With the release of the 1921 census, this year promises to be an interesting one for family historians and here at Staffordshire Record Office we have an exciting announcement of our own!
After months of work by the staff and volunteers of our Wellcome funded Asylums Project team, on Monday 10 January our Asylums Index will go live. Accessed through the Staffordshire Name Index, https://www.staffsnameindexes.org.uk/, it lists patients who were admitted to the Staffordshire Asylums between 1818 and 1920. Users will be able to search the database by name, occupation, hospital and a date span to find out more about the thousands of men, women and children who spent time in these institutions during the nineteenth and early twentieth century. For those who are interested in discovering further information about a particular patient, the Index invites you to contact the Record Office about surviving patient case records.
Thanks to a number of important campaigns by mental health charities and organisations, awareness and understanding of mental health issues has increased massively in recent years, helping to remove barriers to people seeking support. But of course, in previous decades things were very different. Since our project began, we have been contacted by several people who have been searching for answers to the ‘gaps’ in their family history. Owing to the stigma and secrecy surrounding asylum admissions during this period, in many cases family members were completely unaware that their relative had been admitted because it was never mentioned.
Case books over 100 years old can be viewed at the Staffordshire Record Office
People could find themselves in these institutions for a number of different reasons. Family historians are sometimes surprised to discover that their relative had been sent away because they had epilepsy, yet this was very common in the days before effective medication became available to control the condition. Discovering that someone in your family spent time, often a very long time, in an establishment of this type can be a shock, and the details can be quite harrowing, but most people who have contacted us have said that having this knowledge had helped to make sense of what they already knew about their family history.
For those who are seeking more detailed information, the surviving case books housed at the Stafford Record Office can provide the family historian with various details about the person they are interested in. In addition to information regarding age, marital status, religion, and occupation, there will sometimes be brief details of their family background. Usually a diagnosis is given, together with a brief description of symptoms and a supposed cause of their condition. If a patient died in the asylum there will be a death notice and reference to a postmortem if one was carried out. A substantial number of patients who were admitted during the late nineteenth century had their photographs taken on admission and sometimes also when they were discharged. Case books containing records over 100 years old are available to view at the Staffordshire Record Office.
In addition to the Name Index, a more detailed database is available to academic historians on request. This includes anonymized information extracted from patients records up to 1948. For more details, please contact Rebecca Jackson (rebecca.jackson@staffordshire.gov.uk) at the Staffordshire Record Office.
James Beveridge Spence spent most of his working life at the Burntwood Asylum where he became highly respected in the role of Medical Superintendent. He also played an important role in establishing national standards for the training of asylum nurses and attendants.
Born in 1849, he was educated at The Queen’s University of Ireland, qualifying in 1869. Dr Spence joined the Burntwood Asylum as Assistant Medical Officer soon after, in June 1872, but left two years later to take up the same position at the Earlswood Asylum in Surrey, which specialised in the care of people with learning disabilities. In 1881 the first Medical Superintendent at Burntwood, Dr Davis, resigned on grounds of ill health, following a disagreement with the Housekeeper which exposed irregularities in the stores and intoxication amongst the staff of the establishment [1]. Dr Spence, now aged 31, returned to take over as Medical Superintendent and remained in post for the next 43 years.
Appointed to the position of Registrar of the Medico-Psychological Association in 1892, he served as President in 1899. He is perhaps best known for his involvement in establishing the Association’s training and examinations for nurses and attendants. At his inaugural speech as President he spoke at length about the advances made in providing training for asylum nurses, concluding with the following comments;
“It has been asked, what have we gained by all this lecturing and training and certificate granting? The reply to my mind is sure and certain. Much has been gained by those at the head of asylums; an increase of their confidence in those who have the direct charge of patients – a feeling of security which in the old days was wanting – an assurance that the cases entrusted to our nurses and attendants are treated, not as prisoners by warders, but with all the care and skill and attention which a trained nurse can give to a sick patients.”[2]
Newspaper clipping from 1895. Examination for the Certificate in Nursing
He argued that training had also proven beneficial to the asylum nurses themselves, leading to an increase in salaries in recognition of the superior skills of trained staff and greater opportunity for promotion.
In addition to his roles in the Medico-Psychological Association, Dr Spence was an honorary member of the American Medical Psychological Association and in 1901 he was made president of the Psychological Section of the British Medical Association.
It appears that Dr Spence was highly regarded by those who knew him, as indicated by the responses to a tragic event that occurred in 1901. On the evening of June 3rd, the senior assistant medical officer at Burntwood was distracted whilst he was preparing sleeping draughts for six female patients and accidentally administered a concentrated solution instead of dilute. Both solutions were colourless and were in identical bottles. At this time there was no dedicated pharmacist at Burntwood; the role of dispensing was carried out by assistant medical officers, who might be called away to deal with an emergency, such as a patient choking, whilst they were preparing medication. Sadly, three of the patients died. Recording a verdict of ‘death by misadventure’, the coroner’s inquest recommended that in future bottles containing poison should be made more distinguishable, reducing the risk of error. Despite the dreadful outcome of this mistake, the relatives of the deceased expressed their confidence in Dr Spence, and their sympathy for the medical officer who had prepared the draughts, stating that patients were treated with kindness by the staff.[3]
The following portrayal of Dr Spence was included in a detailed description of the institution, published by a visitor to the Burntwood Asylum in 1905, ‘fair in complexion, with an open, frank, good-humoured, kindly face, standing some six feet three or four, burly in body and large of limb,’ adding, ‘he has the impressive presence which ought to belong to one in such a position as his.’[4] David Budden, a former Pharmacist at the asylum, states in his book, A County Lunatic Asylum: The History of St Matthew’s Hospital Burntwood, that staff remembered Spence as ‘a tall, upright man; a man who could be stern and even harsh,’ but also ‘very generous and who showed deep concern for the welfare of his patients’.
During the First World War, Dr Spence was the only medical officer to remain in the institution, the other men having signed up for military service. This was a particularly difficult time for the asylum, not only because of staff shortages, but also because of the increased number of patients who had been transferred to Burntwood to free up space for military patients in other asylums. His service during this time was recognised in 1920 when he was awarded the OBE. Dr Spence retired to St Leonard’s on Sea in 1924 and died in 1928.
