Looking Back: The house of cure

There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside – the asylum which our forefathers built with such immense solidity.
Enoch Powell, Minister of Health, 1961

On 10 May 1837 the Leicestershire County Lunatic Asylum opened its doors to patients. Built at a cost of £17,948, the asylum was located on the current site of the University of Leicester in a rural landscape. There was space for 104 patients (the first recorded being a Mary from Shepshed). My research has turned the pages of the surviving admission registers, case books, superintendents' journals and reports of visitors to discover what life was like for more than 7000 patients admitted before the doors closed in 1908.

I spent many hours with the records, held at the Record Office for Leicestershire, Leicester & Rutland at Wigston Magna. I lived with Sarah the Bible reader from Shepshed, Mark Anthony the warehouseman from Loughborough, Harry the timber agent from Syston: very real people, what brought them to the asylum and what happened to them. My own misconception that mentally ill individuals arrived hidden in carriages and often in restraints, to spend the rest of their lives behind locked doors, was soon cast aside. The Visitors Committee remarked in 1849 that the Asylum was to be 'a house of cure and not a house of detention', and it does appear that around 50 per cent of the people admitted were cured enough to eventually return to their former lifestyles.

The need for admission

Twenty-six patient case books, which run from 2 January 1845 up until its closure, are the most informative documents, containing the basic admission details, plus a full description of illness and treatment. They are extraordinary vehicles of historical research, because so much effort was originally made in compiling them. The patients had to have the necessary paperwork at the time of their admission, or they would be discharged immediately. At times, the admitting officer would reveal frustration at a lack of information:

The previous history of the patient like that of most others is wrought in mystery, for the reasons so frequently assigned before and it is much to be regretted, that some more compulsory means are not adopted by legal enactment, to remedy so important a deficiency in the furnishing of information essentially useful in the treatment of the case and most invaluable in a statistical point of view.

However, we do know that around half of the admissions were recorded with mania and approximately a quarter with melancholia. The strategic importance of an accurate classification of a patient's medical condition at the time of admission is emphasised by the following inclusion in the Medical Superintendent's Journal 15 Sept 1869, with one of the phrases being underlined by the superintendent:

There has been considerable amount of excitement and confusion in the wards lately owing principally to the want of classification – and to the admission of some very maniacal patients.

The most difficult to classify accurately were those with severe mental handicap (over 400 of them), which was usually the result of congenital defect, a serious accident or a major infection. They were often very noticeably younger than the general clientele, with two boys being admitted aged just four. Young Frederick from Knighton was multiply handicapped:

The patient is completely unable either to walk, speak or feed himself, he is obliged to be fed with a spoon of the attendant and passes both faeces and urine apparently without consciousness.

Many family households would have found it exceptionally difficult to care for those affected with such a degree of disability. There are also many records made of incoming patients also suffering from epilepsy.

For many, they did not have to be mentally retarded to cause noticeable difficulties within their environments.

A hosiery seamer from Wigston suffering from chronic mania was found cooking meat, sugar and tea together in a frying pan; Mary Theresa from Glenfield would go out gardening with a carving knife at 4am.

Religious beliefs played a major part in the lives of almost all the patients being admitted, and around 200 patients were just too wrapped up in their religion, which was reputed to be the cause of their mental malady. William, a bricklayer from Castle Donington, complained of pains in the head due to his being 'Too much engaged in the work of God', and David the labourer from Earl Shilton 'had a commission from God to destroy all unbelievers'.

On occasion the case books reveal more everyday disquiet. Martha, who had apparently starved her children and believed herself to be the worst woman in the world, had:
…what has been commonly called an ill assorted marriage, for her former husband she entertained the fondest affection, for the latter unmitigated disgust, hence arose those fruitful sources of domestic disquietitude [sic], unhappy comparisons, and mutual recriminations, until the domestic hearth became desecrated and her home a hell upon earth… how few of these instances are ever recorded, yet how fearfully, they add to the long list of misfortunes and insanity.

Patients of all ages, sexes, religions and occupations therefore came to the asylum as patients, and most entries in the case books suggest good reasons for their admission. However, one officer seemed quite annoyed about the admission of William, an intemperate framework knitter:

This case is a very deplorable one… he seems to be sent into the asylum simply because he is dirty and troublesome.

A few patients had the same answer to any question, like Mary from Shenton: 'When can I go home?'

Treatment within the 'house of cure'

The records suggest that the asylum never lost its stated focus of being a 'house of cure'. Many positive things continually happened within those walls, but less positive things were inevitably going on too.

The number of deaths within the asylum walls cannot be ignored. At least eight patients died on the day of admission or the very next day, 259 died within a month of admission, virtually 700 died within a year of admission with another almost 700 dying within the first five years as a patient. Yet equally we cannot ignore the fact that many patients were very seriously physically debilitated and critically ill at the time of entry. There were also large numbers of individuals being admitted in old age, and outbreaks of smallpox and influenza to contend with.

