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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40%

20%

>2 0y ea rs

10