[1] David Budden, A County Lunatic Asylum: The History of St Matthew’s Hospital Burntwood
[2] James Beveridge Spence, ‘The Presidential Address delivered at the 58th Annual Meeting of the Medico-Psychological Association’, The Journal of Mental Science, 45, 191 (1899), 635-657 (p. 654)
[3] ‘Asylum News’, The Journal of Mental Science, 47, 198, July 1901, p.632.
[4] ‘Cycling’, County Advertiser & Herald for Staffordshire and Worcestershire, 15 April, 1905.
The cover of this rather tattered little notebook offers no clue as to its contents. Yet inside is a wealth of information regarding staff recruitment at the Burntwood Asylum. Almost 300 job advertisements, which were placed in local and national newspapers between 1892 and 1928, have been painstakingly cut out and glued in, with a record of when and where each was published. Printed in national and local newspapers, including those covering Montgomeryshire, Worcestershire and North Wales, they suggest that attempts were made to attract applicants from a wide geographical area. Numerous annotations enable us to see how the job specifications were modified before they were re-issued, following a poor response to the original advert or when the post became vacant again at a later date.
The following adverts, taken from the Birmingham Post in 1892 demonstrate the difference in salary paid to men and women who were essentially performing the same role. We can see that the wages for male attendants commenced at £30 per annum, more than double that of nurses, who began at £14 per year ‘with a probability of increasing to £25’ with board, lodging, washing, uniform and £2 10s beer allowance.
Cuttings from the Birmingham Post, 9 April 1892 showing vacancies for a female nurse and a male attendant
Asylum experience was not required for any of these advertised posts but age was important; applicants for all posts needed to be at least 19 years of age and usually over 21. Physical stature also seems to have been a particular consideration for female nurses, reflecting the demands of managing challenging behaviour within the institution.
Male attendants were often required to play a musical instrument in the asylum band. This advert from 1902 specifies the ability to play the cornet or clarinet. An additional £4 per year would be paid to a competent bandsman.
‘No application will be considered except from players of one of the above mentioned instruments‘
Requirements for female staff often focused on character, as in this advert from 1908 for a Dining-Hall maid;
‘must have a good character for industry, honesty, and steadiness of conduct‘
Ward assistants needed to be ‘respectable’, whilst Kitchenmaids were generally required to be ‘strong, healthy’ girls. One advert simply states,
‘KITCHENMAID (good) Wanted. Wages £16 a year and £2 10s beer money’
The Cook earned a higher salary than the Nurses, commencing at £35 and rising to £40, which reflected the importance of this role in a large institution. Despite this, it appears that it was a difficult role to fill, since it was advertised several times between 1900 and 1902, with later versions of the advert adding, ‘A woman who has been head kitchenmaid under a good cook might be suitable’
The role of Housekeeper, advertised in 1896, seems to have been particularly demanding.
‘She must thoroughly understand the management of a large establishment, be capable of superintending the cutting out and making up of the clothing, and would be expected to superintend the kitchen and laundry arrangements’
A Junior Assistant Medical Officer could expect a salary of £150, rising to £175 at the end of the first year and £200 a year later. He was required to be under 30 years old, unmarried and, like the attendants, would receive board, lodging and washing. Marriage was not prohibited for all staff and it some cases it was preferred; a married couple was required to take charge of the Infirmary ward, though they were not allowed to have a family. Similarly, young boys who were admitted to the asylum were placed in a special ward under the care of a married couple. Girls were under the care of a female member of staff.
‘If holders of the Medico-Psychological certificate for proficiency in nursing an additional £2 per annum each will be paid‘
Other newspaper clippings give us an idea of the wide variety of artisan roles in the asylum. They include vacancies for a tailor, an upholsterer or handyman willing to learn how to make mattresses, a waggoner, gas stoker, wheelwright, carpenter and odd job man, a groom and a man to run the electric plant and battery room. Many of these roles would have included the supervision of patients who were employed in the asylum workshops. The Clerk of Works, later referred to as the Works Foreman, was responsible for supervising the artisans and for carrying out general repairs. The Baker received 25 shillings per week, together with a House and Garden, and could be married or single. The role of Farm Bailiff also came with an unfurnished house and a garden, being paid a salary of £60. He was responsible for the farm, the conduct of the labourers, and the livestock, which included sheep, cattle and poultry.
In the back of the notebook a record has been kept of the outcome of the advertisements during the period 1915-16. As you can see below, very few led to a successful appointment. The outbreak of war in 1914 led to vacancies for temporary male attendants up to the age of 45 and by 1916 this age limit had been extended to the age 50 years. No applications could be accepted from men who were eligible for war service, making it difficult to recruit. The recruitment and retention of female staff was always challenging.
In the right-hand column we can see the reasons why applicants were not appointed. Several did not return the forms, others lived too far away, or could not produce a satisfactory character reference. One unsuccessful applicant was a conscientious objector and another was rejected for wearing glasses. These details may not seem particularly significant but they help us to understand just how difficult it was to find suitable staff to work in the asylums, particularly during wartime.
The events of the past eighteen months have, for many of us, highlighted the importance of access to outdoor space. In the depths of lockdown, a daily walk brought a little bit of respite from the isolation of being shut away and those of us who were fortunate to have a garden appreciated the quiet joy of being able to potter about outside. Even if you detest gardening (I much prefer to go hill-walking), there is no denying that just being outside in the fresh air can make you feel better.
In recent decades mental health organisations have promoted outdoor activity as a means of improving our mental well-being. These ideas are nothing new. Two hundred years ago, medical superintendents were just as keen to encourage asylum patients to take plenty of vigorous exercise in the open air, as a means of maintaining muscle tone and physical fitness, improving sleep patterns, using up excess energy and providing a distraction from the stresses of everyday life. In practice, this usually meant long walks in the countryside or working in the asylum gardens and grounds. Such work has been presented as an exploitative means of reducing the costs involved in feeding vast numbers of patients and, of course, the financial aspect of such work was an important consideration. Yet employment on the farm and in the gardens and grounds was regarded by many superintendents as one of the most beneficial forms of treatment, particularly during the nineteenth century when a large proportion of patients were younger and more physically active.
W.C. Ellis, Superintendent of the Wakefield Asylum and later of the Hanwell Asylum, who famously advocated work for patients, believed that a sedentary lifestyle left people from the wealthier classes more prone to over-anxiety and less able to cope with the demands of modern life. He observed that, ‘from the habits and mode of education of the upper ranks, particularly of the females, the brain and nervous system are kept in a state of constant over-excitement, whilst the frame is debilitated, from the muscles being rarely called into proper and regular exercise’. The poorer classes, he said, were more vulnerable to the effects of poverty and drink.
