Hearing Voices - Brendan Kelly

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of the Asylum, may admit upon their or his own authority, stating on the face of the order the ground thereof, provided always that when a patient has been admitted under this rule, the Resident Medical Superintendent, or in his absence the Visiting Physician, shall submit that case to the special consideration of the Board at its next meeting for the decision of the Governors thereon.268

      Various other regulations governed conditions and procedures within the asylums, and provide a valuable insight into the recommended patterns of asylum life:

      •‘The patients shall, on admission, be carefully bathed and cleansed, unless the Resident Medical Superintendent shall otherwise direct. They shall be treated with all the gentleness compatible with their condition; and restraint, when necessary, shall be as moderate, both in extent and duration, as is consistent with the safety and advantage of the patient’.269

      •‘Patients, except when special reasons to the contrary may exist, are to be clad in the dress of the institution, and their own clothes are carefully to be laid by, to be returned to them on their discharge’.270

      •‘Strict regularity shall be observed with respect to the hours for rising in the morning and retiring for the night; that for rising being fixed at six o’clock from the 1st of April to the 30th of September, called the Summer six months, and for retiring at an hour not earlier than half-past eight o’clock nor later than nine for the same period. During the Winter six months the patients shall rise at seven, and retire not earlier than seven nor later than eight o’clock’.271

      •‘The like regularity must be observed with respect to meals; in no case shall the ordinary number of meals be less than three, and they shall be supplied during the Summer six months at the following hours, viz: breakfast at eight o’clock; dinner at one o’clock; and supper at six o’clock; – and during the Winter six months at the following hours, viz: breakfast at nine o’clock; dinner at two o’clock; and supper at six o’clock; but patients actively employed in or out of doors may have an additional allowance of food between the usual meals by direction of the Resident Medical Superintendent’.272

      •‘On the admission of a patient the Resident Medical Superintendent, or if he shall be absent on leave, the Consulting and Visiting Physician, shall make himself acquainted as far as possible with the history of the case, and note the same down in the General Registry; he shall also examine into the bodily condition of the patient, who is to be placed in an appropriate division, and carefully attended to both medical and personally’.273

      •‘Patients may be visited from time to time by their friends, with the permission of the Resident Medical Superintendent, and as a general rule between the hours of noon and 4 o’clock, P.M.’.274

      These revised rules were certainly much needed as there was, during the 1860s and 1870s, a compelling and recognised need for better regulation of the asylums. John A. Blake (1826–1887), MP for Waterford and a governor of Waterford Asylum, was especially outspoken about asylum conditions, which, he claimed, had not improved despite the stark findings of the 1858 commission. In the early 1860s, Blake drew particular attention to the low quality of asylum staff, arguing that both staff selection and working conditions were deeply unsatisfactory.275 He also highlighted the lack of recreation or employment for patients, which impacted greatly on their wellbeing. Other problems included violence towards staff and between patients, sometimes resulting in death by, for example, choking (in Ballinasloe, 1873).276 A chamber pot was a common weapon: one female patient killed another with a chamber pot in the Richmond in July 1889,277 while five years later, in the Cork asylum, a male patient died owing to a combination of ‘shock’ and being hit on the head by another patient with a delf chamber utensil.278

      There were many other problems in the asylums too, not least of which were various illnesses and the relatively high risk of death as an inpatient.279 In the Richmond, for example, numerous patients were affected by a mysterious illness in the summer of 1894, and several died of the disorder which appeared to involve inflammation of the nerves. The RMS, Conolly Norman, consulted various experts, including Dr Walter G. Smith (president of the Royal College of Physicians of Ireland) and Sir Thornley Stoker280 (president of the Royal College of Surgeons in Ireland and brother of Bram, author of Dracula),281 among others. Though the condition was initially deeply puzzling for the physicians it ultimately proved likely that the asylum diet (low in fruit and vegetables and high in white bread) had led to beri beri,282 stemming primarily from a nutritional deficit in vitamin B1 (thiamine). While this mysterious episode remains the subject of scholarly study,283 it did, at least, draw considerable attention to the importance of diet in the asylum and highlighted the need for good physical healthcare for patients.284

      Tuberculosis, too, presented significant challenges to physical health in nineteenth and early twentieth-century Ireland, both inside and outside the asylums. By 1904, tuberculosis accounted for almost 16 per cent of all deaths in the Irish general population.285 Staff and patients in asylums were at particular risk and in 1901 tuberculosis accounted for 25 per cent of deaths in Irish asylums, with an average age of death of between 37 and 39 years.286 This problem was by no means exclusive to the Irish asylums: tuberculosis was also the leading cause of death in South Carolina Lunatic Asylum at the turn of the century.287 In Ireland, progress with tuberculosis was slow, but the start of the twentieth century saw renewed public health initiatives,288 dedicated legislative measures, such as the Tuberculosis Prevention (Ireland) Act of 1908,289 and changes in sociopolitical circumstances that helped alleviate matters somewhat.290

      Even so, death rates in Irish asylums still presented a substantial cause for concern throughout this period. In 1893, the Inspector of Lunatics reported a national death rate of 8.3 per cent in the asylums; this figure was derived by dividing the number of deaths in Irish district asylums in 1892 (995 deaths) by the daily average number of asylum residents; on 1 January 1893, that number stood at 12,133.291 Of those who died in district asylums, 198 (19.9 per cent) underwent post-mortem examinations which were, in the Inspector’s opinion, ‘of so much importance for the protection of the insane and for the furtherance of the scientific study of insanity’.292

      Death rates varied between asylums, with, for example, the Richmond in Dublin reporting a death rate (12.5 per cent) higher than the national average (8.3 per cent), possibly related to particular problems with overcrowding and infective illnesses at the Richmond.293 Comparable rates were, however, reported in other jurisdictions, with a 14 per cent death rate in South Carolina Lunatic Asylum between 1890 and 1915.294 Similarly, one third of men and 21 per cent of women admitted to the Toronto Asylum between 1851 and 1891 died there.295 At the Central Criminal Lunatic Asylum in Dublin, 42 per cent of individuals committed following a court finding of mental disorder between 1850 and 1995 died there,296 and 27 per cent of women committed following infanticide or child murder between 1850 and 2000 died there.297

      Walsh and Daly studied admissions to Sligo District Lunatic Asylum between 2 February 1892 and 6 May 1901, during which period there were 454 admissions with sufficient details for analysis.298 Of these, 75 per cent were male, 64 per cent single and 86 per cent Roman Catholic. Among those for whom family history was recorded, some 87 per cent had a family history of mental disorder. The most common recorded causes were heredity, alcohol, and domestic issues or financial worries. The most common diagnoses were mania (40 per cent) and melancholia (28 per cent). The most frequent recorded causes of death were tuberculosis and phthisis (probably pulmonary tuberculosis; 23 per cent), exhaustion (16 per cent) and dementia (9 per cent).

      Serious challenges with physical health continued into the 1900s, with the influenza epidemic of 1918299 hitting the asylums especially hard: a fifth of all patients in Belfast asylum died of it, and one patient in every seven in the asylums in Kilkenny, Castlebar, Maryborough and Armagh fell victim.300 Against this rather bleak background, there were, nonetheless, continued efforts to ameliorate the problems in the asylums, with Norman at the Richmond, for example, doggedly (if unsuccessfully) promoting ‘boarding out’ in the late 1800s and early 1900s.301 In addition, outpatient clinics were promoted in the early 1900s and the Society of St Vincent de Paul was later approached to set up an after care committee.302

      Notwithstanding these efforts, conditions in Irish asylums remained very difficult throughout the late 1800s and early 1900s, owing to toxic combinations of

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