Looking at female patient case notes from the Wakefield Asylum

As research assistant on the project, I share Rob’s feeling of being swamped! The sheer number of female patient case notes from the Wakefield Asylum dating from between 1818 to 1900 is staggering enough!

Deciding on which particular case notes to focus on has been difficult; each set tells an interesting story about an individual’s life before and after admission, and, in some cases, after their discharge. An individual patient’s case notes ranges from any where between one and 20 pages, depending on the patient’s length of stay. Attempts at finding patterns among the data have also been hampered by the fact that the case note format changes over the period, sometimes in line with the priorities of new medical staff and superintendents. Certainly, an increasing amount of information about each patient was recorded as the period progressed. Such a finding may serve to confirm the popular thesis that Victorian asylums increasingly functioned as a means of social control under a medical gaze, but for our current purposes, it makes our job of sifting through such information more challenging but, ultimately, endlessly interesting.

However, I’ve familiarised myself enough with these case notes during the eight weeks I’ve been working on the project  to be able to highlight a few interesting themes and examples. I’ve also cross-matched the case notes with the asylum’s annual reports to compare individual patient stories with a ‘bigger picture.’ We are currently developing new undergraduate learning resources based on this research:

1. Age, sex, marital status, and occupation – These basic facts about patients were recorded from the very first asylum admissions. A preliminary survey of patient ages demonstrates that females as young as 12 and as old as 80 were admitted. Perhaps surprisingly, approximately half of the female patients were recorded as single. This finding perhaps challenges an assumption common among some historians that nineteenth century asylums primarily functioned as an institution for men to dispose of their troublesome and hysterical wives (Showalter, 1987). We hope to explore this possibility further.

The most common occupation among married females was ‘housewife’ and the majority of the unmarried females appear to have been employed in domestic service. This highlights an interesting class perspective: the asylum directors always claimed that Wakefield was one of the only true pauper asylums in Britain, but does the large number of housewives indicate that this wasn’t the case? Of course, medical staff only recorded information provided by the patient, friends or relatives and thus ‘housewife’ may have been used as an all encompassing term. It is also apparent that a number of both female and male patients had no occupation and were transferred from a number of workhouses in the surrounding area, such as Sheffield, Leeds and Halifax. Weaving was the most common occupation among the male patients in the early nineteenth century. This is unsurprising given the West Riding’s dominance in the British textile industry. Interestingly, ‘labourer’ replaces ‘weaver’ as the most common occupation for male asylum patients by the late nineteenth century, possibly indicating the industry’s regional decline and the urban growth of the surrounding area.

2. Supposed cause of insanity and length of time insane – Asylum staff recorded a variety of causes of insanity among their patients. Among some patients, insanity was said to be triggered by specific circumstances, such as the death of a loved one, some form of domestic abuse or anxiety caused by poverty. For example, Mary Ariery aged 42 was admitted to the asylum in September 1819 and diagnosed with grief caused by the death of her two sons. One of Mary’s sons, a soldier, died in battle six years earlier and the other died from unknown causes in 1818. Other causes of insanity included some form of physical trauma. Phoebe Sharp, a 33 year old housekeeper admitted to the asylum in August 1891, suffered from acute mania following “a blow to the head with a hatchet” during a series of family arguments over furniture. Heredity is also frequently cited as a cause of insanity and lengthy details of a patient’s family history are almost always recorded. For example, the case notes for Susannah Brown, a 38 year old worsted weaver admitted in January 1891, detailed that her “father is said to have been insane; died from phthisis 30 years ago. Patient’s uncle died insane at another asylum. Grandmother was insane when she died.” (image 1.). Intemperance and possessing “unclean habits” were other commonly cited causes.

Image 1. Susannah Brown described in her case notes as “excited, deluded and prone to being violent,” January 1891, C85/3/6/54/p61-64/1.

  The estimated duration of an ‘attack’ or episode of mental illness was almost always recorded because those studying mental illness generally believed that the disease could be more successfully treated the earlier it was diagnosed. Medical staff frequently complained that the overseers of the Poor Law were particularly tardy about sending patients to asylums from workhouses for treatment. They also made pleas to family members and friends to send their loved ones to the asylum for treatment as soon as signs of mental illness began to appear. It was also common to record whether this was the patient’s first attack and the case notes reveal that a number of patients were readmitted after suffering from a recurring attack, sometimes several years after their first.

3. Moral and Medical Treatment - Asylum staff clearly spent a great deal effort monitoring and treating patients’ bodily state of health. From the earliest nineteenth century patient records, it is clear that asylum staff were obsessed with monitoring patients’ bowel movements, urine samples and the condition of their tongues. By the late nineteenth century, recordings of patients’ pulse and temperature, as well as reports on their circulatory, pulmonary and genito-urinary systems, were incorporated into this system of medical monitoring. Pulse and temperature readings became plotted on a chart, enabling asylum medical staff to quickly visualise variations (image 2.).