At the Hanwell Asylum during the 1830s, Dr John Connolly noted that wealthier private patients were missing out on the positive effects of cultivating the gardens because, unlike pauper patients, there was no expectation that they should work.[1] For richer patients who were used to being busy at their usual occupation, it could be very difficult to find a suitable pastime to relieve the monotony of being in an asylum, particularly for those who were not fond of reading. He suggested that if gardening was encouraged in childhood more people would be able to benefit from the ‘primaeval simplicity of occupation’ with multiple benefits for mental health. Gardening, he argued, had the advantage over many other pastimes that it could be tailored to the individual, exercising both mind and body, and offering a wide variety of tasks, from researching plants to laying paths. The whole process of cultivation was also inherently forward-looking; for patients who were suffering from depressive illness this could be particularly helpful.
Some patients actually requested that they be allowed to work. When John Eaton, a publican from Stockport, was admitted to the Stafford Asylum in July 1819 he asked to be employed, evidently aware that staying mentally and physically active would aid his recovery. He was reported to be very happy in the gardens and in this he was not alone. Over time, it was found that gardening, more than any other activity, was beneficial for patients’ mental wellbeing. Recognising this, the Physician to the Stafford Asylum, Dr Edward Knight, was given permission to have part of the grounds developed into a botanical garden on the condition that it was cultivated by the patients. Similarly, at Cheddleton, the wards and day rooms were filled with flowers which had been specially grown in the asylum greenhouses.
For those patients who were unable or unwilling to work, outdoor activity was encouraged in other forms. For pauper patients this usually meant exercise in the airing courts but many private patients were given the opportunity to play bowls, go fishing, or take walks in the surrounding countryside, accompanied by an attendant. Over time the opportunity to exercise beyond the boundaries of the asylum was extended to larger numbers of patients, depending on their condition. By the late 19th century, cricket matches and lawn dances took place weekly during the summer and the annual picnic would see around 200 patients taken out for the day to nearby beauty spots such as Cannock Chase. The Annual Report for 1889 records that, ‘Exercise beyond the airing courts but within the estate of the Asylum is given daily, we are informed, to 140 men and 220 women, exclusive of the patients working on the land. On Sundays about 200 males are walked beyond the Asylum boundaries, and twice or thrice weekly 130 women are so exercised.’[2] Late summer brought the opportunity for patients to go blackberry picking in the hedgerows of the surrounding villages.
St Edward’s, Cheddleton, Cricket Field, 1960s. (Image: Staffordshire Past Track)
By the early 20th century there was a greater emphasis on the provision of outdoor sport, particularly for men. At Cheddleton, Medical Superintendent Dr Menzies was especially fond of cricket and it is said that cricketing ability was a major consideration when appointing male staff. However, he conceded that for the patients no sport could compete with football in terms of popularity. Writing in 1923 he observed that, ‘the football team has been fairly successful in the North Stafford League’ adding that this was ‘a recreation which interests more patients than all other sports put together’. Whether as players or spectators, sport served the additional function of boosting morale amongst both staff and patients and became an important part of asylum life.
[1]Familiar Views of Lunacy and Lunatic Life by the Late Medical Superintendent of an Asylum for the Insane (London: John W Parker, 1850), pp. 81-83.
[2] Commissioners in Lunacy, The 71st Annual Report of the County Lunatic Asylum at Stafford, 1889.
Thanks to the Victorian obsession with collecting data, we know that most of the people who were admitted to the Staffordshire Asylums during the nineteenth century had low levels of literacy. The table below, taken from the Annual Report of 1851, indicates that over half of patients were unable to read and write and over a quarter were ‘totally uneducated’. The asylum was at this time still admitting private patients who would probably have accounted for those ‘of good education’. It is likely that the true levels of literacy were even lower than these figures suggest because, as was noted at the time, the statements given on admission were frequently found to be false and the mental condition of the patients meant that testing was not possible.
Amount of Education [Patients admitted in 1851]
Males
Females
Total
Of good Education
6
4
10
Able to read and write
34
28
62
Able to read only
24
25
49
Totally uneducated
26
32
58
Totals
90
89
179
In 1855 Dr Mark Noble Bower, who had succeeded James Wilkes as Medical Superintendent at Stafford, commented that a lack of education was the fundamental cause of many asylum admissions, since he believed this led to a greater likelihood of intemperance which could result in insanity. His solution was to establish a school within the asylum which would provide patients with a basic education. A schoolmaster and schoolmistress were appointed to deliver lessons on the male and female sides of the asylum. The school was open for 3 days each week and taught simple reading, writing, and spelling. Attendance was voluntary and during the first year 65 out of a total of approximately 400 patients took up the opportunity to learn. They were described as being very attentive and it was reported that many had improved under tuition. By 1857, 45 male and 40 female patients were regularly attending the school each week, representing almost one fifth of the asylum population. This demonstrated, according to Dr Bower, that their lack of education prior to admission was not the result of being unwilling to learn but rather a reflection of the limited provision of education in the locality.
A greater emphasis on moral treatment during this period meant that medical professionals were keen to find ways to keep the patients occupied and to promote opportunities for positive social interaction. For most patients this meant carrying out some kind of work within the asylum. However, not everyone was capable of physical labour, so the school provided another means by which patients were able to spend their days productively. After a promising start, by 1860 Dr Bower had become more pessimistic about his venture. He now believed that for patients who were totally uneducated, employment in the grounds or workshops was the only suitable occupation, and that only those who already had a small amount of education were able to appreciate and benefit from the lessons provided in the asylum schoolroom. Only 120 of the 250 patients admitted that year were able to read and write. In 1863 an even smaller proportion could do so; 61 out of 219. Nevertheless, attendance at the school continued to grow steadily, with figures slightly higher for men than women; by 1863 55 men and 33 women were attending, compared with 192 men and 145 women who were employed.
