether Down had welcomed his own departure, taking lucrative private patients with him from Earlswood to his new institution, may remain forever unknown, although the significant number of private patients who had previously appeared on Earlswood registers and were then admitted to Normansfield does look rather suspicious. Down was thus a profoundly successful medical man in a dynamic and uncertain market in the Victorian era, an example of the volatility and porosity of the social structure of Victorian England. But what of his legacy in the taxonomy of mental disability and his murky role in the minor scandal that led to his own resignation? With regard to the latter, it does seem, in retrospect, that Down had overreacted to the decision of the Board. Perhaps he had grown tired of answering to the ministrations, or what he might have seen as meddling, of lay members of the Earlswood Board. Perhaps the death of Andrew Reed in  and John Conolly in  had deprived him of powerful patrons who could mediate between the ambitions of the young alienist and the interests of the lay philanthropists. By  Down stood at the pinnacle of his career, so there seemed little reason to continue his association with Earlswood indefinitely, although he must have regretted the embarrassment that surrounded his departure. Extraordinary for those familiar with Victorian etiquette, the Earlswood Board did not even mention, still less thank, Langdon Down in the annual reports that followed his departure. Down’s novel ethnic classification was soon forgotten; but his designation of Mongoloid idiocy adopted by other writers of textbooks on idiocy continued until well into the second half of the twentieth century, even after his racial theory was finally debunked by the statistical investigations of Lionel Penrose and disproved by the cytogenetic research of the s. In a strange twist of fate, it was at the Royal Eastern Counties Institution (formerly Essex Hall), Colchester, the sister house to the original Asylum for Idiots, where Penrose would conduct his famous studies of the blood types of those suffering from ‘Mongoloid idiocy’ in the s. Debunking the ‘Mongolian ancestry’ of ‘Mongolian idiots’, Penrose suggested that researchers adopt the phrase ‘Down’s Syndrome’ or ‘Down’s Anomaly’ to avoid Down’s misleading appellation and theory, even though the term  N. Anderson, and A. Langa, ‘The Development of Institutional Care for “Idiots and Imbeciles” in Scotland’, Hist. Psych.,  (), .  Kevles, In the Name of Eugenics, .

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Mongoloid continued to be commonly used in professional and lay journals until the s. French-speaking countries and jurisdictions, perhaps in a fit of cultural pique, never fully accepted Down’s claim to fame and opted instead for ‘Trisomie ’, perhaps in a nod to the French cytogeneticist Lejeune who discovered the chromosomal abnormality in . Down’s formulation of Mongolism must be seen in the context of mid-Victorian popular and professional debates about cerebral localization and evolutionary anthropology. As Roger Cooter has shown, phrenology proved attractive to asylum superintendents, who sought to solve the complex nature of mental disorder by embedding theory in the growing anatomical knowledge of the Victorian era. In his own way, Down was clearly trying to build a bridge between phrenology with Darwinian evolutionary theory, attempting to find a science of the mind that was relevant to specialists in idiocy. Perhaps inadvertently, by theorizing ‘Mongoloid idiocy’ as atavistic, as representing racial reversion, he and his colleagues in the other idiot asylums were also contributing to an emerging discourse on degenerationism. The last three decades of the nineteenth century were to witness the convergence of degeneration theory, fears over urban squalour and the declining (middle-class) birth rate, and the slow encroachment of the state, in the formulation of a murky Social Darwinism that would ultimately give birth to the eugenics movement. If not in the midst of ‘Mongols’, eugenicists felt surrounded by the danger of the feeble-minded. Rather than subjects of ethnological curiosity, the mentally disabled soon became the objects of a darker campaign of forced segregation and sterilization. 

Cooter, ‘Phrenology and the British Alienists’.

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The Danger of the Feeble-minded By the late s county pauper lunatic asylums, many of which had been constructed immediately following the  Asylums and Lunatics Acts, were experiencing severe overcrowding. The total asylum population had climbed to , patients, and the dreams of establishing small therapeutic institutions had been shattered. Medical superintendents of lunatic asylums blamed overcrowding, in part, on the large number of ‘incurable’ patients conveyed from workhouses. Meanwhile, the numbers of reported ‘insane’ in Poor Law Union workhouses had also increased substantially: by  just over , resided in workhouses and with ‘friends’. Partly in response to this crisis, Parliament established a Select Committee (–) to investigate the operation of the ‘lunacy laws’. The Select Committee attempted to solve the problem of overcrowding by recommending the construction of a new set of institutions specifically for the residence of ‘chronic’ and ‘harmless’ patients. ‘These auxiliary asylums’, the committee explained, ‘would be intermediate between [Poor Law] union workhouses and the principal curative asylums.’ Such a suggestion proved controversial. The medical profession had been campaigning for years to wrest control of Poor Law infirmaries from lay authority and was not likely to endorse a proposal for asylums outside medical control. On the other hand, some medical superintendents were also wary of promoting medical institutions for the ‘incurable’, which many believed would undermine their therapeutic crusade. Some letters to the Journal of Mental Science suggested alternatives to the asylum, such as a system of ‘cottages’ located near county asylums and still under the authority of the local asylum medical superintendent. Most county magistrates and Poor Law Guardians, however, were simply not convinced that a second system of asylums merited the extra cost to ratepayers. The establishment of new, non-therapeutic institutions was thus   

 JMS  (), . Scull, Museums of Madness, . As cited in Ayers, England’s First State Hospitals, . E. Toller, ‘Suggestions for a Cottage System’, JMS  (), .

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postponed (for the moment at least), and permission was granted, in the  Lunatics Amendment Act, for the return of ‘harmless’ and ‘chronic’ patients from county pauper lunatic asylums to workhouses in order to maximize space for the ‘curable’ and ‘dangerous’. This gave legal sanction to a phenomenon that had been under way, rather covertly, in counties for several years. Thus, the s witnessed a return of hundreds of mentally disabled persons from provincial county pauper asylums to Poor Law Union institutions. In this way the discussion in the s over the appropriate locus of care for the ‘harmless and incurable insane’ intersected with a larger debate about the relationship between the medical profession and the Poor Law. Following the Medical Registration Act of , members of the now unified medical profession sought to increase the professional status and remuneration of medical practitioners of all ranks. The lowliest members had always been the Poor Law medical officers, who worked in allegedly ‘appalling’ conditions and were subject to the ‘parsimony’ of Poor Law Guardians. The editor of the Lancet, Thomas Wakley, crusaded to expose the conditions in London’s Poor Law workhouse infirmaries and general wards by sending ‘Lancet inspectors’ into Metropolitan infirmaries. During their inspections his officers uncovered significant numbers of idiots and imbeciles in workhouses and workhouse infirmaries. Certain reports dealt at length with the unsatisfactory arrangements for idiots and imbeciles and their separate treatment and accommodation: A very objectionable arrangement is made for the idiots, who are lodged in the lower wards of the infirmary; which are totally inadequate, we do not hesitate to say, to their wants, . . . [of] all cases which demand our sympathy and care, surely none are more worthy our best efforts to ameliorate their condition than those of the poor creatures whom Providence has thus sadly afflicted.

The Lancet echoed the conclusion of the parliamentary committee five years earlier by proposing large specialized medical institutions to facilitate care and treatment of workhouse idiots and imbeciles. To allow idiots and imbeciles to continue ‘neglected’ in mixed workhouses, concluded the Lancet inspectors’ report, would ‘outrage . . . the conscience of the  Twenty-one ‘harmless and idiotic’ people were removed from the Wakefield Asylum in , and  from the Nottingham Asylum in the three years – in order to make room in the asylum for new, ‘curable’ applicants. Smith, Cure, Care and Safe Custody, ; C. Aldiss, MA thesis (), .  ‘Report on Greenwich Workhouse Infirmary’, Lancet [ Aug. ] (, ii), .

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State’. However, the outrage of the Lancet report obscures an important discovery by their inspectors: many Poor Law Unions had already erected separate buildings for their imbecile and idiot poor. St Leonard’s Union, for instance, had a separate building accommodating  imbecile inmates. In this way, Poor Law Unions had circumvented the spirit of the lunacy laws by establishing new purpose-built ‘asylums’ for their own ‘chronic insane’. Thus, although the medical profession had proved ambivalent about asylums for the incurable under the auspices of the Lunacy Commission, Poor Law Unions in London had taken it upon themselves to erect just such institutions under their own control. Parliament responded to the Lancet’s revelations about the Metropolitan Poor Law infirmaries by passing the Metropolitan Poor Act of , which sanctioned the creation of three huge custodial institutions to serve Poor Law Unions of the metropolis. These asylums were constructed just outside the metropolis, in Caterham (Surrey), Leavesden (Hertfordshire), and Darenth (Kent). Notably, these huge asylums (housing approximately , patients each) were not subject to the provisions of the Lunacy Acts. Rather, they were to be treated as part of the responsibility of the Poor Law Board. Constructed between  and , they precipitated a remarkable shift in the locus of thousands of idiots and imbeciles from Union workhouses and county ‘lunatic’ asylums in the south-east of England. Hundreds of inmates from the Middlesex county asylums of Colney Hatch and Hanwell were transferred to them, and hundreds more were conveyed from Poor Law Union workhouses and infirmaries. Some even came from further afield. The discharge of patients from the Middlesex asylums freed beds so that ‘lunatics’ with settlement in Metropolitan Unions, but who were residing temporarily in provincial county asylums because of lack of space, were returned to the county of Middlesex—a veritable musical chairs of institutional provision for the mentally disabled and the mentally ill. The state, however, was increasingly coming to terms with a new group of the mentally disabled—the backward children revealed in the early years of national elementary education. The administrative framework of the  Elementary Education Act centred on the new Local   

‘Our Workhouse Infirmaries: A National Scandal’, Lancet [ July ] (, ii), . ‘St. Leonard’s’, Lancet [ July ] (, ii), . The discharge papers of the Buckinghamshire County Asylum show that on  March ,  idiots and imbeciles aged  to  were transferred from Bucks. to Caterham, and at least another  in May to Leavesden.

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School Boards, , of which were created between  and . The Boards consisted of five to fifteen members, elected every three years from districts on the basis of cumulative voting. The school boards included large numbers of women, barred from entering other traditional male enclaves such as medicine and the law. The school boards offered them a career that, although not high in salary, did afford a modest amount of political influence, an appealing attribute in the days before female suffrage. Positions on the school boards were often not full-time jobs, thus freeing time for philanthropic activity or familial duties. Further, education dealt with children, a group which Victorian society believed to fall within the domain of female expertise. While large numbers of men participated in the new School Boards, it was the women Board members who were most active in establishing education as a respected profession and advancing its scope and prestige by the ‘scientific’ study of education and children. In these particular cases, attendance officers and teachers were unclear how to proceed in discriminating between the ‘normal’, the ‘backward’, and the ‘imbecile’. The search for a solution led the education authorities to the superintendents of the asylums for idiots. In doing so, an important professional association between these alienists and School Board officials arose, promoting institutional treatment and education of idiot and imbecile children. Helen and Mary Dendy, among the most articulate advocates of legislation, were two such individuals who worked closely with male medical superintendents of idiot asylums. Their father, a Nonconformist minister in Salford, near Manchester, ensured that all his children received higher education. After university his sons took up a variety of middle-class professional jobs, from law to the clergy. His daughters, by contrast, pursued the two routes open to women—education and philanthropy. Helen, after graduating from Newnham College, Cambridge, relocated to London to become a teacher. Mary graduated from Bedford College, London, and moved to Manchester to commence a career in philanthropy, working on schemes to improve living conditions in the slums of Manchester in the s and s. Within a few years they had switched professions: Mary had run for, and been elected to, the

   

J. Lawson and H. Silver, A Social History of Education in England (London,), . P. Hollis, Women in Local Government, – (Oxford,), . Lawson and Silver, A Social History of Education, . Evidence, RCFM, PP, , xxxv,  ().

