Victorian London - Health and Hygiene - Hospitals - Middlesex County Lunatic Asylum (Hanwell)

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from The Illustrated London News, 1843

    The Middlesex County Lunatic Asylum.- This institution is distant from London about 8 miles, is situate at Hanwell, and owes its origin to the act of the 48th George III., cap. 96, and was completed under the act of the 9th George IV., cap. 40. This act was passed to enable the justices of the several counties to erect asylums for the reception and maintenance of the insane and lunatic poor, and to improve and ameliorate the condition of lunatics. Although these acts were not compulsory, the magistrates of Middlesex lost no time in taking the necessary steps to secure to this bereaved portion of the inhabitants of the county the full benefit of their benevolent provisions; and immediately appointed a committee to take all necessary preliminary measures with respect to the site and building, with a view to rescuing them as speedily as possible from the neglect and inattention of the workhouse, or the cupidity, ignorance, and cruelty, too often practised by those who farmed them in private asylums.
    The site is bounded on the north by the high road leading to Uxbridge, sad on the south by the Grand Junction Canal; and has the advantages of a dry gravelly soil, a pure atmosphere, and a plentiful supply of water. Architecturally, the building presents nothing more than simple plainness; but the large front airing-grounds, to which the patients have access daily, the shrubberies, gravel-walks, sun-shades, fountain and bowling-green, and other requisites are all indicative of comfort and order within.
    The asylum was erected in the years 1829 and 1830, and opened for the inception of patients on May 16, 1831. Owing, however, to the imperfect lunatic returns at that period, the committee considered accommodation for 300 patients would be sufficient for the county; and after making choice of the best of three plans, for which they had offered premiums, they accordingly contracted with Mr. William Cubitt for a building and offices to that extent, for 63,000l. This limited accommodation was soon found totally inadequate to accomplish the end in view; and the asylum has been consequently enlarged from time to time, and now contains 965 patients, and 97 resident officers and servants, The cost of 84 acres of land for the purposes of the asylum has been 19,267l. 6s. 4d., and that of the building and offices about 160,776l. 14s. 5d., making a total of 180,044l. 9d.
   
Nothing can more strongly mark the progress which society has made within the last fifty or sixty years, than the different aspect under which the insane have been viewed, and the different way in which they have been treated Formerly there was but little difference in the treatment of the criminal and the insane. What advantage there was, was on the side of the criminal. He was punished for a crime, and under the authority of the law; the other was visited with a lengthened punishment for no crime, and subjected to the control of one whose brutal will, perhaps, was his only law. The law afforded no adequate protection to those who, by the loss of reason, were unable to protect themselves. Their very misfortune seemed to shut them out from all sympathy with those who possessed the light of reason. Who ever thought of applying himself to better the condition of the insane? There was one man, however, Pinel, an intelligent and noble-hearted French- man, who in 1792, in the midst of surrounding horrors, brought commiseration and kindness within the walls of a lunatic asylum. We owe to his courage and humanity the many beneficial changes which have been brought about in this country in the treatment of the insane; he has the distinguished honour of having instructed the nations of Europe practically in the Christian duty of  dealing out to the insane the same measure of mercy which we ourselves should desire were we to be similarly afflicted.