Image 2. Temperature and Pulse chart for Mary Jones, December 1889, C85/3/6/47/p1-4/6.

Added to this system of monitoring from the 1860s were photographs of patients taken under the supervision of medical superintendent and director James Crichton-Browne. Crichton-Browne established a photography studio and believed, along with many of his contemporaries, that studying the facial characteristics and expressions of patients could uncover the nature of mental illness. Indeed, he sent a number of patient photographs to Charles Darwin at a time when Darwin began to study the significance of facial expressions (University of Leeds PhD student Mike Finn is currently researching Crichton-Browne’s work at the Wakefield Asylum. For more details, visit http://www.leeds.ac.uk/site/custom_scripts/people_profile_details.php?profileID=979)

Treating a patient’s body was often more straightforward than attempting to assess and treat their state of mind. Patients were well-fed and well-clothed but few effective treatments for the mind were available, certainly in terms of drugs. In fact, the case notes reveal that drugs were typically administered as a response to particular circumstances. For example, opiates and other sedatives were often only given to a patient following an aggressive outburst and laxatives were given following bouts of constipation. Susannah Brown was given Blaud’s pills twice daily for her anaemia but little medication for her recurrent melancholia. Harriet Marsden, a 25 year old domestic servant, was given milk and egg yolks as a treatment for acute mania.

Yet, the case notes give a clear indication that the medical staff thought good bodily health and a relaxed state of mind were co-dependent. Although there were exceptions, many patients seemed to have displayed poor bodily health when their mental anxieties were most severe. It is also clear that the ‘moral management’ of the patients – that is their employment in making their own clothes and on the farm land, their participation in recreational activities and attending chapel – aimed to heal both body and mind. As a part of the moral regime, the medical staff continually emphasised that they only used the mechanical restraints common a century earlier in very rare and extreme cases.

4. Patient behaviour – Asylum staff also recorded changes in patient mood, temperament and behaviour in the case notes. Terms such as ‘unruly’ and ‘violent’ were commonly used to describe patients’ behaviour. For example, one report about Susannah Brown stated that she:recently became excited and insolent so that it was necessary to seclude her and leave her in a simple room at night. She is idle, unsociable, sullen and disinclined to speak.” She was later described as “excitable, moody, ready to burst into violence.” Interestingly, a number of patients seem to have complained about the violent behaviour of the nursing staff. In these instances, doctors checked the body of patient for evidence of bruising or scarring and in some cases, nurses admitted using unreasonable force. This perhaps suggests that not all staff members adhered to the principles of moral treatment. Patients’ delusions and visual and aural hallucinations were also recorded and obtained through lengthy discussions between doctor and patient. For example, the 1890 case notes of Ann Plant, a 54 year old housewife, explained that the patient began to think she was possessed by a dog, continually barking instead of speaking, following a bite she had received from a dog some months earlier. Phoebe Sharp frequently reported her fears that Jack the Ripper “was after her.” A number of patients were also recorded as being suicidal or a danger to others.

There is much more I could tell you here but I think I’ll leave it there for today. However, the blog will be continually updated as the project develops. Emma will shortly be telling you more about learning resources. Watch this space!

Claire

Claire Jones, Research Assistant, History to Herstory Project

4 Comments

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4 responses to “Looking at female patient case notes from the Wakefield Asylum

  1. Interesting stuff, thank you. I worked years ago in a “Victorian asylum” in Surrey for a time. The hospital had been established as a self-contained community with orchards and a farm and housed hundreds in its heyday. There were quite a few women who had lived the bulk of their lives there whose only psychic foible (to coin a phrase) was marked down with a diagnosis of “moral insanity” (I kid you not).

    At the time I saw these women (and I read their notes) they had been living in the hospital for 60 and 70 years after being taken in following discharge from service as chambermaids and the whatnot, once their pregnancies became apparent. So, if they weren’t actually a bit loopy when they arrived, they certainly were after many decades living in that community.

    I would have predicted that this was a widespread practice and wondered if you have come across evidence or hints of it??

    Anyway, good luck with it; sounds to be a veritable mountain of material to wrestle into understandable form.

  2. Paul Atkinson

    It’s great to see this project coming to fruition (having been asked about applying for the developer job myself – I’m glad Claire got the job in the end). I read a few hundred of these patient records myself about 4 years ago and couldn’t agree more about what a great resource they are. Lucky undergraduates! Hopefully the University of Huddersfield is going to be able to build on this work and further develop its expertise in C19 mental health.

  3. I was very interested in this collection, as I have used (and indexed) many medical case books from a mental institution in Australia. There are a lot of similarities between the two collections, as you can see from the description on my Web site.

  4. Sharon Howe

    I really enjoyed reading about your research. Please post updates.

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