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Manchester School Board in ; Helen quit teaching and accepted a post as a salaried district secretary to the Charity Organisation Society. This move was to have important personal and professional consequences, for in  she met Bernard Bosanquet, the co-founder of the society, starting a friendship that would soon be consecrated in marriage in . Originally called the Society for Organising Charitable Relief and Repressing Mendicity, the Charity Organisation Society (COS), was founded in  on a classical liberal ideology. It saw social problems as a function of individual moral failure. By returning once again to the ‘principles of ’, the COS hoped to restrict Poor Law relief to the ‘deserving’ for fear that the able-bodied would become dependent upon local Poor Law rates. Consequently, it sought to co-ordinate philanthropy by organizing all charities and Poor Law boards into one efficiently run network. Although the stated goal of the COS was to ‘co-ordinate’ charity relief, it quickly earned the derision of contemporaries, who complained that the COS spent more time dissuading charity than promoting it. The society soon fell under the influence of a young Balliol graduate named Charles Loch, who was to be Secretary of the COS from  until . Loch, who was also a member of the Royal Statistical Society, was so thorough in his investigations that contemporaries compared his research and reports to small Royal Commissions. Loch’s scientific background represented a second and sometimes conflicting predisposition within the COS, one that sometimes ran counter to the society’s conservative leanings. For the COS, under Loch’s guidance, was obsessively concerned with the placement of charity on a ‘scientific’ basis, a commitment that earned it the derogatory title of the ‘scientific charity’ from unsympathetic commentators. Its members were firm in the conviction, ‘reinforced by every new invention and scientific discovery, that any problem, such as the problem of poverty, could be solved by study, thought, the ascertainment of facts, [and] the application of the scientific method’. In essence, the COS developed, thanks to  M. Cruickshank, ‘Mary Dendy: Pioneer of Residential Facilities for the Mentally Retarded’, Journal of Educational Administration and History,  (), .  A. M. McBriar, An Edwardian Mixed Doubles—the Bosanquets Versus the Webbs: A Study in British Social Policy, – (Oxford, ), –, .  Owen, English Philanthropy, .  It surprised few when he sat as a Commissioner on the Royal Commissions on the Aged, the Unemployed, and the Feeble-minded. C. Mowat’s Charity Organisation Society, –: Its Ideas and Work (London, ).  M. Roof, A Hundred Years of Family Welfare: A Study of the Family Welfare Association – (formerly the Charity Organisation Society) (London, ), .

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Loch’s influence, into a professional organization unto itself, earning it the reputation amongst social policy historians as the first professional social work agency. The central office orchestrated a complex network of district committees, whose purpose was to co-ordinate the local boards of Guardians and local philanthropy. It was staffed by educated members of the middle class, bound by a common outlook, and provided a useful service to local officials after the reorganization of local government in . It published weekly, and later monthly, periodicals which co-ordinated professional activities in a manner similar to journals of medical associations. While the medical community was studying the treatment of disease, the COS studied the aetiology of pauperism. As Loch professed: ‘It is desirable that it should be distinctly understood that it is the chief aim of the Society to deal with the causes of pauperism rather than its effects’, a quotation which reinforces a particular strain of the COS platform which saw itself, to paraphrase its own self-perception, as exercising ‘preventative’ philanthropy. The COS became interested in idiot and imbecile children during its surveys of poorer districts in the s. Many working-class families could not afford the cost of asylum care, and as a consequence many households struggled with the financial burden of supporting dependent members. The COS, determined to deal with the ‘causes of pauperism’, sought to find a solution that did not rely on Poor Law relief. It considered this a significant enough problem to justify setting up a committee on  July  to consider ‘the Best Means of making a Satisfactory Provision for Idiots, Imbeciles and Harmless Lunatics’. Chairing the committee was Charles Trevelyan, a Liberal MP who was interested in the study of the ‘feeble-minded’, a new social category of individuals less disabled than idiots and imbeciles. Joining Trevelyan was the predictable host of medical experts introduced in the previous chapter—John Langdon Down, William Ireland, Fletcher Beach, and George Shuttleworth—as well as the indefatigable educational reformer, Sir James Kay-Shuttleworth—guaranteeing a potent mix of medical experts in idiocy and specialists in educational reform. After thirteen meetings the committee suggested changes to the system which were uncharacteristic for any committee endorsed by  Helen Bosanquet, Social Work in London –: A History of the Charity Organisation Society (London, ). For a more detached analysis, see ch.  of Owen, English Philanthropy.  Fifth Annual Report of the Charity Organisation Society, –, as quoted in Mowat, Charity Organisation Society, .  Charity Organisation Society, Crippled and Epileptic Child and Adult (London, ).  Sutherland, Ability, Merit and Measurement, .

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the COS. The report urged that the state take partial responsibility by a grant of  shillings per week per person to the receiving institution, and put forward the idea that pauperization should not occur with receipt of this grant. Further, the committee made the distinction between ‘educable’ and ‘non-educable’ idiots. For the former they recommended special training schools; for the latter they suggested, like the Parliamentary Committee of – and the Lancet Commission of –, new county idiot asylums designed for their care and custody. Sitting on the COS special committee with Fletcher Beach and Shuttleworth was Major-General Moberly, a retired army officer who was also an active chapter secretary and field-worker of the COS. Moberly well illustrates the interaction, and overlap, between government and philanthropic agencies. He was a Poor Law Guardian, ran successfully for the London School Board, and chaired its subcommittee on education of the deaf and blind. His work with the COS undoubtedly led to his interest in the ‘feeble-minded’ and his successful bid to establish London’s first special schools. In  Moberly initiated several studies into the provision for the feeble-minded on behalf of the COS, using his many connections in the fields of philanthropy, Poor Law, education, and medicine. He convinced Francis Warner, Physician to the London Hospital and Consulting Physician to the London School Board, to conduct a random study of , children to determine roughly the number who would require special supervision. Warner’s findings encouraged the COS sufficiently to warrant a much more comprehensive study. For this purpose the society obtained the active support of the British Medical Association and several smaller charitable societies, including the Metropolitan Society for Befriending Young Servants and the National Vigilance Society. This represented the first systematic medical investigation of the prevalence of idiocy in the general population since Samuel Gaskell’s inquiries in the s, and many reformers took advantage of the process to conduct official and non-official statistical inquiries into the prevalence of other diseases among children. A second and more substantial investigation involved over , children under supervision of the London School Board. Warner sought to determine exactly the number of ‘defective’ children in the school system and  ‘Training of Idiots’, BMJ [ June ] (, i), ; [ July ] (, ii), –. This report was published by the COS in .  Evidence, CDEC, PP, , xxvi, – (–).  Sutherland, Ability, Merit and Measurement, .  Evidence, CDEC, PP, , – (–).

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advise as to the appropriate provision. With the aid of Shuttleworth and Fletcher Beach, Warner concluded that out of , children examined,  were ‘feeble-minded’. If extrapolated to a population of , children in the city, the total number of ‘defective children’ came closer to ,. ‘If this be so, the question is one of national importance’, concluded Warner to the Royal College of Physicians of London. The COS, as it promised, published Warner’s study in two pamphlets, The Feeble-minded Child and Adult () and The Epileptic and Crippled Child and Adult (), popular tracts meant for non-medical groups. The books summarized the outstanding social problems of feeble-mindedness and recommended methods of training, special schools, and exemption from the stigma of pauperism. The social investigation into the prevalence of idiocy between  and  coincided with the increasing emphasis on the hereditarian basis of mental disability. Assigning family weakness or consanguinity to the aetiology of idiocy was not entirely new—Samuel Gridley Howe proposed these as contributing factors in the early s. But the change of emphasis was pronounced from about  onwards. Medical men began to associate mental backwardness with other social evils of the time, such as intemperance. Norman Kerr, for instance, was a prominent member of the Medico-Psychological Association and President of the Society for the Study of Inebriety. ‘A drunken mother, a drunken father, a drunken grandparent’, he argued, ‘may hand down to their descendants an alcoholic taint which not even a lifetime of entire abstinence from intoxicating drinks can eradicate.’ Langdon Down, who had postulated that idiocy might well be caused in many cases by the intoxication of the father or mother during conception, also stated that in ‘In Norway, when the spirit duty was removed, insanity increased  per cent, and congenital idiocy  per cent’. Others were more sceptical of any simple correlation. Ireland, who believed that drunkenness was indeed a  

BMJ [ Mar. ] (, i), . The Feeble-Child and Adult: A Report on an Investigation of the Physical and Mental Condition of , School Children with Suggestions for the Better Education and Care of the Feeble-minded Children and Adults (London, ); The Epileptic and Crippled Child and Adult: A Report on the Present Condition of these Classes of Afflicted Persons, with Suggestions for their Better Education and Care of the Feeble-minded Children and Adults (London, ).  Mowat, Charity Organisation Society, .  Howe, On the Causes of Idiocy (Boston, ).  N. Kerr, Inebriety: Its Etiology, Pathology, Treatment and Jurisprudence (London, ).  Down, ‘Some of the Mental Affections of Childhood and Youth’, Lecture , BMJ (), .

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contributing factor, was sceptical of Down’s theory about drunken conception, concluding that if it were true there would be ‘many more idiots than could be counted’. The increasing tendency to conflate perceived social evils with mental disability shaded into a renewed interest in biological and hereditarian explanations for idiocy. Down, it will be remembered, constructed an ethnological explanation for the causation of Mongoloid idiocy, one that, by extension, implied a defect of congenital nature, a ‘spontaneous’ reversion that might be related to maternal and paternal misbehaviour. Although he implied that a general process of degeneration was occurring, the next generation of alienists located idiocy causation more firmly in heredity. Shuttleworth, in , asserted that: ‘The greater part of the value of an asylum . . . as of a hospital, consists in its usefulness as a school where a particular complaint there treated may be studied, not merely that we may know how to cure it, or how to alleviate it when it comes before us, but that, if possible, we may trace it back to its source, and so guard against it in future.’ This increasing emphasis on biological explanations of idiocy, a concern over heredity, and a disillusionment with the therapeutic and educational aspects of the idiot asylum reflected a broader shift in the intellectual atmosphere of late-Victorian Britain. The last quarter of the nineteenth century constituted a period of growing uncertainty and anxiety in British society. The unparalleled boom of the mid-Victorian period, which had placed Britain as the unrivalled great power of the world, had come to an abrupt end with the economic downturn of . The great depression continued in varying degrees of severity until the end of the century, affecting both agricultural and manufacturing industries, causing widespread unemployment and urban unrest. Meanwhile, the rise of the United States, recovering from a civil war, and Germany, unified under Bismarck, led to some apprehension that the British position in the world was no longer unassailable. The period of progress and prosperity had faltered. Against this gloomy backdrop, the National Association for Promoting the Welfare of the Feeble-minded was created in , due primarily to   

Ireland, Mental Affections, –. G. E. Shuttleworth, BMJ (), . There seems to be some variation as to the date of the founding of the National Association. Jeffries and Pinsent testified, in front of the Royal Commission on Care and Control of the Feebleminded, that the Association was founded in : Evidence, RCFM, PP , xxxv,  (), but Kathleen Jones and others have marked the date as . Jones, A History of the Mental Health Services, .

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the efforts of three women—Pauline Townsend, a Miss Jeffries, and Ellen Pinsent. Of these, Pinsent would join forces with Mary Dendy to become the most important lobbyists for legislation on the ‘feeble-minded’ in the Edwardian era. Born Ellen Parker, Pinsent was, like Mary Dendy, the daughter of a minister whose brothers had taken up professional work in law. After receiving higher education she was elected to the Local School Board of Birmingham. Like many of the other women who became involved with the National Association, she had interviewed ‘feeble-minded’ children in her work on the special schools subcommittee of the Birmingham School Board. Pinsent took it upon herself to inspect personally all the schools within the Birmingham district in order to inform them as to the procedure of medical inspection. With the aid of the newly appointed medical inspector, Caroline O’Conner, there were soon  children in the special schools. Under Pinsent’s guidance the National Association co-ordinated and represented eighteen charitable agencies and established strong connections with the officials in the asylum system and poor law communities. Activities with poor law Guardians received the support of Poor Law activists, like Louisa Twining, in the hopes of establishing ‘permanent protection for the feeble-minded’. The National Association also forged a union with the COS, so close that some have characterized the former as merely a wing of the larger philanthropic agency. There was certainly a great deal of overlap. Charles Loch and Helen Bosanquet were active supporters, the National Association often used COS facilities, and the positions of the COS and the National Association were almost indistinguishable. Yet the National Association drew more heavily on expertise of other professionals, including George Shuttleworth and Fletcher Beach, and the aforementioned Mary Dendy and Ellen Pinsent from the local School Boards. The original goals of the National Association stressed the care, self-sufficiency, and protection of the feeble-minded. But the conflicting interests of the National Association could be seen in its own original goals: it sought to protect society from future social problems, and ‘to fortify and lift the feeble-minded up in order that, so far as possible, they may be rendered self-supporting, and saved from becoming      

Jackson, The Borderland of Imbecility, passim. Kevles, In the Names of Eugenics, . K. Jones, A History of the Mental Health Services, . Ibid. . Sutherland, Ability, Merit and Measurement, . BMJ [ July ] (, ii), .