    In this country, long after the example which Pinel had set, though there were isolated attempts to introduce a humane system of management into asylums, they were the exceptions only. Cruelties of the most revolting kind continued to be practised by sordid unprincipled men. The law threw not its protection round the insane; their sufferings were known, were un-heeded, because they were supposed to be for the most part unavoidable. It was believed that the insane could only be ruled by brute force; and therefore brute force continued to be the rule, and enlightened humanity the exception.
    But this scandal to a Christian country was gradually to be removed as the spirit of inquiry was awakened and sounder principles prevailed.
    Almost the first and certainly the greatest benefit conferred upon the insane pauper, was the act of the 9th George IV., cap. 40, which was intended to facilitate the erection of county lunatic asylums for the poor, and to improve the condition of lunatics. Thenceforth, in those counties that wisely took advantage of the act, the friends of the insane pauper could be assured of that which the laws of society are bound to afford, protection against cruelty and security against neglect.
    On the completion of the asylum, the committee appointed Dr. and Mrs. Ellis to be the superintendent and matron. Dr. Ellis was a man who from his experience of some years as the physician of the Wakefield Asylum in the county of York, and from his active habits of life, was well qualified to put the machine in working order, and to see that it worked well; and Mrs. Ellis, the matron, brought to the office talents of a superior order; and from both the institution derived great benefit during the time of their remaining there.
    Among the useful suggestions for which the asylum was indebted to Dr. and Mrs. Ellis, was the extensive employment of the patients. In his very first report, he mentions that considerable amelioration had taken place in the condition of the insane poor of the county, and adds, "but with even the greatest solicitude for their comfort, the want of sufficient air and exercise, which can only be obtained in a large building with ample grounds, presents the most formidable obstacle to their cure;" and in December 1832, says that the system for employing them has been pursued most perseveringly in every variety of work adapted to their respective qualifications. Then, as if anxious to relieve the public mind from all ungrounded fears, and to accustom it to more humane and rational sentiments, he concludes by saying that not a single accident had occurred from the patients having been trusted with the tools used in their different occupations. These, among other less formidable weapons, were spades, bill-hooks, and scythes. The right spirit which Dr. Ellis displayed in these and similar remarks seems to be the germ of that principle which, when brought practically to bear, has since ended in the abolition of all mechanical restraints.
    The same earnest endeavours to employ the patients in useful handicraft labour continued to engage his active mind during the time that he remained at the asylum. At the same time the non-restraint system was gradually making its way, by the exertions of intelligent men, in two or three other public establishments of the kingdom, and was to some extent adopted in a few amongst the best conducted private establishments. To Sir William and Lady Ellis the praise is certainly due of having prepared the way for the crowning, though difficult task, which was afterwards successfully undertaken by Dr. Conolly. By the humane and judicious conduct of Sir William Ellis, he was the pioneer who prepared the way for the removal of those deep-rooted prejudices which had well nigh opposed a fatal barrier to much of the comfort and to the possible recovery of the insane. By his exertions he gave the establishment (to a certain extent) the appearance of a little independent colony, rather than that of a sick hospital, by making each one take a share in promoting the general welfare. These were the endeavours of Sir William Ellis; and though from the imperfect system and instruments he had to work with, it was not possible fully to carry them out, they entitle his memory to honour.
    The resignation of Sir William and Lady Ellis, in 1838, was at the time felt as a great loss to the asylum; for under their direction the institution had made considerable advance towards that point when another system, founded on more enlarged principles, could be successfully introduced.
    In the choice of their successors the visiting justices were not fortunate. The physician continued at the asylum about a year, and the matron only a few months.
    To the election of Dr. Conolly, the asylum is mainly indebted for the full establishment of the humane and eminently rational system of non-restraint; but without the zealous assistance of the other officers, this could not have been effected.
    Dr. Conolly saw that the forcible restraint of refractory patients did, in fact, create many of the outrages and dangers they were designed to subdue; and in his first report instanced the better practice pursued at the Lincoln Asylum, where for three years, and with 150 patients, there had been no restraint whatever. He did not presume to say that strong restraints might never be required, but pointed to the example of Lincoln as a successful attempt to do without.
    In the soundness of these views the visiting justices concurred. They were forcibly struck with the many considerations which would render such a humane system of management eminently desirable, if it were practicable. But at the same time that they felt the force of the reasoning, they could not look without deep anxiety at the progress of the experiment which had so many serious obstacles to contend with.
    They were, however, soon satisfied that the danger of non-restraint was not near so great as that which was the result of exasperating the insane by the application of mechanical force; and that there was comparatively but little danger Where gentleness, and the constant attention of ward attendants in sufficient numbers, were substituted instead.
    In his last report Dr. Conolly says, "The great and only real substitute for restraint is invariable kindness. This feeling must animate every person employed in every duty to be performed. Constant superintendence and care, constant forbearance and command of temper, and a never-failing attention to the comfort of the patients, to their clothing, their personal cleanliness, their occupations, their recreations - these are but so many different ways in which such kindness shows itself; and these will be found to produce results beyond the general expectation of those who persevere in their application."
    In the same report he says, "The whole of this subject occupied so much of my earlier reports (1839 to 1844) that trusting such particular allusion to it as I have made on this occasion will be considered excusable, it is probable that I may seek no further opportunity of enforcing view which my experience continually confirms. For my own part, in what has been undertaken, or in what has been accomplished, I trust I have never shown a desire to overstate it. I have always acknowledged myself indebted to Dr. Charlesworth, and to Mr. Hill (of Lincoln), for the original suggestion of managing the insane without restraint. The magistrates of Middlesex gave me, ten years ago, the opportunity of attempting this on the greatest scale; and they have honoured me, in all those years, with their steady support. In relation to the great principle of non-restraint, I owe much to the assistance of many able officers, who have devoted themselves to overcoming many incidental difficulties. Above all, I have never forgotten on what higher aid the success of all human attempts to accomplish good depends."
    The preceding is a brief account of the more important circumstances connected with the history of the institution; and the reader is now referred to the engraving, which shows the general arrangement of the interior as well as out-offices.
    The wards are provided with day-rooms, in which the patients take their meals; these rooms have open fire-places, which adds much to the comfort of the unemployed, who spend the greater part of their time in the wards. The asylum is well furnished with baths; and each ward has a room fitted up with a row of washing-basins, which are accessible to the quiet patients at all hours of the day.
    The wards have not less than two attendants in each, in some there are three; and, on an average, about fifty convalescent patients are under the care of two attendants; but in the refractory wards two attendants have the charge of about 25 patients. The attendants have to pay strict attention to the directions of the medical officers, as regards the treatment, employment, amusement, and exercise of the patients. They have to see that their patients are kept clean, and as neat as circumstances will permit, and in every instance are required to treat them with the greatest kindness. 
    Independent of the wards of the asylum, there are kitchen, sculleries, larder, dairy, washhouses, and laundries. The out-offices are, bakehouse, brewhouse, and general store-room. The clerks' office is at the entrance of the asylum. There are separate workshops for the various trades, namely, upholsterers, printers, tailors, shoemakers, carpenters, tinmen, plumbers, and smiths. There is also a steam-engine for raising water into the building, and gas-works for lighting.
    The government of the asylum is placed under the control of a comittee of justices of the peace of the county; they meet usually about once a fortnight, at the asylum. The medical and other journals are then examined, and signed by the chairman; they see the patients which may have been admitted since their last meeting; and all patients to be discharged as cured, or on trial, are brought before them; they hear and determine any complaint that may be made against any officer or servant; and generally perform such such duties as are required for carrying into effect the Act of the 8th and 9th Vict., cap. 126.
There is also a sub-committee, appointed by the general committee. They

