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“Few subjects in medicine are so intimately connected with the history and philosophy of the human mind as insanity. There are still fewer, where there are so many errors to rectify, and so many prejudices to remove. Derangement of the understanding is generally considered as an effect of an organic lesion of the brain, consequently as incurable; a supposition that is, in a great number of instances, contrary to anatomical fact.” Philippe Pinel, Treatise on Insanity, 1801
Until the second half of the 19th century, the study of the brain and its interplay with the mind was beset by mysticism and confusion. Speculation was rife and constituted little better than a repository for the guesswork of ignorance. In varying degree, both neurology and psychology were culpable. In his book, The metaphysical foundations of modern physical science, EA Burtt described the concept of mind as “a convenient receptacle for the refuse, the chips and whittlings of science, rather than a possible object of scientific knowledge”.
The 19th century hospitals, created for the mentally ill, had two distinct but intertwined functions. The first was to provide a caring place for the treatment of the mentally ill who were commonly spurned by society, receiving brutal and harsh physical treatments and inhumane restraints over many centuries. Pinel had written Treatise on insanity,1 a revolutionary recipe for more gentle treatment and abolition of widespread brutality for the mentally ill. The second and often neglected function was the analysis of brain function and disease, whose investigation in time was to bear the fruits of the neurological sciences.
The 1842 Licensed Lunatic Asylums Bill proposed a Barristers’ Commission because it was recognised that county licensing and visiting were defective. It stated that two legal commissioners should visit and report on county houses supplementary to the county visitors. The House of Commons rejected this proposal and an amended bill became the 1842 Inquiry Act. Two medical and two legal commissioners were added. One of the medical commissioners was a psychiatrist, the other a statistician. They jointly visited and reported on public asylums and licensed houses throughout England and Wales, and in 1844, the commission published a 300 page report with recommendations. The 1845 County Asylums Act compelled every county and borough in England and Wales to provide asylum treatment for all its pauper lunatics. Lord Ashley told Parliament that this would “effect a cure in 70 cases out of every 100” (Hansard 6 June 1845 column 193).
Northern institutions included The Retreat at York, opened by the Quaker merchant William Tuke in 1796, and extended by his son Henry, and grandson, Samuel Tuke. There was also The Retreat at Castleton Lodge, near Leeds, “under the skilful management of Mr Hare, surgeon”.
The West Riding Pauper Lunatic Asylum2 (later, Stanley Royd Hospital)3 was sited in Wakefield, on East Moor, and Samuel Tuke gave advice about its workings and plans. It opened on 23 November, 1818. William and Mrs Ellis were the superintendent and matron from 1818 to 1831.It was a large establishment, and was repeatedly expanded. It was under the control of the West Riding Magistrates; and the initial land, buildings, and furniture cost about £100 000. CC Corsellis, MD, was an early resident physician and director and often had under his care about 450 lunatics. Henry Maudsley, born in Settle, in the Yorkshire dales, was briefly the director; he was the most esteemed psychiatrist of the day, and founded the Maudsley Hospital. Slater in 1864 noted its expansion:
“The asylum is situated about a mile north east of the town. Another building was erected in 1849, which far surpasses the old one, both in size and architecture; the whole combined are calculated to give accommodation to upwards of a 1000 patients.”
The hospital had many clinical clerks, clinical assistants, and physicians who attended the sick.4 By 1 January 1844, there were 433 patients—all paupers. The Stephen Beaumont Museum of Mental Health was in the hospital until it closed in 1995; it was moved to Fieldhead Hospital. It relates the history of the asylum and contains many exhibits. In 1948 a report on Wakefield was made by a medical officer to the new Leeds Regional Hospital Board. It described:
“The old gaol-like buildings at Wakefield are gloomy and depressing and the galleries where many patients aimlessly spend so much of their time are deficient in natural lighting. The accommodation can best be described as austerely pre-Dickensian, falling far short of usually acceptable standards . . .”
A major salmonella outbreak at Stanley Royd Hospital in 1984 led to the deaths of 14 psychogeriatric patients and the infection of nearly 400 others. The hospital closed in 1995.
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