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vagrant, pauper, and criminal’. The underlying tenets of what would be later known as the ‘national efficiency’ movement were thus already apparent in the s, long before the debacle of the Boer War. After sitting on the Manchester School Board for two years Mary Dendy followed the now-established pattern of selecting mentally deficient children for inspection by local physicians with an eye to establishing separate segregated schools. With the assistance of a medical practitioner, she inspected every school of the Manchester district board, , children in all, and selected  as ‘defective in intellect’, in the winter of –. Upon completion of her survey, she took the extraordinary measure of creating her own philanthropic organization, the Lancashire & Cheshire Society for the Permanent Care of the Feebleminded, of which she became Honorary Secretary. The Lancashire and Cheshire Society was created, as its title suggests, with the strict principle of permanent control, in the belief that ‘only “permanent control” could be really efficacious in stemming the great evil of feebleness of mind in [the] country’. Thus, the interdependence of the extension of the state (in the guise of national elementary education), the philanthropic impulse, and the co-operation and support of medico-psychologists led inexorably to the rise of special schools in larger urban centres. The cost of special provision and the continuing lobbying of members from the education, medical, and philanthropic communities led to the establishment of a Parliamentary Committee in the final years of Victoria’s reign. In  a Parliamentary Committee on Defective and Epileptic Children was charged with inquiring ‘into the existing systems for the education of feeble-minded and defective children not under the charge of guardians, and not idiots or imbeciles, and . . . advis[ing] to any changes, either with or without legislation, that may be desirable’. The subtle shift of focus from the term ‘idiot’ to a more vaguely defined ‘feeble-minded’ class of children (above the status of  

Evidence, RCFM, PP , xxxv,  (). For a discussion of national efficiency, see G. R. Searle, The Quest for National Efficiency (Berkeley, ).  Evidence, RCFM, PP , xxxv,  ()  Dendy in C. Lepage, Feeble-mindedness in Children of School Age (Manchester, ), . The Society had been active in the training and supervision of the feeble-minded, and by  had two schools whose costs were borne partially by charitable donation, partially by the Cheshire County Council, and partly by the Manchester Education Committee. Evidence, RCFM, . For an examination of the Sandlebridge Colony, see Jackson, ‘Institutional Provision for the Feeble-minded in Edwardian England’.  Evidence, CDEC, PP, , i, .

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imbecile) is instructive, and foreshadowed fears of a sub-class of degenerate lumpenproletariat of the Edwardian era. Among those interviewed by the Parliamentary Committee were Loch, Shuttleworth, Fletcher Beach, and Dendy. By  the medical witnesses to the committee were beginning to articulate more stridently the central importance of heredity and the connection between mental backwardness and crime. ‘Inherited mental condition’, concluded Fletcher Beach, ‘play[s] a very important part in the production of these children.’ Loch continued his pleas for the establishment of a national grant-in-aid for the support of these children, in a manner analogous to the  shilling Parliamentary grant-in-aid enacted in , to offset the cost of asylum accommodation for certified lunatics. The Parliamentary Committee duly obliged by recommending a system of provision similar to that of the Elementary Education (Blind and Deaf Children) Act of , which provided national grants to School Boards for each blind or deaf child on the register. The resultant legislation, the Elementary Education (Defective and Epileptic Children’s) Act of , was, like the  legislation, permissive and allowed local education authorities to implement special classes, or if the numbers warranted, special schools. Even with the grant-in-aid, the permissive nature of the legislation meant that only the wealthier and larger Unions established special classes. By  only one-third ( out of ) of Local Education Authorities had exercised their powers. Two factors prevented an extension of special classes. The first came from local rate-payers who, having had to bear over half the burden of a national education system, the cost of which had risen twofold (s. to s. per week) from  to , saw little need for the creation of special schools, especially when these cost significantly more per student than the regular classes. Secondly, many parents themselves resented the herding of their children into what were derogatorily called ‘silly schools’. The social stigma attached to these classrooms obviously caused great concern to school officials, who tried repeatedly to convince parents of the advantage of segregated instruction. The demand for institutional accommodation for idiot and imbecile    

M. Jackson, ‘Institutional Provision for the Feeble-minded’, –. Ibid. . See also , , , . D. Pritchard, Education and the Handicapped, – (London, ), . In  % of the costs of the national educational system fell on local rates. P. W. Musgrave, Society and Education in England Since  (London, ), .  Evidence, CDEC, .

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children articulated by this Parliamentary Committee was promoted by fear and anxiety, rather than the therapeutic optimism and evangelical humanitarianism that dominated discussion in the s. The rapid increase in the numbers of the insane had reinforced a pessimism brought on by the imperial rivalry with Germany and the economic downturn of the last two decades of Victoria’s reign. Returns of the Commissioners in Lunacy recorded , pauper insane in . By  the number had risen threefold to ,. The Lunacy Commissioners warned that improved techniques of investigators might well have increased the figures. Others recognized that the general population had increased twofold during this same period, thereby lessening the impact of the apparent rise, and even Henry Maudsley, the most prominent specialist in insanity in the late-Victorian period and a man not unaccustomed to pessimism, admitted that it was difficult to determine the real amount of the increase and advised against alarmism. Yet the overwhelming impression was that insanity was on the increase. Louisa Twining, the long-standing social reformer, believed that the numbers of ‘mental defectives’ was on the rise and would likely ‘continue without check or hindrance [until the government] grant[s] further powers of detention’. Public anxiety was not helped the by sensationalist American studies of degenerate families mentioned in the last chapter. Hereditarianism was underpinning a new and darker impetus in social policy and institutional segregation. By the mid-s the proto-eugenicist underpinnings to public debate about the institutional confinement of idiots and imbeciles were beginning to reveal themselves. When new types of self-sufficient asylums— colonies, as they were popularly known—were proposed in the middle of the s, the British Medical Journal, lobbied by General Moberly and Drs Fletcher Beach and Shuttleworth, supported the idea on the premiss that segregation (and control of procreation which resulted therefrom) would diminish the numbers of idiots and lunatics in future generations: [the colony system] seems to ask support, not only from the point of view of philanthropy, but from that of social economy, for the segregation of those afflicted with feeble-mindedness in special homes would tend to diminish the evil of the  

ARCL, PP, , xxxvii,  (). Maudsley, after taking into account the increase in recording techniques and the lessening desire of parents to hide their idiot children, still assumed an increase of , new cases on insanity and idiocy every year. H. Maudsley, Physiology and Pathology of the Mind (London, ), .  L. Twining, Workhouses and Pauperism (London,), .

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next generation, while they would themselves earn something towards their support, and be less of a burden on the community.

Scientific papers detailing the transmission and manifestation of a degenerate ‘taint’ in successive offspring began to appear in medical journals in the late s. By placing social problems like alcoholism, prostitution, criminality, and pauperism on an equal footing with more recognized diseases, such as epilepsy and consumption, socially unacceptable behaviour was legitimized as a medical category. Tree diagrams implicitly accepted the direct hereditary transmission of social failures. ‘The presence of an appreciable number of children feebly gifted mentally but not imbecile is now fully recognised both by the [medical] profession and by the public; such cases . . . tend to swell the ranks of the failures, the unemployed, and the delinquents’, opined the British Medical Journal. The desire to segregate the feeble-minded, and thus control their fertility, led to a variety of institutional proposals. The most popular solution, beginning in the s, was the ‘colony system’. The first establishment along these lines was the colony at Chalfont St Peter, started in  by the National Society for the Employment of Epileptics. Based on the Bethel Colony for Epileptics founded earlier in Westphalia, the National Society for Epileptics stressed a ‘moral’ home environment re-created in a rural setting. It consisted of a series of smaller cottages, each with a master in charge, a kitchen, bedroom, and play areas. Each residence was segregated by sex (at this time for moral as much as eugenic reasons) and some larger residences by age. Part of the day would be spent teaching rudimentary academic skills, the balance occupied by working in the fields. The National Society sought to occupy the inmates with gardening, dairy work, and poultry farming. The stress was on occupation and self-sufficiency in the open country air: ‘Everything “institutional’’ ’, explained one reviewer, ‘is kept as much in the background as possible.’ With this rationale in mind, a similar philanthropic movement for feeble-minded  ‘The Borderland of Imbecility’, BMJ [ Dec. ] (, ii), .; see also BMJ [ Aug. ] (, ii), .  See W. L. Andriezen, ‘The Pathogenesis of Epileptic Idiocy and Epileptic Imbecility’, BMJ [ May ] (, ii), .  BMJ [ Oct. ] (, ii), .  E. Sellers, ‘The Story of a Colony for Epileptics’, Cont. Rev., (), .  There is evidence that these colonies often ‘loaned’ labourers to local farmers during harvesting periods at a low wage which offset part of the cost of the colony. It is as yet unclear how widespread this practice was.  BMJ [ Sept. ] (, ii), .  BMJ [ Dec. ] (, ii), .

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colonies arose soon afterward, one that sought a more comprehensive network of colonies than the homes that had sprung up for feeble-minded girls. Ironically, the Charity Organisation Society, which had been so hostile to Booth’s Salvation Army plan for labour colonies, warmed to the idea of colonies for ‘degenerates’. Charles Loch gave evidence before the Royal Commission on Labour () on the utility of Dutch colonies, and argued in favour of colonies, rather than institutions, for epileptics to the  Departmental Committee on Defective and Epileptic Children. By  the COS was supporting Dendy’s call for a national system of farm colonies in order to ensure ‘continuous and permanent supervision’ of the feeble-minded. These experimental feeble-minded colonies were supported strongly by the medical community, and specifically by members of the Medico-Psychological Association, for reasons of race betterment. ‘It is only by some scheme of industrial colonies,’ opined one editorialist, ‘where the [mental] defectives will be usefully employed in segregation from the ordinary population, that the maximum of benefit to the community seems likely to be attained, inasmuch as in this way the risks of handing down the infirmity to the next generation will be minimised.’ The British Medical Journal, which had been the first to circulate ideas about the transmission of hereditary idiocy, began to press for a Royal Commission on the subject, and supplemented its arguments in favour of segregation for purposes of medical treatment and training with others for the purpose of medical prevention. C O N C LU S I O N

In the sixty years of Victoria’s reign, therefore, the climate of opinion had shifted dramatically, from an optimistic environment espousing the training of idiot children so that they could take up their positions as full members of society, to a pessimistic, restrictive ideology of controlling the movement, and later the fertility, of the ‘feeble-minded’ to prevent them sewing the seeds of future social failure. Yet, despite the transformation in the intellectual climate, many of the older social realities recognized after the establishment of the New Poor Law in  persisted into the Edwardian era. In the Minority Report of the Royal Commission on     

Anon., ‘Gift of a Home for Feeble-minded Girls’, BMJ [ Dec. ] (, ii), . Mowat, Charity Organisation Society, . Evidence, CDEC, PP, , xxvi,  ().  BMJ [], . Mowat, Charity Organisation Society, . BMJ [ Dec. ] (, ii), .