A decade after it was established, Dr Bower publicly acknowledged the limitations of the asylum school, ‘although it is found useful as a means of occupying the time and attention, still it must be confessed, that as far as improving the education is concerned, it is not successful’. However, he was keen that it should continue because it offered patients the opportunity to write to their relatives and, like attendance at the Chapel, was ‘beneficial in promoting orderly behaviour’. In a further attempt to promote literacy, bookcases were placed in the wards, though initially they were kept locked and patients were rarely given access to the mainly religious books contained within. Over time this changed and the reading matter on offer became more varied, to include newspapers and illustrated periodicals. Patients had access to books and papers in the Dining Hall as they waited for their meals, as well as in the day rooms.
In 1874 Dr Bower died and his successor, W. Thompson Pater, does not seem to have placed the same degree of importance on the school, preferring to encourage outdoor activities. Levels of literacy amongst the patients were no longer recorded in the annual reports and the numbers attending the school gradually decreased through the next decade although, interestingly, female attendees significantly outnumbered males; in 1881 there were 45 women but only 25 men, by 1889 35 women and 20 men.
Alcohol featured prominently in the nineteenth century asylums, mainly as a staple drink for both staff and patients but also as a form of medication. The Stafford Asylum had its own brewhouse and, according to the 1851 diet table, male patients would routinely be given a pint of beer with dinner and a second pint with supper each day, whilst female patients would receive three quarters of a pint daily. This would have been weaker beer than we drink today and would have been considered safer to drink than the water that was pumped to the asylum. Only boiled water, in the form of tea or coffee, would have been likely to have been drunk until the later years of the century.
Reading through the earliest case notes, it appears that careful consideration was given as to whether each individual should have alcohol included in their diet. Patients who struggled to sleep might be prescribed a pint of ale at bedtime, whilst for those who were suffering from violent mania the consumption of beer and other fermented liquor was to be avoided. For patients whose physical condition was life-threatening, alcohol may have helped relieve their suffering. William Brookes, a pauper aged 33, was emaciated and suffering with a chest infection when he was admitted with melancholia in February 1823. His treatment included wine three times a day, a pint of ale and a glass of brandy at night. Sarah Wynne, aged 42, the wife of a cooper and basket maker from Wolverhampton, was admitted in January 1821 having refused food for a number of days. Her case notes include the observation that she was constantly moaning and was extremely agitated, suggesting that she may have been experiencing a high level of pain. She was confined to a chair, given extra food, 1 pint of ale daily and opium. This was later increased to 3 glasses of port wine each day. Sadly, both of these patients died within a fortnight of admission.
Asylum Attendants and Nurses received a portion of their annual salary in the form of a beer allowance until the late nineteenth century. Similarly, patients who worked in the grounds and workshops of the asylum were entitled to extra beer rations, along with extra bread, cheese and tobacco. The daily allowance of beer at mealtimes had been reduced in 1853 to ¾ pint for men and ½ pint for women but the prospect of earning extra rations provided patients with an incentive to engage in some form of occupation, if they were well enough to do so.
Excessive alcohol intake was a frequent cause of admission amongst patients of all social classes throughout the century. Sometimes this was due to a short-lived bout of drunkenness linked to a particular occasion or time of the year. There are, for example, several cases in the early Staffordshire Asylum records of agricultural labourers who were admitted because of the combined ill-effects of too much sunshine and alcohol during harvest-time and of men who drank too much and engaged in riotous behaviour during the local elections. Most of these patients would stay in the asylum for a comparatively short time. For others, the problems were more long-term; those who worked in close proximity to alcohol in any capacity, including publicans and wine merchants, seem to have been particularly at risk. By the second half of the nineteenth century there was growing concern amongst Medical Superintendents at the rising levels of intemperance amongst asylum admissions, which will be looked at in more detail in a later post.
During the 1880s there was a move towards ending the provision of beer at mealtimes in some institutions, but at Burntwood Asylum there was some resistance to this policy. Writing in 1883, Medical Superintendent Dr Spence commented, “there would seem to be a remarkable harmony of opinion among those in authority as to the happy influence exercised upon the patients in those Asylums where the use of beer has been discontinued,” however, with the exception of some patients with severe learning disabilities or epilepsy he wrote that, “all my patients have beer and appear to be quite contented with the arrangement”.[1] An investigation into the policies followed by sixty other asylums found that twenty-seven asylums, just under half of the total, gave beer to all patients and nine institutions gave either beer or a substitute such as ale, tea or coffee. However, in fourteen asylums only working patients were given beer or a substitute, whilst in the remaining ten water was the only option for all patients.
The investigation also included information on the provision of beer to staff. In one third of the asylums, twenty in all, the staff beer allowance had been replaced by an increase in salary and a further seven gave staff the option of receiving money or beer. Seventeen institutions still provided ale, whilst a further twelve provided milk and coffee in lieu of ale. In two cases staff were instead given a uniform, rather than being expected to buy their own, and in the final two asylums staff were given only water. Following on from this, the decision was taken at Burntwood to replace the staff beer with a monetary allowance, a policy which was apparently well received by the attendants and nurses. Despite this decision, the provision of beer to patients remained unchanged and they continued to be given beer with their meals until at least 1889. However, the diet tables for the 1920s make no mention of an alcohol allowance, suggesting that the policy was discontinued in the early twentieth century.
The food consumed by patients was recognised by medical superintendents as a key aspect of mental health care. In this post we look at the dietary provision in the Staffordshire Asylums during the nineteenth and early twentieth century.
The Provisions Book for the 1820s gives an indication of the types of foods people were eating in the Stafford Asylum during this period. A typical grocery order might include meat, fish, mustard, salt, treacle, malt, hops, currants, raisins, rice, sugar for brewing, tea, coffee, saltpetre, eggs, poultry, butter, rolls, fine flour, milk, mace, apples, lemons and oatmeal. Smaller quantities of items such as pigeons, rabbits, pike, biscuits and turkey at Christmas were also included, probably for the private patients and/or staff. Bread was supplied by the gaol, an arrangement that did not always operate smoothly; when Matron was not happy with the quality of the loaves this was temporarily discontinued until the problems were rectified.
Provisions Book, Stafford Asylum
The diet would be modified according to a patient’s condition. Those with mania would be likely to be put on a ‘low diet’, avoiding ‘animal food’ (meat), which was believed to worsen the disorder. Elizabeth Mouritz, who was experiencing delusions and despairing of her salvation when she was admitted in 1821 was put on a ‘vegetable diet with pudding’ with no meat or malt liquor. Patients who arrived in a weakened or malnourished condition would be given a ‘generous diet’ until they had built up their strength; particularly women who had recently given birth. Maria Lewis was admitted in an emaciated condition following a miscarriage in 1820 and was prescribed a meat diet twice a day to help her regain strength. Mary Ann Colley became unwell in 1826 after losing her husband and infant child. Having refused food and become emaciated she was placed on ‘the most generous diet, with wine’ and recovered within two months. For pauper patients food was served in broth tins which were kept in the galleries and cleaned by the keepers.
