Table Of ContentMENTAL HEALTH IN HISTORICAL PERSPECTIVE
Civilian Lunatic Asylums
During the First World War
A Study of Austerity on
London’s Fringe
Claire Hilton
Mental Health in Historical Perspective
Series Editors
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School of Humanities and Social Science
University of Newcastle
Callaghan, NSW, Australia
Matthew Smith
Centre for the Social History of Health and Healthcare
University of Strathclyde
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Claire Hilton
Civilian Lunatic
Asylums During
the First World War
A Study of Austerity on London’s Fringe
Claire Hilton
Centre for the History of Emotions
Queen Mary University of London
London, UK
Mental Health in Historical Perspective
ISBN 978-3-030-54870-4 ISBN 978-3-030-54871-1 (eBook)
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In memoriam
Professor Tom Arie CBE (1933–2020)
A psychiatrist who led the way in humanising mental health services
and inspired others to do likewise
May his memory be for a blessing
Foreword
Iamdelightedtoprovideaforewordforthisdetailedandinsightfulbook
exploring the life of London’s asylums during the First World War. It is a
compelling but also harrowing read for all those interested in the history
ofpsychiatryandmentalhealthservices.Thebookexploresthestructural,
legal, relational and procedural side of asylum life in the First World War
with a particular emphasis on the experience of patients. It draws on a
breadth of source material reflecting their experiences.
In England and Wales there were 100,000 patients in asylums and
whilst it might be tempting to think, when exploring the horrors of mili-
tary life, that asylum life might be a welcome respite, the experiences of
patients were quite the opposite. The book shows us that mental health
careneverexistedoutsidethecontextofculture,politicsandworldevents
andwasparticularlypronetoadversitywhenresourceandworkforcepres-
suresabounded.Therewerehugestaffshortagesandgeneralgoodswere
in short supply but what was particularly obvious was the deficit in terms
of innovation that had made some headway prior to the First World War.
There were some enlightened voices urging a focus on what would
benefit patients, but treatment could be harsh and there was disregard
for personal dignity along with poor hygiene and high death rates. It did
make me feel grateful for our safeguardingprocedures, mental health law
that prioritises and protects patients and for regulators with real teeth,
along with encouraging the externalising of complaints and concerns,
rather than suppressing them.
vii
viii FOREWORD
Animportantreasontoexplorethepastistolearnlessonsforthefuture
and Claire Hilton’s book does that. Some challenges are still very much
present100yearson:stigma,humanrights,powerimbalances,resources,
workforce, research, regulation and organisational structure remain part
of our current discourse.
Read on with an open mind, a thirst for knowledge and with grati-
tude for what we can do for our patients. Continued self-reflection and
challenge are vital. We could still do so much more.
Dr. Adrian James
President of the Royal College of Psychiatrists
London, UK
Preface
BombardedbyhistoricalanalysesofFirstWorldWar“shellshock”andthe
suffering of military casualties left me wondering how 100,000 “pauper
lunatics” fared in the wartime civilian lunatic asylums. Asylum patients
were low priority on the scale of social welfare, regarded as a burden on
the economy and unable to contribute to the war effort. Standards of
careandtreatmentfell,dischargeratesplummeted,anddeathratesdueto
infectious diseases escalated far in excess of those in the community. The
neglect was particularly disturbing because the asylum leadership knew
what should be done in the interests of the patients, but too often failed
to act on that knowledge.
Thisbookcentresroundthepatientswhoweretheraisond(cid:2)’etre ofthe
asylums.Itexploreshowindividualshelpedthemandhinderedthemand
how the system let them down. It is an un-told story, about real people,
which deserves to be heard.
London, UK Claire Hilton
ix
Acknowledgments
Many people have helped, cajoled, criticised, supported and guided the
researchandwritingofthisbook.Librariansandarchivists,particularlyat
the Wellcome Collection, London Metropolitan Archives, Royal College
ofPsychiatristsandtheNationalArchivesatKewhavehelpedsortendless
requests for documents. The Wellcome Collection generously provided
the funds to publish this book open access. Matt Smith and Cathy Cole-
borne, series editors, and Molly Beck, Joe Johnson and Meera Mithran
at Palgrave, have been a supportive team to work with. Two anonymous
peerreviewers,onewhoreadthesynopsisandanotherwhoreadtheentire
manuscript offered valuable feedback and helped shape the final text.
Rhodri Hayward read chunks of the work and his comments were much
appreciated. Advice from Nicol Ferrier about post-mortems was most
welcome and discussionswith Louise Hide are always thought provoking
and fruitful. Adrian James found time to write the foreword, and I am
grateful for his continued interest in the history of psychiatry. Hugh and
Gus Fowler-Wright and library staff at King’s College London provided
invaluablecopyrightinformationaboutillustrations.MyhusbandMichael
has allowed me to disappear into lengthy anti-social hibernation with my
laptop,andhehascontinuedtoexploreformerasylumsandasylumceme-
teries with me. I am particularly indebted to David Jolley for his enthu-
siasmandencouragementandvaluablecommentsafterreadingtheentire
manuscript, some parts more than once.
xi
