Idiocy, Imbecility and Insanity in Victorian Society: Caterham Asylum, 1867–1911 (Mental Health in Historical Perspective) 3030273342, 9783030273347

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MENTAL HEALTH IN HISTORICAL PERSPECTIVE

Idiocy, Imbecility and Insanity in Victorian Society Caterham Asylum, 1867–1911 Stef Eastoe

Mental Health in Historical Perspective Series Editors Catharine Coleborne School of Humanities and Social Science University of Newcastle Callaghan, NSW, Australia Matthew Smith Centre for the Social History of Health and Healthcare University of Strathclyde Glasgow, UK

Covering all historical periods and geographical contexts, the series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It will publish works that engage actively with contemporary debates related to mental health and, as such, will be of interest not only to historians, but also mental health professionals, patients and policy makers. With its focus on mental health, rather than just psychiatry, the series will endeavour to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that. The scope of the series is kept as broad as possible to attract good quality proposals about all aspects of the history of mental health from all periods. The series emphasises interdisciplinary approaches to the field of study, and encourages short titles, longer works, collections, and titles which stretch the boundaries of academic publishing in new ways. More information about this series at http://www.palgrave.com/gp/series/14806

Stef Eastoe

Idiocy, Imbecility and Insanity in Victorian Society Caterham Asylum, 1867–1911

Stef Eastoe Independent Scholar London, UK

Mental Health in Historical Perspective ISBN 978-3-030-27334-7 ISBN 978-3-030-27335-4  (eBook) https://doi.org/10.1007/978-3-030-27335-4 © The Editor(s) (if applicable) and The Author(s) 2020 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover credit: Classic Image/Alamy Stock Photo This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

This book is dedicated to my Great Aunt Pat (1928–2017), whose story I will one day write & my daughter Florence, who one day will write her own.

Acknowledgements

This book grew out of my Ph.D. research and thus is the product of many fruitful conversations and the support given to me during my time as a postgraduate student at Birkbeck College, University of London. Dr. Julia Laite was a constant source of guidance, advice and inspiration of how to both conduct and write history, but also how to be a generous scholar and member of the academic community. Her ability to ask me the right questions and to provide space to think allowed me to tease out many stories and voices that would otherwise have remained hidden. Thanks must also be made to Dr. Fay Bound Alberti for the many discussions we have had not only about this book, but about scholarship, academia and the nature of research. I am also grateful to my fellow students, colleagues and peers at Birkbeck Drs. Carmen Mangion, Louise Hide, Hazel Croft, Emma Lundin, Barbara Warnock, Janet Weston, Susanna Shapland, Saul Bar Haim and Simon Jarrett and also to my colleagues at Queen Mary, who in the later stages of the book provided me with helpful advice, solidarity and support, Drs. Jane Freeland, Charmian Mansell, Linda Briggs and to Rhodri Hayward and Edmund Ramsden for their guidance. For all their collective kindness, I am most grateful. I am also indebted to those who have provided me with feedback and comments at various conferences, seminars and workshops, p ­ articularly Drs. Leonard Smith, Katherine Rawling, Rebecca Wynter, Jennifer Wallis, Steven Taylor, Beatriz Pichel and Rory Du Plesis, many of whom helped me to untangle and unravel the richer, emotional and ethereal elements vii

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ACKNOWLEDGEMENTS

of the book. My thesis examiners, Drs. Jane Hamlett and Rob Ellis, have provided me helpful comments, insights and guidance over the years. I am indebted to archivists at London Metropolitan Archives, City of London and the Surrey History Centre, particularly Julian Pooley who speaks so beautifully of the power of archives, and I felt emboldened to tell the story of Caterham in a humane, kind and thoughtful way. The staff at these archives and libraries have all been especially helpful in carting numerous dusty volumes of casebooks and committee minutes, photographs and maps, allowing me time and space to unearth the stories of Caterham’s residents. I have been incredibly lucky to have received much support and counsel from a plethora of brilliant women and a few good men, who became a village of support over the years, especially Julia, Sarah, Cat, Kate, Eleanor, Margreet, Farhana, Amy, Jackie, Lucy (Dancer), Lucy (Teacher), Karen, Anahita, Rebecca, Sharada and the indomitable Adam, whose belief and insight knows no bounds and who has provided me with many hours of advice, entertainment and joy. Particular thanks to Salina for our many discussions of writing, of teaching, of telling stories and of laughing at life. To Claire, one of my oldest friends who has always believed in me, her friendship and love has helped me soar in many ways and she always knows the right thing to say. All have provided me with much good humour, excellent counsel and such wonderful encouragement, and I am forever indebted to you all. Finally, thanks must go to my family, especially my parents, Roger and Jeannine, who have always believed in me and have never let me think I was not capable.

A Note on the Text

Throughout Idiocy, Imbecility and Insanity, much of the terminology is based on the language used by contemporaries and is informed by the medical, psychiatric and popular texts published on the subject of idiocy, imbecility and insanity. Idiot and imbecile, regarded as forms of ­incurable insanity, were terms used throughout the eighteenth, nineteenth and early twentieth centuries for what some would nowadays refer to as learning disability, which itself is an ever-expanding term. Idiocy was reserved for those with severe intellectual deficiencies, often present at birth. Imbecility was regarded as less severe condition, with individuals believed to be capable of some form of education, learning or training. Weakminded was a common term, often used by lay professionals, such as poor law medical officers, nurses and attendants, and was also used by the staff at Caterham Imbecile Asylum. The terms, alongside feebleminded, also used throughout the period covered in this study, appear in the text without speech marks for reasons of historical accuracy. When I use the term incurable insanity, I am referring specifically to idiocy, imbecility or weakmindedness. When discussing historical actors, namely patients and staff members, I refer to patients by their first name and surname initial. This is for reasons of anonymity. Whilst I would like to refer to these people by their full names, as I do for staff members, I have decided that to anonymise them is not an act of silencing, but is an act of respect. Their lives are theirs. I hope that by telling their stories, I am both resuscitating their voices and doing so in a humanising manner. ix

Contents

1 Introduction and the Roots of Caterham 1 2 Creating Caterham 27 3 Populating Caterham 59 4 Experiencing Caterham: Work, Occupation and Asylum Life 97 5 Visualising Idiocy, Visualising Caterham 127 6 Geographies of Idiocy and Imbecility 159 7 Conclusion 191 Appendix A—Admissions 201 Appendix B—Deaths 203 Appendix C—Discharges 205 Index 207 xi

Abbreviations

AMO Assistant Medical Officer LMA  London Metropolitan Archives, City of London MAB Metropolitan Asylum Board PLB Poor Law Board

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List of Figures

Fig. 2.1 Fig. 2.2 Fig. 3.1 Fig. 3.2 Fig. 5.1 Fig. 5.2 Fig. 5.3 Fig. 5.4 Fig. 5.5 Fig. 5.6

Woodward ward (male side), c.1927, Surrey History Centre, Ref 4209/3/38/10 47 Baily ward (female side), c.1929, Surrey History Centre, Ref 4209/3/39/2 48 Patients admitted to Caterham 1870–1911 72 Number of patients who died in Caterham per year, 1870–1911 86 Patient Portrait Edward W. H., Male Casebook 13, City of London, London Metropolitan Archives, H23/SL/B14/030, 180 128 Patient Portrait Honora S., Female Casebook No. 8, City of London, London Metropolitan Archives, H23/SL/B14/008, 95 137 Patient Portrait Adolphus B., Male Casebook 11, City of London, London Metropolitan Archives, H23/SL/B14/028, 84 139 Patient Portrait Emma E., Female Casebook 1, City of London, London Metropolitan Archives, H23/SL/B14/01, pt no. 38 141 Patient Portrait Martha B., Female Casebook 1, City of London, London Metropolitan Archives, H23/SL/B/14/001/B, pt no. 1185 142 Patient Portrait MaryAnn M., Female Casebook 14, City of London, London Metropolitan Archives, H23/SL/B14/012, 94 144

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LIST OF FIGURES

Fig. 5.7 Fig. 5.8 Fig. 5.9 Fig. 6.1

Patient Portrait John W., Male Casebook 12, City of London, London Metropolitan Archives, H23/SL/B14/029, 1 Patient Portrait Amy Eleanor D., Female Casebook 10, City of London, London Metropolitan Archives, H23/SL/B14/010, 57 Patient Portrait of Annie M., Female Casebook 10, City of London, London Metropolitan Archives, H23/SL/B/14/010, 109 Patient Portrait Emma J. Female Casebook 12, City of London, London Metropolitan Archives, H23/SL/B14/012, folio 26

145 147 151 177

List of Tables

Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 6.1 Table 6.2

Number of idiot or imbecile persons, per million of persons enumerated 75 Ages of patients admitted to Caterham (total) 1870–1911 76 Classification of patients resident 1872–1911 79 Total numbers of patients discharged from Caterham, 1870–1911 88 Patient addresses (census) grouped using Booth classifications 166 Idiot, Imbecile & Weakminded patients discharged from Caterham 1871, 1875, 1881, 1885, 1891, 1895, 1901, 1905, 1911 178

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CHAPTER 1

Introduction and the Roots of Caterham

On a fine December morning in 1872, William Gilbert, secretary of the Society for the Relief of Distress, visited Caterham Imbecile Asylum, which had formally opened two years previously. He published an account of his visit in the popular Victorian periodical Good Words, beginning the article with an admission of his anxieties about the trip.1 ‘My fear, however, was groundless…[whilst there were] instances of misery within the walls’, Gilbert claimed that there were numerous instances of ‘humanity, skill and discretion displayed in the management of the patients’.2 Upon his arrival, he was met by Dr James Adam, the asylum’s medical superintendent and was promptly taken on a tour of the kitchens, considered by many to be the most important area of an asylum. In this cavernous space, full of huge copper pots, heaving with staff and full of activity, Gilbert enquired how many cooks were employed to prepare the 1600 meals consumed at each mealtime. ‘About thirty’ was the reply from Dr Adam, ‘four or five are regular cooks…the other twenty-six are patients’.3 Gilbert was amazed, informing his readers, that ‘[y]es…these well-cooked dinners were the handiwork of twenty-six idiots (poor creatures, who at home would not have been trusted to put a kettle on the fire)’.4 After this, he was taken to the asylum laundry, where again he was surprised by the size, scale and amount of work undertaken by the 80 patients who were assigned to this area, assisting the six laundry maids who were all under the supervision of the laundry matron. ‘Although the place, which is a large, lofty and well-ventilated hall,

© The Author(s) 2020 S. Eastoe, Idiocy, Imbecility and Insanity in Victorian Society, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-030-27335-4_1

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was a scene of great bustle, yet the most perfect order and regularity prevailed throughout’, which is why over 2000 articles a day could be washed, pressed and dried.5 The quality of the washing was ‘excellent – certainly if a snow white colour is any test’.6 Throughout his article, Gilbert was amazed by the skill and ability demonstrated by the patients. One such individual may well have been Mary B. She was the 21st female patient admitted to Caterham when she arrived on the 3 October 1870.7 Mary was a servant before she was transferred from the workhouse to the asylum, after she lost her position due to frequent fits and a nervous temperament. Following her admission to Caterham, Mary was classified as being weakminded and imbecile. Perhaps due to her skills and knowledge learned during her time working as a servant in London Mary was put to work in the laundry, and in later years on the wards. She died in 1910, though the cause of death was not recorded in the casebook. Aged 62 at death, Mary had been a patient at Caterham for forty years. This lengthy residency was not untypical. Idiocy, imbecility and weakmindedness covered a wide range of conditions, psychiatric and physical. Many of them were considered to be permanent, incurable and chronic states which were often identified in relation to intellectual and developmental delay, such as the inability to count to twenty, to tell the days of the week or know how many shillings were in a pound. Designed and managed by the Metropolitan Asylum Board (hereafter MAB), an offshoot of the Poor Law Board (hereafter the PLB), Caterham was a unique site. It was, alongside its sister institution Leavesden, one of the first state imbecile asylums built in England. It was intended, from the outset, to provide suitable long-term accommodation and care to the incurable insane paupers drawn from London, commonly referred to as idiots and imbeciles. Located in a quiet Surrey village, overlooking the verdant Caterham valley, the asylum at its height had over 2000 beds. However, Caterham’s roots were in the workhouse, welfare and sanitary reforms of the 1860s, in part a product of the limits of the mixed economy of welfare and existing lunacy legislation which shaped the admission, and conversely nonadmission, of certain patient groups to the various institutions that made up this vast network. Caterham’s founding and the experiences of the people like Mary are the focus of this book, which represents the first monograph that considers the history of a pauper imbecile asylum. It will not trace the history of the medical theories or the evolution of the classifications of idiocy, imbecility

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and mental deficiency, which have been ably explored by many historians of medicine, psychiatry and education. Indeed, the contributions to the recently published Intellectual Disability: A Conceptual History, 1200– 1900 edited by Christopher Goodey, Patrick McDonagh and Tim Stainton provide an excellent overview of the evolution of the concepts related to idiocy, including mental deficiency and learning disability, considering the social, cultural, political and medical factors that shaped these understandings.8 Rather, the focus of this book is the asylum itself and the lives of the people sent there. How a consideration of the inner world of the asylum, from its design to its regime, its social geography and material culture, can provide us an insight into life within Caterham, and how idiocy was understood by staff, by families and by Victorian society more broadly. The nineteenth century saw the passing of a spate of Acts which legislated for the creation and building of various institutions, including workhouses, asylums and madhouses. Some of these had greater impacts than others for particular patient groups, especially the incurable insane. One of the first key pieces of legislation was the 1808 Asylum Act, which empowered local magistrates and authorities to build asylums for the pauper insane, which included idiots, imbeciles and all those regarded as being of unsound mind.9 The stimulus for this Act was the high costs of accommodation in the private madhouses, and to create some form of checks and balances on institutions which were found to be neglectful of their vulnerable charges. Indeed, the popular press was filled with sensationalist articles of men and women chained up and placed in dirty and dismal wards, at the mercy of exploitative asylum managers who were only interested in making money rather than treating the insane. This was quite the opposite of the ideals and opportunities offered by the moral therapy, a system of treatment and patient management that had emerged from the Quaker built York Asylum at the turn of the century.10 In many of the new asylums, built following the 1808 Act, parishes and unions would pay for the care and accommodation of their insane paupers, an administrative term for those in receipt of poor law assistance. However, the main point being that costs would be much less than in the private institutions, which were rapidly being seen as sites of containment rather than cure.11 The main limitation of the 1808 Act was that it was permissive; authorities could choose to build an asylum, and thus as a result, few were actually built. Between 1808 and 1834, a total of 13 public lunatic asylums were erected in England.12 Despite this, as Leonard Smith suggests, the 1808 Act did create an infrastructure and an important administrative foundation for the creation

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of public institutions and spaces for the care, accommodation and management of the insane.13 Indeed, the Act represented something of a sea change in attitudes and responsibilities of the state, authorities and communities in caring for their insane, idiot and mentally unsound members. As Elaine Murphy has shown, many unions and parishes would pay for accommodation in public and private asylums, madhouses and in homes, as well as accommodate the insane in the workhouse.14 Demand for such care, which only increased over the following years, placed particular pressures on the poor law, in terms of rates and space. Indeed, the process of boarding out was curtailed following the passing of the 1834 Workhouse Reform Act, which focussed on the provision of indoor relief in an effort to cut the spiralling costs of care and accommodation. Thus, many people considered to be insane, curable and incurable, found themselves incarcerated in the common and infirmary workhouse wards. In an effort to remedy this, and the wider mistreatment of the insane, the government passed the 1845 County Borough and Lunacy Acts. In what has become something of a familiar pattern in the passing of insanityrelated legislation, much like the passing of the 1808 Act, Vieda Skultans has shown that in the build-up to the 1845 Acts there was an outpouring of moral outrage felt by many involved in the management of insanity, ‘upon the discovery of the revolting and inhumane conditions endured by the insane’.15 This outrage was in part stimulated by the fact that moral management, delivered in well-designed and well-appointed asylums such as Hanwell which was run by the renowned Dr John Conolly, promised effective therapy of the insane. Many who agitated for a change in lunacy policy believed it to be a grave error on the part of a modern and forwardthinking society to allow the insane to languish in outdated and badly managed institutions, when cure and efficient treatment was possible. The 1845 Acts made county and borough asylums compulsory, and there followed an explosion of large-scale asylums across the country, many of them in urban areas such as London and Leeds. In 1850, there were around 24 public asylums providing accommodation to over 7100 patients. By 1860, the number of beds reserved for the insane had more than doubled to over 15,800 patients across 41 asylums.16 These institutions had grown not only in number, but also in scale, from an average of 300–500 beds per asylum to over 1500. Indeed, the second Middlesex County Asylum, also known as Colney Hatch, opened in 1851 and was one of the largest asylums in Europe with over 2500 beds. The 1845 Acts also created a new national inspectorate body, the Commissioners in Lunacy (hereafter

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the CIL). They were responsible for investigating and regulating the care of the insane across this vast network of institutions and would visit all sites where the insane were accommodated, including private madhouses, asylums and workhouses. Under the wording of the 1808 and 1845 Lunacy Acts, idiots and imbeciles were included under the term insane.17 However institutional authorities and managers frequently made a distinction between the curable and incurable insane, for financial, administrative and medical reasons.18 Magistrates and Poor Law medical officers involved in the certification and committal of the insane focussed on the dangerous and troublesome, rather than the quiet and harmless insane who proved to be much less bothersome than their violent brethren. This saw many of the incurable insane be retained in the workhouse, which as Peter Bartlett and Elaine Murphy have shown, operated as an informal clearing house for the curable insane and a warehouse, to some degree, for idiots and imbeciles.19 This issue was raised by the CIL in their 1859 annual report. They highlighted the large numbers of idiots and imbeciles in the workhouses, claiming it to be an evil act to keep them there.20 They called for better classification and certification of the insane, stressing the need to ensure that the curable were sent to lunatic asylums so they could receive appropriate medical attention and treatment. Importantly, they made the claim for the creation of auxiliary asylums specifically for the care and accommodation of pauper idiots and imbeciles. Alas, their recommendations were ignored. Rather than see a reorganisation of the workhouse population, the 1862 Lunacy Laws Amendment Act was passed which effectively allowed for the detention and retention of the ‘non-dangerous’ insane, namely idiots and imbeciles, within the workhouse.21 The Act was an attempt to ease the overcrowding in public lunatic asylums and as a result saw large numbers of harmless insane discharged from these institutions, which were predicated on care, cure and discharge and thus saw the incurable as undesirable, back to the workhouse. However, workhouses were also institutions which were temporary in their nature and intention, and the large numbers of incurable and chronic cases were placing significant strains on the system. There was also a rise in destitution following widespread unemployment in London due to various socio-economic factors, which put increased pressures on workhouses and led to high degree of overcrowding. Indeed, the increase in demand did not see a rise in provision or the building of new workhouses. By 1865, around 15% of the workhouses in England and Wales had separate wards for the

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curable and incurable insane.22 Whilst we could view this spatial provision as an act of care, it was more often an act of necessity and a realisation that these inmates required space, accommodation and attention that was markedly different to the wider workhouse population. Quite often, these areas were carved out of existing wards or buildings, many of which fell far below acceptable standards of sanitation and ventilation, thus placing ever more pressures on an already overstretched system. The issue of the pauper idiot became an ever more pressing concern, especially in the Metropolis where the concentration of so many incurable and chronic insane across these urban workhouses saw them be described as ‘asylums in everything but attendance and appliance which ensure proper treatment’.23 Indeed, a number of exposés, reports and investigations, highlighting the deplorable conditions in many London workhouses were published across the popular press. In response to growing agitations, and increasing calls for the reorganisation of welfare provision, the Metropolitan Poor Act was passed on the 14 March 1867, ‘for the establishment in the Metropolis of asylums for the sick, insane and other classes of the poor…’.24 These new institutions, which included Caterham, its sister asylum Leavesden and a number of fever hospitals, were to be built and managed by the MAB. These institutions and services were financed by the Metropolitan Common Poor Fund, a pot of money to which Metropolitan unions and parishes would pay a certain amount based on the annual rateable value of property within their area. This money would fund the building and furnishing of the new asylums, infirmaries and dispensaries and pay for the medicines, running costs and staff salaries.25 Parishes and unions were also able to claim back expenses for the maintenance of sick, infirm and imbecile patients housed either in the MAB asylums or other public institutions.26 Caterham’s roots spring from two institutional sources, asylums and hospitals, and two systems of provision, health and welfare. This study contributes to the growing social history of asylums and of idiocy and imbecility more broadly. As well as being the first major study of a pauper imbecile asylum, Idiocy, Imbecility and Insanity also represents an important contribution to the history of the MAB, a body which represents a ‘decisive shift in terms of medical provision for the sick poor’ and, as Keir Waddington states, was a ‘systematic effort…to provide public institutions to the sick poor’.27 Yet, it is an organisation that has been little studied by scholars of welfare, workhouses and asylums in the late nineteenth and early twentieth centuries.