By 1851, a diet table, which was included in the Annual Reports, outlined exactly what pauper patients could expect to eat during their stay in the asylum. For men, breakfast would consist of a pint of porridge and 8oz of bread. Dinner on Sunday, Wednesday and Friday would include 6oz cooked meat served with vegetables and 6oz bread. Quantities of vegetables, which were grown on site, are not specified. Monday would be 14oz meat pie and vegetables. Tuesday, Thursday and Saturday would be a pint of soup with 6oz bread and 10oz rice or suet pudding.
Dinner was washed down with a pint of beer and a second pint of beer accompanied a daily supper of bread and cheese. For women breakfast would be 6oz bread and butter and a pint of tea. Dinner would be the same as for the men, with slightly reduced quantities of food and only three quarters of a pint of beer. Supper would be the same as breakfast. Those in first class accommodation probably enjoyed much more choice and we know that at least some of the wealthiest patients dined with the Medical Superintendent.
Comparison with the dietary table for workhouses show that the food allowance in the asylums was more generous. This issue proved contentious amongst those who believed that paupers, whose care was paid for by ratepayers, should receive the bare minimum. Stafford was amongst the more generous Asylums and the Medical Superintendents there were clear about the detrimental effect that a lack of proper nourishment had on mental health. In their annual reports they frequently commented on the poor physical condition of the men and women who arrived at the asylum, particularly those arriving from the workhouse, noting that they saw a marked improvement in their mental condition once they had regained their physical health. Writing in 1856, Medical Superintendent Dr Mark Noble Bower resisted pressure to reduce the amount spent on pauper diets to bring it into line with that spent in workhouses, commenting that ‘the urgent importance of a diet, which from its nutritious properties will suffice to keep up the strength of insane patients is so palpably evident, that any curtailment, rendered necessary by reducing the charge for maintenance, would prove false economy, and would, by cutting off one of the chief means of cure, only tend to swell the amount of mortality or augment the number of inmates’.[1] Investment in Asylum farms helped reduce costs by becoming more self-sufficient in meat, milk, eggs and vegetables, in addition to providing occupation for the patients.
Inspecting the Stafford Asylum in March 1857, Commissioner James Wilkes, the former Medical Superintendent of the asylum, noted that the soup which was served on 3 days of the week was ‘poor and insipid’ and should be replaced by a larger amount of solid food. He also recommended that the quality of the broth should be improved by adding ‘fresh meat, herbs, vegetables and seasoning’. Following these recommendations, the dietary allowance was increased, resulting in ‘evident advantage, both in the appearance and the health of the inmates’.[2] Cocoa was added at breakfast for the male patients and those who were suffering from illness or debility were entitled to ‘extras’ of soup, arrowroot, eggs, bacon with ale, wine or brandy. Working patients were allowed extra bread, cheese, beer and tobacco as ‘indulgences’.
Whilst the food was simple, it was nutritious, the allowance appears to have been adequate for dietary needs and patients frequently gained weight during their time in the asylum. Some of the case books from the later years of the nineteenth century record the height and weight of the patients on admission, together with their weight when they were discharged. The difference in some of these is quite astonishing and there is often a visible difference in photographs taken within a comparatively short space of time. The introduction in 1885 of a systematic plan to weigh every patient once a month at the Burntwood Asylum showed that over a period of six months 60 % of patients had increased their weight, 30% had decreased and 10 % had shown no change.
By the 1860s a dining hall had been built at Stafford so male patients no longer had to eat on the wards; it is not clear when the women received the same provision. The new recreation and dining hall built at Burntwood in 1889 had panelled walls, a stage at one end and a musician’s gallery at the other. However, growing numbers of admissions meant that dining space soon became inadequate. At Cheddleton, by 1923, the dining hall could seat only half of the patients so hot-food waggons were needed to supply food to the wards.
Increased understanding of the importance of vitamins in the diet contributed to a marked improvement in patient health over time, though financial constraints continued to be an issue. The 1924 Annual Report lamented the ‘prohibitive cost of fruit, except at the height of season in the case of oranges’, and noted that for Vitamin A ‘cheese is relied upon for the able bodied and cod liver oil in case of ill health’. In addition to porridge, a meat or egg dish was offered every day for breakfast and at least two courses for dinner. There were also plans to install gas so that fried fish breakfasts could be provided. The reduction in mortality from pulmonary tuberculosis was attributed to better hygiene and improved diet, ‘especially the introduction of Marmite’ which was added to all soups after cooking to provide Vitamin B. Similarly, cases of dysentery were decreasing, and it was reported that ‘five years of aminoacids and vitamins have accomplished what no preventative medicine had previously done, and the disease is dying out among the insane’.
[1] Mark Noble Bower MD, 37th Annual Report of the Visitors of the Staffordshire County Lunatic Asylum, for the year ending December 31, 1855 (Stafford: R and W Wright, 1856), p. 13.
[2] Mark Noble Bower MD, 39th Annual Report of the Visitors of the Staffordshire County Lunatic Asylum, for the year ending December 31, 1857 (Stafford: R and W Wright, 1856), p. 19.
Many of the men and women who entered the Staffordshire Asylums were admitted for reasons related to religion. During the nineteenth century ‘religious excitement’ or ‘religious enthusiasm’, which would now be termed fanaticism, featured prominently in admission notes and was regarded by early practitioners as a cause of mental illness. Later, it was recognised that intense application to religion was more likely to be a symptom of mental disorder, rather than a cause. The difficulty for medical practitioners was, and remains, how to distinguish between signs of mental illness and strongly held religious beliefs.