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examine the weekly and other returns, inspect the food, see that the contracts are duly performed, and inquire into the state of particular patients and the general condition of the asylum.
    A list of the officers is given in Table II., and the heads of their respective duties are nearly as follows:-
    The visiting physician attends at the asylum and examines the patients three times a week, and gives such directions as he considers necessary for their welfare. 
    The management of the patients, as regards their classification, employment, and treatment, is under the direction of the two resident medical officers, one for the male, and the other for the female department. The dispenser makes up the medicines, and otherwise assists the medical officers.
    The chaplain celebrates divine service twice on Sundays, and reads prayers every morning and evening in the week, in the chapel of the asylum, to such patients as are able to attend; and performs such other clerical duties as may be required.
    It is the duty of the matron to superintend the domestic management of the asylum where females are employed; to see that all female officers, ward attendants and servants are diligent in the performance of their duties; that all orders as to the classification, employment, amusements, and management of the female patients, as well as the directions of the medical officers, be duly performed. The assistant-matron is under the control and direction of the matron, and assists her generally in the performance of her duties.
    All supplies of provisions, and stores, are received and accounted for by the steward, who is also the store-keeper. He superintends the brewing and baking department; and, under direction of the House Committee, manages the grounds, gardens, and farm.
    The clerk of the asylum keeps the cash accounts, registers, and all documents relating to the admission and discharge of patients.
    The resident engineer superintends the repairs of the asylum, and has the care of the gas-works, steam-engine, warming apparatus, and other machinery. 
    The superintendent of the bazaar has the care of those female patients, during the daytime, who are desirous of amusing themselves with fancy and useful needlework, reading, or music. The profit arising from the sale of their work to visitors is expended in little extra indulgences.
    There is a school for the male patients: among those who attend many are unable to employ themselves usefully about the establishment. They have morning and afternoon classes daily; the patients who are engaged in labour during the day have a weekly evening writing class; there is also a singing class in the chapel, where both male and female patients attend in considerable numbers. The schoolmaster occasionally gives a lecture in the evening on natural objects, such as plants, animals, and other amusing subjects. The lectures are sometimes illustrated by aid of a magic lantern; and the patients present on these occasions take great interest in such entertainments.
    The amusements for the patients are varied. In the wards, a good supply of books, periodicals, bagatelle boards, draughts, dominoes, and cards, is kept up. A few of the patients amuse themselves with drawing and painting, and decorating their rooms; in some of the wards there are also pianofortes, which have been presented by visitors for the use of those patients who are musically inclined.
    The assembling of the patients at stated times in the large front airing grounds, or in the wards of the asylum, for the enjoyment of music and dancing, and the little extra indulgences then allowed, is looked forward to with no small degree of pleasure.
    The asylum is supplied with water from an artesian well, which is considered to be the best in the kingdom. The shaft, to a depth of 31 ft., is 10 ft. in diameter, and thence to a further depth of 209 ft., 6 ft. in diameter, together, 240 ft.; the whole of which is constructed of brickwork in cement. The boring was commenced at the bottom of the shaft, with pipes of 14 in. internal diameter; these are carried down about 50 ft., into a stratum of flint stones overlaying the chalk formation, making the whole depth from the surface about 290 ft., whence the water rises into a tank, 20 ft. above the ground floor of the asylum, without the aid of pumps, at the ratio of 90,000 gallons per diem. The strata through which the well is sunk and bored are as follows:- vegetable soil, 1 ft. 6 in.; gravel, 7 ft.; sand, 2 ft. 6 in.; gravel and sand. 9 ft.; brick clay, 2 ft.; blue, or London clay, 169 ft.; indurated mud, sand, and clay, with pieces of wood and shells imbedded, 24 ft.; pebbles and shells, 3 ft.; plastic clay, 22 ft.; sand, 2 ft.; plastic clay, 14 ft.; indurated mud, sand, and clay, 8 ft.; dark brown clay, 9 ft.; green sand and clay, 7 ft.; oyster bed, 2 ft. 9 in.; pebbles and yellow clay, 2 ft. 3 in.; bed of flint stones, into which the bore is carried, 5 ft.
    The temperature of the water, as it overflows the surface, is 55 of Fahrenheit. 
    The analysis of the water, as made in 1845, was