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Asylums, Idiocy and Scholarship Studies into the history of asylums have shown that these institutions were not the static, monolithic or totalising sites as described in the works of Andrew Scull, Michel Foucault or Erving Goffman.28 These important texts, which have been challenged and critiqued over the past forty years, laid the groundwork for how we might want to think about the roles of various agencies and the impact of urbanisation, industrialisation and medical professionalisation in the process of confinement and the emergence of institutions in the Victorian period. With the growth of the social history of medicine, scholars have taken up Roy Porter and Bill Luckin’s pleas to consider the people, the places and the rituals involved in the history of asylums and the management of the insane.29 Research by John Walton, Steven Taylor, Cathy Smith, Joseph Melling and Cara Dobbing, to name just a few, has highlighted the role of the family in the identification of lunacy.30 Collectively, their work has shown that the certification of insanity was frequently a social act and contributed to the circulation of the insane across the mixed economy of welfare in numerous ways. Moreover, such studies further support the claim that the medical superintendent, and indeed the psychiatric profession, was often at the periphery of the pathway to the asylum. Scholars across the humanities have also turned their attention to the experience of the asylum itself, in an effort to create more nuanced institutional histories that reflect their multifaceted natures, drawing on various aspects in the management and administrative regime, such as patient dress, work, exercise and sport, as well as the architecture, design and geography of these sites to open up the inner worlds of the asylum.31 Within these studies, which use asylum patient populations as their focus, are people who were considered to be idiots, imbeciles, and as the nineteenth century wore on, weak- and feeble-minded. As much of the research on asylums has been on the curable insane, the experiences of the incurable insane have been overlooked. This is a result of academic focus and trends in scholarship, which have been shaped by contemporary texts, the development of Victorian psychiatry and an institutional network that tended to prioritise the study of insanity, lunacy and madness. Before discussing some of the key themes in the wider history of asylums, to which this book speaks, it is important to understand how contemporaries, and historians, have understood the various conditions that fell under the broad umbrella term idiocy. As Patrick McDonagh states, idiocy is a slippery term, now and in the past. Idiocy and imbecility emerged as distinct

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areas of medico-psychiatric study at the turn of the nineteenth century.32 For some doctors, physicians and psychiatrists, idiocy and imbecility were a form of developmental delay evidenced by poor social skills, for others it was a form of intellectual impairment, often identified in relation to an inability to recount the days of the week. William Wotherspoon Ireland stated in his 1877 book that ‘idiocy is mental deficiency, or extreme stupidity, depending on mal-nutrition or disease of the nervous centres’.33 These could be caused by environmental, hereditary or pathological factors, or physical deformities which began in utero due to the poor nutrition of the mother or the unsanitary environment in which the family lived. Historians of medicine, of psychiatry, and of learning disability have sought out the roots of these ideas and understandings of idiocy, including Edgar Miller and German Berrios who suggested that many ideas surrounding idiocy were shaped as much by contemporary scientific understandings as they were by broader social anxieties.34 Miller and Berrios’s work, much of which was published in the early 1990s, represents the first considered assessment of medico-psychiatric attitudes and theories regarding idiocy and imbecility. Tracing the ideas and biographies of key nineteenth-century psychiatrists, including Philippe Pinel and Édouard Séguin, they were able to show that despite a lack of a concise definition of idiocy and imbecility, as evidenced by numerous classification schemes and terms that emerged in the nineteenth century, there was a significant consistency of certain attitudes and understandings. Indeed, it was broadly agreed that both idiocy and imbecility were permanent conditions, incurable and chronic, but could, in certain cases and with a certain degree of focussed training, be improved, educated and most significantly, cared for. Focussing on the early modern period, Peter Rushton and Jonathan Andrews explored the identification, treatment and responses to idiocy, using a wide range of sources, such as theological texts, poor law documents and parish records, to unearth popular lay understandings.35 Collectively, their work has highlighted the visibility of idiocy, stressing the need to pay attention to the ‘meaningfulness of contemporary language about mental disability in its own context’.36 Importantly, Andrews shows that there were coherent and meaningful distinctions made between different groups of the ‘disorderly poor’, which included idiots and imbeciles. He has shown that compared to some, idiots and imbeciles were often provided with levels of care and compassion which was not necessarily granted to other groups.37 As the seventeenth century progressed, there was a growing consistency in how parish officers described the incurable insane, with a distinct shift

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occurring at the turn of the eighteenth century. The term innocent, regularly used to record those recognised as having an intellectual delay from birth or in early childhood, was eventually replaced by the term idiot, an expression more frequently used in scientific and legislative circles. This change in language reflected a rejection of more metaphorical terms such as ‘natural fool’ or ‘innocent fool’ and was indicative of a desire by parish authorities to employ standardised language in part to appear more professional.38 However, despite this standardisation of language, popular perceptions of idiots and imbeciles saw them continue to be discussed and regarded as ‘harmless, manageable and irredeemable’.39 This perception, as harmless and irredeemable, was a double-edged sword. Whilst they were not treated with the fear and disdain reserved for the mentally ill, the perceived incurability of idiocy and imbecility effectively permitted parish officers to make no attempts to provide ‘extravagant arrangements for their care’, especially given the high costs of institutional care.40 The same could be said for Poor Law officers, asylum managers and welfare administrators well into the nineteenth century, who experienced similarly limited financial resources to their eighteenth- and seventeenthcentury forbearers. Even in the Victorian mixed economy of welfare, the priority, economically and institutionally, was the curable, dangerous and violent insane.41 Both Andrews and David Wright have suggested that the perception of the idiot and imbecile pauper as a less serious or pressing problem in terms of welfare reserves effectively led to them occupying an ‘impoverished ontological’ position in contemporary thought.42 Wright contends that the lack of separate institutional provision or specific legislation regarding the incurable insane resulted in idiot and imbecile paupers occupying ‘a devalued position in the psyche of Victorian lunacy reform’.43 He goes on to state that [t]he emphasis on controlling ‘dangerousness’ and treating ‘curable lunatics’ meant that the English state devalued learning disability and regulated it to an ancillary concern within the expanding Victorian asylum system. The concentration on ‘lunacy’, rather than ‘idiocy’ was a legacy of the Victorian period that continued to have a great impact on the provision of health and social services well into the twentieth century.44

Whilst there is some value to these claims, both Wright and Andrews are judging the responses to idiocy through the lens of lunacy, a perspective which can create a distorted picture and uneven reading of the history.

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To chart the institutional reaction to idiocy and imbecility purely through a lunacy lens is problematic and at times unrepresentative. Indeed, Wright ends his research just before the passing of the Metropolitan Poor Act 1867. As many studies on the history of lunatic asylums, workhouses and the mixed economy of welfare have shown, idiot and imbecile patients were constituent members of these patient groups. As the evolution of lunacy legislation shows, idiocy was regarded as a form of insanity, but there were important distinctions, which at different points in time and in different contexts came to hold greater administrative, medical and cultural weight. With the growth of institutions and the professionalisation of psychiatry and medicine, idiocy and lunacy were being presented as two diverse conditions, the main division resting on the notion of curability. It was this belief, in the opinion of Wright and Andrews, which led many asylum managers and medical superintendents to discharge or obstruct the admission of these individuals to their institutions. Indeed, as Mathew Thomson has suggested, the 1886 Idiot Act saw the distinction between idiocy and lunacy formally recognised, but this had little impact on the institutional provision for the incurable insane.45 The challenge to their presence in the buildings and sites which formed the mixed economy of welfare was as much to do with their being undesirable as it was to do with the ‘a humanitarian concern that idiots should not suffer the stigma of being placed alongside the mad or indigent poor’.46 Thus, the decision to not admit idiots, imbeciles and the incurable insane was not necessarily a manifestation of their devalued status in the Victorian mind, and to claim so is to overlook many important nuances in the creation and working of the mixed economy of welfare, and the so-called circulation of lunatics. Indeed, several studies have shown that many groups were denied access to the limited resources of the overstretched and underfinanced poor law workhouses and infirmaries, such as the aged, the poxed and even the curable insane, at different points in history.47 This exclusion, often based on financial and administrative matters, has not led historians to conclude that these patient groups had a lesser ontological status. Making the claim that the incurable insane were regarded as having a lower social capital only serves to perpetuate the negative narrative that continues to surround idiocy and imbecility, and such a view is at the cost of more nuanced discussion of their experience and place in society. In understanding the development of the Edwardian and twentiethcentury institutional terrain, Thomson picks up on these subtle differences. He explores the debates and discussions that shaped the policies

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behind the various solutions to the ‘problem’ of what was, following the passing of the Mental Deficiency Act 1913, referred to as mental deficiency, including community care, sterilisation and residential institutions. Importantly, Thomson is careful to not make too much of the supposed strength and influence of the eugenics movement in the development of residential institutions in the twentieth century.48 Rather than read the rise of these schools, colonies and homes as agents of social control, Thomson’s insightful reading of the reform debates and legislative policies has shown that there was a marked humanitarian aspect to this institutional provision and development.49 Despite many well-meant intentions, due to lack of funds and competing professional and administrative interests, the attempts to entirely realise these safe therapeutic communities were never fully realised.50 This is a familiar pattern of events, which occurred in the years before the founding of Caterham. However, writing off a lack of dedicated care and accommodation as a form of lower ontological status of the idiot, the imbecile or the weakminded is to ignore these important views and attitudes. Indeed, many in the twentieth century believed that the mentally deficient required support, care and protection. Importantly, these were ideas which had their roots in the nineteenth century. Moreover, Caterham and the MAB can most certainly be regarded as seeds of these ideas and networks. That this support, care and protection was eventually delivered through what some would term segregative practices was—in the view of contemporaries—as much to shelter the mentally deficient from society, as society from the mentally deficient. Many discussions about the geography, the design and even the need for Caterham as an asylum highlighted the need for specific care for adult idiots and imbeciles, hinting at the failings in other sites and spaces reserved for the insane. This is a particularly different, and significant, reading of the social status of the mentally deficient to that offered by the wider and established history which viewed the lack of institutional provision as evidence of their devalued status in the wider mixed economy of welfare. Acknowledging these motivations and how they shaped the legislative landscape of the twentieth century, Thomson paints a more multifaceted picture of popular attitudes to idiocy, imbecility and the feebleminded, and the place of these individuals in society. Mark Jackson explores similar themes in his research on the Sandlebridge School, set up by educational reformer Mary Dendy, whose ideas were shaped by the eugenic debates which emerged in the early years of the twentieth century.51 Dendy was a keen advocate of using science to

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legitimise and justify her aims, and with the support from the eugenicists movement, was a lead campaigner in the calls for the social segregation of the mentally deficient. Through careful and detailed analysis of Dendy’s claims, and the agitations of her fellow reformers who readily espoused the merits of the ‘scientific morality of permanent care’, Jackson sketched out the emergence of feeblemindedness as a political and medico-social phenomenon, and the particular attitudes to which this condition spoke.52 Importantly, like Thomson and Andrews, Jackson’s research has shown the presence of the incurable insane across the mixed economy of welfare and society more broadly. Indeed, across the work of Walton, Smith, and Dobbing, all have illustrated the diverse range of agencies and actors involved in the management of the insane, be they classified as idiots, imbeciles or as feebleminded, such as families, administrators and medical professionals.53 Their attitudes, understandings and motivations concerning the care, admission and committal of an idiot to an institution were a complex act, shaped by wider social, cultural and political factors. Ideas in the nineteenth century about the value of training were different to those held by educators, such as Dendy, in the Edwardian period. Caterham was an institution which provided numerous forms of care, some of it long-stay, some of it temporary, some of it educative, some of it pastoral. It straddled these ideas and to some degree remained broadly unchanged despite the debates and theories of campaigners like Dendy. Charting the pathways of certain individuals, recreating their lives through the patchwork that is the asylum casebook allows us to consider how these ideas may, or may not, have impacted the lives of people identified as idiots or imbeciles and admitted to Caterham in the late nineteenth and early twentieth century. In markedly different ways, Jackson and Thomson’s work illustrates the visibility of idiocy. This is a history which has often been presented through the lens of marginalisation. Indeed, in a 1995 article concerning the physical characteristics of the ‘feebleminded’ recorded in photographs taken by Charles Paget Lapage in the early twentieth century, Jackson focussed on narratives of deviance.54 In a special issue of Area published in 2004, Edward Hall, a geographer, claimed that the social and institutional geography of learning disability was best explained by an overriding ‘will to segregate’.55 Contributors to the issue took up this claim, asserting that the nineteenth century saw a distinct shift from inclusive to exclusive responses to learning disability, as they referred to it, with the institution acting as a definitive spatial, architectural and geographical marker of this ‘will to

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segregate’. This will to segregate was stimulated by ‘the spread after the 1850s of ‘degenerationist’ fears, closely allied to …‘eugenicist’ plans for countering any diminution of the qualities of national racial stocks, the idiot institutions—complete with their set-apart geographies—acquired a wholly new rationale as key spaces in the pursuit for positive mental and physical hygiene.56

There may well be some truth to these claims, however as Thomson and Jackon’s research has shown, it was the Edwardian period that saw a considerable growth in specialist institutions following the passing of the Mental Deficiency Act 1913. Before this point, the development of such sites had been slow. Indeed, by 1913 the MAB itself had four idiot asylums, Caterham, Leavesden, Darenth (for children) and Tooting Bec (for aged patients). Alongside this, there were a small handful of charitable asylums for children like Earlswood and Normansfield, both managed at certain points by the infamous John Langdon Down. Indeed, as Steven Taylor has shown, idiot children were routinely dealt with in the existing mixed economy of welfare.57 This limited growth does not speak of a wave of fear sparked by anxieties around degeneration, especially when we compare it to the growth of lunatic asylums. These readings of the geography of idiocy have transposed early twentieth century views retrospectively onto the nineteenth century sites.58 Whilst it is undeniable that individuals considered inconvenient, such as the sick, the fevered and the insane, were increasingly removed from society and placed in institutions, the topography, presence and visibility, is more nuanced. Teasing out these geographies is a central aim of Idiocy, Imbecility and Insanity, not least to challenge some of these negative narratives, but also to interrogate the notion of degeneration and deviance in relation to idiocy in Victorian society. Many contributions to Pamela Dale and Joseph Melling’s 2006 edited collection Mental Illness and Learning Disability since 1850: Finding a Place for Mental Disorder in the United Kingdom, and Anne Digby and David Wright’s edited collection From Idiocy to Mental Deficiency highlighted the range of responses to, and the management of, idiots, imbeciles and the weakminded, including the links between the Poor Law and lay professionals in the creation, development and maintenance of the institutional and care networks reserved for the incurable insane.59 Through a range of essays, researchers examined the attitudes towards idiots and imbeciles

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across the past three centuries, charting the changes in legislative, medicosocial and administrative terminology. Whilst the notion of segregation and stigma is an ever-present theme, there is also acknowledgement of the humanitarian ethos that was an equally important feature of institutional developments, as revealed by the works of Kathleen Jones, Leonard Smith and Thomson.60 Analysing idiot asylums within the same ideological context as lunatic asylums is problematic, not least as there were significantly different sets of assumptions, understandings and expectations which lay behind the founding, design and management of each institution. It is these particular sets of assumptions and beliefs, shaped by the language, politics and culture of the time, that scholars must pay attention to in order to tease out the character and purpose of a particular institution and the experiences of those who were admitted to such sites.

Aims and Scope To understand Caterham and the experiences of its residents, it is important to consider the activities, debates and campaigns that led to its founding. This provides insight into how idiocy was understood in the minds of campaigners, of administrators and of members of the medical profession. Asylums were built for specific purposes and to provide specific forms of medical, therapeutic, and educative attention to certain patient groups. Indeed, as mentioned, Caterham was born of a different set of debates to those that created the more familiar lunatic asylums. A key feature of these debates, from reformers, campaigners and welfare administrators, was the idea that it was inhumane to house idiots and imbeciles alongside the violent and dangerous insane in lunatic asylums, or the indigent poor in the workhouse. This hints at how idiocy was understood before the passing of the 1913 Mental Deficiency Act, not least that it was a social evil to submit them to the gloomy outlook offered in the workhouses, or the injury, psychological and emotional, that could result from being accommodated in a lunatic asylum. The aim of Idiocy, Imbecility and Insanity is to consider these ideas, the founding of Caterham and how it formed part of the Victorian and Edwardian mixed economy of welfare. The geographical focus will be on London, as this was the area where many people sent to Caterham lived, be it at home or the workhouse, before admission. At the time it was built, Caterham was the first state imbecile asylum in England, alongside its sister Leavesden which was located in Hertfordshire. In part due to the

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limited archival sources for Leavesden, and in order to provide an in-depth analysis and history of a single institution, I decided to focus on Caterham, the sources for which were more extant. As well as providing the first comprehensive history of a pauper imbecile asylum, Idiocy, Imbecility and Insanity also seeks to challenge some of the negative narratives that have surrounded such institutions and idiocy more broadly, through a nuanced reading of its design, its regime, daily life and the experiences and demographics of its patient population. As historian Douglas Baynton claimed in an article published in 1998, ‘disability is everywhere in history’, it is just a question of acknowledging its presence and of actively seeking it out in the texts, sources and documents that make up institutional, organisational and public archives.61 The voice, personal testimony and experience of socially marginalised groups are often difficult to uncover, and in the case of the incurable insane, the lack of direct archival presence has been, at times, interpreted as an illustration of stigma, exclusion and isolation. However, as the work of Christopher Goodey, Simon Jarret, Jan Walmsley and Dorothy Atkinson have shown, there are ample traces of idiots, imbeciles and the learning disabled across a diverse range of documents, textual, visual and oral across time and place.62 Whilst I do not wish to argue that life for idiots, imbeciles and the insane in the nineteenth century was devoid of stigma, shame, and neglect, I do wish to suggest that these responses and experiences were not inevitable, nor the general experience of all persons so identified. Caterham’s history and the records it has left behind, charting the admission, classification and experiences of patients, suggest that there are ample possibilities for discussing the lives of these supposedly ‘disappeared’ people: lives that should not necessarily be explained by notions of shame, abuse and abandonment. Thus, I shift the focus out from the institutional archive and draw on contemporary social surveys, such as the census and the Charles Booth maps, to offer an insight into how individuals labelled as idiots and imbeciles lived within, and as part of, Victorian society. By doing so, it is possible to ask questions related to social presence and visibility, rather than explain how those deemed to be idiots and imbeciles were physically removed from society and rendered invisible. Where and with whom did the patients live prior to their committal to Caterham, how long did they remain within the home and what was the composition, environment and character of the surrounding neighbourhood? What can such an exploration tell us about the experiences of people identified as mentally deficient and what can the answers to these enquiries tell us about contemporary attitudes?

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Much of the recent rich history of idiocy and idiot asylums has been focussed on institutions reserved for children, and the attitudes and experiences related to their care, treatment and management.63 The language, expectations and assessments levelled at adults perceived to be idiots or imbeciles were significantly different to the ways in which idiot and imbecile children were discussed. Training and educability were routinely used to frame and explain the purpose of the idiot asylums which catered to children, such as Earlswood. No such claims were made in the justification for the building of Caterham, which was to be a long-stay institution and provide suitable care and accommodation to adult idiots, namely those aged 16 and over. The demands and indeed the experience of caring for an adult with physical, mental or intellectual deficiencies were significantly different to the care and management of an idiot or imbecile child. What was considered to be suitable in terms of care, accommodation and therapy for adult idiots in a pauper asylum drew on established ideas regarding moral therapy, but also considered the issues of sanitation, health and hygiene which had come to dominate the management of institutions in the second half of the nineteenth century. By considering these factors, and exploring the lives of adults identified and certified as idiots and imbeciles who were admitted to Caterham, Idiocy, Imbecility and Insanity opens up several overlooked areas in the wider history of welfare, asylums, incurable insanity in the Victorian and Edwardian eras.