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the Poor Laws (), the Fabians lamented the state of the mentally disabled still languishing in Poor Law Union workhouse wards, six decades after the establishment of county asylums. In a passage that bore striking resemblance to the Lancet Reports of –, the Fabians declared: ‘We have been painfully impressed, in our visits to the General Mixed Workhouses in England, Wales and Ireland, with the almost universal herding of the idiots, imbeciles, epileptics and feeble-minded of all grades indiscriminately with the other inmates of these institutions.’ The authors of the Minority Report estimated that there were still , idiots, imbeciles, and other ‘harmless insane’ in general mixed workhouses. They agreed with the Majority Report that colonies should be established for ‘mental defectives’. The co-operation of superintendents of idiot asylums and Local School board committees facilitated the rise of mental testing, first in the metropolis and then in the provinces. The London School Board, through its inspectors, selected, on the recommendation of the teacher, children across the district who were considered to be possibly mentally deficient. The medical men would then investigate and decide whether the child could be certified. Certified children were sent to the Darenth Asylum for Imbecile Children; if the child was found ‘normal’, he or she was returned to the classroom. If the child was uncertifiable but, in the mind of the medical officer and the teacher, incapable of receiving proper education in the regular classroom, then he or she was sent to one of several ‘special classes’. Smaller, provincial School Boards did not enjoy the luxury, as London did, of having a separate ‘asylum for imbecile children’ and twenty-six special schools. Only six other school districts in England had special schools by , and most of these grouped all the cases who could not properly be taught in the regular system into the same classrooms. Smaller communities still sufficed with a separate classroom, and a great many made no separate provision whatsoever. The new institutions at Caterham, Leavesden, and Darenth represented an important, if ambiguous, moment in the history of public provision for the mentally disabled in modern Britain. Although, as stated earlier, the medical profession had resisted a separate asylum system under Poor Law control for the chronic and harmless insane across the country, separate ‘institutions for the incurable’ were indeed set up for the metropolitan region, providing a precedent for the permissive  Idiots  

Fabian Society, Minority Report, , –. Pritchard, Education and the Handicapped, .

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Act and the obligatory  Mental Deficiency Act. The metropolitan asylums also represented a separation of urban and provincial accommodation for the mentally disabled, whereby the care and the custody of idiots and imbeciles outside London remained centred largely on the Poor Law Union workhouses until the twentieth century. Thus, despite the novelty of the Metropolitan Asylums Board institutions, the last three decades of the century continued to see the Poor Law Union workhouse as central to the ‘filtering’ of the provincial insane poor who could not be accommodated in their own households. Since decisions tended to be based on behaviour and violence rather than ‘diagnosis’, the chronic and generally non-violent nature of idiots and imbeciles meant that they, along with the senile demented, were the most easily retained in the rural Poor Law Union workhouses. Campaigners in favour of state asylums for the mentally disabled would wait until similar rate-aided institutions were enacted at the county level countrywide. The last three decades of the nineteenth century witnessed the stagnation of the voluntary ideal. Contrary to Andrew Reed’s vision in the s, the national system of voluntary idiot asylums failed to materialize. Rather, the relentless demand for asylum accommodation and the growth in the number of adult idiots in Poor Law workhouses and ‘defective’ children in the new elementary state schools forged a debate over the appropriate locus of care for idiots and imbeciles. Most middle-class professionals, doctors, and School Board officials alike agreed that workhouses were not an appropriate place in which to house them. They inevitably looked for other institution structures—state asylums and special schools—as alternatives. The widespread feeling was that biology, and not simply philanthropy, must be brought to bear on the problem. The optimistic faith that enlightened humanitarianism would solve most social problems had given way to a darker belief in hereditarianism. The innocent idiot children had been replaced by the social danger of the feeble-minded. 

ch. .

Day and Jancar, ‘Mental Handicap’, ; Thomson, The Problem of Mental Deficiency,

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Conclusion In the year of Victoria’s death W. H. Dickinson, a member of the London County Council and President-Elect of the National Association for Care of the Feeble-minded, predicted that ‘the future of the [English] nation depended largely upon the stamping out of feeble-mindedness’. This is a far cry from the first official meeting of the organizing committee of the Asylum for Idiots in , which had proclaimed, with the optimism of the age, that the new asylum would be the last ‘great link in the golden chain of charity’. A far cry, too, from the penny plea of Eliza Grove, who poetically described the new voluntary asylum as ‘a beam for mental darkness’. In the sixty years that intervened the mentally disabled had evolved from symbols of advancement in the ‘Age of Improvement’ to representatives of racial decline in an era of national degeneration. An increasingly sophisticated society devalued the mentally disabled as objects of social improvement, and demonized a vaguely defined group of individuals—the feeble-minded—as the promoters of crime, delinquency, and prostitution. Within this sea-change of social attitudes, the Earlswood Asylum had been the mid-Victorian flagship of institutional treatment for idiot children. ‘We are proposing to raise a Model Institution,’ wrote Andrew Reed in his first Report, ‘and have thrown it open to the Empire.’ It did indeed provide the inspiration for the construction, in the s and s, of four other voluntary idiot asylums, situated, respectively, near the provincial capitals of Colchester, Exeter, Birmingham, and Lancaster. Although they were designed to serve specific regions, each asylum was based on the election of patients by subscribers for fixed periods of time, and enshrined the basic principles of providing educational and vocational training for idiot and imbecile children. In many respects, however, these asylums also symbolized a passing era. After the construction in  of  

BMJ [ Mar. ] (, i), . Grove, A Beam for Mental Darkness. A ‘penny plea’ was a philanthropic undertaking, whereby an individual would produce something (in this case a book of poems) and ask for donations (not always mere pennies) to a specific charitable cause.  First [Annual] Report, AREA, SRO ///, .

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the Midlands Asylum for Idiots, England was to see the construction of no more substantial purpose-built philanthropic idiot asylums. The Darenth ‘colony’ for idiot and imbecile children, erected in the wake of the  Metropolitan Poor Act, heralded a new generation of state institutions, funded by local rates (taxes), and operating on the structure of local government. Following the First World War, a nationwide system of publicly funded institutions would be established in the wake of the controversial  Mental Deficiency Act, thus creating a complementary system of county institutions parallel to the county lunatic asylums (most of which had renamed themselves as ‘mental hospitals’). With the advent of other welfare agencies, and particularly the expansion of elementary education and ‘special schools’, the mentally disabled were frequently shuttled between different statutory and voluntary bodies. Within this complex array of overlapping legal and medical jurisdictions, the Victorian idiot asylums assumed a diminishing and increasingly outmoded role. The Earlswood Asylum was taken into public ownership following the National Health Act of . Some time after this date, administrators painted over the list of subscribers in Earlswood’s Great Hall, symbolizing the new era of post-war statutory national health insurance, and erasing the most visible memorials to Victorian philanthropy. This book has demonstrated that, far from operating on the fringes of Victorian welfare provision, idiots represented an important constituency for Poor Law Overseers in the early modern period. The English lunacy laws included idiots and imbeciles under the rubric of the ‘insane’; and after  local Poor Law and lunacy officials colluded in keeping harmless idiots and imbeciles out of state asylums, retaining them in local Poor Law Union workhouses, because of overcrowding and the cost of institutional treatment. The interests of workhouse masters (employed by the Poor Law Guardians), county magistrates (responsible for supervising the asylums at county level), and the medical profession (claiming unique expertise in the treatment of ‘insanity’) resulted in a protracted debate during the first half of the nineteenth century over the locus of care for the mentally disabled. Medical superintendents in asylums did not want ‘incurables’ clogging up their ‘curative’ institutions. Yet, equally, they did not want to cede any potential patients to lay authorities. Poor Law Guardians recognized that pauper idiots and imbeciles were not appropriately cared for in mixed workhouses, but resisted, largely for financial reasons, the construction of a new system of asylums. Magistrates, concerned primarily with controlling violent lunatics at large, preferred

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to turn a blind eye to the retention of the mentally disabled in workhouses. The balance of interests of these principal players in the Poor Law-Asylum system resulted in the retention of idiots and imbeciles in the workhouses and local communities. The lack of any statutory institutional provision for idiot and imbecile children provided an opportunity for philanthropy to fill this perceived gap. Against this backdrop of changing statutory provision emerged what we might call the ‘idiocy reform’ movement of the s. The optimism that surrounded the moral treatment of ‘lunacy’ infected lay and medical attitudes to idiocy. The writings of French physicians expounding their success in training idiot children were widely disseminated in English medical circles during the s and early s. The sanguine contention that the ‘idiot could be educated’ resonated with cultural significance in the ‘age of improvement’. A confluence of factors led to the congregation of a group of individuals intent on merging medicine, philanthropy, and liberal politics into a campaign to establish the first idiot asylum in England. A few years before the construction of the famous Hospital for Sick Children on Great Ormond Street, this group rented homes for England’s first asylum for idiots, embarking on a project that the founders saw as a monument to a more progressive and enlightened society. Like the founders of the public asylums, the philanthropic committee managing the Earlswood Asylum could not have predicted the demand for admission to their fledgling institution. Recent research on the rise of asylums in the nineteenth century has suggested that families occupied a central role in the process of institutional confinement. This book has investigated the pre-institutional experiences of children admitted to the Earlswood Asylum, and the social, economic, and demographic factors which may have played a role in their families’ decision to seek institutional care. It has demonstrated that the history of idiot asylums must be seen within the context of patterns of care and kinship of the Victorian family and, particularly, the role of women and young daughters in the caring network of the household. Despite the variety of social pressures brought to bear by industrial change, and the preoccupation of historians with the expanding asylum system, the asylum remained only one of several options. The nuclear family persisted as the primary locus of care for idiots throughout the nineteenth century. Moreover, there seems little evidence to support the contention, popular amongst working-class historians, that reciprocal exchanges of caring responsibilities between neighbours and nonco-residing kin were very common. To what extent the nature of the

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sources, which tended to be oriented to the domestic co-residing group, underestimated kinship caring remains to be explored further. What is clear is that care outside formal institutions was much more central to the ‘mixed economy of care’ than the historiography of psychiatry has so far admitted. Popular representations of the Victorian asylum abound with stereotypes of the miserly madhouse keeper or the inhumane state institutions for the vagrant poor. Histories of charitable asylums for the ‘middle classes’ constitute an important corrective. The Earlswood Asylum, like many other idiot and lunatic charitable institutions, accepted patients from families living throughout England and Wales, and from households across the socio-economic spectrum. An examination of the familial backgrounds of patients admitted in six sample years provided the data for a detailed analysis of occupation, length of stay, and previous place of abode. A further linkage of the addresses of the patients admitted during census years of , , and  to their families’ census enumerator schedules of the same year permitted a rare insight into family structure, migration, and household composition. This book has illustrated the diversity of institutional experiences of asylum patients. One-half of admissions died in the asylum, some soon after admission, others after remaining for as long as ten or twenty years. By contrast, half of the , admissions under study stayed for five years of training and were indeed returned to their households. Thus, rather than characterizing the asylum as a place where families rid themselves of unwanted members, it is possible for historians to conceptualize Earlswood and other similar institutions as representing a resource used strategically by poor households intent on overcoming periods of impoverishment. Asylums were often only one dimension in a lifelong endeavour to care for the dependent and the disabled, even during the apex of asylum provision. Within Victorian asylums, day-to-day care of the inmates devolved onto cohorts of asylum attendants and nurses, about whom there has been very little detailed research. By examining staff wages books, there emerges a picture of two separate occupational paths. Male attendants were most often recently decommissioned soldiers and sailors, seeking temporary employment as they reintegrated into civilian life. Women attendants and nurses followed a more predictable path, tending to come from domestic service into more prestigious and better remunerated hospital employment. Despite characterizations as indolent, unmanageable, and violent, there seems little evidence from the Earlswood Asylum that attendants were the ‘dregs of society’. Rather, they sought asylum

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employment as a short-term occupation in a volatile economy of Victorian England. Attendants and nurses were deeply engaged in the local labour market. Their movement in and out of the institution was no less dynamic than that of the patients they cared for. Such a pronounced staff turnover posed significant challenges to a medical staff eager to ensure a degree of continuity in their medical and educational efforts. Staff turnover was partly due to lower wages offered in some asylums. However, one of the least explored aspects of the history of psychiatry is the financing of these expensive institutions and the relationship between financing, institutional confinement, and the level of care. Nor have historians explored in detail the competition between different types of mental hospitals—private, charitable, and pauper—for financial resources within the rapidly expanding ‘lunacy sector’. The role of institutional philanthropy was important in the development of institutional psychiatric provision. Through an examination of the financial returns of the annual reports, and a database study of subscribers’ books, patterns of financial support were analysed between  and . The vicissitudes of the economy, and the caprice of subscribers, made the management of a voluntary asylum an unpredictable affair. Consequently, an analysis of the changing financial fortunes of the Earlswood Asylum, described by its founder as the ‘last link in the golden chain of charity’, illuminates the ineffectiveness of the voluntary sector in the face of the relentless demand for institutional accommodation. By the close of the nineteenth century the financing of public asylums was the single largest social welfare item in many western countries. Despite the financial difficulties of the asylum, it succeeded in implementing a radical new approach to teaching idiot children social and vocational skills. This novel training system, and the culture of the asylum generally, constituted a unique institutional experience. The Earlswood Asylum, like many Victorian mental hospitals, underwent important changes in its interior representation and social organization, as medical men and lay members of the board attempted to create a bourgeois culture of conformity, order, and gentility. Within the ‘moral architecture’ of the Victorian idiot asylum, special attendants experimented with approaches to teach numeracy and literacy to the ‘uneducable’, and   

An important exception is Digby, ‘Changes in the Asylum’, –. [Annual] Report, , AREA, SRO ///, . See, inter alia, Finnane, Insanity and the Insane, –; P. Bartlett, ‘The Poor Law of Lunacy, –; G. Grob, The Mad Among Us: A History of the Care of America’s Mentally Ill (Cambridge, Mass., ), .

