ТОП просматриваемых книг сайта:
Hearing Voices. Brendan Kelly
Читать онлайн.Название Hearing Voices
Год выпуска 0
isbn 9781911024446
Автор произведения Brendan Kelly
Издательство Ingram
Middleton was well established as principal medical superintendent at Hanover Park before turning his entrepreneurial eye on Carlow Castle. His injudicious use of blasting powder, however, resulted in an explosion early on the morning of 13 February 1814: the castle’s two eastern towers collapsed, as well as part of the adjoining walls.101 Middleton’s subsequent career was marked by further controversy and litigation, although he did publish, in 1827, a noted ‘essay on gout’.102
By 1825, there were at least five private asylums in Ireland, in addition to charitable asylums in Dublin.103 As well as Hallaran’s Citadella in Cork, there were three private asylums in Finglas, County Dublin (including asylums managed by Dr William Harty and Mr Gregory) and one in Downpatrick (Mr Reed). From 1826, it was necessary for the Inspector-General of Prisons to visit and report on asylums kept for profit every two years.104
The situation for private asylums changed significantly in 1842 when the Private Lunatic Asylums (Ireland) Act made it unlawful for anyone to keep a house for two or more insane persons unless that house was licensed.105 Patients could only be detained on foot if a certificate signed by two doctors and medical input was required at the establishment. Harty, in Finglas, objected strenuously against official interference in private asylums, penning a pamphlet addressed to Sir Robert Peel arguing that private asylums were well conducted and under the control of doctors.106 Ironically, Harty’s own establishment was subject to court proceedings in 1842, when the Lord Chancellor directed Harty to release a woman patient after Harty had refused to allow visits by her brother and her doctor. Further controversy followed and Harty’s establishment soon vanished from the list of private asylums.
In addition to the private asylums, paying patients were accepted into the Carlow, Maryborough and Richmond asylums during the 1840s.107 Other asylums were less enthusiastic: the first paying patients were admitted to Cork in the 1870s and, even then, initially on a small scale.108 By the end of 1862, there were some 21 private asylums in Ireland and the inspectors (Drs John Nugent and George Hatchell) found that the quality of care varied considerably between them. Mauger, in a superb study of private asylums in Ireland, notes that the number of such establishments generally increased from 1820 onwards, in notable contrast to England and Wales, reflecting differing legislative provisions.109 The increasing importance of this sector in Ireland was highlighted by the 1842 Act, the first legislative measure exclusively devoted to private asylums, which for the first time provided for the licensing and regulation of these establishments. While they catered chiefly for the Irish upper classes, this did not mean restraint was not used or that the private asylums were free from allegations of poor conditions, although, for the most part, conditions were generally reported as acceptable.110
Private asylums continued to operate throughout the latter part of the 1800s and early 1900s. By 31 December 1929 there were 841 patients (333 males, 508 females) in private establishments, of which eight were ‘licensed in pursuance of the provisions of the Private Lunatic Asylums (Ireland) Act, 1842. The remaining four (Bloomfield Institution, St Patrick’s Hospital, St Vincent’s Institution, and Stewart Institution) being “charitable, institutions supported wholly or in part by voluntary contributions and not kept for profit by any private individual” [were] exempt from licensing. Licences were granted in 1929 for the reception of 553 patients, an increase of 20 compared with the previous year’.111
Private asylums played important roles in both providing care and developing the profession of psychiatry during this period. Prominent establishments included Dr Osborne’s Lindville Private Lunatic Asylum on Blackrock Road in Cork112 and Verville Retreat in Clontarf, Dublin. By 1930, Lindville, then under the stewardship of Mrs Elizabeth E. S. Osborne, received a generally positive report from the Inspector of Mental Hospitals:
The demeanour of the patients, as well as their neat appearance, reflects credit on the management of this institution. Concerts, dances and card parties are held. One patient required restraint. Catholic and Church of Ireland clergy visit the house frequently. A number of patients are allowed out on parole and some occupy themselves at gardening and fancywork.113
At Verville, Dr Patrick Daniel Sullivan was elected to the Irish Division of the MPA in 1922.114 In 1929, the Inspector reported that Verville was ‘well kept’ and the ‘general health’ of the patients ‘remarkably good’;115 by 1933 a veranda had been erected, ‘restraint or seclusion was not necessary in any case’, and ‘some of the patients attend cinema performances’;116 and in 1934 it was noted that ‘several patients go for walks and motor drives in the country’.117 In April 1949, the Irish Division of the RMPA held its Spring Quarterly Meeting in Verville, at the invitation of Dr Mary Sullivan.118 Thirty-six members and two guests attended. Dr M. O’Connor Drury read his ‘Report on a Series of Cases Treated by the ECT-Pentothal-Curare Technique’ and Dr Gilmartin gave a clinical demonstration of the use of curare and pysostigmine to produce a modified seizure in ECT (Chapter 5).
In that year, Verville had 30 patients, all female, including 7 women detained under the Mental Treatment Act 1945.119 The Inspector provided a positive report with particular emphasis on the use of ‘modern treatment’:
This home was well maintained. Re-decoration of some rooms had been carried out. Patients appeared to receive excellent nursing and many took part in outdoor recreation. All forms of modem treatment were applied with very good results.120
By 1949, Lindville had forty-one patients (including eight men), of whom eight were detained.121 Both Lindville and Verville would later close as mental hospitals, but back in the mid-nineteenth century, these kinds of private asylums were a key part of Ireland’s complicated, emergent ‘system’ of care, which was becoming noticeably more medical in nature with each passing year.122 A general lack of enthusiasm among governors for attending board meetings was another factor in shaping the evolving asylums:123 many governors never visited the institutions or attended any meetings, seeing their appointments simply as expected recognition of their positions in the local ascendancy.124
But, as Parry notes, it was, above all else, the advent, in 1843, of the General Rules for the Government of All the District Lunatic Asylums of Ireland125 that was pivotal in setting developments on their distinctively medical trajectory:
A major advance in the medical take-over of Irish asylums was the passing into law of the General Rules for the Government of all the District Lunatic Asylums in Ireland on March 27th 1843 … the 1843 rules gave the visiting physician complete authority in Irish district asylums. Describing the duties of the various offices on the district asylums, the Rules state that the manager should ‘under the direction of the Board, and subject to the directions of the Physician as to the treatment of the Patients, superintend and regulate the whole of the Establishment’126 […]. The physician henceforth was ‘to direct the course of Moral and Medical treatment of the patients’.127 The first victory of the Irish medical profession regarding madness was complete.128
The 1843 rules indeed placed very many responsibilities on the physician, who was ‘to attend on three days (to be named by the Board) at least in each week, and on every day at such Asylums in which the number of Patients shall exceed 250’:
•He shall also visit on particular occasions, when called on by the Manager, and shall prescribe for all Patients and Servants who may require Medical aid, and for the Resident Officers who may request Medical assistance. […]
•He shall attend daily on cases of Fever and on any other cases of an urgent nature.
•He is authorized to order such Diet as he may think necessary for any particular case, having, however, due regard for economy in each Article.129
•He should always visit every Patient under restraint, and, when he deems it safe, require such Patients to be temporarily relieved from restraint, and examine them so as to ascertain that they are not cramped or injured; and he should frequently go round the Asylum so as to see the state and condition of