There were other negative inclusions amongst the records, with the most disturbed requiring, 'strait' 'stout' or 'short' waist coats and manacles, which were usually used to facilitate admission. The padded rooms were at times used after admission, but these corrective and protective facilities are very rarely mentioned. 'Confinement, probation or punishment of any inmate' was forbidden without medical authority.

There was to be 'no deceit or terrifying of patients, or irritation by mockery or mimicry'. The keepers 'shall not indulge or express vindictive feelings'; they were to 'forgive all petulance on the part of the patients and treat with equal tenderness those who give the least trouble'.

Whatever the state of those admitted – 'curable' or 'incurable', whether they were desperately incapacitated, relatively healthy, in a filthy condition or cleanly dressed – their treatment always started immediately. The Superintendent said of John from Ashby Folville: Upon referring to the date of admission and the recent date of the patient's illness it will be seen how rapid the recovery was and how important it is to subject insanity to adequate treatment in its early stage.

The priority was for patients to have access to the basic necessities of life. Many were from desperately impoverished backgrounds, so the availability of an adequate and appropriate diet was essential. The committee of visitors would come in as tasters, and diet sheets would be on view in the main hall. Those who had a total disinclination to food unfortunately had to be fed via an oesophageal tube.

Some, by contrast, had ravenous hungers: a housewife from Bottesford had an absolute passion for potatoes, and had to be watched at meal times as 'she would bolt off with them from the plates of others'.

One of the most important parts of the treatment process was to allow patients to experience some degree of a normal life. A troubled mind needed other things to think about, not directly related to their immediate problems. This was particularly important for those who were not fit enough for their free time to be spent actually working for the asylum in some way, such as in the laundry or out at Newbold Unthank on the asylum farm. The staff appear to have been focused in finding therapeutic activities for each and every patient, including basic recuperative activities or lighter tasks such as dusting, watering plants, sewing and darning.

Music, with its therapeutic potential, appears to have taken a major place within asylum life. The weekly dances were a much-favoured pursuit and even the young 'idiots' were given access to this activity. After a few brass instruments were purchased, a band was put together, composed of both attendants and patients. The Superintendent virtually took up the role of an entertainment manager with dramatic performances of either outside, amateur groups or those with staff as the cast. Ventriloquists, conjurers, comedians, puppet shows, choirs, musicians also all performed within the Recreation Room.

Fresh air was viewed as vital part of recovery and virtually everybody would have had access to the two 'airing courts'. Several patients were allowed to go unaccompanied for excursions into town and a few were actually given a key to the door. When an elderly patient was mugged whilst out, the street lighting was improved, rather than the patients being kept in. The trips were often not just around the corner: the Superintendent's Journal notes a trip by five patients down to London by train to view the Crystal Palace Exhibition in 1855, and 350 patients and staff went for a day's picnic by train to the asylum farm in June 1883. It certainly surprised me to find that in June 1885:…in the afternoon, Not one male patient was in bed, in the wards, or even in the airing courts – That is every individual male patient was free & beyond lock & key – and it may be doubted whether this ever occurred before in any Asylum. 

In 1882, the Superintendent had commented:
I believe the whole asylum is going on smoothly and without friction: which is greatly owing to our possessing a carefully selected and very respectable staff of servants all round, as well as the great liberty allowed to Inmates.

In case the reader thinks I am viewing the records through rose-tinted glasses, let me assure you that there are plenty of horrendous details to be found, including eight suicides. The Superintendent's detailed journals really do enlighten us to life within the asylum, and there is a sense that no dastardly deed or tragic event will be covered up. Looking back, we have to understand that within the asylum's 70 years of treating patients, many were admitted from such financial or experiential circumstances that breakdowns were perhaps inevitable. Despite this, counselling was a natural occurrence and patients were able to share their uneasy thoughts. When an extinct delusion was mentioned the patient was able to comment 'Ah bah humbug'. Camaraderie amongst the patients was in evidence: the records suggest that many patients established vital parental roles with some of the younger inmates or were helpful guardians to the frailer more elderly patients.

Essentially, the prevailing positive attitude of the staff remains in evidence, even when dealing with a widowed knitter 'wandering about with a face as long as a ladder', or Henry: 'unamused, glum, silent and unassociating'. Despite the tough task, the asylum recorded a statistical success of curing or noticeably relieving over two thousand patients within less than a year of their treatment. To me, the long-standing belief that once you were behind asylum doors you stayed there for ever totally devalues the extent of dedicated care and treatment afforded to the mentally ill of days gone by.

- The book, The House of Cure, is available from the University of Leicester Bookshop, David Wilson Library Building, University Road, Leicester LE1 7RH or http://shop.le.ac.uk, for £9.99. All profits go towards digitising the case books.

- Diane Lockley is a retired teacher and avid historian, based in Leicester [email protected]