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to rank children on mental ability and educational attainment. Simultaneously, the asylum encouraged the acquisition of class- and gender-specific skills, preparing the children and adolescents for discharge into the real world of Victorian society, and shaping the ‘purposeless’ behaviour of idiot children into an acceptable form of middle-class conduct. Through this treatment, the idiot children can be seen to represent a microcosm of the middle-class impulse to inculcate self-sufficiency, thrift, and obedience within Victorian society more generally. The Earlswood Asylum was well connected in the mid-Victorian world of medicine, involving such luminaries as John Conolly, William Little, and Sir James Clark. All three brought their influence to bear in support of the new institution. Shortly after the construction of the permanent edifice on Earlswood Common, the Board of Management hired John Langdon Down as its second resident medical superintendent. The story of Langdon Down’s rise, fall, and rise again will remain a subject of some debate. For his supporters, he was a towering figure of stunning intellect and originality. He pioneered the medical treatment of idiocy, classified a new type of mental disability, and raised the cause of the mentally disabled in the English-speaking world. To his detractors, Langdon Down represented an ambitious young doctor who self-interestedly championed medical over lay control of the mentally disabled, advanced sub-types of idiocy based on a racialized hierarchy, and left the asylum in disgrace over his eagerness to benefit financially from the demand for private institutional care. A balanced and critical account of Down’s fascinating life remains to be written. This book has concentrated on his tenure at the Earlswood Asylum, during which time he built his reputation as the leading light in the English-speaking world on mental diseases of childhood. His ten years at the asylum intersected with the major debates in psychiatry in the Victorian era, the role of institutions in the formation of the profession, and the construction of medical expertise and the marginalization of lay authority over mental disorder. His ‘discovery’ of Mongolism would prove to have a long-lasting effect on society by formulating the archetype of mental disability. Down’s writings bridged the heady optimism of the s and the  The study of admission registers for asylums in England actually dates from ParryJones, The Trade in Lunacy; studies since then have been well summarized in the Introduction to A. Beveridge, ‘Madness in Victorian Edinburgh: A Study of Patients Admitted to the Royal Edinburgh Asylum under Thomas Clouston, – (part I)’, Hist. Psych.,  (), –.

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degenerationism of the late-Victorian period. By the s the intellectual climate within England had changed profoundly from the optimistic days of the s. The era of unfettered Victorian progress was undermined by the great depression, beginning in ; the creeping self-doubt of the late-Victorian mindset was reinforced by the rise of other world powers. Historians have extensively researched the emergence of a darker, more pessimistic era of social thought, as commentators fretted over the degeneration of an urban lumpenproletariat. The new-found pessimism also spread throughout the asylum world, as demand for accommodation continued to outstrip supply, as medical superintendents doubted the efficacy of their own treatments, and as long-stay patients clogged up the institutions built immediately after the  Asylums and Lunatics Acts. Moreover, as national elementary education brought thousands of schoolchildren—with their attendant mental and physical maladies—into the public view, social commentators were faced with the immense scale of the problem. As this book has illustrated, the shift in the intellectual basis for confinement illuminated Social Darwinistic ideas about degenerationism, particularly as they affected the idiot and imbecile population. Because many viewed county lunatic asylums as a therapeutic failure, there was a great debate over what form state institutions for idiots should take. A faltering step had been taken in , when the Metropolitan Poor Law Act established institutions for the ‘chronic and incurable insane’ of London. A more pervasive innovation was the emergence of ‘special schools’ in the wake of national elementary education. Established in the early s, these offered local residential and day schooling for backward children. Regardless of the institutional form, however, degenerationism was beginning to creep into public discourse. By the time of a Parliamentary Select Committee of , an emerging educational elite, armed with psychiatric expertise and assistance, promoted the segregation of the feeble-minded on Social Darwinistic rather than therapeutic lines. The dawn of the twentieth century, far from ushering in a new era of neutral scientific and medical progress, represented the beginnings of a mental hygiene movement dedicated to ‘stamping out’ mental disability from society. The legacy of the Earlswood Asylum eludes simple evaluation. Conceived as a call for the education of idiot children, it did indeed highlight the potential of those assumed, by some at least, to be beyond the  See G. Stedman Jones, Outcast London: A Study in the Relationship Between Classes in Victorian Society (Oxford, ).

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reach of care and individual treatment. Taken as a radical experiment in the education of those previously deemed unimprovable, however, it had only marginal success. In the s inflated claims of future success would undermine later modest measures of improvement effected at the institutional level. Early in the history of the asylum there was a distinct lowering of sights. The Board even resorted to the evasive tactic of arguing that patients who had shown little or no improvement were at least prevented from degenerating further. With such slippery rationalizations, the Earlswood Board and the superintendents avoided systematically evaluating the degree of success in social or vocational training, or indeed whether any skills imparted to the inmates continued once they had returned home. Annual reports highlighted the few stellar cases of improvement amongst a patient population of several hundred. Forty years later, the Lunacy Commissioners employed the then popular justification that: ‘Whether any of those whom we saw there employed [in the workshops] can be made self-supporting may be open to doubt, but the utility of an instruction, such as this, is not to be estimated by this test, but rather by the relief it affords to families afflicted by an idiot member.’ The over-zealous contentions of the asylum’s proponents can thus be seen as the first in a long history of exaggerated claims that have typified educational efforts for the mentally disabled. If the miracle cures predicted by Andrew Reed, John Conolly, and William Twining in the s were few and far between, there also seems little evidence to conclude, pessimistically, that the institution degenerated into a locus of custodialism and dehumanization. Clearly, the level of accommodation, especially in the early years, left much to be desired. But so, too, did the housing and diet of poor labourers in the same period. It is unlikely that care or supervision outside the institution was better, or kinder, than that which patients received within its walls. Recent research on ‘care in the community’ of idiots and lunatics in Victorian England suggests that, especially in poorer households with few resources, neglect, restraint, and cruelty were not uncommon. The cases of neglect and restraint within the Earlswood Asylum, and other Victorian institutions, must therefore be compared to the social reality uncovered in households   

[Annual] Report, , AREA, SRO ///, . Thirty-eighth Report, ARCL, PP [] xl,  []. See e.g. J. Melling, B. Forsythe, and R. Adair, ‘ Families, Communities and the Legal Regulation of Lunacy in Victorian England: Assessments of Crime, Violence and Welfare in Admissions to the Devon Asylum, –’, in Bartlett and Wright (eds.), Outside the Walls of the Asylum, –.

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and communities across the country at the same time. So much more work needs to be conducted on familial or community care of idiots or lunatics in Victorian England that any comparative evaluations of institutional and ‘community’ treatment may prove premature. If it is simplistic to attack institutionalization as a historical phenomenon thrust upon helpless victims, so too is it misleading to suggest that care and treatment outside the walls were, by contrast, idyllic and wholly humane. The results of the database analysis of more than , patients strongly suggest that Earlswood Asylum was not dominated by long-term chronic patients dumped into the institution until their demise. Rather, the patient population revealed a variety of institutional experiences. The vast majority of patient-pupils were admitted as charitable cases and, after the allotted five years, discharged back to their families and communities. Many had exhibited their slowness of learning or violent behaviour for months, if not years, before confinement. Thus, it seems likely that the asylum represented only one stage in a lifelong series of often temporary solutions whereby families sought to accommodate, care for, and control the mentally disabled in the Victorian era. The existence of extensive historical records from famous institutions such as the Earlswood Asylum should not lead us to believe that an undocumented, and less regulated, form of institutional care and control did not occur after discharge, either in Poor Law Union workhouses or in the black market of private care which coexisted with regulated and licensed medical institutions. Detailed work on workhouse provision for idiots and imbeciles is urgently needed to answer some of these questions. Although mental hospitals have long been associated with ‘dehumanizing’ conditions, and with the desire to segregate and isolate ‘deviants’ from society, it is well worth remembering that the origin of the Victorian idiot asylum was informed by an optimism over the reintegration of the mentally disabled back into society. Institutions were seen, paradoxically, as a way of training backward children in order to incorporate them more fully as citizens, albeit into a particularly Victorian, independent, and self-sufficient definition of citizenship. Ironically, asylums erected ostensibly for the greater integration of idiot children may well have lowered the tolerance of families and communities to care for their dependent kin and neighbours, thus leading to a century of segregation and physical isolation. Society may well wonder whether the rush to close mental  For a similar conclusion regarding the use of pauper lunatic asylums, see Walton, ‘Admissions to Lancaster Asylum’, .

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deficiency institutions in the last three decades of the twentieth century, fuelled by an ideology of normalization, has also led to a situation that leaves many of the mentally disabled physically integrated but socially isolated. In their desire to pinpoint the origins of stigma and discrimination, critics have too easily pointed to bricks and mortar as the root of the problem. We have reflected too little on the culture of educational achievement and cult of self-sufficiency that undermines our valuation of mental disability, and that reigns more supreme today than it did at the time of the National Exhibition of . With the emergence of political ideologies which eschew corporate responsibility for those who cannot earn an independent living, will the successful campaign to close down the last vestiges of institutional care and treatment for people with mental disabilities turn out to be a hollow victory?

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SELECT BIBLIOGRAPHY Archives PUBLIC RECORD OFFICE

Census of England and Wales for the Year , PRO series RG Census of England and Wales for the Year , PRO series RG Census of England and Wales for the Year , PRO series RG SURREY RECORD OFFICE

The Records of the Royal Earlswood Hospital (formerly the Earlswood Asylum) General Court // Minutes of General, Annual General and Special General Court vol.  – // Annual Reports vol.  – vol.  – vol.  – // Printed List of Subscribers vol.  – vol.  – vol.  – Board Meetings // Minutes Index to Board Minutes vol.  Minutes of Stewards Meetings, – vol.  Lists of Guests – // Board Meetings vol.  July –May  vol.  June –Aug.  vol.  Aug. –March  // Earlswood Management Committee // Matters referred to House Committee // Medical Superintendent’s Report to Board // Letter Books vol.  Letters to the Board, –

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Letters of thanks to the Board, – Letter copying books, – ″  ″ – ″  ″  ″ –

House Committee // Minutes // House Committee Rough Minutes // Medical Superintendents’ Reports to House Committee vol.  – Finance Committee // Minutes // Finance Sub-Committee Minute Book Case Committee // Minutes vol.  – // Election Admission Book vol.  – Sub-Committees and Special Sub-Committees / Minutes vol.  – Registers of Visitors // Visitors’ Book vol.  – // Visiting Medical Officers’ Reports vol.  – vol.  – // Visits by Friends of Patients vol.  – Patients: Registers and Case Books // Registers of Patients vol.  – // Registers of Names, Residences, etc. of Cases vol.  – vol.  – vol.  –



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vol.  – vol.  – // Recertification Registers // Case books vol.  – (Females—duplicate set) vol.  – ″ vol.  – (Males) vol.  – vol.  – vol.  – School Records // Girls Schools’ Case books vol.  – Medical Records // Register of Deaths vol.  – Financial Registers // [Staff] Wages Books vol.  – vol.  – Males // [Patients], Ledger of Life Payment Cases vol.  // [General Expenditure] vol.  ‘Annual Expenditure Book’ [–] Papers / Papers Relating to the Charter, Rules & Regulations, Etc. vol.  Documents Relating to the Charter [–] vol.  Rules and Regulations [–] vol.  Engagement and Receipt Forms [c. ] Admission Papers (including Certificates of Insanity and Orders for the Reception of a Private Patient) / vol.  vol.  vol.  vol.  vol.  vol.  vol. 