Sources and Methodology Like many historical studies of asylums, the main sources to be used in this study are the archival documents of Caterham, which include patient casebooks, management committee minutes and annual reports.64 With each record type, there are particular opportunities and challenges. Annual reports can be considered to be the bread and butter of many institutional histories. They contain both qualitative and quantitative information regarding the operation and management of an asylum, providing a glimpse of its particular administrative character, as well as important statistical information concerning the demographic qualities of the patient population. These include tables reporting the annual admission, discharge and death rates, patient ages on arrival to Caterham, as well as their occupation and marital status before committal. By the end of the nineteenth century, these annual reports became much less qualitative and consisted of a brief introduction from the medical superintendent, followed by pages

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of charts and data. This echoes the professionalisation of psychiatry, which saw impartial quantitative information be prized over subjective and objective qualitative information. Importantly, up until the end of the nineteenth century, the Caterham annual reports also had contributions from the Matron, Steward and Resident Engineer, alongside the standard and expected musings and reflections of the Medical Superintendents. These also provide a window into the day-to-day workings of the asylum from a range of perspectives, be they circumscribed by the limitations of the institutional annual report. Despite the diverse range of information, annual reports can present a rather myopic picture of the asylum. As Anne Digby has suggested, historians need to be aware of the nature and role of these annual reports in the ‘competitive world of asylumdom’.65 As well as being promotional materials, annual reports could also massage certain statistics and selectively present information that would not necessarily provide an accurate depiction of the asylum. All these claims can be made of Caterham’s annual reports, which as a poor law institution did not need to advertise for subscribers or donations, but did need to satisfy the PLB and the rate payers. However, even with the lack of critical awareness and their tendency to present the institution in the best possible light, annual reports remain invaluable sources of information to the historian. It is the patient casebooks which form the core of this study. Within the numerous volumes, which cover the entirety of Caterham’s operation from 1870 to the early 1990s when it closed, are the biographical details of patients, such as name, address, age, poor law union and address of nearest known relative. They also contain medico-psychiatric information such as the patient’s institutional classification and notes concerning their condition on arrival to the asylum, distinguishing marks or physicality, and a medical history.66 Asylum casebooks are, as Sally Swartz states, ‘complex discursive sites’ and provide insight into a range of experiences and understandings which can ‘notwithstanding the power relations which frame them…offer the potential to give voice to previously silenced stories’.67 As well as being administrative and medical accounts containing the voices and opinions of the asylum medical staff, the information recorded in the casebooks also captures the recollections and experiences of patient’s family members. How patients were described by the medical staff or poor law officer, the latter often going on information provided by the patient’s

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relatives, provides us with the opportunity of seeing what people were confronted with when dealing with, managing, and treating adult idiots and imbeciles. The Caterham patient casebooks are an incredibly rich resource. They are a snapshot of past lives lived, traces of voice and echoes of experience. Nestled within the hastily written notes, which more often than not claimed that patients were ‘going on as usual’ or that there was ‘no change’, are photographs of patients. Or rather patient portraits as Dr Adam, Caterham’s first Medical Superintendent, liked to call them. The portraits are emotive and complex sites of memory. They provide a visual record of people whose lives were often recorded in quick standardised sentences and phrases that became, in and of themselves, formulaic. Some of these images are, like the notes that surround them, formal and follow the conventions we have come to expect of asylum photography, especially in pauper institutions. Patients are sat three-quarters to the camera, the omnipresent mirror behind them. Others are less formal and have the air of a family snapshot about them. In recent studies of asylums, scholars have used patient and asylum photography in a number of ways, moving beyond narratives of deviance and the power of the medical gaze, in early works such as Jackson. In her monograph exploring the professionalisation of science in Victorian asylums, Jennifer Wallis used a wide array of asylum photographs, including patient photographs and pathological images to explore how psychiatrists developed knowledge of the body and mental illness. Katherine Rawling has explored the myriad purposes of patient photographs in public and private asylums, how they were used as tools to communicate information about insanity between doctors, patients and their families and how patients used them to communicate their own identity and experience.68 Jane Hamlett and Lesley Hoskins used patient photographs to explore dress and agency within asylums. Collectively, their work shows the value of going beyond the notion of medical gaze, power and narratives of deviance to show that these images can provide insight into lives, into the experience of the asylum and the wider experience of insanity. Indeed, as Caroline Bressey states in her work using photographs from the Stone Asylum, these are visual records of people; they are to be looked at as images of lives lived and importantly show us what people looked like which is not something that can always been successfully conveyed by the written word.69 However, the documents that make up asylum archives are also heavy with silences. These are institutions that were undoubtedly sites of sorrow, the process of committal a distressing experience, which asylum staff were

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keenly aware of. Dr Adam made a number of references to the strain the journey from London could have on patients, that removal from their familiar, and indeed familial, surroundings could prove to be injurious mentally, physically and emotionally.70 There are also hints of the violence that was an inevitable feature of asylum life. Many of the people admitted to Caterham were suffering from a range of often debilitating conditions, mental and physical. These could be brought on or exacerbated by the institutional setting and could manifest through violent and fractious behaviour. It was not unknown for patients to attack fellow residents or staff members. They would also observe and hear aggression, cruelty and brutality within the asylum wards. Indeed, one patient was transferred from Caterham to a lunatic asylum after he smashed a window, struck an attendant and threw a spittoon at Dr Adam.71 Staff could also be violent and abusive towards patients, though the recording of this is limited in the committee minutes and the wider asylum archive. Reference to such behaviour is completely omitted in the patient casebooks. Indeed, in my reading of the annual reports which cover a 43year period, I have found one direct reference to a staff member being abusive to a patient. The case involved a male chimney sweep who was found to have had sex with a female patient.72 The asylum management committee and Dr Adam wished to press charges of rape against the man in question. However, it was reported that as the patient had stated she was a willing participant and gave her consent the charges could not be brought. The unnamed staff member was dismissed immediately. Within the annual reports and committee minutes are references to the staff being dismissed for disorderly conduct; code for a number of misdemeanours which one can suspect included abusive behaviour. Whilst I have an intuition that the case referred to above was not an exception, and that violence and neglect occurred regularly in such a large institution, I cannot invent it. I can, however, acknowledge the silences. Whilst the three Medical Superintendents of Caterham would repeatedly state, with a hint of pride, that seclusion had not been used, during their annual inspections of the asylum, the CIL would note that restraint, by way of strong clothing or restrictive chairs, was regularly used at Caterham. Staff would claim that restraint through these measures was for the safety, security and benefit of patients, to stop them hurting themselves or others, or destroying their clothes. Yet, as I am fully aware, restraint could also be used to control troublesome individuals and be used as a form of punishment. However, to focus on unspoken abuses and neglect would be to dismiss the instances

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of positive experiences, care and humanitarian responses that are as much part of the institutional regime as the negatives: negatives which we are bombarded with and which further neglect and stigmatise the asylum and the idiot in history. Whilst I fully acknowledge the silences, hints and whispers of neglect and violence, the answer is not to ignore the instances of positive response and care with Caterham.

Overview of the Book The book begins with the events and activities that led to the founding of Caterham, focussing on the welfare reforms, public health and sanitary improvements of the 1860s to contextualise both the passing of the Metropolitan Poor Act 1867, the creation of the MAB, the organisation responsible for the building and management of Caterham. The following chapter offers a detailed examination and exploration of the Caterham patient population from a number of angles, beginning with an assessment of the demographic characteristics of the people admitted, discharged and who died within the walls of the asylum. Attention will also be paid to the classifications of patients, and this is where we will see the sociocultural understanding of idiocy, imbecility and insanity, the diagnostic similarities with other conditions, the differences and how medical staff sought to manage this, at times, frustrating situation of dealing with so-called curable insane patients in an institution for the incurably and chronically insane. Chapter 4 considers the experience of the asylum, how patients lived within Caterham and how they interacted with staff through various activities, from work, occupation and entertainment. As Louise Hide and Wallis have shown in their recent works, we cannot imagine the asylum to be made up of two neatly segregated and isolated sides, staff on one side and patients on the other.73 In many asylums, staff and patients remained for lengthy periods of time, especially senior staff. At Caterham, each of the medical superintendents, as well as living on-site, worked at the asylum for upwards of ten years. Similarly, the matron and steward worked at Caterham for over two decades and a lived in houses that were on-site with their families, who often participated in extra-curricular aspects of daily life in the asylum. The asylum regime, in terms of medical treatment, work and occupation, afforded numerous opportunities for patients and staff to interact, within and outside the formal institutional relationship, from sport to theatrical performances. Caterham will be shown to be a diverse and multifaceted site, with an equally diverse population, staff and patients

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alike. In line with this, the chapter will also consider the material culture of Caterham. It will explore how staff and patients lived within the site, how occupation, entertainment and exercise were used both as therapeutic tools for patients, and were also opportunities for staff to engage with their charges beyond the formal regime relationship. The final chapters of the book explore the lives of people admitted to Caterham, and the geographies and wider visibility of idiocy, imbecility and insanity in the late nineteenth and early twentieth centuries. As a number of Caterham patients had their photograph taken, we are provided with a visual record of these individuals. Whilst patients were described with varying detail by the medical staff and relatives in the casebooks, a photograph is an incredibly powerful record.74 These photographs are used in two ways to further understand and explore the history of idiocy. In Chapter 5, they provide a window into the material and experiential world of Caterham. How were patients dressed, how were patients presented and how were they visually recorded. Asking and answering these questions provides more opportunities to discover how the daily life in the asylum and the wider regime were experienced by the hundreds of people who were committed to Caterham. These questions and explorations are built on in the final chapter; when using the photographs alongside the biographical data and geographical information, I am able to illustrate the visibility and social presence of people identified as idiots and imbeciles in Victorian London in a number of contexts, not solely as individuals admitted to an asylum, but as people, as family members, as sons, daughters, sisters and brothers and as individuals who were cared for and cared about. Stitching all of these facets together, from the founding of Caterham, the patient pathway, their biography and particular geography, the structure and composition of their family and the nature of their neighbourhood, we are able to see how they lived within society. Such a detailed approach afforded by nominal record linkage between a diverse range of sources challenges the idea that the geography of idiocy can be explained by a will to segregate and that the institutional terrain of the nineteenth century was shaped by protoeugenicist debates and concerns regarding degeneracy, moral and mental weakness. Whilst these may have been hotly debated in some circles, at the lay, popular and administrative level these ideas did not filter down, nor did they to the so-called front line of asylum care, nor, indeed, to the families who identified their kin as idiots, imbeciles or incurably insane.

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Notes 1. William Gilbert, ‘The Idiot Colony at Caterham’, Good Words Magazine 13 (1872): 271–277. 2. Gilbert, ‘Idiot Colony’, 271. 3. Gilbert, ‘Idiot Colony’, 271. 4. Gilbert, ‘Idiot Colony’, 272. 5. Gilbert, ‘Idiot Colony’, 272. 6. Gilbert, ‘Idiot Colony’, 272. 7. Female Casebook (admissions 1870–1875), LMA H23/SL/B/14/001/B, folio 22. 8. Patrick McDonagh, Christopher F. Goodey, and Tim Stainton (eds.), Intellectual Disability: A Conceptual History, 1200–1900 (Manchester: Manchester University Press, 2018). 9. David Wright, ‘Learning Disability and the New Poor Law in England, 1834–1867’, Disability & Society 15.5 (2000): 731–745. 10. Anne Digby, ‘Changes in the Asylum: The Case of York, 1777–1815’, The Economic History Review 36.2 (1983): 218–239. 11. Wright, ‘Learning Disability’, 734. 12. Leonard Smith, Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-Century England (Leicester: Cassell, 1999), 82. 13. Smith, Cure, Comfort, and Safe Custody, 6. 14. Elaine Murphy, ‘Mad Farming in the Metropolis. Part 2: The Administration of the Old Poor Law of Insanity in the City and East London 1800–1834’, History of Psychiatry 12.48 (2001): 405–430. 15. Vieda Skultans, Madness and Morals: Ideas on Insanity in the Nineteenth Century (London: Routledge & Kegan Paul, 1975), 103. 16. Louise Hide, Gender and Class in English Asylums, 1890–1914 (London: Palgrave Macmillan, 2014), 16–17. 17. Wright, ‘Learning Disability’, 731–745, 736. 18. Jonathan Andrews, ‘Identifying and Providing for the Mentally Disabled in Early Modern London’, in Digby and Wright (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (London: Routledge, 1996), 65–92. 19. Peter Bartlett, The Poor Law of Lunacy: The Administration of Pauper Lunatics in Mid-nineteenth Century England (London: Leicester University Press, 1999), 44–50; Elaine Murphy, ‘The Lunacy Commissioners and the East London Guardians, 1845–1867’, Medical History 46 (2002): 495– 524. 20. British Parliamentary Papers, Copy of the Supplement to the Twelfth Report of the Commissioners in Lunacy to the Lord Chancellor, 1859 (228), Volume IX.1 21. Wright, ‘Learning Disability’, 740.

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22. Bartlett, The Poor Law of Lunacy, 44. 23. Wright, ‘Learning Disability’, 735. 24. Cecil Austin, The Metropolitan Poor Act , 1867 , with Introduction, Notes, Commentary, and Index (London, 1867), 1. 25. William Andrews Holdsworth, The Handy Book of Parish Law, 3rd ed. (London, 1879), 183. 26. Gwendoline Ayers, England’s First State Hospitals and the Metropolitan Asylums Board, 1867 –1930 (London: Wellcome Institute for the History of Medicine, 1971), 21. 27. David Green, Pauper Capital London and the Poor Law, 1790–1870 (London: Ashgate, 2010), 238; Keir Waddington, Charity and the London Hospitals, 1850–1898 (Woodbridge: Boydell Press, 2000), 10. 28. Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth Century England (London: Allen Lane, 1979); Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (London: Tavistock, 1985); and Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Harmondsworth: Penguin, 1968). 29. Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society 14 (1985): 175–198; Bill Luckin, ‘Towards a Social History of Institutionalization’, Social History 8.1 (1983): 87–94. 30. John K. Walton, ‘Lunacy in the Industrial Revolution: A Study of Asylum Admissions in Lancashire, 1848–1850’, Journal of Social History 13.1 (1979): 1–2; Steven J. Taylor, ‘“All His Ways Are Those of an Idiot”: The Admission, Treatment of and Social Reaction to Two “Idiot” Children of the Northampton Pauper Lunatic Asylum, 1877–1883’, Family & Community History 15.1 (2012): 34–43; Cathy Smith, ‘Family and Community and the Victorian Asylum: A Case Study of the Northampton General Lunatic Asylum and Its Pauper Patients’, The Journal of Family and Community History 9.2 (2006): 144–157; and Cara Dobbing, ‘The Circulation of Pauper Lunatics and the Transitory Nature of Mental Health Provision in Late Nineteenth Century Cumberland and Westmorland’, Local Population Studies 99.1 (2017): 56–65. 31. Rebecca Wynter,‘“Good in all respects”: Appearance and Dress at Staffordshire County Lunatic Asylum, 1818–1854’, History of Psychiatry 22.1 (2011): 40–57; Jane Hamlett and Lesley Hoskins, ‘Comfort in Small Things? Clothing, Control and Agency in County Lunatic Asylums in Nineteenth- and Early Twentieth-Century England’, Journal of Victorian Culture 18.1 (2013): 93–114; Steven Cherry and Roger Munting, ‘Exercise is the Thing? Sport and the Asylum 1850–1950’, The International Journal of the History of Sport 22.1 (2005): 42–58; Rob Ellis ‘Asylums and Sport: Participation, Isolation and the Role of Cricket in the Treatment of the Insane’, The International Journal of the History of Sport 30.1 (2013):

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32. 33. 34.

35.

36. 37. 38.

39. 40. 41. 42. 43. 44. 45.

46. 47.

83–101; Dolly McKinnon, ‘“Amusements are Provided”: Asylum Entertainment and Recreation in Australia and New Zealand c.1860–c.1945’, in Graham Mooney and Jonathan Reinarz (eds.), Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (Amsterdam and New York: Rodopi, 2009), 267–288; Leslie Topp and James Moran (eds.), Madness, Architecture and the Built Environment: Psychiatric Spaces in Historical Context (London: Routledge, 2007), 241–263; and Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007). Patrick McDonagh, Idiocy: A Cultural History (Liverpool: Liverpool University Press, 2008), 5. William Wotherspoon Ireland, On Idiocy and Imbecility (London: Churchill, 1877), 1. Edgar Miller, ‘Mental Retardation: Clinical Section Part I’, in German. E. Berrios and Roy Porter (eds.), A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders (London: Athlone Press, 1995), 212–224; German Berrios, ‘Mental Retardation: Clinical Section Part II’, in German. E. Berrios and Roy Porter (eds.), A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders (London: Athlone Press, 1995), 225–237. Peter Rushton, ‘Lunatics and Idiots: Mental Disability, the Community, and the Poor Law in North-East England, 1600–1800’, Medical History 32.1 (1988): 34–50; Jonathan Andrews, ‘Identifying and Providing for the Mentally Disabled in Early Modern England’, in D. Wright and A. Digby (eds.), From Idiocy to Mental Deficiency (London: Routledge, 1996), 65–92. Andrews, ‘Identifying and Providing’, 68. Andrews, ‘Identifying and Providing’, 68. Jonathan J. Andrews, ‘Begging the Question of Idiocy: The Definition and Socio-Cultural Meaning of Idiocy in Early Modern Britain: Part 1’, History of Psychiatry 9 (1998): 65–95. Andrews, ‘Identifying and Providing’, 86. Andrews, ‘Identifying and Providing’, 86. Wright, ‘Learning Disability’, 743. Andrews, ‘Begging the question’, 66. Wright, ‘Learning Disability’, 742. Wright, ‘Learning Disability’, 743. Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain c.1870–1959 (London: Clarendon Press, 1998), 12. Thomson, Problem, 12. Elaine Murphy, ‘Mad Farming in the Metropolis. Part 1: A Significant Service Industry in East London’, History of Psychiatry 12 (2001): 245–282;

1

48. 49. 50. 51.

52. 53.

54. 55.

56. 57. 58.

59.

60.

61.

62.

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Felix Driver, ‘The Historical Geography of the Workhouse System in England and Wales, 1834–1883’, Journal of Historical Geography 15 (1989): 269–286; and David R. Green, ‘Workhouses Pauper Protests: Power and Resistance in Early Nineteenth-Century London Workhouses’, Social History 31.2 (2006): 37–41. Thomson, Problem, 19–23, 297. Thomson, Problem, 26–27. Thomson, Problem, 147. Mark Jackson, The Borderland of Imbecility: Medicine, Society and the Fabrication of the Feeble Mind in Later Victorian and Edwardian England (Manchester: Manchester University Press, 2000). Jackson, Borderland, 53. Mark Jackson, ‘Images of Deviance: Visual Representations of Mental Defectives in Early Twentieth-Century Medical Texts’, The British Journal for the History of Science 28.3 (1995): 319–337. Walton, ‘Lunacy in the Industrial Revolution’, 13–16; Smith, ‘Family and Community’, 118–121; Dobbing, ‘Circulation of Pauper Lunatics’, 58–62. Chris Philo and Deborah Metzel, ‘Introduction to Theme Section on Geographies of Intellectual Disability: “Outside the Participatory Mainstream”?’, Health & Place 11.2 (2005): 77–85, 80. For more on this see Edward Hall, ‘Social Geographies of Learning Disability: Narratives of Exclusion and Inclusion’, Area 36.3 (2004): 298–306. Philo and Metzel, ‘Introduction’, 81. Steven J. Taylor, Child Insanity in England, 1845–1907 (London: Palgrave Macmillan, 2016). Pamela Dale, ‘Implementing the 1913 Mental Deficiency Act: Competing Priorities and Resource Constraint Evident in the South West of England before 1948’, Social History of Medicine 16.3 (2003): 403–418. Pamela Dale and Joseph Melling (eds.), Mental Illness and Learning Disability Since 1850, Finding a Place for Mental Disorder in the United Kingdom (London: Routledge, 2006); David Wright and Anne Digby (eds.), From Idiocy to Mental Deficiency (London: Routledge, 1996). Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services: From the Early 18th Century to the 1990s (London: Athlone Press, 1993); Leonard Smith, Cure, Comfort, and Safe Custody: Public Lunatic Asylums in Nineteenth Century England (London and New York: Leicester University Press, 1999); and Thomson, Problem, 27–28. Douglas Baynton, quoted in Paul K. Longmore and Lauri Umanksy (eds.), The New Disability History: American Perspectives (New York and London: New York University Press, 2001), 2. Christopher Goodey, A History of Intelligence and ‘Intellectual Disability’: The Shaping of Psychology in Early Modern Europe (Ashgate, 2011); Simon

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63.