Leonard Smith notes that the case books often reveal judgemental language used in relation to religious insanity.[1] Most medical superintendents regarded excessive religiosity as dangerous and a cause of insanity, including those who were themselves deeply religious. At Suffolk Asylum, Superintendent John Kirkman sought to inculcate his patients with ‘Doctrinal Truth’ to counteract the ill effects of sectarianism. Similarly, the Superintendent of Wakefield Asylum, William Ellis, who had converted to Methodism, recognised that religious fanaticism could be harmful to mental health but at the same time believed that the solution was to soothe the minds of his patients with religious instruction according to his own evangelical beliefs.[2]
The case books from the Staffordshire Asylums afford an insight into the aspects of religion which were considered to be problematic, either as a perceived cause or a symptom of mental illness. Early in the nineteenth century simply attending Methodist meetings was often cited as evidence of religious enthusiasm. The period between 1790 and 1830 saw a rise in Methodism which was closely associated with radical politics and therefore viewed with suspicion by some. The Primitive Methodists, known for their day-long open-air ‘camp meetings’ originated in the Potteries and enjoyed a revival throughout the Midlands in 1817 and 1818, the year the Asylum opened. Circuits of towns and villages found themselves swept up in a temporary religious fervour, filling them with a ‘glowing excitement for many months’ before disillusionment and despair set in.[3]
These early case notes provide an insight into the prevalence of various religious sects in Staffordshire and neighbouring counties during the 1820s. William Marshall, a farmer from Newton was thought to be suffering illness caused by religious enthusiasm, ‘having previously become one of the sect of Anabaptists and shown much zeal towards that faith’. Hannah Archer, a 47 year-old mother of six from Wigginton was said to have been ‘excited by a sect called Ranters who have been in the village some time and whose religious meetings she has been a very zealous attendant’. Josiah Harrop, a glass maker from Kingswinford was admitted in 1823, having also ‘been amongst the Ranters’ and having frequently preached himself. However, unlike in later Case Books, patients’ religious affiliation is not routinely recorded, even where religion was considered a factor in their admission. For Joseph Hopwood, a farm labourer from Shropshire, there is no record of his religious affiliation. No cause could be found for his illness other than that he had ‘been very zealous lately in attendance on religious duties and is always studying and reading religious books’. It was noted that ‘the disorder manifested itself by his leaving his work, wandering to the Church Yard and straying over the Country, by incoherency of actions and language’. Joseph was discharged well after two months but was readmitted a week later for a further six months.
In most cases, patients exhibited clear symptoms of mental illness. Ellen Atherstone, a domestic servant from Stone, had become ‘deranged… in consequence as is supposed of religious enthusiasm, she having attended Methodist meetings very much’. It was reported that she ‘has refused to take medicines, and occasionally particular articles of food from religious motives’. Further reading reveals that Ellen was also experiencing disturbing auditory and visual hallucinations. In other cases, however, the reasons for admission appear rather vague. Sarah Walton, a mother of three had been unwell for 2 months when she was admitted in 1822. Her disorder was attributed to her attending religious meetings and studying religious books and she was ‘constantly talking about her sins and despairing of her own salvation’, something which is noted in very many cases. Sarah was so distressed on hearing that she was to be taken to the asylum that she had threatened to take her own life. Despite apparently receiving no treatment, within a month of her admission she was discharged recovered.
Religious excitement continued to be recorded as a cause of mental illness throughout the century, but it appears to have become less likely to be associated with methodism. However, as late as 1895 it was attributed as a cause, rather than a symptom, of mental illness. Frank Wilson Howes, a baker from Wolverhampton was admitted with mania having experienced religious delusions. His notes record that he ‘has lately embraced Roman Catholicism and has never been the same since’. Frank was one of only two male patients admitted for reasons of religious excitement that year.
Occasionally, we find evidence from other sources which expands on the information given in the admission notes. When Andrew Grant was admitted to the Stafford Asylum in January 1894 at the age of 20, it was noted that he was quoting scriptures and ‘argued well on religious topics’. According to local newspaper reports he had been preaching in Queen Square, Wolverhampton when a Police Constable had become concerned by his ‘gesticulations and exhortations to passers-by to seek salvation’ and had taken him to the Police Station.[4] From there he was taken to the Union Workhouse and was certified to be suffering from acute religious mania. Little was known of his history, but he said he had come from New York and had been travelling from town to town preaching the Gospel. Sadly, his case notes are very damaged and impossible to read in places, but his photograph, in which he is holding his bible, has survived. It is very unusual for patients to photographed in this fashion, but we learn from his notes that Andrew became very distressed if anyone tried to interfere when he was preaching, which perhaps explains why he is depicted in this way.
Andrew Grant
The Asylum records provide a wealth of information regarding religion in Staffordshire, providing great potential for further research. Our volunteers have been looking at the life stories of individuals who were admitted for reasons associated with religion and these will be added to our ‘Patient’ pages.
[1] Leonard D. Smith, ‘Cure, Comfort and Safe Custody’: Public Lunatic Asylums in Early Nineteenth-Century England (London: Leicester University Press, 1999), p. 110.
Religion played an important role in asylum care during the nineteenth century, being integral to systems of moral management which emphasized the need for patients to be treated humanely and provided with the means to regain their powers of self-control. Whilst for some patients delusions with religious associations were the most obvious symptom of their mental illness, for others their faith provided comfort and helped them on the road to recovery. Many patients were admitted for reasons associated with ‘religious enthusiasm’, illustrating the delicate balance between mental health and mental illness, which will be explored in a later post. Here, we explore the ways in which patients were able to practise their religion during their stay in the Staffordshire Asylums.
Until the late eighteenth century it had not been considered necessary to provide for the spiritual needs of the mentally ill because there was a belief that a loss of reason rendered a person incapable of divine worship. However, some practitioners in the early nineteenth century had recognised that religion could play a therapeutic role in the lives of the mentally disturbed, including Thomas Bakewell, proprietor of the Spring Vale Private Madhouse in Stone. Bakewell regarded religion as fundamental to his belief that all patients should be treated as rational beings. He reported that each evening the people in his care would listen as he read a portion of the scriptures, before singing a hymn and saying prayers together. It was astonishing, he said, that even patients who were ordinarily noisy and violent would become calm and composed and he supposed that this was because the practice of religion made a ‘strong and rational impression’ upon them. [1]
When the Stafford Asylum opened in 1818, like most other asylums at this time, it did not have a chapel or provide religious services, although patients did have access to prayer books and bibles. Nationally, there was growing recognition of the benefits to patients of religious provision and in 1825 the Visiting Committee of the Stafford Asylum issued an order that Divine Service should be delivered at the institution by the Chaplain to the Gaol.