      

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

Other Records, Surrey Record Office /// Rules for the Guidance of Attendants and Servants and all persons engaged in the service of the Surrey County Asylum at Brookwood,  /// Register of Officers, Attendants and Servants [–], Surrey County Asylum at Brookwood Acc. CC/ Register of Staff, Surrey Constabulary PA R L I A M E N TA RY PA P E R S

Number of Pauper Lunatics and Idiots in each County in England and Wales; distinguishing those who are contained in Pauper Lunatic Asylums built under the provisions of  Geo. , c., those confined in Private Lunatic Asylums, and those under the Care and Management of the Guardians and Overseers of the Poor, PP [], xlvii, . Reports of the Commissioners in Lunacy to the Lord Chancellor, PP [–]. Census of England and Wales , Population Tables, , Pt. I., Vol. I: Area and Population, PP [–], lxxxvi, . Census of England and Wales , Population Tables, Vol. I: Number and Distribution of People, and Index to Names of Places in England and Wales, PP [], l.; General Report, PP [], lii, . Census of England and Wales , Vol I: Area, Houses and Inhabitants PP [] lxvi, Pt. I; Vol II: Index to Population Tables PP [], lxvi, Pt. II; Vol. IV (Gen. Rep.) PP [], lxxi, , Pt. II. Census of England and Wales , Vol. I: Area, Houses and Population (Counties)  PP [], lxxviii,; IV (Gen. Rep.) PP [], lxxx, . Census of England and Wales , Index to Population Tables, PP [–], civ, . Royal Commission on the Employment of Women and Children in Agriculture, , evidence for Surrey, PP [–], xiii, – (–). Departmental Committee on Defective and Epileptic Children, PP, , xxvi. Royal Commission on Care and Control of the Feebleminded (RCFM), PP, , viii. N E W S PA P E R L I B R A RY, B R I T I S H L I B R A RY

Reigate and Redhill Express Surrey Gazette

Unpublished Manuscripts ALDISS, C., ‘Moral Treatment in the County Asylums: The Case of Nottingham and Norfolk’, MA thesis, University of Nottingham ().

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BARRETT, M. A., ‘From Education to Segregation: An Inquiry into the Changing Character of Special Provision for the Retarded in England, c.–’, Ph.D. thesis, Lancaster University (). BARTLETT, P., ‘The Poor Law of Lunacy: The Administration of Pauper Lunatics in Mid-Nineteenth-Century England, With Special Reference to Leicestershire and Rutland’, Ph.D. thesis, University College, London(). DUPREE, M., ‘Family Structure in the Staffordshire Potteries, –,’ D.Phil. thesis, Oxford University (). GELBAND, H. S., ‘Mental Retardation and Institutional Treatment in Nineteenth Century England, –’, Ph.D. thesis, University of Maryland (). HERVEY, N. B., ‘The Lunacy Commission, –, With Special Reference to the Implementation of Policy in Kent and Surrey’, Ph.D. thesis, Bristol University (). JACKSON, M., ‘The Borderland of Imbecility’, unpublished manuscript (). MILLER, F., ‘The Perseverance of “Mongolism”: The Old and the New in Medical Cytogenetics, c.–’, unpublished paper read before the Annual Conference of the American Association for the History of Medicine,  May . NEUGEBAUER, R., ‘Social Class, Mental Illness and Government Policy in th and th Century England’, Ph.D. thesis, Columbia University (). RUSSELL, R., ‘Mental Physicians and their Patients: Psychological Medicine in the English Pauper Lunatic Asylums of the Later Nineteenth Century’, Ph.D. thesis, University of Sheffield (). SAUNDERS, J., ‘Institutionalized Offenders—A Study of the Victorian Institution and its Inmates, With Special Reference to Late-Nineteenth Century Warwickshire’, Ph.D. thesis, University of Warwick (). WRIGHT, D., ‘The National Asylum for Idiots, Earlswood, –’, D.Phil. thesis, Oxford University (). ZIHNI, L., ‘A History of the Relationship Between the Concept and the Treatment of People With Down’s Syndrome in Britain and America, –’, Ph.D. thesis, University College, London ().

Published Books and Articles P R I M A RY S O U RC E S

ABBOTT, J., Handbook on Idiotcy (London, ). ANDRIEZEN, W. L., ‘The Pathogenesis of Epileptic Idiocy and Epileptic Imbecility’, BMJ [ May ] (, ii), . Anon., The Education of the Imbecile and the Improvement of Invalid Youth (Edinburgh, ). —— ‘Notes on Idiocy’, JMS (), . —— ‘The Psychology of Idiocy’, JMS [], –.

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INDEX Abel Smith, B.  Abendberg  accoucheurs  Adams, L.  admissions, see asylum admissions admissions papers ,  admissions registers , ,  African Americans  agents  agricultural labourers , ,  Albert, the Prince Consort ,  Aldridge, E.  Aldridge, J.  alienists  American  attitudes to lunatics in workhouses  attraction to phrenology – ideas about asylum construction  role in certification  specialist knowledge  specializing in idiocy – see also medical superintendents almshouses ; see also Poor Law workhouses America , ; see also United States American Civil War  anatomy  Andrews, J.  Anthropological Society of London  anthropologists  anthropology: debates over evolution – evolutionary  humanitarian  anti-psychiatry movement  apothecaries , ,  Apothecaries Hall  Arieno, M.  Arlidge, J. T.  armed services – army – arson – artisans –,  Ashford, C.  Ashford, J.  Ashley, Lord –

Association of Medical Officers of American Institutions for Idiotic and Feeble-Minded Persons – Association of Medical Officers of Hospitals and Asylums for the Insane , ; see also MedicoPsychological Society; British Psychiatric Association asylum admissions –, n. characteristics of  to county asylums  to voluntary asylums  see also Earlswood Asylum patients asylum care: comparison to community care  ‘cottage system’ n.,  numbers of patients in  private demand for –, ,  as respite care – stereotypes ,  Asylum Journal ; see also Journal of Mental Science asylums (county pauper and philanthropic lunatic) , , –, , , , ,  accommodation in , , , , ,  administrators of  admissions to, see asylum admissions attendants, see attendants; nurses auxiliary  backlash against – clerks , ,  construction of  cost of constructing  custodial – demand for accommodation in ,  diet within  educational  employment in , , ,  financing of ,  for chronics ,  gender division within  historiography of –, , ,  idiot, see asylums for idiots image of  infirmaries  inspection of 

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asylums (county pauper and philanthropic lunatic) (cont.): licensing of  life within , , , ,  location of  management of , , n., ,  medical superintendents, see medical superintendents non-restraint within ; see also restraint overcrowding in ,  patients, see patients punishment within  recruitment patterns of staff  rise of ,  size of ,  staff, see attendants; nurses status of inmates within  superintendents, see medical superintendents symbolic importance of  therapeutic , , ,  transformation in attitudes towards – Visitors’ Books  voluntary , ,  work ,  workshops  Asylums (county pauper and philanthropic lunatic): Abergavenny  Bethlem , ,  Devon county pauper , n., n. Durham county pauper  Essex county pauper  Gloucestershire county  Hampshire county pauper  Hanwell, see Middlesex county pauper (Hanwell) Kent county pauper , n., , ,  Lancashire county pauper , , , n. Leicestershire & Rutland county  Lincoln county , ,  Liverpool  Manchester ,  Middlesex county pauper (Barning Heath)  Middlesex county pauper (Colney Hatch) , , 

Middlesex county pauper (Hanwell) , , –, , , , ,  Norfolk county pauper  Northamptonshire county  Nottinghamshire county , , , n. Pennsylvania state n. St Luke’s , ,  Surrey county pauper (Brentwood)  Surrey county pauper (Brookwood) , –, , ,  Surrey county pauper (Wandsworth) , –,  ‘Three Counties’ pauper  Worcester county  York county  York Retreat (Quaker) , ,  Yorkshire county (Wakefield) n. asylums for idiots: early ideas of , , ,  economic justifications for  in France  historiography of ,  medical superintendents, see medical superintendents public funding of ,  rapid increase in size  regimentation of  regional  similarities to lunatic asylums – state funded  strategic use of  in United States , ,  Asylums for Idiots: Baldovan (Scotland) , , n. Bath Institute  Belvedere  Darenth Colony for Idiot and Epileptic Children, see Asylums for Idiots, Metropolitan (Darenth) Earlswood, see Earlswood Asylum Eastern counties (Colchester) , ,  Essex Hall, Colchester –, , –, ; see also Asylums for Idiots, Eastern counties Larbert n., , –,  Metropolitan (Caterham) n., , , , – Metropolitan (Darenth) , n., , , –, 

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Index Metropolitan (Leavesden) n., , , , , – Midlands counties (Knowle) , n.,  National, see Earlswood Asylum Northern counties (‘Royal Albert’, Lancaster) , , , , , n., , ,  Normansfield Training Institution for Imbeciles , ,  Park House, Highgate , , , , , ; see also Earlswood Asylum Scottish National, see Asylums for Idiots, Larbert Western counties (‘Starcross’, Exeter) , , , ,  asylums for orphans ,  Asylums for Orphans: Asylum for Fatherless Children  Infant Orphan Asylum  London Orphan Asylum  asylums (for profit) , , , , , , ,  in Hampshire  idiots in  in Kent  in Surrey  in Sussex  Metropolitan () , ,  White House, Hampton Wick  see also Asylums for Idiots, Normansfield Training Institution for Imbeciles Asylums (for profit): Camberwell House , ,  Chartwell  Droitwich  Hook Norton  Peckham House ,  Ticehurst n., , , ,  Whitney  atavism  Atkinson, D. n., n. attendants –, –, –, – background of –, ,  character profiles  conditions of employment  experience of – employment of  farm and garden  female , –, , , , , , , , ; see also nurses



‘keepers’  length of stay of , – male –, ,  occupational mobility of , , , – occupational training  patterns of employment – previous employment – private  promotion practices  quality of  reasons for leaving  remuneration , , –, , ,  trades – training of  turnover rate –,  as ‘unemployable’  unionization of  Wages Books , ,  working conditions  see also nurses Averyon  bakers  Balliol College, Oxford  Banbury  bankers  Banner, C.  Barker, E.  Barker, Mrs  Bartlett, P.  basketmaking  Beach, F. –, –, , – Bedford College, London  Bedford, Mr  Belfast, Ireland  Berry, A.  Birmingham ,  Bishop of Oxford  Bismarck  Blackie, G.  Blagrove, M.  Bleyer, A.  ‘boarding out’ , , , ,  Boer War  Bosanquet, B.  Bosanquet, H.  brass-finishers  Brighton , , , – Bristol  Britain , –, ,  British Empire 

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British Foreign and Medical Review  British Medical Association ,  British Medical Journal , , – British Parliament , ,  British Psychiatric Association , ; see also Association of Medical Officers of Hospitals and Asylums for the Insane; MedicoPsychological Association Brixton  Brockdish, Norfolk  Brook, F.  Brook, K.  Brooks, H.  Browne, W. A. F.  Bryder, L.  Bucknill, J.  Budd, S.  butchers  butlers  Buxton, C.  Callaway, T.  Cambridge University , ,  Cambridge, Duke of  Cambridgeshire  Canada  Canterbury  Carlisle, Lord  Carney, T.  carpenters  carpentry  Carroll, Sir G.  casebooks (medical)  Castleford, Yorkshire  censuses: decennial , , n., ,  household enumerations ,  household enumerators’ schedules , , , , , , , , ,  population indexes,  Census Office  cerebral abnormalities  cerebral localization  cerebral palsy  certificates of insanity , , –, –,  certification: assistance of legal textbooks  assistance of medical textbooks ,  at the asylum n. evolution of  identity of doctors –

legal requirements for , n. poor standards of,  role of clergy in  role of family in , ,  role of medical practitioners in , – and the Poor Law  stigma of  testimony in ,  tests conducted during – within the household ,  Chambers’ Edinburgh Journal – charitable trustees  charities  competition between  financial difficulties of ,  see also Earlswood Asylum Charity charity , –; see also philanthropy Charity Organisation Society –,  Chartist demonstrations  Cheltenham Dispensary  chemists , ,  Cheshire County Council n. Chichester  childhood  mental diseases of  children ,  ‘caretaker years’ of ,  household responsibilities of  idiot , ,  orphan  pauper ,  periodicals  role in caring – chloral hydrate  cholera  Christian piety  chromosomal abnormalities  cigar makers  Clark, Sir J. , , , , , ,  clergymen , , ,  clerks , ,  coachmen ,  Coates, A.  Cockburn, Miss  Colchester , ,  colonies –,  Chalfont St Peter  Bethel Colony for Epileptics  Commonwealth of Massachusetts  community care , , , , – Company of Apothecaries 