64.

65.

66.

67. 68.

69.

70. 71. 72. 73. 74.

Jarrett and Jan Walmsley (eds.), Intellectual Disability in the Twentieth Century Transnational Perspectives on People, Policy, and Practice (Policy Press, 2019); Dorothy Atkinson, Mark Jackson, and Jan Walmsley (eds.), Forgotten Lives: Exploring the History of Mental Deficiency (Kidderminster: BILD, 1997). David Wright, Mental Disability in Victorian England: The Earlswood Asylum, 1847 –1901 (Oxford: Oxford University Press, 2001); Steven J. Taylor, Child Insanity in England, 1845–1907 (London: Palgrave Macmillan, 2016). All of the primary source documents relating to Caterham from patient casebooks to the MAB committee minutes are held at the London Metropolitan Archive. From 1887 onwards, the asylum annual reports were reported in the MAB Statistical Reports, which are held at the Wellcome Library. Anne Digby ‘Quantitative and Qualitative Perspectives in the Asylum’, in Roy Porter and Andrew Wear (eds.), Problems and Methods in the History of Medicine (London, 1987), 153–174. Historians have used patient case notes in a variety of ways to draw out both qualitative and quantitative information. See Jonathan Andrews, ‘Case Notes, Case Histories, and the Patient’s Experience of Insanity at Gartnavel Royal Asylum, Glasgow, in the Nineteenth Century’, Social History of Medicine 11 (1998): 255–281; Rick Rylance, ‘The Theatre and the Granary: Observations on Nineteenth-Century Medical Narratives’, Literature and Medicine 25 (2006): 255–276. Sally Swartz, ‘Lost Lives: Gender, History and Mental Illness in the Cape, 1891–1910’, Feminism and Psychology 9.2 (1999): 152–158. Katherine Rawling, ‘“She Sits All Day in the Attitude Depicted in the Photo”: Photography and The Psychiatric Patient in the Late-Nineteenth Century’, Medical Humanities, Special Issue on Communicating Mental Health 43.2 (2017): 99–110. Caroline Bressey, ‘The City of Others: Photographs from the City of London Asylum Archive’, 19: Interdisciplinary Studies in the Long Nineteenth Century 13 (2011): (n.p.). MAB Committee Minutes, Vol. VIII (1874–1875), 360. Caterham Male Casebook 11, LMA H23/SL/B14/28, 136. MAB Committee Minutes, Vol. XIII (1879–1880), 880. Wallis, Investigating the Body, 13; Hide, Gender and Class , 156–157. Bressey, ‘The City of Others’.

CHAPTER 2

Creating Caterham

[there is an] abundance of light and air, and, above all, a cheerful, “sunny aspect” (as the architects call it) is given in every case.1

In 1892, Sir Henry Charles Burdett, a leading authority on the design of Victorian hospitals, infirmaries and asylums, described Caterham Imbecile Asylum as ‘well arranged (and we use the word advisedly) for the storage of imbeciles’.2 Burdett’s comment could well be viewed as a precursor to Andrew Scull’s oft-referenced quote that asylums were effectively warehouses for society’s residuum; isolated and punitive institutions created to provide effective segregation of the insane, curable, incurable, troublesome and chronic, from wider society. However, Caterham was neither a county or borough asylum, nor was it a site of cure or restoration. It was a new form of poor law institution, built following the passing of the Metropolitan Poor Act in 1867. This Act saw the sick, fevered and insane paupers, who were regarded as undesirable and costly patients in the overcrowded workhouses, redistributed across new institutions, designed, created and managed by the MAB. Caterham was born of a particular set of debates that shaped its remit, its role in the mixed economy of welfare and the wider institutional landscape of the nineteenth century. These debates were influenced by contemporary ideas and understandings of the asylum’s intended residents, namely adult

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pauper idiots and imbeciles. They were also shaped by the attitudes of campaigners concerned with the failings of the existing poor law system. At the time of writing this description of the asylum, Caterham had been in operation for two decades. The asylum had grown in size and in scale during this time. Several new ward blocks had been built on the male and female sides of the asylum, and more land had been purchased which increased not only the size of the all-important farm which provided food to Caterham’s resident population, but also increased the outdoor areas used for sport and exercise. However, it was not these spatial or environmental factors that led Burdett to consider Caterham to be well arranged for the hundreds of idiot and imbecile paupers transferred from the numerous workhouse and infirmary wards of south London. In fact, he felt that ‘no good word can be spoken’ of its ‘enormous size’.3 Rather, it was the design of the building, the arrangement of the site and the layout of the asylum that merited his paradoxical compliment. It is these factors that will be explored in this chapter. Indeed, as suggested by Burdett’s quote, and his publication on the subject of institutional structures, buildings are not neutral. As sociologist Thomas Gieryn notes, they are symbols and reflections of attitudes, beliefs and perceptions of their designers and their managers, and the societies which they serve.4 In the case of asylums, as James Moran and Leslie Topp have stated, these sites were ‘important formative factors in changing modes of care for the physically ill’, physical representations of shifting ideas and considerations.5 Significantly, Topp highlights the overzealous emphasis placed on the apparent ‘spatial separation’ and isolation of asylums, an emphasis which can obscure the nuanced nature and history of these sites.6 Indeed, it is undeniable that the asylum as a structure, a form of accommodation and as a site of treatment and care took on particular meanings in the nineteenth century. In the past two decades, research has considered the architecture, geography and spatiality of asylums in a broader social and cultural context.7 Geographers such as Chris Philo, Sarah Curtis and Wilbert Gesler have considered the role of the environment, the landscape and the community in the geography of asylums.8 Their work has shown that physical location of asylums was dictated by a number of factors, including the notion that removal or segregation from society was seen as beneficial both for the patient and the community. Thus, to understand the roots, the purpose and the conception of Caterham Imbecile Asylum, we need to understand what factors led to its creation, the motivations behind its founding and how it was intended to

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operate within the wider mixed economy of welfare. To do this, the chapter will focus on a specific time and a specific episode: the events leading up to the passing of the Metropolitan Poor Act 1867 and the building of Caterham.

Ideal Institutions By the time Caterham was being designed, there had been several waves of institutional building. From the small-scale asylums built to echo country houses following the passing of the so-called 1808 Wynn’s Act to the largescale asylums like Colney Hatch following the 1845 Lunacy Acts, as well as numerous hospitals and workhouses erected in the early to mid-nineteenth century, the managers of Caterham were surrounded by a plethora of institutional forms. Alongside these physical structures were numerous texts, articles and books on the subject of asylum design, taking into account the newest innovations in medical, sanitary and scientific theories to afford greater efficiency in terms of economies and administration of patients, staff and residents in these sites. Caterham was built on the pavilion plan, a design that was more commonly used in hospitals and infirmaries. It was considered by contemporaries, Burdett included, to be incredibly sanitarily efficient. In fact, it was a style much favoured by the MAB, and versions of it were used for a number of its institutions, including the St Pancras Infirmary in Archway, London.9 Wards were naturally ventilated, with the circulation of fresh air afforded by the high ceilings and the numerous long windows which opened at the top for matters of sanitation, safety, and security. Attention was also paid to the internal arrangement, with the beds placed between the windows to maximise airflow and to ensure the greatest amount of cubic space per patient, which were central features of the sanitary practicalities of the pavilion plan design. The rectilinear corridors connecting the three-storey ward buildings to the central administrative block further prevented disease and illness from being transferred between these different sections of the asylum site. Bad air was seen as a corrupting force, carrying with it disease, illness and in many cases death. This foul air, with its miasmatic qualities, was an ever-present concern to Victorians, before the advent of germ theory towards the end of the nineteenth century, and was a particular concern to institutional managers who were often dealing with demands of smells, limited space, and sickness. Thus, buildings that could ensure the flow of clean, fresh and good air were welcomed by

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many involved in the management and administration of the sick, fevered and insane. However, there was one main drawback of the pavilion plan asylum. In the opinion of Burdett, this particular layout was best suited to asylums with less than 1000 patients. Caterham at its highest capacity provided accommodation to over 2000 patients. He felt that the scale was too great to ensure efficient supervision, sanitation and management of patients, which were regarded by many as the most pressing concerns when it came to asylums. This mixed interpretation of Caterham hints at the factors that were considered most important and pertinent to the MAB. Caterham was born of the sanitary reforms of the 1860s, not the psychiatric reforms that led to the founding and building of lunatic asylums. These reforms were a consequence, in part, of the so-called great confinement of the 1840s and 1850s, afforded by the growth of workhouses, asylums and infirmaries. The sanitary crisis and welfare reforms were also a product of the wider industrial and urban expansion of London. Throughout the nineteenth century, London, like many of Britain’s cities, experienced a huge increase in terms of size, scale and people. Many men and women flocked to London to seek out employment and economic opportunities in the manufacturing warehouses, workshops, industries, offices that dotted the city.10 This influx of people put particular stresses, not only on the city in terms of employment and housing, but also sanitation, care and welfare. Caterham had many architectural features that were common, and to some degree expected, in institutional designs and plans, not least the central administrative block where patients were received on arrival to the asylum. Towards the front of this central block were the offices of the medical superintendent and his assistants, as well as offices and mess rooms for the head attendants, the asylum clerk and a well-appointed board room to be used when the management committee or poor law guardians visited. To the rear of this central block were the vast asylum kitchen, scullery and numerous store rooms filled to the brim with food, cleaning and medical supplies, and beyond these rooms was the cavernous laundry which was located at the very end of this mammoth structure. The ward blocks fanned out on either side of the central administrative building, female patients on one side and male patients on the other, with the asylum chapel laying to the right of the main block and the houses for senior staff to the left. Contemporary maps show that Caterham was built in a relatively rural location, which may well have been interpreted by Burdett as evidence of being well arranged, geographically and socially speaking. A common

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theme in the history of asylums has claimed that their location was dictated by a desire to physically and visually remove the insane from society.11 However, this supposed segregation is more nuanced than being explained as a form of removal of the inconvenient from the eyes, and perhaps hearts, of Victorian society. As Clare Hickman has shown, a major factor in the geography of asylums was the contemporary belief in the healing and restorative power of nature.12 The rural landscape with its cheerful and tranquil character would counter the negative effects of urban living. Dr David Brodie, medical superintendent of the Idiot Asylum at Larbert Edinburgh, a private institution catering to 300 patients, stated that the ideal environment for an imbecile asylum …ought to be in the country, but near to a town, easily accessible at all seasons, so as to allow full and frequent intercourse with the outer world…The situation must secure perfect hygienic conditions, abundance of pure water, equal to all possible demands for bath, lavatory and water closet requirements, perfect drainage, and liberal space for playground, walking exercise, and garden or farm operations13

Elements of this environmental ideal can be found in Caterham’s geography, from the connection to the local village to the liberal space for occupation, entertainment and exercise. Moreover, certain additions to the asylum capitalised on its hygienic features, such as fresh air, good light and an abundance of clean water that was pumped on-site. The asylum was built on a 72-acre site, which overlooked the verdant Caterham Valley. The location was described by the management committee as having strong prevailing winds, a good chalky subsoil which was perfect for farming and a general tranquillity that would undoubtedly assist in keeping the asylum hygienic and sanitary.14 It was also well connected to London with the local train station ‘a little more than a mile away’.15 The railway was to play an important role in the running of the asylum, beyond that of transporting patients, goods and staff to the asylum doors. Family members were actively encouraged to visit the asylum, and in 1872 the Management Committee, following requests from the medical superintendent, arranged with the South Eastern Railway Company, which ran the line between London and Caterham Station, for reduced price train fare for patient families. By 1874, over 14,000 of these specially arranged tickets had been issued to patients’ relatives.16 The railway station was, in some respects, the gateway to the asylum in the village. On visit days, hundreds of families would

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alight at the station, passing the large box on the platform stamped with Caterham Imbecile Asylum where railway staff would place the daily newspapers, erected at the request of the asylum steward to save the delivery man from making several trips a day to collect small items. The railway also acted as a barrier between the healthy asylum and the unhealthy city during times of epidemic in the capital. When London was experiencing an epidemic, admissions and visits were suspended, and the railway station would fall silent on the weekly open days. Considering these factors helps us to understand the geography, physical and social, of asylum sites. As discussed, the Victorian era saw a growth in buildings: civic, medical and educational. These were designed with specific intentions and purposes, and careful reading of them can reveal the opinions and theories that shaped their architecture.17 Across popular and medical texts, including reform literature and investigation reports, there was a distinct view that buildings could impact negatively or positively on residents, patients and society more broadly. For many Victorians, buildings were regarded as tools; they could be healthy or unhealthy, they could be curative or a source of disease, they could be sites of care or custody and they could incite immoral, or indeed, moral behaviour.18 Asylums are made up of a number of components: the physical building, the location and environment, and the design. Through these, we can read the intentions of the architects, managers and staff as to how they saw the role of the institution. Barbara Taylor has raised the important point that asylums could act as ‘stone mothers’, providing safety and sanctuary to vulnerable groups.19 This sanctuary could be delivered and enacted through various facets of the institution, through practical matters such as the medical care and attention on offer, but also through the shared knowledge that the asylum existed to be a separate and distinct space to provide suitable accommodation to those who required it. This idea of the asylum as a site of compassion was explored, albeit briefly, by Michel Foucault in a 1967 lecture on the topic of heterotopias.20 Foucault identified two main types of heterotopia, one of crisis and one of deviation. The former was to provide a safe space for ‘individuals who are, in relation to society and to the human environment in which they live, in a state of crisis [such as] adolescents, menstruating women, pregnant women, the elderly’.21 Heterotopias of deviation such as prisons, psychiatric hospitals and retirement homes were places reserved for ‘individuals whose behaviour is deviant in relation to the required mean or norm’.22 Importantly, Foucualt notes that certain sites could operate as both forms of heterotopias. The retirement

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home, for example, was a dual-heterotopic site as ‘old age is a crisis, but is also a deviation since in our society where leisure is the rule, idleness is a sort of deviation’.23 Taking this view, idiocy, similarly to old age, was considered by contemporaries as a deviation from certain acceptable behaviours, levels of intellect and in some cases, physical development. In his text On Idiocy and Imbecility, published in 1877, William Wortherspoon Ireland noted the similarities between idiocy, imbecility and dementia, namely ‘[t]he intelligence of the dement and of the idiot may be for some time about equal; but the one has reached it by the process of subtraction; the other by the process of addition…’.24 Moreover, as discussed, the unsanitary environment of the workhouse was a deviation from the ideal of the healthful and beneficial institution. Heterotopic sites could be forms of compensation due to their ordered and regulated design and regime. Foucualt argued that ‘to create a space that is other…that is well arranged as ours is messy’ was to provide a secure environment for those who were existing in ‘jumbled’ or ‘ill-constructed’ surroundings.25 Caterham from the very outset was to provide an ordered environment to compensate for the disordered, and unhygienic, environment of the workhouse.

Lay Attitudes to Idiocy and Imbecility In 1859, the CIL, the national inspectorate body created following the 1845 Lunacy Acts, published their annual report.26 Throughout the year, members of the CIL would visit workhouses, asylums and madhouses, to inspect the care and accommodation given to the insane, which under the wording of the 1845 Acts included idiots and imbeciles.27 The report, described as ‘blistering’ by the historian of mixed economy of welfare Peter Bartlett, highlighted the particularly poor treatment of the incurable and chronic insane in workhouses.28 It came at a particularly intense time in the administrative and political relationship between the PLB and the CIL. Indeed, as Bartlett claims, it was an attempt by the CIL to draw fire into the Poor Law arena where the CIL had been losing significance, administrative power and political traction, especially concerning the management of the insane.29 Whilst the main focus of the report was on the question of the curable insane, the plight of pauper idiots and imbeciles was also considered and discussed at some length. The investigation highlighted the awful conditions which many idiot and imbecile inmates were subjected to, which had

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numerous economic, social and medical repercussions. The lack of proper superintendence of these patients, they believed, led to poor sanitary habits, inclinations to vice and fractious behaviours, which impacted the wider workings of the workhouse. The CIL report contained hundreds of examples of male and female pauper idiots and imbeciles kept in deplorable circumstances, with little attention paid to their health, well-being or welfare. For example, at the Huddersfield workhouse, where 28% of the institution’s 124 population were classified as idiots or imbeciles, many were found to be ‘habitually dirty in their habits’, kept in a room that was ‘impregnated with noxious vapours’.30 In some workhouse lunatic wards, the beds and floors were soaked with urine, with piles of sodden blankets and clothing heaped in corners; others had no washing facilities, with little or no ventilation, and in many cases no access to outdoor spaces. The lack of care provided in workhouses, which were initially created to provide accommodation at subsistence level to the able-bodied indigent poor, often saw the compromised idiot and imbecile body become more degraded. There were numerous accounts of idiot and imbecile inmates, who would regularly soil themselves, or wander about aimlessly, destroying their clothing, often crying and screaming maniacally. This could cause other patients to react negatively, and violence between inmates was a frequent occurrence. The treatment of the insane, curable or incurable, was not a pressing concern for many poor law medical officers or the workhouse nurses, many of whom were overworked and underpaid. Thus, beyond the practicalities of accommodating and feeding inmates, there was little on offer within the workhouse. Outdoor space and exercise were a premium in many poor law institutions, and when it could be accessed, it was often found to be inadequate. In one workhouse, the exercise court was little more than a refuse yard, which backed onto the ‘dead-house’.31 At the Portsea Island workhouse, the wards reserved for the incurable and curable insane did open up on to a small enclosed airing court, but it was used for the drying of soiled beds and bedding rendering it unsuitable as a space for exercise or fresh air.32 The lack of space, be it indoors or outdoors, resulted in unsanitary environments that impacted the physical and mental health of workhouse inmates. As a result of their findings, the CIL were adamant that the workhouse was a wholly inappropriate institution for idiot and imbecile paupers. Leaving them to live out their days in these decrepit sites, where they would be restricted in terms of occupation, fresh air and above all else medical

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attention, they would, in the opinion of the CIL, ‘sink into further degenerate bodily and mental states’.33 This included profligacy, sexual deviance and violence, and accordingly the CIL provided numerous accounts of weakminded, unmarried, women arriving at the workhouse pregnant with several imbecile children in tow, a nod to the presumed inheritability of idiocy. This class of inmate required ‘better accommodation than a Workhouse affords…better nursing, better clothing and better bedding…and with rare exceptions, all require more tender care and more vigilant superintendence than is given in any workhouse whatsoever’.34 Their solution to the problem was clear the best mode of making provision for the Insane Poor who cannot be received into the present Asylums, will be by the erection of inexpensive buildings, adapted for residence of idiotic, chronic and harmless Patients, in direct connexion with, or at a convenient distance from the existing institutions.35

The CIL report was sensationalist in tone, its aim to agitate a change in lunacy administration, and to afford them more sway within the mixed economy of welfare. Unfortunately, the CIL were unsuccessful in their demands. Whilst the government and the PLB overlooked the report and the CIL’s recommendations, it caught the attention of a number of medical men, welfare reformers and sanitarily minded campaigners. In the following years, a number of articles appeared in The Lancet and BMJ with titles such as ‘Shameful Ill Treatment of Lunatics at Workhouses’ and ‘Maltreatment of Lunatics at Workhouses’, with idiots and imbeciles getting a mention.36 They echoed the views of the CIL, stating that the insane, both curable and incurable, should be removed from the ‘evil’ and ‘neglectful’ workhouses to purpose-built auxiliary asylums, institutions that were to be halfway point between the workhouse and the county asylum, administratively, geographically and theoretically.37

Workhouse Reform and Pauper Idiots The issue of workhouse reform and the reorganisation of the pauper population, in the name of efficiency and sanitation, became a pressing concern within the medical and popular press. Disease epidemics, unsanitary conditions, unskilled attendants and dilapidated buildings saw Thomas Wakley, editor of the infamous medical journal The Lancet, describe Metropolitan