The 1828 County Asylums Act recognised the importance of religion in asylum care, noting in the preamble that, ‘the hopes and consolations of religion may soothe and compose the minds of patients, and thereby tend to subdue the malady under which they are suffering’. In October of that year Reverend Buckridge was formally appointed to the role of Chaplain to the Stafford Asylum on an annual salary of £50. He was to fulfil the requirements of the new Act by performing Divine Service on Sundays and on the great Festivals ‘and also give such attendance upon the patients during the week, with the consent of the medical officers, as their respective situations may require’.
The rise of Evangelical reformers such as Lord Shaftesbury during the nineteenth century put religion at the centre of asylum care. Reverend Buckeridge remained as Chaplain until his resignation in 1843, two years after James Wilkes became Medical Superintendent, when thanks were given for the ‘zealous performance of his duties’. With the appointment of his successor, Reverend Thomas Harrison, plans were immediately put in place for the erection of a Chapel, ‘it being so essentially necessary to the welfare of the Institution’. Wilkes appears to have insisted on more formal arrangements than had previously been in place, introducing a book in which the Chaplain was to record the days and hours of his attendance and what portions of divine service he performed.
The Chapel was finished by December 1844, allowing Divine Service to take place there on Sunday afternoons. In addition, prayers were to be read on Wednesdays and Fridays, for which Rev Harrison was paid an extra £30 per annum. Visiting Justice E Monkton Esq. noted that during his visit to the asylum in March 1845 he had ‘attended Divine Service at the Chapel this afternoon and was much pleased with the manner in which the duty was performed and the orderly behaviour and attention of the patients’. The 1849 Report of the Commissioners in Lunacy recorded that approximately half of the patients regularly attended Divine Service. Further investment was agreed to encourage greater participation; the following year £15 was spent on glass for the chapel windows, plans were made to lower the floor of the Chapel and £70 was spent on installing an organ.
The focus at the Stafford Asylum appears to have been on the benefits to patients of the act of collective worship, rather than any perceived moral improvement to be derived from religious teachings. At Asylums run by Superintendents who were more devout, however, religion was seen to have a more instructive role. At Suffolk Asylum, Superintendent John Kirkman believed that ‘moral and religious principles should be ceaselessly inculcated, to counteract (as far as human power can) the effects of moral evil on the animal frame’.[2]
During the 1850s funds of £650 were required to build an enlarged chapel with room to accommodate three hundred people and separate entrances for males and females, reflecting the divisions in the asylum. By 1857 approximately half of the patients, up to 250 in number, attended services in the chapel three times per week. During the 1860s and 1870s the numbers of patients attending prayers increased until the chapel was full to capacity, though this was due to an overall increase in admissions and still represented only half of the asylum residents.
Thanks to the Victorian passion for gathering data we have a good idea of the different religious affiliations amongst the asylum population. The table below, taken from the 1875 Annual Report for the Stafford Asylum shows the information gathered from patients on admission. We can see that just over half of patients belonged to the Church of England, a third were Dissenters and approximately 7% Roman Catholic. A similar number had no religion assigned. Despite there being a significant number of Roman Catholics, mostly Irish patients, it was not until 1884 that a Catholic Priest was appointed to deliver a weekly service.
57th Annual Report of the County Lunatic Asylum, Stafford, 1875 (Wellcome Library CC)
Services continued to be seen as an important part of asylum life which encouraged ‘orderly behaviour’ amongst the patients who were noted to be ‘uniformly attentive’ and contributed ‘in a marked degree to the recovery of a sound state of mind’. At Burntwood Asylum, 200 patients, representing just over a third of those resident, would assemble daily to hear the Medical Superintendent read the Morning Prayer but the Commissioners’ Report for 1881 noted that it had required the ‘praiseworthy perseverance of Dr Spence’ to ensure that grace was now sung at meals, as he had faced some opposition from the patients.[3]
The Chapel provided other benefits to mental health besides music and prayer; one patient at the Burntwood Asylum was able to express their creative talent by decorating the walls of the Chapel with ‘beautifully illuminated texts of scriptures and other artistic works’.[4] Similarly, the role of Chaplain extended far beyond delivering sermons as a substantial element of his role was to visit patients who were sick or dying. Following the death of Rev Thomas Harrison in 1871, his successor, Rev JH Theodosius was said to display ‘great punctuality and zeal’ in his services and visits to the sick. Medical Superintendents during this era repeatedly commented on the poor physical state of the patients on admission, some of whom were close to death when they arrived so these visits were regarded as extremely important. By 1875, under the leadership of Medical Superintendent William Thompson Pater, weekday services were dispensed with at the Stafford Asylum and instead the Chaplain made twice-weekly visits to the wards, although Divine Service still took place on Sundays.
Religion continued to be regarded as an important part of asylum life, reflecting life outside the institution. At the end of the century the last of the three Staffordshire Asylums opened at Cheddleton with a Chapel large enough to seat 500 people, including a private pew for the Medical Superintendent and a Choir made up of Nurses and Attendants which was conducted by Dr Rice, the Assistant Medical Officer.[5]
[1] Thomas Bakewell, A Letter Addressed to the Chairman of the Select Committee of the House of Commons: Appointed to Enquire into the State of Mad-Houses; to which is subjoined remarks on the Nature, Causes, and Cure of Mental Derangement (Stafford: C.Chester, 1815) pp. 57-58.
[2] Third Annual report of the Suffolk Lunatic Asylum: December 1840, p.14.
[3] David Budden, County Lunatic Asylum: The History of St Matthew’s Hospital, Burntwood (1989), p. 29.