Carbonate of lime 0.27 grains
Chloride of sodium 1.52 grains
Sulphate of soda 4.51 grains
Phosphate of lime 0.28 grains
Grains in an imperial pint 6.58

    The Adelaide Fund.-The interest of this fund is appropriated to the relief of patients who, when cured, are discharged from the asylum.
    The fund originated in 1835, with the superintendent, Sir William Ellis, who suggested it to Colonel Clitherow, for many years the esteemed chairman of the asylum. From the late Queen Adelaide he received a donation of 100l., with a generous permission to profit by her royal patronage, and to distinguish the charity as "The Adelaide Fund." At that period, by kind assistance, a sum of 2000l., 3 per cent. consols, was obtained. The increase of patients rendering additional resources desirable, in 1840 efforts were made by Mr. Serjeant Adams and other active magistrates to extend the permanent resources, and among other donations was that of Her Gracious Majesty the Queen of 100l. On that occasion another application was made to the Queen Dowager, who then began an annual subscription of 25l., and benevolently and punctually continued such assistance until her death. A fund of 5300l. 3 per Cent. consols had been accumulated up to 1846. And now, by a legacy under the will of Miss Mary Phillips, deceased, and certain proceedings taken in the Court of Chancery, and an order made thereon, during the present year, the further sums of 5644l. 17s. 2d., 3 per cent., and 2136l. 5s. 2d., 3 per cent. reduced annuities, have been added to the former amount of the fund.
    In conclusion, it may safely be said that this institution will ever stand high in the estimation of all those who feel for suffering humanity, on account of the ameliorating system pursued with regard to the treatment of its unfortunate inmates; but the greater portion of the asylum having been erected upwards of 20 years, it may not be surprising if many defects in construction be found to exist, when compared with asylums of later date. On the compiler of this account pointing out some of these defects to Dr. Ferguson (one of the Commissioners for building the lunatic asylum at Kingston, Jamaica), that gentleman emphatically replied to the effect, that the asylum might have its defects; he had however, seen most of the asylums in France, Germany, and the United States as well as those in England; and he must say, with regard to the Provisions, bedding, clothing, convenience, and comfort of the inmates, he had seen no other place of the kind to equal it; and it may be added, that visitors generally express similar opinions.

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TABLE II.-THE ESTABLISHMENT, DECEMBER, 1850.

    Officers.-1 Visiting physician; 1 resident medical officer (males); 1 resident medical officer (females); 1 dispenser; 1 chaplain; 1 clerk to committee of visitors; 1 clerk of the asylum; 2 assistant clerks; 1 store-keeper; 1 assistant store-keeper; 1 engineer; 1 schoolmaster; I matron; I assistant matron; 1 housekeeper; I superintendent of bazaar; I superintendent of workroom; 1 superintendent of laundry.
   
Servants, Males.-26 attendants; 2 garden attendants; 2 tailors; 2 upholsterers; 2 shoemakers; 1 tinman; 1 brewer; 4 stokers; I gas-maker and chimney sweeper; 1 gardener; 1 cowman and pigman; 1 assistant to cowman and pigman; 1 carter; 3 farm and garden labourers; 1 porter at lodge; 1 house porter; 1 house labourer; 2 foul-linen washers.
   
Servants, Females- 1 head attendant; 37 attendants; 4 housemaids; 1 bakeress; 5 laundry maids; 2 laundry maids (foul linen); 2 cooks; 2 kitchen maids; 1 dairy maid. 
    The expenditure of the asylum for the year 1849 was 22,061l. 2s. 4d. for the maintenance, &c., of the patients; and 1808l. 11s. 4d. for the repairs and improvements of the asylum, making together a total of 23,869l. 13s. 8d. 
    For the information of those persons desirous of visiting the asylum, it may here be mentioned that orders for admission can be obtained of any member of the Committee of Visitors.

The Pictorial Handbook of London, 1854

see also Charles Davies in Mystic London - click here