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workhouses as ‘ante-chambers of the grave’.38 His friend Joseph Rogers, medical officer at the Strand Workhouse and staunch advocate for welfare reform, set up the Association for the Improvement of London Workhouse Infirmaries in 1866 alongside high-profile supporters including Charles Dickens and Florence Nightingale.39 Following the death of two relatively healthy men from medical neglect in the winter of 1864, there followed a spate of articles detailing the awful conditions and woeful management of Metropolitan workhouses.40 There ensued a number of high-profile investigations exploring the sanitary, medical and environmental aspects of these institutions. Most vocal of all of these was The Lancet’s Sanitary Commission for Investigating the State of the Infirmaries of Workhouses, with a series of enquiries and examinations published first in The Lancet, then as a stand-alone publication in 1866.41 Whereas the CIL report was national in its scope, The Lancet’s focus was the capital city. Echoing the findings of the CIL some five years previously, The Lancet investigation brought to the fore the plight of the pauper idiot. The concentration of hundreds of incurable and chronically insane saw members of The Lancet Commission describe workhouses as ‘asylums in everything but attendance and appliance which ensure proper treatment’.42 Nationally, by 1865 around 15 per cent of the workhouses in England and Wales had separate wards for the curable and incurable insane, many of which fell far below acceptable standards of space, sanitation and ventilation.43 A survey of Poor Law Returns shows that of the 39 London workhouses, 22 had a separate idiot or lunatic wards in the mid-nineteenth century, which equates to 56%. The Lancet stressed the negative impacts that the lack of care, attention and hygiene had on the lives of idiot and imbecile paupers. Importantly, they painted the pauper idiot and imbecile as individuals deserving of pity, continually mentioning examples of the deplorable suffering of this class of inmate in workhouses: suffering that was the result of mass overcrowding, lack of space, poor diet and absence of treatment. The Strand Workhouse imbecile ward was described as …[having] the usual want of any provision for the frequent enjoyment of fresh air by the unfortunate imbeciles…[they] are placed in wards which offer the reverse of the conditions (as to ventilation, &c.) which ought to distinguish rooms used for such a purpose, and their life appears to be gloomy and objectless44

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In the opinion of The Lancet, the culmination of these evils was the complete ‘absence of any effort to keep alive the existing gleam of intelligence’ in those considered idiot and imbecile.45 The Lancet advocated for the need for more space, air, exercise, cheerful surroundings and occupation for the pauper imbeciles, the lack of which had resulted in inmates being subjected to ‘gloomy and objectless’ lives. The choice of language used by The Lancet to express their displeasure is significant as it alludes to the wider humanitarian turn emerging at this time, and a shift in wider medico-social attitudes towards welfare and the incurable insane more broadly.46 The Lancet’s findings were discussed across the medical and popular press, with complementing articles appearing in the BMJ and The Times, written by high-profile medical doctors and social reformers such as Ernest Hart and Edwin Chadwick.47 These reports, articles and discussions were further complemented, to some degree, by investigations undertaken at the begrudging behest of Charles Villiers, the Chair of the Poor Law Board between 1859–1866, who was becoming aware of the changing tide in opinion.48 Indeed, across the medical and popular press, repeated calls were made for workhouses to be reconfigured and transformed from the unsanitary sites that they had become.49 The solution was becoming clear; separate institutions were required for the sick, the diseased and the incurable insane. The suggestion that these asylums needed to be designed, built and understood as performing a different function to that already on offer in lunatic asylums illustrates a belief that pauper idiots and imbeciles deserved and needed their own form of institutional accommodation. County and borough lunatic asylums were not equipped, nor designed, for their needs. These were sites that were predicated and managed on the notion of cure and restoration; thus, idiots and imbeciles were regarded as undesirable patients. Similarly with workhouses, which were designed to be sites of temporary accommodation, the incurable insane often became long-stay patients. Thus, for different reasons and in different contexts, the idiot and imbecile pauper was not only being understood as being the wrong type of patient, but discussions and opinions emerged that revealed the nuances and problems that had resulted in this complicated administrative status. Importantly, rather than being written off as undesirable patients, idiots and imbeciles were becoming recognised as a distinct patient group who required specific forms of institutional, medical and psychiatric care. Moreover, it is interesting to note that within many of the reform debates and discussions, whilst idiocy was regarded as a permanent condition, it was becoming clear that it

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could be made worse by an individual’s surroundings. To be incurable was not a static condition; indeed, as suggested by the concerns of The Lancet and the wider workhouse reform movement, the incurable insane could be made worse, and conversely better, by their environment.

The Metropolitan Asylum Board In 1866, Gathorne Hardy was appointed as the new president of the Poor Law Board and with his appointment came a new approach to the question of Poor Law reform, and the care of the incurable insane in workhouses. Unlike many of his predecessors, Hardy was amenable to the idea of welfare, Poor Law and workhouse reform. He organised several investigations to assist him in this work, and to how best deal with the improvement and restructuring of the workhouse and wider Poor Law services. Hardy appointed several high-profile committees to explore the state of workhouses, and to consider the best manner in which to reform and reorganise the system. He called in the services of the president of the Royal College of Physicians Sir Thomas Watson, Dr William Markham, former editor of the British Medical Journal and Mr Uvedale Corbett, an experienced investigator, amongst others, to examine the conditions in many of the Metropolitan workhouses.50 Findings from these reports agreed with the investigations of The Lancet and the CIL, concluding that it would be beneficial to all parties, from the sick to the guardians, and the rate payers more broadly, if certain groups were removed from the workhouse and sent to separate institutions, namely children, the poxed, the fevered and the incurable insane.51 This removal, and restructuring, would not only afford better care and treatment of the sick and insane, it would also allow for the workhouse to be used for its original purpose, which was to provide deterrent accommodation and occupation to the indigent poor and unemployed.52 The Metropolitan Poor Act was passed on the 14 March 1867, ‘for the establishment in the Metropolis of asylums for the sick, insane, and other classes of the poor…’, and it was a piece of legislation that led to significant changes in how welfare and public health was delivered and managed in London.53 A Times article printed on the day of the Act’s passing highlights the paternalism and humanitarian turn which Hugh Freeman has suggested was a key feature of the institutional developments of the mid-nineteenth century.54 The Times piece stated that ‘[the Bill] opens questions which have engaged the attention of thinking men and experienced administrators

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for a long time, and which, as the spirit of humanity increasingly pervades society, will tend to become more and more matters of public concern. It is an attempt to remedy a deeply felt evil, a national disgrace…’.55 The Metropolitan Poor Act was to change the institutional geography of London, bringing with it new welfare services, a new approach to public health, and significantly for idiots and imbeciles a new form of institutional accommodation.56 To oversee the building, design and management of these new institutions, a new administrative body was created, the MAB.57 Organised into subcommittees and answering to a central Board of Managers, the 60 men that constituted the board were drawn from Poor Law union boards of governors, hospital boards and institutional committees.58 Their area of responsibility was the 3 million people who lived within the 118 square miles of metropolitan London, which included a workhouse population of between 25,000 and 30,000, of whom around 3000 were classed as idiots and imbeciles, as well as the thousands of fevered, sick and poxed paupers who resided across these sites. The MAB represented an important shift in how the sick poor, be they mentally, physically or intellectually compromised, were to be accommodated, cared for and supported by the poor law.59 An article in the BMJ published in 1902 illustrates the size and scale of the MAB network. Over the last three decades of the nineteenth century, the MAB had built 45 different institutions, services and departments, which included ‘six ambulance stations’ and ‘three wharves and piers…’ for the conveyance of sick patients, as well as Dreadnought training ships, and numerous medical supplies, all paid for by the Common Poor Fund.60 In terms of hospitals, infirmaries and asylums, as well as Caterham and four other imbecile asylums, the MAB managed 17 fever hospitals, three smallpox hospitals, a training ship, two ringworm schools, two ophthalmic schools, three seaside homes, four defective children homes and three remand homes for children, providing a total accommodation of 18,401.61 Looking at the number and range of different institutions that were built and managed by the MAB, it is clear to see that it was predominantly concerned with health, sanitation and welfare.

Designing Caterham In the summer of 1867, the newly created imbecile subcommittee presented the general MAB Board of Managers with their report regarding the

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best ‘mode in the opinion of the committee by which such accommodation may be the most efficiently provided’.62 Based on the belief that there were approximately 3000 idiot and imbecile paupers who required accommodation, they decided that two 1500 bed asylums located a maximum of 20 miles from Charing Cross would be the ideal solution.63 These asylums needed to be close to a railway station, at best one mile, for easy transportation of goods, people and patients. In September 1867, the imbecile committee advertised for sites, and by November of that year had decided upon two locations: Leavesden in Hertfordshire to serve the unions in the north of London and Caterham in Surrey to provide for those in the southern districts of the metropolis. In their description of the sites, members of the committee made repeated references to the cheerful, tranquil and healthy qualities of these localities, the holy trinity of the ideal institutional environment. By the mid-nineteenth century, there were numerous books and articles on the subject of asylum design and management. Many of these were authored by asylum medical superintendents, who regarded the physical building as an important instrument in the treatment and management of patients.64 Dr John Conolly’s The Construction and Government of Lunatic Asylums and Hospitals for the Insane, originally published in 1847, was frequently republished throughout the period.65 In his introduction, Conolly stated determinedly that asylums were places of mental, psychical and restorative security where ‘recovery of the curable and the improvement of the incurable, the comfort and happiness of all the patients, should therefore be steadily kept in view by the architect.66 Indeed, the layout, design and spatiality of asylums concerned the advocates of the institutional care for idiots and imbeciles, such as Édouard Séguin.67 In a similar fashion to Conolly, Séguin stressed the fact that the institution needed to relate to the particular needs of the patients, asserting that the buildings of the institution must have a special character…to correspond with the certain idiosyncrasies of the children and with numerous exigencies of their treatment. Idiots vitiate the air very rapidly; hence the necessity of supplying them with more than an ordinary share of it, by making their rooms very high and large, very airy and easily ventilated, accessible equally to natural and artificial heat68

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In the literature concerning the design, running and organisation of imbecile and lunatic asylums, a number of themes emerged, namely that the building was to play an active role in the management of the patients and that great effort should be made to ensure that they were not gloomy or frightful places. All stressed the fact that the building needed to relate, respond and be informed by the peculiarities and characteristics of the intended patients, as well as existing treatment regimes of the time. Thus, lunatic asylums were often modelled on ideals related to moral therapy, and the many idiot asylums, which were predominantly built for children, were focussed on providing stimulating educational environments following Séguin’s experiments and experiences with his patients. However, the adult pauper idiot had a number of different peculiarities and needs that were distinct from the curable insane and the mentally deficient child. As suggested in Séguin’s quote, the CIL report and the investigations of The Lancet, there were medico-social ideas that cast the idiot body as one that was unsanitary, often a result of their particular effluence and incontinence. It was a view and understanding of the idiot body that would come to have a particular significance in the design and geography of Caterham. Ventilation was an important feature in many nineteenth-century institutions, from infirmaries to schools. Particular attention was given to airflow, as disease was believed to be caused by noxious fumes.69 Indeed, the open cesspools, poor sewerage and miasma emanating from the decaying matter filling the city streets were regarded as the root causes of many ailments. As well as leading to the ‘fetid effluvia’, ‘poisonous exhalations’ and ‘reeking atmosphere’ which came to exemplify the city in popular Victorian thought, as Anne Hardy suggests, these poor environmental conditions were also seen as the very ‘source of the physical, moral and mental deterioration of the poor’.70 By the time of the MABs founding, there had been several waves of institutional development, theory and practice, from asylums to training schools, workhouses to hospitals. Thus, there was an established and varied institutional terrain, in terms of design, arrangement and planning, for the members of the MAB to draw inspiration from. The MAB was made up of several boards and committees, each responsible for a different institutional type. Alongside a smallpox hospital committee, a fever hospital committee and a general works committee was the Board of Managers which each committee reported to. The imbecile committee, much like the MAB as a whole, was made up predominantly of lay professionals who were well skilled in terms of welfare and hospital administration.71 William Wyatt,

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chairman of the first MAB imbecile committee, was a Justice of the Peace and chair of the St Pancras Board of Guardians.72 Following the division of the imbecile committee into two subgroups in 1868 to oversee the building and management of the two imbecile asylums, Wyatt become the chair of the Leavesden management committee. Dr William Cortis, a medical doctor, well versed in hospital administration, led the Caterham committee.73 It is perhaps important to note that no member of the Caterham, Leavesden, or indeed MAB board, had psychiatric training or experience in building, managing or administering an asylum. Despite this lack of experience, the MAB imbecile committee lost no time in setting administrative wheels into motion. In December 1867, after several weeks of discussion and planning, the imbecile committee invited architects to submit plans, offering a prize for the top three designs.74 In their instructions to architects, the committee detailed what was required of these new asylums.75 Alongside separate houses for the Medical Superintendent, Matron, Steward and Resident Engineer, each asylum was to provide 1580 beds, 850 for female patients, the remaining 650 for male patients, with a small detached infirmary providing 80 beds for individuals suffering from infectious diseases, perhaps a hint to the continuous threat of cholera, fever and smallpox plaguing the city. Attention was also paid to the size and scale of the patient blocks, to ensure maximum space per patient. The main patient blocks were to be of three floors, the upper two floors to be dormitories, the lower floor being used as day rooms which must ‘communicate with airing courts’.76 These instructive requests give rise to the sanitary thinking of the time that was held by the imbecile committee members, in particular the need to provide sufficient cubic space per patient, as well as the desire to provide enough height in the patient areas to ensure sufficient ventilation. The design of architectural partnership John Giles and Biven, the second cheapest at £66,700, was selected as the winner. So complete was the design in its planning, facilities and arrangement that it was used for both Caterham and Leavesden.77 The BMJ described John Giles as ‘a comparatively a young man, but has thoroughly mastered the subject of sanitary architecture and may he be congratulated on his success in these important competitions’.78 The winning design was also discussed in the architectural journal The Builder, a widely read publication which acted as an informal conduit between the various interested parties in nineteenth-century institutional design.79 The article provides a fascinating insight into how the design was viewed by industry insiders. Paying attention to the features

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that were regarded as significant by contemporary commentators provides a unique insight into the perception and understanding of the asylum. The day rooms measured ‘105 ft by 36 ft. and 14 ft. high, with windows on the north side 6 ft. from the ground … and with a large bay on that side also’.80 The patient wards, on the top two floors, could accommodate eighty patients, made up of ‘an attendants‘ room, a lobby for the patients’ clothes at night (it being very undesirable for these to remain in the dormitory), a linen store and a spacious lavatory’.81 The article went on to mention the arrangement of the wards and their windows, detailing that there were twelve on either side of the ward, directly ‘opposite each other; they are 3 ft. wide and 4 ft. from the floor’ and were intended to be between the beds ‘not over them’, to ensure sufficient air flow which was further afforded by the window at ‘each end, giving through direct ventilation to the staircase of each block’.82 The weight given to the sanitary efficiency of the asylum is evident, not least in the frequent mention of windows and their arrangement. The discursive space and time given to such matters illustrate how sanitation came to dictate the arrangement of the asylum. For example, the reference to the need for patients’ clothing to be stored away from the dorm echoes the claims made by Séguin regarding the effluence of the idiot body. The patient wards, and the asylum site as a whole, were designed and arranged in line with the emerging modern hospitals and infirmaries, the windows positioned to provide suitable levels of air flow and ventilation, beds positioned between them to counter the perceived contaminating qualities of their bodies. However, this three-floored ward block arrangement, based on the pavilion plan was, as discussed at the start of this chapter, against much of the received wisdom of the time when it came to asylums. Lunatic asylums were typically built on the linear plan, which saw patient accommodation running off from a long corridor. Conolly, was of the view that a building running over two storeys was difficult in terms of ‘access and egress of the patients’ and that the third storey would also inevitably become ‘dull…[and] almost unavoidably neglected’ due to its lofty position at the top of the block. Moreover, in the opinion of Burdett, it posed a number of problems in terms of observation and surveillance, and the design was ‘equally opposed to good classification and proper superintendence’ of the residents.83 However, across the MAB committee minutes, be it general meetings or reports from the imbecile committee, there was little reference made

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to matters of surveillance: themes and design features that were considered important in the management of lunatic asylums. For them, health and sanitation were the keys to effective arrangement and were not necessarily at the cost of effective patient surveillance and observation. The pavilion plan design was a sign of innovation, especially in hospital architecture. Effective ventilation and sanitary building design was particularly significant in the age of miasma theory. Charlotte Newman in her study of workhouse architecture has shown that the pavilion plan was often used by forward-thinking urban unions, keen to express their fresh approaches and understandings of welfare, poverty and illness.84 A similar assertion has been made by Carla Yanni, highlighting contemporary opinion of the pavilion plan as innovative and modern asylum design.85

Design Features: Sanitation and Surveillance Correspondence between the MAB management board, Caterham imbecile committee and the PLB reveals a number of insights into the ideas which determined the asylum’s design. Paying attention to these exchanges allows insight into intentions and beliefs of the managers and how they saw the asylum in terms of its purpose, its remit and how best to accommodate patients. They also reveal how the pauper idiot was understood by the members of the MAB and the PLB more broadly. The MAB, as a satellite of the PLB, was required to report to them all matters regarding the management and administration of these new welfare institutions.86 In the process of sanctioning the building of Caterham, and its sister Leavesden, the PLB queried a number of design details, which reveal various lay understandings of idiocy and the purpose of the asylum more broadly.87 The PLB questioned the height of the patient dorms, requesting that they be enlarged from 12 to 13 ft in height in order to increase the levels of cubic space.88 Cubic space was a key concern of workhouse reform literature. The PLB commissioned several reports to assess the amount of cubic space needed per patient across the mixed economy of care, with several focussing specifically on workhouses.89 They recommended that the chronic and infirm required 500 cubic feet, with the offensive cases, those who were fevered and infectious, requiring 1200 cubic feet.90 The PLB also queried the number and location of water and earth closets, the width of the corridors and stairwells, and the lighting and ventilation of the patient and staff areas.91

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The issue of patient supervision, whilst not absent in these debates, was often at the periphery, with the majority of the points raised by the PLB concerning the accommodation and hygiene of the entire asylum population, staff and patients alike. For example, the PLB requested that a window be placed in the porters’ room, located beside the main entrance, so that all those who entered and left the asylum could be observed and recorded in the necessary logbook.92 This entrance was used for patients, staff and visitors, including the management committee when they came to review the asylum during their fortnightly visits, as well as members of the CIL and PLB during their annual inspections. The committee had no major objection to this suggestion; however they did state that a door with glass panels was most probably in the original plans, intimating that this was sufficient in terms of observation.93 The internal arrangement of the wards saw one concession made to patient supervision. According to the Builder, the modern infirmary pavilion blocks had W.C.s and lavatories placed at the furthest end of the corridors and dorms, for matters of health and hygiene. At Caterham, they were placed at the front of the ward rooms, as it was ‘essential that the class of persons here should be, with the least possible labour to attendants, constantly watched, and this could never be the case with these places far removed from the centre of supervision’.94 There appears to have been little direct discussion or comment on the positioning of the toilets in the existing MAB committee minutes, nor is there any reference or mention of the reasons for this decision. However, that the Builder made a point to acknowledge this design feature suggests some concession regarding the issue of surveillance over sanitation. This is significant for it is the only such concession made that was entirely about the issue of patient observation, with all other matters discussed through the lens of hygiene, sanitation and the improvement and maintenance of patient health. However, it was the subject of the windows of the asylum that took up a significant portion of the correspondence between the imbecile committee and the PLB.95 At the design stage, the PLB were concerned about the gloomy appearance the high narrow windows on the original plan conveyed. At only 2 ft wide and placed 6 ft from the floor, they were considered to be too narrow, but it was also noted that they were too high for patients to see out of. And above everything else, this style, size and positioning of windows would give Caterham the look and feel of a prison.96 In line with both sanitary and modern institutional design conventions, and aesthetic considerations, the PLB ordered the MAB to have them widened