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Index confinement (institutional) , , , , , , , , , , ,  laws governing  role of family in  see also institutional committal congregational donations  Congregational preachers  Conolly, J. , –, –, , , , –, , , , –, –, –, , –, ,  Continent, see Europe Cooter, R.  Cordwainers of London  Cornard Parva, Suffolk  Cornwall  corporal punishment  Corporation of the City of London  corpus callosum  Cossington, Somerset  county constabularies ,  county magistrates  Cox, J. ,  cranial malformation  cranial physiognomy ,  cretins – education of –,  cretinism , ,  Crimean War ,  criminal justice system  Crookshank, F. – Crystal Palace , ,  Cunningham, C.  Curters, A.  Curters, E.  Cutters of London  Cyclopaedia of Practical Medicine  cytogeneticists  Darwin, C. , ,  ‘deaf and dumb’ n., n. death certificates  degenerationism , , ,  delusions  Dendy, H.  Dendy, M. , –,  Departmental Committee on Defective and Epileptic Children ()  Devon  Dickens, C. ,  Dickenson, Mr  Dickinson, W. R. 



Digby, A. , ,  disability ,  disability studies  discharge orders  diseases  diseases of the mind ,  dispensaries  Dissenters , , ,  doctors, see medical practitioners Doel, S.  domestic servants: in asylums ,  becoming asylum attendants –, ,  caring for idiot children –, – cost of ,  institutional  migration of  testifying during certification – domestic service , , , –, ,  domiciliary care  Dorsetshire  Dover  Down, J. L. , , –, , –,  ethnic classification of idiots –, –, –, –,  formulation of Mongolism , ,  lectures  private practice of , –,  view of John Conolly ,  Down, Mrs M. L. , – Down, P. ,  Down, R. , – Down’s Syndrome (or Anomaly) – Drapers of London  drills – Dublin  Dufferin, Lord  Dugdale, J. L.  Duncan, P. M. , –,  Dupree, M.  Dutch colonies  Earlswood Asylum: admissions procedures , , – annual fees  applications to ,  architecture of , – attendants, see attendants; nurses

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Earlswood Asylum (cont.): Board of Management, see Earlswood Asylum Board of Management brass band  Case Committee  Christmas pageant  clerks  Constitution , ,  construction of – diets ,  drilling and imitation rooms  education within , , –, –, –, – excursions , – fees – female wards  founding of – gender division within  income – infirmary  internal structure ,  legacy of  medical superintendents ,  as a model asylum –,  mortality rate  nurses, see attendants; nurses Nursery for Infants  patients, see Earlswood Asylum patients recreation within – regimentation of life within –,  revenue, see income Royal Charter  rules of admission to  size of ,  staff, see attendants; nurses Staff Wages books  Subscribers’ Books , n., –, ,  subscriptions to – success of ,  workshops , – Earlswood Asylum Board of Management: Case Committee  composition of  criticisms of  election of  financial position of – Honorary Presidents & Vice-Presidents List  House Committee  inaugural meeting of  members of 

non-conformist tendencies  petitions to  policy on applicants  Provisional Committee ,  rejection of applicants – Secretary , n. tensions within ,  Whig and Nonconformist members of – Earlswood Asylum patients: age of –,  attachment to staff  charitable , , , , ,  criteria for admission , – length-of-stay , –, , ,  ‘life’ cases  Life-Elections  Life-Payments  Life Presentations n. nomination  number of – as pupils –,  polling papers  pre-institutional experiences of , ; see also community care private –, , , , , –, ,  readmissions  removal of  rules governing  status on admission – teaching of life skills within  Earlswood Asylum Charity: Annual Festival Dinner  Association of Ladies  benefactors – debt held by , ,  donations  financial position of , , , , – fund-raising  general voters  life voters , ,  marketing of – new subscribers to , ,  publicity  semi-annual meetings of ,  size of – subscriptions to , , –, ,  summer fêtes  Earlswood Common , , , ,  East Anglia 

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Index Eastbourne  Ebery, M.  Edinburgh  education: dame school  elementary education , , , ,  special schools , ,  Educational Exibition of the Society of Arts, Manufacturers, and Commerce  educational reform  election system –, , – cards ,  criticism of  direct subscriber nomination  life vote  list of applicants  patients to  proxies  re-election  selection process for , , ,  semi-annual election ,  ballot election/selection –,  subscribers’ role in – Elwyn Training School  Enfield, London  Englefield House, Berkshire  English Heritage n. epidemics  epilepsy ,  epileptic fits , ,  epileptics n., ,  Esquirol, J. E.  Essex  Established Church  ethnologists  ethnology , ,  Ethnology Society  eugenicists  eugenics movement  Europe , , , ,  evangelicalism , ,  Everitt, Mrs – Evington, J.  evolution  Exeter, Devon , , ,  Fabian Society  familial care , –, , –,  impact of formal institutions on  impact of mother’s occupation  resumption of, after discharge , 



role of daughters in  role of elder siblings in ,  role of servants in – supervision of idiot children  families , , ,  bonds  demand for asylum care  extended – geographical background of  life-cycle of –,  lower middle class  middle class , ,  mobility of , – networks  occupations of  payment for care ,  poor –,  relocation  role in concealing idiocy, see households, role in certification role in certifying idiots  siblings , , – social construction of  wealthy – working-class  widowed  Faraday, M.  farm bailiffs  farm workers, see agricultural labourers feeble-minded , , –,  as promoters of crime  controlled fertility of – segregation of –,  female suffrage  fertility  Finnane, M. , ,  First World War  Fishmongers of London  Fletching  Forbes, J.  Foreign and Medical Review  Foreman, Dr – Foucault, M. ,  Fox, R.  France, –, , , ,  Fraser, R. – Frayling, H.  Freeman & Sons, London  Freemasons of London  Friedberger, M.  Gall, F .J.  gardeners , 

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 gardening  Gaskell, S. –,  General Medical Council  Germany ,  ‘gift relation’  Gilman, S.  Girdlers of London  Gittins, D.  Goffman, E. ,  Goldsmiths of London  Goodwin, J.  Gospel  Gould, S. J.  governesses  governors  Gray, R.  Great Britain ,  Great Exhibition ()  grocers  Grove, E. –, ,  Guggenbuehl, J. – gymnastics , – Haberdashers of London  Hackney, London  Hammersmith, London  Hanwell ,  Harrison, G.  Haslam, J.  Hatfield, S.  Heap, Revd  Hedon  Henderson, J.  hereditarianism ,  heredity  Hervey, N. – Higgs, E. ,  Hill, R. G.  Hindon, Wiltshire  Hirst, D. n. Holloway, London  Horsham  hospitals: charitable ,  concentration of  epileptic  foundling ,  general ,  governors of  mental, see asylums Metropolitan – patients restricted from  provincial , , , , 

Index specialist  subscribers to  teaching  voluntary n., , ,  Hospitals (non-psychiatric): Bath Infirmary  Bicêtre Hospital –, ,  Bristol  Children’s (Great Ormond St.) , ,  Guy’s  London Hospital , , , , – London Epileptic Hospital  Northampton  Royal Berkshire  St Mark’s ,  hospitals (mental), see asylums households , , , , –,  as a locus of care –, , , ,  as a locus of certification  as a locus of confinement – composition of n., ,  crisis of care , ,  crisis of caring – dependants within  economies of  fire within – housekeepers  management of  nursing in  resources  role in certification  role in confinement ,  size  social disorder within – structure of , , ,  type  violence  Howard, M.  Howe, S. G. ,  humanitarianism  Humber river  Humphrey, J.  Humphrey, Mrs  Hunecke, V.  Hunt, Dr J.  Hunter, Dr P. W.  idiocy , ,  American study of ,  congenital , –,  in the county of Lancashire 

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Index differentiation from lunacy –, – gendering  identification of , –,  ‘Kalmuc’ – medical conference on  ‘Mongolian’  racial dimensions – tests for identifying  idiocy reform ,  idiot children: confusion with ‘dumb’ children n. teaching of social and vocational skills  within elementary school system – idiots , , –,  ‘Aztec’  certification of  children, see idiot children community care of  in county lunatic asylums –, – cruelty towards  dangerous behaviour of – education of –, , , , –, ,  enumeration of , n. epileptic fits  ‘Ethiopian’ ,  familial care of  gender of  harmless and incurable –,  ineducability of  ‘Malay’  medical monopoly over  medical treatment of  ‘Mongolian’ –, –, – moral education of  perceived dangerousness of  Poor Law provision for  property of  self-injury of  training of , , ,  see also imbeciles; mental defectives Illustrated London News  imbeciles: certification of  in county asylums – education of  enumeration of n. historical interest in  historical use of the term 



and property rights  see also idiots; mental defectives imbecility – incarceration ; see also confinement (institutional) industrialization , ,  infirmaries (provincial), see hospitals inmates, see patients insane: chronic and harmless –,  criminal responsibility of  historical definition of  national returns of  pauper  perceived dangerousness of  in Poor Law workhouses  public attitudes to  see also lunatics; mentally ill insanity: aetiology of  certification of, see certification intoxication as cause of  medical definition of  moral treatment of ,  pathology of  prohibition from admission to hospitals  treatment of  institutions: histories  non-therapeutic  purpose-built –, ,  salaries , ,  staff fluctuations  therapeutic  working conditions ,  see also medical institutions institutional care  institutional committal , , , , , , –, ,  cultural reasons for  role of family in  social impact  intemperance  Iowa, USA  Ireland , , ,  Ireland, W. , –, , ,  Irish lineage  Islington  Itard, J.  Jackson, M.  Jackson, Dr 

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Index

Jones, W.  Journal of Mental Science , –, –,  Journal of Psychological Medicine  journals: of the Revd Andrew Reed –,  professional and lay  Jukes family  Justices of the Peace ,  Kallikak family n. ‘Kalmuc’ race  Kanner, L. ,  Kay-Shuttleworth, Sir J.  Kendrick, T.  Kerr, N.  kin , , , , –,  King, E.  King, Mrs  labour market , ,  Lancashire –, ,  Lancashire & Cheshire Society for the Permanent Care of the Feeble-minded  Lancaster , ,  Lancet , –,  Lancet Commission (–)  Langdon Down, J., see Down, J. L. learning disabled , ; see also mentally disabled learning disability, see mental disability Leavesden, Hertfordshire n. legacies – legislation , ,  Legislation: Asylums Act () , ,  Asylums Act () , , , , , , , , , –, ,  Elementary Education Act ()  Elementary Education (Blind and Deaf Children) Act ()  Elementary Education (Defective and Epileptic Children) Act ()  Idiots Act ()  Lunatics Act () , , , , , , , –, , , , , –, , , ,  Lunatics Amendment Act () ,  Lunatics Amendment Act () ,  Madhouses Act () , 

Medical Registration Act () ,  Mental Deficiency Act () ,  Metropolitan Poor Act () , , ,  National Health Act ()  Poor Law Amendment Act () , , , ,  Leicester , ,  Leighton  Leopold, Prince  Lettsomian Lectures ,  ‘liberal’ politics , ,  life-cycle poverty  Lincolnshire ,  Little, E.  Little, W. , –,  Littlehampton  Liverpool  Local Education Authorities  local school boards ,  classification of children within  women within  Local School Board of Birmingham  Loch, C. –, , ,  lodgers  London Assurance Company  London County Council  London elite ,  London Hospital Reports ,  London School Board ,  London Society of Apothecaries  London University Medical School  Lord Chancellor  lunacy  curability of  differentiation from idiocy – identification of  see also insanity; madness Lunacy Commission –, –, , , , , , ,  annual reports  Lunacy Commissioners –, , , –, –, , , , , , , , , , , , –, –, ,  Scottish  ‘lunacy reform’ movement , , –, , ,  lunatico inquirendo  lunatics: enumeration of n.