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to three feet and dropped from the original height of 6 ft to between 3 and 4 ft from the floor so as to provide a better view of, and from, the asylum.97 The committee quickly agreed. These newly repositioned and widened windows would provide sufficient ventilation, ample light, good views of the abundant countryside, and above all else eliminate any sense of penal confinement. The decision appears to have been a successful one, at least in terms of visual appeal. In 1872, William Gilbert, secretary for the Society of Relief of Distress, published an article in the Good Words Magazine based on a visit to Caterham. He described Caterham as being ‘in good taste and by no means unpicturesque’.98 The reference made to the picturesque qualities of the asylum is significant, as it hints at the wider healthful, tranquil and cheerful qualities of the institution and the importance of such features to visitors, managers and administrators. As Hickman suggests, these terms were indicative of wider notions of the healing and restorative power of nature and the healthful benefits of a rural environment.99 Photographs of the asylum wards, taken in the early twentieth century, show them to indeed be filled with light, with most every window open at the top (see Figs. 2.1 and 2.2). The photographs show the size, scale and number of windows on each ward, as detailed in the Builder article, allowing light and air to flood into what must have been, with 40 beds per dorm, incredibly cramped environments. Louise Hide, in her research on London County Council lunatic asylums which were of similar size to Caterham, has shown that ‘living within such close proximity to each other, patients and staff stood an increased risk of contracting contagious diseases, frequently succumbing, sometimes fatally, to influenza, diarrhoea and sickness’.100 As an illustration of Caterham’s sanitary efficiency, there is no record of a serious outbreak, such as smallpox, typhoid or typhus, diseases that blighted many nineteenthcentury institutions. As records relating to staff illness or absences have not survived in the asylum archive, it is impossible to assess the rates of staff sickness, but that there is no record of a detrimental outbreak or epidemic, we can assume the sanitary efficiency of the asylum was successful. This hints at the way in which health contributed to the heterotopic qualities and functioning of the asylum. As Caterham was intended to be a longstay asylum, many patients remained within the asylum for lengthy periods of time, many upwards of ten, twenty or thirty years. Indeed, it was not unheard of for patients to die in their 70s, 80s and 90s after living at Caterham for several decades. This in part attests to its healthy environment and sanitary order. Of course, the health of the patients was not solely the result

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Fig. 2.1 Woodward ward (male side), c.1927, Surrey History Centre, Ref 4209/3/38/10. Reproduced by permission of Surrey History Centre

of the design of the asylum; washing, cleaning and sanitising of the wards, much of which was undertaken by patients employed as ward helpers who worked alongside nurses and attendants helped to keep the asylum population healthy. Indeed, this work was both a form of therapy and occupation and is discussed in greater detail in Chapter 4. Yet this should not detract from the fact that in terms of the sanitary purpose of the building, the MAB intentions were realised to a certain degree. Another area of contention between the MAB and the PLB was the burning question of where to store patient clothing. Whilst this may seem a trivial matter and perhaps beyond the scope of an organisation as large and as busy as the PLB, the exchange provides an insight into attitudes to idiocy and the role of the asylum in their care and management. As has already been shown, odour control, ventilation and hygiene were particularly pressing concerns of both the MAB and the PLB, though for different reasons. The issue of where best to put patient clothing was the subject of several heated exchanges between the two bodies. It all centred around the presumed need for a separate storage room, which the PLB strongly rejected. On the original plans, the clothing storage room, to store the used

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Fig. 2.2 Baily ward (female side), c.1929, Surrey History Centre, Ref 4209/3/39/2. Reproduced by permission of Surrey History Centre

clothes during the night, was next to the clean linen store. Patients were to be provided two sets of day clothes, one for every day wear, one for indoor wear if they worked outside or in the laundry, and one set for Sunday best. They would all be provided one set of night clothes. The PLB claimed the lobby was not ‘necessary, and was objectionable from its proximity to the linen stores, and the absence in it of any provision for external light and ventilation’.101 They recommended that patient clothes could be kept on the wards, either at the foot of the patient bed, or in a locker, with the freed up space to be given over to the existing linen stores.102 The imbecile committee in no uncertain terms rejected this suggestion stating that ‘anyone who has practical experience in these large dormitories know[s] how unpleasant an odour is emitted from the clothes of persons of this class’.103 Indeed, Peter Duncan and William Millard, medical superintendent and visiting physician to the Essex Hall Idiot Asylum, echoing Séguin, stated that rooms were to be airy and light, with good ventilation, given the ‘smell of idiots which soon infects a room’.104 The clothes store was kept, and the MAB instructed the architects to add another window to the adjoining lavatory to increase the ventilation in the lobby room. The

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exchange can also been seen as an expression of the MAB showing their knowledge, and flexing their managerial muscles in an effort to gain some autonomy from the PLB. These comments reveal how idiocy was understood by the MAB and the PLB, organisations made up of lay persons, whose skills lay in the administration, provision and management of welfare, and whose psychiatric knowledge was negligible. What they did all know about, however, was sanitation. Hygiene, cleanliness and health were organising features and a way to manage and administer the patient population. Perceiving the asylum, and its intended patients, through the lens of sanitation provided the members of the MAB and the PLB a language, theory and common ground to understand their respective work.

Healthy Spaces, Healthy Bodies Surveillance, moral management and moral therapy dictated the design, space and arrangement of the lunatic asylum. Whilst there was a need to regulate and control the asylum population at Caterham, the defining characteristic of this spatial ordering was from a health perspective. Control was not to be, initially, mediated through a modified form of moral management, but through sanitary order. Two important additions were made to Caterham during its formative years which illustrate the committal and adherence to sanitary theory and management. The first example concerned the building of a Turkish Bath and swimming pool at the asylum. In 1873, three years after the asylum opened Dr Adam, Caterham’s first medical superintendent requested permission and funds to build a Turkish Bath. In his annual report of 1873, Dr Adam stated that Amongst the means for improving the general health and condition of the Patients and, consequently, for their mental improvement, none is more important than the judicious use of bathing; I therefore beg strongly to urge the advisability of erecting a Turkish Bath. A suitable structure of [a] simple plan could be erected at a small cost, and I feel sanguine that good results would follow in its use. From former experience, I can state that the peculiarly disagreeable odour which is emitted from the secretion of the skin of the insane is perceptibly modified. The bath would be much liked by the Patients, and it would prove economical in labour and water105

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The onus in his appeal was on the sanitary aspects of the bath, rather than its curative or restorative powers. This was to appeal to the sanitary and hygienic sensibilities of the MAB, whose skills, experience and broader knowledge base was, as discussed, health and welfare, rather than psychiatry and medicine. The committee did not acquiesce at first. In his annual report of the following year, Dr Adam once again requested funds for a Turkish Bath, now with adjoining swimming baths, stating that ‘my opinion then expressed continues the same, or is strengthened by larger experience of the favourable results that would accrue to the Patients from its use’.106 Before his appointment as Medical Superintendent at Caterham, Dr Adam had previously worked as an AMO at Colney Hatch Asylum, during which time he experienced the positive effects of the Turkish Bath installed there at the insistence of Dr Edgar Sheppard, a keen hydropathist and advocate for their use.107 The first recorded use of the Turkish Bath as a treatment for insanity was published in 1861, following its use at the Cork District Lunatic Asylum, under the direction of Dr Thomas Power and at the Sussex County Lunatic Asylum. Malcolm Shifrin, historian of the socio-medical history of Turkish Baths in Victorian England, stated that Dr Sheppard made the long journey to the Cork Asylum in 1863 to observe the workings of the Turkish Bath and upon his return to Colney Hatch proceeded to have one installed, regaling its therapeutic and restorative properties.108 It appears that Dr Adam was successful in his second attempt. The Turkish Bath and swimming pool were built and in operation by 1875.109 The focus on the body of the patients rather than their mental affliction or their behaviour is significant. Echoing the claims of Séguin, and the findings of the CIL and Lancet Sanitary Commission, that the idiot body was a site of smells and effluence that could infect a room, Dr Adam built on wider concerns regarding the transmission of disease, focussing on the health and hygiene of the individual, and depending on the context, reflecting their inability to care for themselves. Similarly, received wisdom of the time, especially in workhouse reform and sanitary campaign literature, noted that the mind and intellect of the idiot and imbecile in adulthood was broadly beyond improvement. Their bodies, however, could be improved, managed and controlled, sanitarily and hygienically. A second example concerns the alternative use of the fire escape bridges built in 1886. These were large metal walkways that connected the first and second floors of the large three-storey ward blocks, to afford easy access for the asylum fire brigade (composed of male staff members), as

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well as easy escape for the patients should an evacuation be required. In their visit of 1886, the CIL remarked favourably on the alternative use of the walkways, commending their innovative use as makeshift balconies and open-air galleries for the infirm, bed-bound and paralysed patients. These were often the patients who, it was reported, were ‘previously unable to bear being carried up and down the stairs’ thus the new walkways gave them access to air and a ‘varied view of the surrounding countryside’ which was, the CIL believed, to be applauded.110 The landscape and environment of the asylum was a frequent topic in the asylum annual reports. In 1874, Dr Adam remarked that for many patients ‘the removal from London to the bracing atmosphere of the Caterham Hills soon makes a marvellous change in the bodily condition and in many cases the mind also keeps apace’, which by the 1880s was being supported by various structural changes to the asylum.111 Thus, health, hygiene and sanitation through fresh air, clean bodies and good ventilation were not only important to the managers, the staff, but also to the CIL, who had first raised the issue of sanitation, bad environments and the plight of the pauper idiot.

Conclusion At the time of its opening in September 1870, Caterham was a new institution. It was one of the first purpose-built asylums, managed by a state authority, for pauper adult idiots and imbeciles. Its primary role was to provide suitable accommodation to individuals deemed to be incurably insane and was intended to provide a suitable, healthy, sanitary and hygienic institutional environment. Thus, the MAB asylums were counter-sites whose purposes were dictated by the needs of other administrative systems, the sanitary failings of the existing institutional terrain, and they were heterotopias that were predicated on the notion of order, cleanliness and health. Caterham’s pavilion plan was a design type that drew on theories and design trends in medical and welfare planning, which paid attention to matters of ventilation, classification and sanitation. In founding, design, intention and purpose, Caterham was an institution built by a welfare and public health authority in the wake of sanitary and health reforms which created new poor law institutions, fever hospitals, smallpox asylums and imbecile asylums. Thus, its spatial arrangement, and indeed its remit, differed from those used in lunatic asylums. Many of the ideas that shaped the design of Caterham stemmed from the need to counter the disorder both of the unhygienic workhouse environment and the effluence of the idiot

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body, which was increasingly recast by the medical fraternity and reformers as unsanitary and unmanageable due to the perceived limited intellect and childish nature of the mentally deficient. It was this sanitary arrangement of the building, supported by its location, geography and spatiality that led Burdett to claim Caterham as being ‘well arranged for the storage of imbeciles’, indicating the orderly compensatory nature of the asylum site.112 Caterham’s design was managed by a group of lay professionals, not by medical superintendents or medico-psychiatric reformers. It was intended from the start to provide accommodation to the harmless incurable insane within the wider remit of the poor law. By paying attention to the design of the institution, it has been possible to show that Caterham should be understood and assessed as a heterotopic space. Indeed, focussing on the design of the asylum also helps us to understand contemporary perceptions and attitudes to idiocy. Viewing Caterham as a site of compassion, of compensation and of sanitary order, created to counter the disorder of the workhouse, helps us to unpack the nuances in the intention, the purpose and the ideals to which its designers and managers were aiming. It also allows us to consider the purpose and role that Caterham was to play in the wider mixed economy of welfare.

Notes 1. ‘The New Pauper Hospitals of London’, British Medical Journal 1.383 (2 May 1868): 430–431. 2. Henry Burdett, Hospitals and Asylums of the World: Their Origin, History, Construction, Administration, Management and Legislation; with Plans of the Chief Medical Institutions Accurately Drawn to a Uniform Scale, in Addition to Those of All the Hospitals of London in the Jubilee Year of Queen Victoria’s Reign: Volume II (London: Churchill, 1891), 103. 3. Burdett, Hospitals and Asylums of the World, 103. 4. Thomas F. Gieryn, ‘What Buildings Do’, Theory and Society 31 (2002): 35–74. 5. Leslie Topp, James Moran, and Jonathan Andrews (eds.), Madness, Architecture and the Built Environment : Psychiatric Spaces in Historical Context (London: Routledge, 2007), 1. 6. Topp, Moran, and Andrews, Madness, 1. 7. Carla Yanni, ‘The Linear Plan for Insane Asylums in the United States before 1866’, Journal of the Society of Architectural Historians 62.1 (2003): 24–49; Barry Edginton, ‘The Design of Moral Architecture at the York Retreat’, Journal of Design History 16 (2003): 103–117.

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8. Chris Philo, ‘“Fit Localities for an Asylum”: The Historical Geography of the Nineteenth-Century “Mad-Business” in England as Viewed Through the Pages of the Asylum Journal’, Journal of Historical Geography 13.4 (1987): 398–415; Sarah Curtis, Space, Place and Mental Health (Surrey: Ashgate, 2010); and Wilbert Gesler, ‘Therapeutic Landscapes: Medical Issues in the Light of the New Cultural Geography’, Social Science and Medicine 34.7 (1992): 735–746. 9. Edward Walford, ‘Highgate: Part 1 of 2’, in Old and New London: Volume 5 (London, 1878), 389–405. British History Online http:// www.british-history.ac.uk/old-new-london/vol5/pp389-405 [accessed 19 May 2019]. 10. Louise Hide, Gender and Asylums In English Asylums, 1890–1914 (London: Palgrave Macmillan, 2014), 18. 11. Andrew Scull, ‘Madness and Segregation: The Rise of the Insane Asylum’, Social Problems 24.3 (1977): 337–351. 12. Clare Hickman, ‘Cheerful Prospects and Tranquil Restoration: The Visual Experience of Landscape as Part of the Therapeutic Regime of the British Asylum, 1800–60’, History of Psychiatry 20.4 (2009): 425–441. 13. David Brodie ‘The Conditions Necessary for the Successful Training of the Imbecile’, BJP 27.117 (1881): 18–30. 14. MAB Committee Minutes, Vol. I (1867–1868), 56. 15. MAB Committee Minutes, Vol. I (1867–1868), 56. 16. MAB Committee Minutes, Vol. VII (1873–1874), 315. For more on family visits to see Graham Mooney and Jonathan Reinarz (eds.), Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (Amsterdam and New York: Rodopi, 2009) especially Leonard Smith Chapter 9 ‘The Keeper Must Himself Be Kept: Visitation and the Lunatic Asylum in England, 1750–1850’, 199–222 and Catherine Colebourne Chapter 13 ‘Challenging Institutional Hegemony: Family Visitors to Hospitals for the Insane in Australia and New Zealand, 1880s–1910s’, 289–308. 17. For discussion of reading buildings in such a way see Felix Driver, Power and Pauperism: The Workhouse System, 1834–1884 (Cambridge University Press, 2003) especially Chapter 4 ‘Designing the Workhouse System, 1834–1884’, 58–72 and Chapter 5 ‘Building the Workhouse System, 1834–1884’, 73–94; Thomas A. Markus, Buildings and Power: Freedom and Control in the Origin of Modern Building Types (London: Routledge, 1993), 3. 18. Joseph Rogers, Medical Officer at the Strand Workhouse set up the Association for the Improvement of London Workhouse Infirmaries, with a view to reforming the workhouse environment. Much of his campaigning and complaint was focussed on the deplorable condition of workhouse wards, see Ruth Richardson and Brian Hurwitz, ‘Joseph Rogers and the Reform of Workhouse Medicine’, History Workshop Journal 43 (1997): 218–225.

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19. Barbara Taylor, The Last Asylum: A Memoir of Madness in Our Times (London: Hamish Hamilton, Penguin, 2014). 20. Whilst other scholars have addressed this idea in terms of the wider workings of the mixed economy of welfare and the developing treatment regimes in asylums, for Foucault, a noted critic of the institution to make such a claim is interesting. 21. Michel Foucault, ‘“Des Espace Autre”: Of Other Spaces—Utopias and Heterotopias (Translated from the French by Jay Miskowiec)’, Architecture Mouvement Continuité 16.1 (1984): 22–27. 22. Foucault, ‘Of Other Spaces’, 26. 23. Foucault, ‘Of Other Spaces’, 27. 24. William Wotherspoon Ireland, On Idiocy and Imbecility (London: Churchill, 1877), 2. 25. Foucault, ‘Of Other Spaces’, 27. 26. Copy of the supplement to the twelfth report of the Commissioners in Lunacy to the Lord Chancellor, 1859, British Parliamentary Papers (228), Volume IX.1. 27. For more on the history of the Commissioners in Lunacy, see Nicholas Harvey ‘A Slavish Bowing Down: The Lunacy Commission and the Psychiatric Profession 1845–60’, in William Bynum, Roy Porter, and Michael Shepherd (eds.), The Anatomy of Madness: Essays in the History of Psychiatry Vol. II, 132–146; For the particular remit of the Commissioners in Lunacy see Kathleen Jones, A History of the Mental Health Services (London: Routledge and Kegan Paul, 1972), 175–179. 28. Peter Bartlett, The Poor Law of Lunacy: The Administration of Pauper Lunatics in Mid-nineteenth Century England (London: Leicester University Press, 1999), 218. 29. Bartlett, Poor Law of Lunacy, 218. 30. Twelfth Report, 49. 31. Twelfth Report, 48. 32. Twelfth Report, 57. 33. Twelfth Report, 38–40. 34. Twelfth Report, 6. 35. Twelfth Report, 37. 36. ‘Shameful Ill Treatment of Lunatics at Workhouses’, Lancet 76, 1928.11 (1860): 145; ‘Maltreatment of Lunatics at Workhouses’, Lancet 76, 1929.18 (1860): 169–170. 37. ‘Medical News’, Lancet 73, 1863.14 (1859): 494–497. 38. Thomas Wakley was a surgeon, MP and strident social, political and medical reformer who campaigned for improvements to public health, medical education and training, as well as the end of slavery and the expansion of the voting rights beyond those with property. He was the founding editor of The Lancet, a radical Member of Parliament and coroner for Middlesex. Richardson and Hurwitz, ‘Rogers and Reform’, 221.

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39. Richardson and Hurwitz, ‘Rogers and Reform’, 221. 40. ‘Alleged Case of Neglect at Holborn Union’, Lloyd’s Weekly Newspaper (London, UK), Sunday, 1 January 1865; Issue 1154, 3; ‘Alleged Inhuman Treatment of Sick Pauper’, Daily News (London, UK), Thursday, 16 February 1865; Issue 5860, 2; Several letters and articles appeared in The Times regarding the death of Timothy Daly from neglectful treatment in the Holborn workhouse in December 1864. Edward Wallwyn James, ‘The Case of Timothy Daly (Letters to the Editor)’, The Times, Monday, 26 December 1864; p. 9. Richard Gibson’s death, from similar circumstances, resulted in a widely reported PLB inquiry and inspection led by Mr Farnall, ‘The St. Giles’s Union and the Poor Law Board’, The Times, Friday, 21 April 1865; p. 8. W. M. Nightingale ‘The “Lancet” On Shoreditch Workhouse’, The Times, Friday, 4 August 1865, 9. 41. For more on the wider ramifications of the Lancet Sanitary Report, see Kim Price Medical Negligence in Victorian Britain: The Crisis of Care under the English Poor Law, c.1834–1900 (London: Bloomsbury Academic, 2015), especially 49–72, 73–102. 42. The Lancet Sanitary Commission for Investigating the State of the Infirmaries of Workhouses: Reports of the Commissioners on Metropolitan Infirmaries (London: Lancet, 1866), 9; David Wright, ‘Learning Disability and the New Poor Law in England, 1834–1867’, Disability & Society 15.5 (2000), 731–745, 735. 43. Bartlett, Poor Law, 44. 44. Lancet Sanitary Commission, 71. 45. Lancet Sanitary Commission, 52. 46. Lancet Sanitary Commission, 71. 47. Ernest Hart, ‘Metropolitan Infirmaries for the Pauper Sick’, Fortnightly Review (April 1886): 460–462; Edwin Chadwick, ‘The Administration of Medical Relief to the Destitute Sick in the Metropolis’, Fraser’s Magazine (September 1866): 353–365; and ‘Workhouse Reform’, The Pall Mall Gazette (London, UK), Friday, 2 June 1865. 48. For more on these activities, see Gwendoline Ayers, England’s First State Hospitals and the Metropolitan Asylums Board, 1867 –1930 (London: Wellcome Institute for the History of Medicine, 1971), 6–11. 49. ‘Workhouse Reform’, The Pall Mall Gazette (London, UK), Friday, 2 June 1865; Issue 99; ‘London Workhouse Mismanagement’, The Huddersfield Chronicle and West Yorkshire Advertiser (West Yorkshire, UK), Saturday, 10 March 1866, 4; Dr Francis Edmund Anstie, ‘Insane Patients in London Workhouses’, JMS October (1864): 327–336. 50. Ayers, First State Hospitals, 10. 51. Edward Smith, Metropolitan workhouse infirmaries, &c.: Copy of the report of Dr. Edward Smith, Poor Law Inspector and Medical Officer to the Poor Law

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52. 53. 54.

55. 56. 57. 58. 59.

60. 61. 62. 63.

64.

65.

66.

Board, on the Metropolitan Workhouse Infirmaries and Sick Wards (London, 1866): 35–36. Ayers, England’s First State Hospitals, 11–12. Cecil Austin, The Metropolitan Poor Act , 1867 , with Introduction, Notes, Commentary, and Index (London: 1867), 1. Hugh Freeman, ‘Psychiatry and the State in Britain’, in M. Gijswjt, H. Oosterhuis, J. Vijselaar, and H. Freeman, Psychiatric Cultures Compared: Psychiatry and Mental Health in the Twentieth Century (Amsterdam: Amsterdam University Press, 2006), 119–140. ‘House of Commons, Friday February 8th’, The Times Saturday, 9 February 1867; p. 4; Issue 25730; col D. Austin, The Metropolitan Poor Act 1867 , 1. ‘Changes Under the New Metropolitan Poor Act’, BMJ 1.333 (18 May 1867): 576. 45 men were drawn from Boards of Guardians, 15 were appointed by the PLB from institutional committees, such as hospitals and infirmaries. David Green, Pauper Capital London and the Poor Law, 1790–1870 (London: Ashgate, 2010), 238; Keir Waddington, Charity and the London Hospitals, 1850–1898 (Woodbridge: Boydell Press, 2000), 10. ‘The Work of the Metropolitan Asylums Board’, British Medical Journal 2 (1902): 1872. “Work of the Metropolitan Asylums Board” BMJ, 1873. MAB Committee Minutes, Vol. I (1867–1868), 18–19. MAB Committee Minutes, Vol. I (1867–1868), 19, 33. A proposal to build three 1000 bed institutions was suggested by one of the imbecile committee members, but was rejected by a vote of 25 to 10 on the grounds of economy and administration. MAB Committee Minutes, Vol. I (1867–1868), 33. W. H. O Sankey, ‘Do the Public Asylums of England, as at Present Constructed, Afford the Greatest Facilities for the Care and Treatment of the Insane?’, The British Journal of Psychiatry 2 (1856): 466–479; John Conolly, ‘On the Residences of the Insane’, JMS (1859): 412; John Charles Bucknill, Notes on Asylums for the Insane in America (London: Churchill, 1876); and C. S. W. Cobbold, ‘Design for a Public Asylum for 310 Patients, Allowing for Extension of Accommodation Up to 450 Beds’, The British Journal of Psychiatry 31.136 (1886): 468–481. John Conolly, The Construction and Government of Lunatic Asylums and Hospitals for the Insane (London: John Churchill, 1847); Whilst these texts were published several decades before the founding of Caterham, they were regarded as important guides for those designing, running and administering such institutions, as evidenced by their frequent reprints and consistent appearances in later publications on the subject. Conolly, Construction and Government of Lunatic Asylums, 1–2.

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67. Édouard Séguin, Idiocy and Its Treatment by the Physiological Method (New York: William Wood & Co, 1866), 172–201. 68. Séguin, Idiocy, 174. 69. Anne Hardy, ‘Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854’, Medical History 43 (1999): 255–259. 70. Gertrude Himmelfarb, The Idea of Poverty: England in the Early Industrial Age (London: Faber, 1994), 357. 71. Dr William Brewer, the MAB chairman, remained in post for nearly twenty years, was a coroner and surgeon. He was assisted in his role by Mr Timothy Holmes and Dr Francis Sibson, both of whom had undertaken investigative reports of English hospitals. Ayers, England’s First State Hospitals, 129– 130. 72. Ayers, England’s First State Hospitals, 130. 73. MAB Committee Minutes, Vol II (1868–1869), 24. 74. MAB Committee Minutes, Vol. I (1867–1868), 63–64. 75. MAB Committee Minutes, Vol. I (1867–1868), 64. 76. MAB Committee Minutes, Vol. I (1867–1868), 64. 77. MAB Committee Minutes, Vol. I (1867–1868), 137. 78. ‘The New Metropolitan Lunatic Asylums’, BMJ 1.377 (21 March 1868): 279. 79. ‘Proposed Asylum for Leavesden and Caterham’, Builder XXXVI.1329 (1868): 541–542, 550–551. 80. ‘Proposed Asylum’, Builder, 542. 81. ‘Proposed Asylum’, Builder, 542. 82. ‘Proposed Asylum’, Builder, 542. 83. Conolly, Construction and Government of Lunatic Asylums, 10. 84. Charlotte Newman, The Place of the Pauper: A Historical Archaeology of West Yorkshire Workhouses 1834–1930, Unpublished Thesis, Department of Archaeology, 2010, 138. 85. Carla Yanni, The Architecture of Madness: Insane Asylums in the United States, 122. 86. Ayers, England’s First State Hospitals, 139–140. 87. In some circumstances, the exchanges between the MAB and the PLB were on the subject of the Leavesden asylum plans, which as noted came to be plans used for both asylums, thus the comments relate to Caterham, and the view of the imbecile asylums more generally. 88. MAB Committee Minutes, Vol. II (1868–1869), 18. 89. See James. E. O’Neill, ‘Finding a Policy for the Sick Poor’, Victorian Studies 7 (1964): 265–284, 281–282. 90. Geoffrey Rivett, The Development of the London Hospital System, 1823–1982 (Oxford: Oxford University Press, 1986), 74. 91. MAB Committee Minutes, Vol. II (1868–1869), 18–20. 92. MAB Committee Minutes, Vol. II (1868–1869), 15.

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93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104.

105. 106. 107.

108. 109. 110. 111. 112.

MAB Committee Minutes, Vol. II (1868–1869), 15. Builder, ‘Proposed Plans’, 542. MAB Committee Minutes, Vol. II (1868–1869), 52–53. MAB Committee Minutes, Vol. II (1868–1869), 52–53. MAB Committee Minutes, Vol. II (1868–1869), 53. William Gilbert, ‘The Idiot Colony at Caterham’, Good Words 13 (1872): 271–277. Hickman, ‘Cheerful Prospects’, 428–430. Hide, Gender and Class , 69. MAB Committee Minutes, Vol. II (1868–1869), 18. MAB Committee Minutes, Vol. II (1868–1869), 18. MAB Committee Minutes, Vol. II (1868–1869), 18. Peter Duncan and William Millard, A Manual for the Classification, Training, and Education of the Feeble-minded, Imbecile, and Idiotic, (London, 1866), 91. MAB Committee Minutes, Vol. VIII (1873–1874), 325. MAB Committee Minutes, Vol. IX (1874–1875), 365. Malcolm Shifrin, ‘Turkish Baths in Asylums: Colney Hatch, London’, Victorian Turkish Baths, http://www.victorianturkishbath.org/6directory/ AtoZEstab/Asylums/ColneySF.htm [accessed 26 June 2014]. Shifrin, ‘Turkish Baths in Asylums’. It is interesting to note that Dr Adam’s second request which was for a Turkish Bath and a Pool was more expensive than the first request. MAB Committee Minutes, Vol. XX (1886–1887), 264. MAB Committee minutes, Vol. VIII (1874–1875), 360. Burdett, Hospitals, 103.

CHAPTER 3

Populating Caterham

Degradation being the tendency of all mental disease, it is to be borne in mind that these, although incurable cases, are saved for going to the lower stages of mental unsoundness and habits, by being brought to, and treated, in an Asylum.1

On the 20 October 1870, William B., a 25-year-old man from the Greenwich Union Workhouse, arrived at Caterham. In the casebook section headed Facts Indicating Insanity, the assistant medical officer (hereafter referred to as AMOs) described William, who was the 56th male patient to be admitted to Caterham, as being ‘of spare habit…[with] a weakly state of bodily health’ and was feeble in mind and intellect. William was regarded as having no memory, could hardly answer questions on arrival to the asylum and was ‘thin, puny [and] haggard’, possibly a result of the poor care he received at the workhouse. He was classified by the Caterham medical staff as an imbecile. During his time at the asylum, he worked on the farm helping with the crops and the animals, as well as working on the vast asylum grounds, which included formal gardens, orchards and airing courts for patients. William died in December 1916, aged 71 from senile decay, a catch-all term that was frequently used across asylums to explain the death of aged patients. William spent 46 years at Caterham, and given

© The Author(s) 2020 S. Eastoe, Idiocy, Imbecility and Insanity in Victorian Society, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-030-27335-4_3

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his physical work on the farm and grounds, his bodily health had presumably been improved through the regular diet, medical attention and the sanitary order of the asylum building and regime. William’s residency at Caterham encapsulates many of the key features of the asylum and its role in the wider mixed economy of welfare. As discussed in the previous chapter, Caterham was to be an auxiliary institution to the workhouse to provide suitable accommodation to those regarded as incurably insane, more commonly referred to as idiots and imbeciles. Asylum populations have been used to explore a range of social, cultural and economic factors. From Joseph Melling and Robert Turner’s research into the demographic character of patients admitted to the Devon County Asylum, to Catherine Colebourne’s study of the patient pathway of those admitted to Australian asylums, these studies have shown that a range of actors were involved in the identification and certification of insanity.2 David Wright discovered similar connections in his research of the Royal Earlswood Asylum, showing the varying links between the family, the broader Poor Law system, and the asylum.3 Moreover, such research, especially that concerning public asylums, has shown the diversity of the patient population in terms of socio-economic character. The term pauper applied to those who were receipt of Poor Law assistance, be it in the workhouse, a public lunatic asylum, like Colney Hatch, or in a poor law asylum like Caterham. Thus, in many Poor Law institutions, there would be inmates, residents and patients that ran the gamut of Victorian lower, working and middle classes, which saw labourers and domestic servants accommodated alongside former teachers, governesses and shopkeepers. This chapter will focus on the making of Caterham’s patient population and the administration of idiocy and imbecility in terms of the identification and certification of patients. It will also explore various demographic features of Caterham’s residents, such as age and gender, as well as death and discharge rates, and how these contributed to the wider character of the asylum. Attention will also be paid to the broad classifications of the many hundreds of people admitted to the asylum, and consider the issue and significance of misdiagnosis, in order to explore the manner in which idiocy and imbecility were understood in relation to other conditions, such as dementia and mania.

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Making the Patient Population Caterham was intended from the outset to provide long-term accommodation to people identified as idiots and imbeciles. This would include those regarded as being weakminded, feebleminded and incurably insane, namely those who were regarded as unfit patients for the many lunatic asylums that formed a core of the institutional network in the Victorian period. In line with this aim, Caterham’s admission policy specified the particular type of patient that it was to receive. Article 2 of the MAB regulations stipulated that the persons to be admitted into the Asylum shall be such harmless persons, of the chronic or imbecile class, as could be lawfully retained in a Workhouse; but no dangerous or curable persons, such as would under the Statutes in that behalf, require to be sent to a Lunatic Asylum, shall be admitted.4

The catchment area of Caterham had been decided at a joint meeting between the asylum’s management committee and that of its sister institution Leavesden, located in Hertfordshire. The meeting, held a month prior to the two asylums opening, saw a number of administrative matters be decided, such as the patient diet, the character of the admissions and the order that parishes and unions would send in their paupers. An imagined line was drawn across nineteenth-century London, from Paddington in the west to Poplar in the east, with the unions south of the line being under the reach of Caterham, those in the north were sent to Leavesden.5 A total of 15 parishes made up Caterham’s catchment area, which included some of the poorest areas of London. This included the Strand Union workhouse, which had come under particular criticism in The Lancet Sanitary Report which described their imbecile wards as …[having] the usual want of any provision for the frequent enjoyment of fresh air by the unfortunate imbeciles…[they] are placed in wards which offer the reverse of the conditions (as to ventilation, &c.) which ought to distinguish rooms used for such a purpose, and their life appears to be gloomy and objectless.6

A maximum of ten patients per day would be admitted to the asylum in the first few months, alternating between male patients on one day, female patients the other. This was to limit the amount of stress on the building, the staff and the patients in the initial filling up of the asylum. Indeed, as

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with many new buildings, there were several teething problems, including interruptions to water supply, trouble with the gas supply, which was produced on-site and issues with the heating on the wards. These were difficult enough to deal with when the asylum was partially full, but were further complicated due to the asylum having a body of staff who were relatively new and unfamiliar with the building, the regime and the patients. Perhaps aware of the potential problems, structural, administrative and managerial, the MAB management committee issued instructions to the Poor Law medical officers, who were responsible for selecting suitable individuals for admission to the new asylums. They stated that it would be preferable to have patients who were ‘as far as possible, in the first deliveries, able bodied, free from epileptic fits and free from dirty habits’.7 Patients admitted to Caterham, like those sent to other public institutions, required three documents: an admission order, a reception order and a medical certificate, none of which were to be dated more than seven days prior to the their arrival at the asylum.8 The admission order was to be signed by the clerk of the Poor Law Board of Guardians from the respective union or parish from which the patient was sent. The reception order was to be signed by a justice of the peace or magistrate and effectively sanctioned that the individual had been found to be ‘lunatic, idiot, or person of unsound mind’, as specified under the existing legislation regarding asylum admission.9 Attached to the reception order was a section which detailed the biographical and medical information of the patient. This was filled out and signed by the poor law relieving officer. The third document was the medical certificate, which had two main sections: Facts Indicating Insanity which had been observed by the certifying medical practitioner and Facts Communicated by Others, who could be family members, the Poor Law officers, workhouse nurses or attendants.10 The pathway often began within the home or the workhouse, with the administrative reach of the Poor Law found in the fact that in many cases it was the relieving or medical officer who would be conducting the initial assessment of the patient and writing the necessary certificates. Peter Bartlett and Elaine Murphy have shown that in varying ways the workhouse operated as an informal clearing house for the lunatic asylums of Victorian England. This relationship was somewhat organic and informal between these institutions and became more formal and cemented as the century wore on.11 In the case of Caterham, opening in the wake of several waves of institutional legislation, building and creation, this was a much

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more formal operation and relationship, as the MAB imbecile asylums were intended from the outset to be auxiliaries to the workhouse. The identification and certification of an individual as an idiot or imbecile, and therefore suitable for removal to Caterham, often relied upon popular understandings of idiocy, not psychiatric interpretations or opinions. Indeed, as Wright states, ‘medical superintendents were unable to influence significantly the process of confinement. It was a social phenomenon of dramatic proportions, seemingly outside their control’.12 This was most certainly the case at Caterham, with Dr Adam noting in his annual report of 1874 that many patients received at Caterham were suffering from impairments of the mind, delusions and memory loss associated with lunacy and were not exhibiting signs, symptoms or behaviours that were indicative of idiocy or imbecility.13 In his opinion, the workhouses, and families perhaps, were ridding themselves of those who were troublesome to nurse, the use of the word troublesome here meaning many things.14 This idea both of the wrong type of patient and the workhouse ridding themselves of troublesome patients by sending them to the MAB imbecile asylums was to be a common theme in the annual reports. Indeed, in 1889 Dr George S. Elliot, then medical superintendent at Caterham, noted that many of the admissions were aged and infirm, often a code for senile, and it would be better for them physically and medically if they had remained in the workhouse.15 Whilst this might appear a callous remark to make, Dr Elliot was aware of the emotional impact removal from ones locality could have on patients. He stated that these aged patients would ‘feel the shock of their enforced removal’ and could become depressed in their spirits, as they were perfectly sensible to their surroundings and, unfortunately, the ‘deranged habits’ of the idiots and imbeciles, who were the target patient group for Caterham.16 Over the period covered in this book, 10,488 patients were admitted to Caterham. Some were in good bodily health, and others were incredibly weak and frail, the original request for clean and able-bodied patients soon forgotten. Following their identification as idiots or imbeciles in the workhouse, and their physical journey to the asylum, accompanied by a Poor Law nurse or attendant, patients were seen in one of the two receiving rooms located at the front of the central administration block. It was in these rooms, one for males and one for females, that patients were examined by one of the members of Caterham’s medical staff, made up of the medical superintendent and two AMOs. Some admissions were the target patient group, idiots and imbeciles, others were found to be suffering from

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dementia, mania or melancholia, a contravention of the issued regulations. Some patients would be in relatively good health, and others were reported to be frail, sick and infirm in body and mind. Indeed, in 1889 Dr Elliot stated that a third of the new arrivals would be sent straight to the infirmary wards on account of their poor health.17 Be they healthy and fit, or frail and infirm, during the admission process all patients were asked a range of questions to gauge and assess their intellectual capacity, such as the days of the week, the months of the year, how many shillings were in a pound and whether they could count to twenty.18 Some patients were able to answer these questions; others were uncommunicative on arrival. This could have been due to the stress of the journey and the shock of institutional committal, whilst for others they may well have been incapable of speech.19 Theresa F., admitted to Caterham in March 1888 from the Fulham workhouse, refused to answer questions on arrival, whilst Emily F., a 41-year-old servant from St Mary parish workhouse in Islington, knew her age and her date of birth, but was incapable of answering other questions correctly.20 Similarly, Jonathan A., admitted in November 1911, was described as having ‘no sense of time, how long [he had] been at [the] place, or value of money, or days of week’.21 Admitted in 1911, the description of Jonathan suggests that after nearly forty years, asylum staff were still employing the same criteria to assess and describe patient intellect, despite developments in intelligence testing, such as Alfred Binet’s IQ test.22 Evidence, perhaps, of Caterham’s staff approach to classification relied on tried and tested matters that worked for them, rather than theories and ideas from higher up the medical chain. Indeed, as with many of Caterham’s patients, the asylum’s senior staff remained at the asylum for several decades. For example, Dr Elliot joined the asylum as an AMO in 1871, succeeding Dr Adam as medical superintendent in 1880. He remained in post for twenty years, retiring in 1900 to be replaced by Dr Campbell, who joined the asylum in 1883 as an AMO. Such longevity of service led to a degree of consistency in language, management and administration, especially in terms of patient classification. Alongside intellectual and memory tests, patients were also subjected to physical examinations to assess their bodily condition and general health. The rationale, and need, for these examinations was varied. Some patients were measured on admission, especially if they presented an unusual case, such as microcephaly. Bruises, marks or injuries upon arrival were noted and recorded in the casebook, in part to illustrate that any form of harm was not the result of violence or abuse from a Caterham staff member. This

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was a very real concern for asylums, and they took great pains to show that they were not abusive or neglectful, which alas was an experience for many asylum patients, Caterham included. Patient’s circulation and bodily functioning were examined, with the AMO noting whether they had murmurs in their hearts, irregular pulses or crackles in their lungs. This could be an indication of certain debilitating conditions, such as tuberculosis, which would merit their transfer to the infirmary wards or the detached hospital. Patients were also checked to see that they were free from disease, lice and other infectious or contagious conditions, in part to ensure the sanitary efficiency of the asylum and the general health of the patient population. Female patients were subjected to more intrusive physical examinations and observations than their male counterparts, in part in an effort to ensure they were not pregnant. This was for two key reasons, medical and administrative. Elaine Showalter has shown that the female reproductive system had become pathologised in the Victorian era, with menstruation and childbirth both regarded as causes of mental illness and instability.23 There was also the fear of profligacy amongst idiot and imbecile women, which was regarded by many to be a sign of their reduced intellectual capacity, not least their inability to make sound decisions regarding procreation, which became seen as a form of dangerous female sexuality. Asylum staff would note when female patients menstruated prior to arrival at the asylum, and when their first catamania occurred at the asylum. If pregnancy was suspected, women would be further examined and placed under close observation to monitor their condition and menstrual cycle. If pregnancy was confirmed, the patient would be discharged back to the workhouse, in some cases being readmitted to the asylum once the child had been delivered. Such was the case of Charlotte H., a 19-yearold servant from Fulham, who was readmitted to Caterham in October 1881 after initially being admitted in April of the same year and discharged due to her ‘puerperal condition’.24 Notes in her casebook state that the child had died.25 Based on comments made by her mother, captured in the original medical certificate which does not survive in the archive but which pertinent sections were neatly transcribed into the asylum casebook, Charlotte was considered to be ‘eccentric at times’ and unmanageable.26 The workhouse nurse, who accompanied Charlotte to the asylum, corroborated this, claiming that ‘if left alone, [she] is not capable of taking care of herself, but gets into mischief’, a possible reference to her unchecked sexual behaviour, and why it was decided to remove her from the workhouse, where she was first sent by her mother, to the asylum.27 Charlotte

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was classified as an imbecile and remained at Caterham until her death in June 1894 from cardiac disease, having lived within the asylum walls for thirteen years. Charlotte’s time at Caterham was relatively short, compared to William B., discussed at the start of this chapter, who had been in Caterham for forty years. When Charlotte died in 1894, a total of eighty two patients who died in the same year had residencies of over a decade, a quarter of whom had been in the asylum for over two decades. Given the recording practices at Caterham, it is difficult to measure length of residency across the period 1870–1911 consistently, as statistical criteria, frequently altered in terms of date range and data criteria. Indeed, length of residency at death represents a different type of residency to that regarding length of time spent in the asylum before discharge, be it transferred to a lunatic asylum or to the care of family and friends. However, broadly speaking, as the century wore on, in line with Caterham’s remit, residency rates had two key trends. For patients who died at Caterham, many died within one or two years of admission, a sign of their frail and aged states, a frequent complaint of the medical superintendents, or they would die after a lengthy residency, often after several decades. It would be easy to interpret these lengthy residencies as a form of institutional dumping, as suggested by Andrew Scull.28 However, Caterham was intended to be a long-stay site; thus, we need to consider the creation of its population through a different lens to that which we might apply to lunatic asylums. We will never fully know what motivated, shaped and influenced the initial admission of a person to Caterham, or why they would remain there for decades. What we do need to consider, however, is that when people were sent to Caterham, it was in the knowledge that they would be there for a long period, given the purpose and role of the asylum in the wider mixed economy of welfare. Moreover, contemporary understandings of idiocy and imbecility were that they were incurable and permanent conditions. Charlotte was not transferred from Caterham to a workhouse or a lunatic asylum. She was considered to be incapable of attending or managing herself and thus was not discharged to the care of her family or friends. Her sexual mischief and socio-economic failings as alluded to in her inability to take care of herself saw her removed to the asylum and kept there for years. This could be seen as form of social segregation of the undesirable from wider society, and an example of social dumping.