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Index ‘harmless and incurable’  perceived dangerousness of  pauper ,  see also insane; mentally ill Luton  Lutterworth  MacDonald, M. ,  MacKenzie, C.  mad-doctors, see alienists madhouses, see asylums (for profit) madness  historiography of – medical problems associated with  scientific approach to  social construction of  transformation into mental illness  see also lunacy Maggs, C.  magistrates , , , , , , , , , , ,  role in administering asylums , ,  role in asylum admissions  maids –,  Manchester  Manchester Education Committee n. Manchester School Board ,  manufacturers  Markley, H.  Markwick, H.  Maudsley, H. ,  Maxwell, Dr  Mayoress of Brighton  mechanical restraint ,  abolition of ,  use in the community  medical assistance – medical care  medical case-books ,  medical degree – medical expertise ,  medical hierarchy  medical inspections ,  medical inspector(s)  medical institutions , , , ,  advantages of employment within  charitable management of  historiography of  life-cycle of  movement of staff between , –,  proliferation of 



structuring power within  tuberculosis n.; see also tuberculosis sanatoria medical jurisdiction  medical practice  community v. institutional  medical practitioners , , , , , , , , , , –, , , , , ,  education of  as general practitioners , , ,  licenses of those certifying idiots  observations of idiocy  role in admission of idiots  role in certification ,  reform-minded  treatment of epilepsy  treatment of idiots  as Visiting and Consulting Physicians , , – medical profession , , , , , –, ,  associations of  authority of  closure to women  composition of  identity of  journals  national register of  specialization of , , ,  medical school  medical school lecturer  medical students  medical superintendents: desire to admit private patients – experience in treating insanity  problems with staff turnover  relationship with attendants – role in certification  status of their wives – medical treatment ,  chemical interventions  medicine: historians of , ,  historiography of ,  medicines  Medico-Psychological Association , , , , ; see also British Psychiatric Association; Association of Medical Officers of Hospitals and Asylums for the Insane medico-psychologists 

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medico-psychology  mental defectives ; see also feeble-minded; idiots mental deficiency, see mental disability mental disability ,  certification of  differentiation from mental illness  historiography of – identification of  ‘racist’ taxonomy of  social construction of  social isolation of  terminology describing – mental hospitals, see asylums mental hygiene movement  mental illness: progressive approach towards  transformation from madness  see also lunacy mental retardation , , , ; see also idiocy; mental disability mentally disabled , ,  and the New Poor Law – education of  liberty in the community  see also idiots mentally ill  barbaric treatment of  involuntary hospitalization of  see also insane; lunatics Mercers of London  merchants  Metropolis , , , ; see also London Metropolitan Asylums Board ,  Metropolitan Hospital Sunday Fund  Metropolitan Society for Befriending Young Servants  Micale, M.  Middlesex ,  midwives  migration n., –, , – militia ,  Millard, W. , –, , , , ,  Ministers  Minority Report of the Royal Commission on the Poor Laws () – Mitchell, Sir A. – Moberly, Major-General ,  mongenists  Mongolism , , –, ; see also idiocy, ‘Mongolian’

Montessori, M.  ‘moral architecture’  moral treatment –, ,  mortality: maternal  institutional ,  National Association for Care of the Feeble-minded  National Association for Promoting the Welfare of the Feeble-minded – National Exhibition ()  national health insurance  National Health Service n. National Phrenological Association  National Society for the Employment of Epileptics  National Vigilance Society  navy  Nazi sterilization programme  needlewomen ,  Newcastle  Newnham College, Cambridge  New Poor Law, see Poor Law (New) New Road church, London  New Testament  New York  Nicholas, W.  Nightingale, F.  Nolan, P. ,  nominal record linkage  Nonconformists , –, , , , ; see also Dissenters Nonconformity ,  non-restraint, see mechanical restraint, abolition of Norfolk  normalization  North America ,  Norway  Notting Hill  nurses , , , – advancement of wages ,  demand for  in households  letters of reference  migration of  places of birth  previous employment of – reasons for leaving  recruitment of –,  role in certification 

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Index wages of ,  working conditions  see also attendants nursing , , , – historians of  historiography of  institutional nursing , , ,  private nursing  O’Conner, C.  Offer, E.  Oliver Twist  opium  Ordnance Survey n. orphan children , ,  out-nursing  Oxfordshire  Owen, D.  Paddington  painters  Palmerston, Lord  Paris , ,  parish doctors, see Poor Law (New), Medical Officers parishes ,  Parkinson, J. ,  Parliamentary Committee on Defective and Epileptic Children ()  Parliamentary Select Committee (to investigate the operation of the ‘lunacy laws’) , ,  Pasteur, L.  patients: admission of  age of – behavioural problems  characteristics of  charitable , –,  chronic  ‘curable’ and ‘dangerous’  dangerousness of  discharge of , ,  gender of – ‘harmless’ and ‘chronic/incurable’ – historiography of ,  individuality of  isolation of  length of stay , , –, , – mortality of  pauper , – payment of , , –, , 



private , –, –, –, ,  re-election of  reintegration of ,  rejected  short-term – socio-demographic characteristics of  subsidized –, –,  transportation of  violence of , , , –,  violence towards  vocational training ,  women  pauperism ; see also Poor Law Pennsylvania  Penrose, L. ,  Peto, S. M. , ,  Pharmaceutical Society  Philanthropic Boys School, Reigate  philanthropy ,  aspirations of  Christian – circles  and evangelicalism  and health care – individuals  institutional  lay philanthropists  medical  and medical institutions  organizations  Victorian  see also charity Philips, C. P.  phrenologists ,  phrenology ,  as ‘pseudo-science’  phthisis ; see also tuberculosis physic  physical disabilities ,  physicians , , –, ,  American  assistant  Consulting ,  to the London Hospital  to the Royal Household  see also medical practitioners Pinchard, L.  platelayers  Plumbe, A.  Plumbe, Mrs A. S. –,  policemen 

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Pollard, A.  Pollard, J.  polygenists – Poor Law (Elizabethan) allowances – boarding-out  Overseers of the Poor –,  rates , ,  Relieving Officers  Settlement  workhouses, see Poor Law workhouses Poor Law (New) –, , , , ,  Guardians, see Poor Law Guardians infirmaries , ,  ‘less eligibility’  Medical Officers , ,  Metropolitan infirmaries  rates ,  relief , , – Relieving Officers  role in certification  settlement  Poor Law Board , ,  Poor Law Guardians –, , , , , –, –, ,  arrangements with idiot asylums  responsibility for identifying insane  Poor Law Unions , Birmingham  Devon county  Leicester  London  Metropolitan , ,  St Leonard’s  St Mary’s, Paddington  Poor Law workhouses , , –, –,  care of idiots in , ,  certification within  cost of maintenance  general mixed  idiot wards ,  imbecile wards  infirmaries , ,  insane in ,  medical practitioners  medical treatment  nurses  removal of idiots to  sick wards  Surrey 

Porter, R.  potassium bromide  poverty  pre-institutional care –,  Prerogativa Regis  Preston, B.  Preston, Lancashire  Price, W.  primates  Prince of Wales  Princess of Wales  prisons , ,  private care –, , ,  private licensed homes, see asylums (for profit) Prochaska, F. ,  provincial infirmaries, see hospitals psychiatrists  private practice  see also alienists psychiatry: in Anglo-America  as a medical sub-discipline  nursing –, , ; see also attendants profession of ,  as psychological medicine  psychological medicine, see psychiatry psychologists  Public Record Office  Quarter Sessions  race ,  Caucasian –,  railway labourers  Ray, C.  Ray, L.  Reading, Berkshire  reception orders , –, , , –, , , , , ,  Redhill, Surrey , , ,  Reed, A. (Snr.)  Reed, M.  Reed, Revd A. , –, –, –, –,  promotion of Earlswood Asylum – as asylum propagandist ,  reformatory schools ,  Reigate, Surrey  Reigate and Redhill Express n. religious denominations 

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Index restraint – abolition of ,  mechanical ,  Roberts, S.  Rochdale, Lancashire ,  Rome  ropemakers  Ross, E.  Royal College of Physicians , , , , , , ,  Royal College of Surgeons , ,  Royal Commission on Agriculture ()  Royal Commission on Care and Control of the Feebleminded ,  Royal Commission on Labour  Royal Medical and Chirurgical Society n. Royal Statistical Society  Rushton, P. ,  Russell, Lord J.  Saddlers of London  St George’s-in-the-East, London  St Giles, Devon  St Pancras, London  Salford, Manchester  Salisbury, Lord  Salters of London  Salvation Army  Sandlebridge Colony n. sawyers  scarlatina n., ,  Scheerenberger, R. ,  schoolmasters , ,  schoolmistresses  schools ,  ragged school  separate segregated or ‘special’ , ,  training schools  Schweppe & Co.  Scotland ,  Scottish Society for the Education of Imbecile Youth n. Scull A. , , , ,  Second World War  Séguin, É. , , , ,  seizures, see epileptic fits Severn Estuary  Shaftesbury, Earl of, see Ashley, Lord shepherds  shipbrokers 



shoemaking  shopkeepers  Shorter, E.  Shrivenham  Shuttleworth, G. , , –, , –, – Sidney, Revd E. , –, , , , ,  Sigerist, H.  silversmiths  Simian crease  Skinners of London  slavery ,  smallpox n. Smith, L. ,  Social Darwinism , , , ,  social history of medicine ,  Society for Organising Charitable Relief and Repressing Mendicity, see Charity Organisation Society Society for Promoting Christian Knowledge , n. Society for the Study of Inebriety  Society of Apothecaries – Society of Friends  soldiers –, ,  solicitors  Southern & South-Western Railway lines n., ,  spastic paralysis  Spencer, C.  Spicer, C.  Spicer Brothers of London  stablemen  staff , , ; see also attendants; maids; nurses Staffordshire Potteries  Stamford Hill, London  Steedman, C.  sterilization ,  Stoha, B.  Stratford  Stubbs, Dr H.  subscribers , , , , , –,  characteristics of – competition for  gender of  to hospitals  loyalty of – Suffolk  suicide 

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Sunday Hospital Fund, see Metropolitan Hospital Sunday Fund superintendents, see medical superintendents surgeon-apothecaries , – surgeons , , –, , ,  surgery  Surrey , –, –,  Surrey History Centre  Sussex  Suzuki, A. ,  Swansea, Wales  Swiss Alps  Swiss Association for the Advancement of Science  Switzerland  syphilis  Szasz, T. – tailors  tanners  Taylor, E.  Taylor, Wm.  Thames, river  Thomson, M.  Tipper, A.  Torpoint ,  Torquay  ‘total institutions’  Townsend, P.  treatment  asylum  barbaric  in-patient  institutional , , , –, , , , – moral, see moral treatment segregated ,  techniques  Tredgold, A.  Trevelyan, C.  Trisomy  ,  tuberculosis sanatoria ; see also medical institutions Twiddy, J.  Twining, L. , ,  Twining, W. –,  United Kingdom  United States , , , 

universal suffrage  university  University of Edinburgh  University of London Medical School  University of Oxford  unsoundness of mind –; see also insanity; lunacy upholsterers  urbanization  vaccinations , ,  vicars  Victoria, Queen , , , , , , ,  Victoria Station, London  Vintners of London  Wakley, T.  Wales , , , , , , ,  boarding-out in  Walker, Mrs – Wall, R.  Walton, J.  Wand, S.  Wandsworth, London  Warner, F. – Warwick and Leamington Phrenological Association  Wash, the  watchmakers  Wellcome Trust  Westminster  Westphalia  Wheeler, G.  Whigs , n. White, W.  Whitechapel, London ,  widows , –,  Wilbur, H.  ‘wild boy’ of Averyon  Wilmarth, A.  Wilson, W.  Winslow, F. – wire-drawers  Woburn, Buckinghamshire – Workhouse Visiting Society n. World Health Organization  wrongful confinement  Zurich, Switzerland 