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However, Caterham was built to provide suitable accommodation to the harmless and incurable insane, who otherwise may well have been subjected to the institutional merry-go-round that saw people circulated between workhouses, asylums and infirmaries, seldom receiving adequate care or attention. Many of the patients received at Caterham, especially in the formative years, had effectively bounced between asylums and workhouses. James Kyle F. was the 20th patient admitted to Caterham when he arrived on 4 October 1870. He had previously been a patient at Bethlem Asylum before being sent back to the Westminster union workhouse. Following his admission to Caterham, he remained at the asylum until his death in December 1910.29 Of course, we could write these patients off as being dumped in an asylum, yet that overlooks a number of nuances of the mixed economy of welfare and the realities for those members of Victorian society who were regarded as incurably and chronically insane, conditions which rendered them problematic in a system predicated on cure. Caterham could be considered to be a heterotopia of compensation in two contexts. It provided order to counter the disorder of the circulation of the idiot and imbecile across the institutional network of Victorian London. Moreover, and for many patients Caterham was a site of stability and consistency to those who required it, acting, perhaps, as a figurative ‘stone mother’ as identified by Barbara Taylor.30 Of course, this was not the experience for all who found themselves admitted to Caterham, but it is important to consider that for some it was a place of sanctuary, a place of care, and a place offering some form of institutional security.

Popular Perceptions Beyond the aims and intentions of Caterham as a long-stay site, how were these individuals viewed, understood and described by lay people, the Poor Law medical officers and families who were often in the front line of care? Considering these factors allows us to consider how and why people like Charlotte, James and others, entered the realm of the mixed economy of welfare. There are glimpses of these attitudes and reasons in the patient casebooks, such as the information transcribed from the admission documents. These snippets are the only glimpse we get of lay perceptions, understanding, and experiences of idiocy in the patient pathways to Caterham as the original certificates do not survive in the archive. These observations are framed and shaped by the certification process, and this practice encouraged people to stress certain behaviours and language that they knew

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would be effective in demonstrating a person’s idiocy, imbecility or insanity. Indeed, as Kim Price has shown, the deserving poor were well versed in the working practices and responsibilities of the poor law. Families were active users of the workhouse, the Poor Law and the wider mixed economy of welfare, able to navigate and negotiate the system often for their own, or family members’, needs.31 The transcribing and copying from the admission documents into the casebooks creates a new type of archive in and of itself, one which is shaped by the medical and institutional gaze. Yet, when one considers the range of information that was captured, and the process of selection and presentation, especially when the voice of the family is noted and recorded, it suggests that the medical gaze or the institutional context was not necessarily totalising or silencing in practice. Charlotte Mackenize has stressed the need to pay attention to such matters, as they can reveal what was considered to be representative or indicative of idiocy, or insanity, to a range of historical actors.32 The case of Elizabeth K., admitted in 1886, illustrates two views and understandings of idiocy. According to notes in her casebook, Elizabeth’s brother felt that she was of weak intellect and ‘cannot be trusted to go on an errand’.33 Sarah Wilson, attendant to the insane at St Giles workhouse where Elizabeth had been sent by her brother on account of her ‘mental weakness’, stated that she was ‘not able to wash and dress herself or cut up her food properly from lack of judgement’.34 It is rare to catch two views, or perceptions, of idiocy within the casebook. Paying attention to the language used allows us to see how people made sense of idiocy, and as Wright has discussed, the ‘juxtaposition of medical and lay testimonies…[allowing]comparison and contrasting of medical and lay definitions of insanity…[and] working-class responses to medicine…’.35 For Elizabeth’s brother, idiocy was to be found in her inability to be trusted or to do simple things, like go on an errand. This hints at the care demands and surveillance required for many families, which for those drawn from the working, labouring and lower classes was stressful when the economics of the household were stretched, or when people were not able to attend and watch over vulnerable relatives. Indeed, at age 25, when she was admitted, Elizabeth would have been expected to undertake some form of work to contribute to the household economy. This may well explain, in part, the decision of her brother to have her admitted to the workhouse, as the care demands, with no parents (who presumably may well have died and

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had been providing care for Elizabeth), proved too much emotionally or financially. Of course, it must be borne in mind that people were also drawing on language and descriptions of certain behaviours that they hoped would ensure committal. Yet this should not always be regarded as a totalising act, as people wanting to have their kin admitted to the asylum were not always doing so for nefarious reasons. For some, it was an act of care, given they, as possibly in the case of Elizabeth’s brother, were unable to manage their family member. This is suggested by the fact that in many cases relatives continued to maintain links with patients following admission. This will be discussed in more detail in subsequent chapters, but it is important to note that family and friends would travel to Caterham on designated visit days, as well as during festivals and fetes that were regularly held in summer months at the asylum. There is also mention of letters and telegrams sent to mothers, fathers, sisters and brothers to tell them of accidents, injuries or impending death to ensure they could see their relative before they left this mortal coil. Returning to Elizabeth, for the workhouse staff, according to the testimony of Sarah who is noted as the Poor Law attendant, her idiocy was manifested through her inability to dress, feed and wash herself. Again, as with the inability to undertake errands within the family home, the inability to manage oneself would have had significant meaning within the workhouse environment, where sanitation was a pressing concern. In the overcrowded and understaffed workhouse, having to attend to people unable to manage themselves was difficult. Thus, this type of description was frequently used by workhouse staff to describe and indicate suspected cases of idiocy and imbecility when filling out admission documents. The lack of reference to intellectual capabilities suggests that for many lay people, idiocy and imbecility were measured in terms of social competency, of being unable to undertake, and complete everyday tasks, rather than appeal to matters of intellect. This was to prove troublesome in terms of Caterham’s patient population composition as the century wore on.

Accommodating Patients Following the physical examination and the assessment of admissions, patients were washed and given an asylum uniform, their own clothes stored away or if they were the property of the workhouse, they would be packed up and returned to the appropriate poor law union. The washing of patients

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served a number of purposes for the efficient running and continued sanitation of the asylum. Dr Adam felt that the insane, curable or incurable, emitted a particularly noxious odour, an opinion expressed by many asylum medical superintendents, some of whom described their eminence of smelling similar to feline urine or having a brassy character.36 As well as countering offensive odours, cleaning patients prevented the chance of a disease outbreak or infestation of lice. Such practices helped to maintain the good health of the patients, something which was incredibly important at a long-stay institution. Moreover, it helped to maintain good sensory order. John Conolly, medical superintendent of the Hanwell asylum, stated that the sign of a well-managed institution was the lack of odour, claiming that ‘nothing offensive to sight or smell should be permitted in any part of the asylum’.37 That included the smell of the patients, as well as the wider institutional building and environment. Once the patient had been assessed, cleaned and clothed, they were sent to the appropriate ward. Those considered to be suffering from infectious diseases were placed in the detached infectious hospital, located at the rear of the asylum complex.38 Patients considered to be in a debilitated or fragile state were sent to the infirmary wards. These were located at the front of the asylum, closest to the AMO apartments and the medical superintendent’s home, which was linked to the administration block by way of a small corridor, so that he could be easily reached in the case of an emergency.39 The asylum also had separate wards for patients who suffered from fits, convulsions or were diagnosed with epilepsy. These wards had a higher ratio of day and night nurses as epileptic patients were susceptible to hurting themselves during fits, especially at night when suffocation during a grand mal was a further concern. In 1880, Dr Elliot informed the management committee that ‘no less than six attendants, three male and three females, are specially employed at night alone’ on these wards, compared to one or two on the other wards.40 Beyond this, patients were grouped together in relation to their behaviour, their physical condition and their employability, such as the 160 female patients accommodated in the newly built laundry block in 1874, which had wards attached for ease of movement and management.41

Patient Admissions Between the years 1870 and 1911, a total of 10,488 people were admitted to Caterham, the vast majority from the infirmary, lunatic and idiot wards

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of metropolitan workhouses. These sites represent the primary institutional network within which Caterham operated. As the nineteenth century wore on and the number and range of institutions which constituted the mixed economy of welfare grew, patients were received from other MAB institutions, such as Caterham’s sister institutions Leavesden, and Darenth built in 1876 for the care, accommodation and training of idiot and imbecile children. Patients were also transferred from local county and borough asylums, such as the two Surrey County Asylums, and a number of Middlesex County Asylums, including Hanwell and Colney Hatch. Patients were also received from nearby private idiot asylums, such as Earlswood and Normansfield. Many of these transfers, especially those from local asylums, were often part of large-scale inter-institutional patient exchanges, with Caterham swapping their undesirable patients, those considered dangerous, troublesome and in many cases curable, for the harmless and incurable insane patients. These were patient groups who were, on either side of the institutional terrain, clogging up the system. For example, in 1875, 29 patients were discharged from Caterham and sent to county lunatic asylums as they were found to be ‘not fit cases…on account of their homicidal or suicidal propensities’, evidence of insanity, not idiocy.42 These exchanges illustrate the prevalence of the wrong type of patient being sent to both lunatic and idiot asylums, hinting at the fact that not all patients admitted to Caterham were idiots and imbeciles, a fact that was an administrative thorn in the side of every one of Caterham’s medical superintendents. As can be seen in Fig. 3.1, there was a steady stream of patients admitted to Caterham. The high number of admissions in 1871 represents the initial filling up of the asylum following its opening in September 1870. The relatively high number of admissions in 1874 and 1876 is due to the opening of two new ward blocks, the first on the female side and the second on the male side, which saw the total accommodation increase from 1500 to just over 2000. These new ward blocks were the result of the widespread demand for institutional accommodation. Leavesden was similarly enlarged in the imbecile asylum’s formative years. Fluctuations in admissions were due to a number of factors. There was of course the perennial issue of the availability, or often not, of vacant beds at Caterham. These were governed by the death, discharge and transfer rates, which will be discussed in more detail later in the chapter. Patient admissions could also be suspended during disease epidemics in the Metropolis. This occurred in 1872, 1877 and 1886, the latter due to an outbreak of smallpox which also led to a cessation of visits from family and friends.

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Fig. 3.1 Patients admitted to Caterham 1870–1911. Sources MAB Annual Reports 1870–1888 and MAB Statistical Reports 1889–1911

These were rather fraught times at the asylum, as during these periods not only were admissions and family visits suspended, but also visits from entertainers, such as the Walter Bijou Company who regularly appeared at the asylum, which were stopped due to fears of contagion.43 The annual reports would note the general dismay felt by patients and staff during these periods, as well as the increasing pressure to both care for and occupy patients at times of increased institutional boredom. Dips in admission, especially during the 1880s and at the turn of the twentieth century, were due primarily to low discharge and death rates during these periods.44 Between 1870 and 1879, a total of 1970 patients died. In the following decade, 721 patients died, and in the following ten years, 762 patients died. In the first decade of the twentieth century, the death rate increased significantly to 1684 patients, many of these representing deaths amongst some of the first waves of patients and the wider ageing of Caterham’s residential population.

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From 1876, there was a relative stabilisation of admissions to Caterham as compared to earlier years. This was due to, in part, to the dispensing of new stricter, admission rules and regulations drafted by the Local Government Board, a new administrative body founded in 1871, which took over many areas of public health and welfare and effectively replaced the PLB.45 There was another reason for the stabilisation of admissions however, which hints at the purpose of Caterham within the wider mixed economy of welfare. By 1875, there had been an effective clearing of the workhouses of their chronic, incurable and infirm cases afforded by the opening of Caterham and Leavesden; thus, after six years, the ‘supply’ of the mass of idiots and imbeciles who had ‘congregated’ in the metropolitan workhouses had been depleted. This was noted by Dr Adam in his annual report of 1876, when he commented on the reduced numbers of admission, ‘…[in] 1874, 504 patients were admitted; in 1875, 486, and now the further diminution has taken place to 385’.46 The cause of this diminution was clear; Dr Adam claimed I cannot state with any confidence, but it may be the case that a class of cases which for a time were considered fit for the treatment in this Asylum are with further experience found more suitably detained and treated elsewhere. The chronic and imbecile cases also, which had previously to the erection of the Metropolitan Asylums, accumulated in large numbers in workhouses, were, after the opening of these Asylums, gradually sent, and the supply is probably now becoming exhausted.47

Even with the falling off of admissions, on average 250 patients were admitted to Caterham each year. As can be seen in Fig. 3.1, women often outweighed men in the admissions in particular periods, especially in the formative years. When Caterham was first designed, the total accommodation was set at 1500: 840 beds reserved for female patients and 660 beds for male patients. The initial accommodation figures and ratio were based on estimations made by the imbecile committee that the number of incurable and chronically insane residents across the metropolitan workhouses was around 3000. Studies have shown that in certain categories women would outnumber men, specifically in the 20–40 age group, and were more broadly the main recipients of outdoor poor law relief.48 Similarly women made up the proportion of institutional admissions and resident populations, in part due to their longer lifespan.49 Thus, these social factors,

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namely the greater number and presence of women across the nineteenthcentury institutional landscape, could have accounted for the greater number of beds being provided for female patients at Caterham, especially at the initial design stage. However, whilst in certain periods women outweighed men in terms of admission in particular years, over the period covered in this book more men were admitted to the asylum. This is despite 60% of the total beds being reserved for female patients. Between 1870 and 1911, a total of 5418 men were admitted to Caterham, which equates to 51% of the total admissions, compared to 5080 women (49%). Whilst these figures are close, these admission rates suggest that the classification of idiocy or imbecility was identified and attributed to men more so than women. This echoes Wright’s findings regarding the gender make-up of the admissions to the Earlswood asylum, which saw almost twice as many boys admitted than girls between 1865 and 1890.50 Peter Carpenter’s research on the Bath Idiot school, one of the first idiot institutions in Britain, had a similar male dominance in the admission rates, most significantly in 1861 when 22 boys aged between 6 and 13 lived in the small asylum, compared to just two girls aged 14 and 15, respectively.51 It is interesting to note that during the six years that children were admitted to the Caterham asylum (1870–1876), boys significantly outnumbered girls. In fact during this period, 68% of 143 patients admitted to Caterham under the age of 20 were male. Due to the lack of large-scale statistical analysis of idiot and imbecile asylum admissions, it is difficult to place Caterham’s admission rates in a broader institutional context. However, looking at data gathered by the census, Caterham’s admission rates correlated with national figures, especially regarding the higher prevalence of idiocy in men. The 1871 census was the first to separately record idiocy and lunacy in the final column where those filling out the form were to indicate whether an individual was blind, deaf and dumb, imbecile or idiot, or lunatic. In the statistical report of 1881, the Chief Enumerator remarked that ‘out of equal numbers [of idiots and imbeciles] living of each sex under 25 years of age, there were 133 [male] idiots enumerated to 100 female idiots’.52 Younger men, especially those who were unemployed or unemployable, could be seen as conspicuous in the nineteenth-century household. Wright has argued that the greater number of adolescent boys in the admissions was due to the ‘household problems of idiot boys…[and] the general bias of Victorian society towards the need to produce self- sufficient young men’.53 Also, as Charlotte Mackenzie and Anna Shepherd have suggested, families were often

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Table 3.1 Number of idiot or imbecile persons, per million of persons enumerated

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Ages

Male

Female

0– 5– 15– 20– 25– 45– 65 and upwards All ages

156 965 1741 1740 1556 1490 2170 1274

100 673 1332 1390 1612 1857 2727 1246

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Source Census of England and Wales, 1881, Vol. IV. General Report BPP 1883 LXXX [C.3797], 67

motivated to seek out treatment for troublesome male relatives who were potential breadwinners, out of economic necessity.54 These sociocultural factors could well explain the reason for a more acute medico-psychiatric focus on the chronic and incurable insane male. Table 3.1 is taken from the 1881 census and shows the rates of idiots and imbeciles per million broken down by gender and age. Men dominate in the younger age groups, and it is not until the mid twenties that women are the greater number, with the differences between the two genders widening in the 45 plus age bracket. As an explanation for the greater number of women returned both as institutional patients and in the older age brackets, the census registrar reported it to be a result of the ‘enormously high death-rate of the male insane as compared to the female insane’.55 This was further explained by the fact that men suffered from more severe forms of mental illness and mental deficiency and thus were ‘more rapidly swept away by death, while the female cases, though fewer in number, live on and accumulate’.56 This was certainly the case at Caterham. In 1883, Dr Elliot, commenting on the history of the asylum for that year, stated ‘there is nearly always a preponderance of Male deaths, which is in a great measure due to the much larger number of GPI amongst the male insane, this the most fatal of all mental disorders, being a comparatively rare disease amongst women’.57 Moreover, Dr Elliot’s comment alludes to the everpresent issue of misdiagnosis in the admissions to Caterham, namely of conditions regarded as curable insanity being mistaken, purposely or accidently, for idiocy and imbecility, which will be discussed in more detail the latter part of this chapter. Suffice to say, however, that women did outlive men inside and outside the asylum.

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Age, Admission and Residency at Caterham Caterham’s admissions in terms of age and gender echoed the Census findings, with more women being admitted in the age brackets above 50. This hints at the character and profile of the wider mixed economy of welfare population, from which Caterham drew its patients. As Table 3.2 shows, whilst there was a fairly even spread across the age groups of patients admitted to Caterham, those aged between 20 to 30 constituted the largest group. From its opening in 1870 to 1875, children were admitted to Caterham, which explains the relatively high number of patients aged twenty and under. It was soon realised that having young children in the same asylum as aged patients was detrimental to both groups and that the former required a different institutional regime, accommodation, and treatment. It was decided that all those aged 16 and under would be transferred initially to Hampstead asylum, originally a temporary fever hospital set up by the MAB, in preparation for the opening of the Darenth Idiot Asylum, which catered to idiot and imbecile pauper children.58 The number of patients admitted to Caterham aged twenty and above correlates broadly with the national figures as identified by the Census Registrar in 1881. This age group represents patients whose parents, namely mothers, may well have died, or when siblings, especially elder sisters, may well have married and left the family home. This could result in a crisis in care and see the informal familial management of idiot and imbecile relatives break down. Indeed, Elizabeth, mentioned earlier, was admitted to the Caterham based on testimony from her brother. It is presumed from Table 3.2 Ages of patients admitted to Caterham (total) 1870–1911

Age

Male

Female

Total