Jean-Martin Charcot became famous for his work in Paris, and the study of hysteria took up much of his time. The symptoms of hysterics who were sent to him at Salpetriere hospital were many and varied. They were usually physical, but sometimes included heightened emotions and moods, and Charcot tried to establish a systematic pattern.[i] The huge number of symptoms, all classed under the banner ‘hysteria’ led Charcot to identify ‘stigmata’ of the condition, or symptoms that seemed always to occur, such as restricted field of vision and insensitive areas on the body.[ii] He also recorded hysterical attacks using photography, which was fast becoming an accepted technique for recording and diagnosing medical and psychological states, and for recording patients on admission to asylums.[iii] He categorised hysterical attacks, using photographic evidence, identifying successive phases – fits, contortions, passionate attitudes and finally delirium or hallucinations.[iv] Charcot believed that, despite physical symptoms, hysteria was a disease of the mind, that it expressed itself partly through physical symptoms, and that neurology (in the form of a ‘dynamic lesion in the brain’) rather than psychology lay at its root.[v] A sexual element was common in many cases, and female hysterics’ sexuality was controlled by doctors on the wards, in extreme cases leading to painful and disfiguring surgery in an attempt to prevent sexual expression.[vi]
Various treatments were tried on hysterical patients, many of whom may have been suffering from ordinary mania. Leeches, electric shocks, extreme baths and drug treatment were all tried by Charcot and his contemporaries at one time or another, along with later attempts at hypnosis, including startling patients into a trance with loud noises.[vii] Ultimately, Charcot and his followers believed that hysteria was based in an individual’s constitution and that it was degenerative, and so easing symptoms rather than searching for a cure remained his main focus. The treatments provided were controversial, and led to accusations that Charcot’s female patients were sometimes being abused, particularly when surgery was used.[viii] This late flowering of ‘hysteria science’ was based in a view of femininity as a problem. As Martha Noel Evans argues, Charcot and his followers saw femininity as a disease, thus allowing them to overlook the social and familial conditions in which patients lived and which led them to develop mental and physical problems – poor working conditions, isolation, sexual abuse or legal powerlessness and lack of agency in a very male dominated society.[ix]
Photographic plate of ‘passionate attitude’ phase of hysterical attack, from ‘Iconographie photographique de la Salpêtrière : service de M. Charcot,’ by Bourneville & Regnard (wellcome collection, CC BY 4.0)
Charcot’s belief that there was an organic cause of hysteria in the brain, a ‘missing lesion’ which would explain the disease came to nothing, and no such root cause could be found for hysteria. Within ten years of his death in 1893, hysteria was on the verge of disappearing from the medical textbooks. Physicians started to look for alternative causes and treatments, and to understand nervous disorders differently. Research into hysteria moved from the neurological to the psychological, and it was at that point that hysteria, as a cogent and meaningful condition, fell apart.[x] In the 1880s, doctors such as Hippolyte Bernheim began to believe that under the right circumstances, everybody was capable of ‘hysteria’, that it was psychological in basis and that the Charcot school of thought had been far too extreme in identifying it as one illness and excessive in the methods used to treat it. After Charcot’s death his explanations of hysteria fell out of favour and the work undertaken by Bernheim and others pointed the way forwards.[xi]
Sigmund Freud, an admirer of Charcot, moved the concept of the illness into the realm of psychology and repressed memory, and away from the idea of a disease with an organic origin, a ‘dynamic lesion’. Hysteria appears to have fallen from grace as a diagnosis very quickly, after a huge mass of material written on the subject during Charcot’s heyday. It appears that hysteria, as a diagnosis and as a cultural idea, was dead or dying after 1900, and that it ceased to be a useful medical diagnosis early in the century. Twentieth century medical literature has largely asked ‘whatever happened to hysteria?’[xii]
As early as 1908, Armin Steyerthal, doctor of a private health spa in Germany, wrote that ‘within a few years, the concept of hysteria will belong to history…there is no such disease and there never has been.’[xiii] Mark Micale writes that hysteria disappeared between 1895 and 1910 because scientific understandings of disease changed, and the understanding of the clinical content of diagnosis underwent a revolution. After this, the condition disappeared, because it no longer made sense as a diagnosis. Scientific understanding reclassified it out of existence.[xiv] Hysteria was effectively a ‘diagnosis of exclusion’ – its diagnosis could only be made when all other possible physical and mental explanations for symptoms had been ruled out. As understandings of organic illness expanded, fewer and fewer symptoms could be put down to ‘hysteria’.[xv] Freud’s belief that hysterics were created by the social mores and sexual repression of the late 1800s was also taken up by later writers. They saw the ‘de-Victorianisation’ of society as the key to understanding why hysteria disappeared. This thesis seems to suggest that hysteria was a distinct ailment or set of ailments, caused by repression and social restrictions.[xvi]
Another more recent theory amongst medical historians and practitioners is that as modern urban life continued, humans developed more sophisticated mental coping mechanisms, leading to a fall in hysteria and a rise in ‘psychological literacy.’[xvii] However, as Mark Micale observes, the prevalence of hysteria appears to have faded as early as World War One. Medical interest in hysteria also declined as we can observe in trends in medical literature, which show a massive spike in published material on hysteria in France and Germany between the 1870s and 1890s. This fell dramatically in the 1890s, and after a modest increase of writing on ‘hysterical disorders of war’ between 1914 and 1918, the published material on hysteria fell to a trickle after 1920.[xviii]
It could be that hysteria was not a real condition, but the piecing together of symptoms of other conditions to form a ‘phantom illness’, a ‘dustbin’ into which were placed all symptoms which could not be explained. It could also have been many different conditions, misdiagnosed using the convenient word hysteria. Hysteria collapsed because nothing underpinned it as a real disease. However, in more recent times, some have suggested that hysteria still exists, but manifests itself in other ways – as chronic fatigue syndrome, for example.[xix] Whatever the full truth of hysteria’s existence or non-existence, it was a label for a diagnosis and cultural idea from the ancient world to almost the present day. Only the highly advanced medical sciences of the last century finally found it wanting.
[i] Martha Noel Evans, p.23
[ii] Martha Noel Evans, p.26
[iii] Martha Noel Evans, p.24
[iv] Andrew Scull, Hysteria p.115; Martha Noel Evans, p.25
[v] Martha Noel Evans, p.28
[vi] Martha Noel Evans, pp.38-40
[vii] Martha Noel Evans, pp.41-42, p.44
[viii] Micale, Approaching Hysteria, p.25
[ix] Martha Noel Evans, p.50
[x] Micale, Approaching Hysteria, p.26
[xi] Micale, Approaching Hysteria, pp.27-28
[xii] Micale, ‘On the “Disappearance” of Hysteria’, p.498
[xiii] Micale, ‘On the “Disappearance” of Hysteria’, p.501
[xiv] Micale, ‘On the “Disappearance” of Hysteria’, p.502
[xv] Micale, ‘On the “Disappearance” of Hysteria’, p.510
[xvi] Micale, ‘On the “Disappearance” of Hysteria’, p.499
[xvii] Micale, ‘On the “Disappearance” of Hysteria’, pp.499-500
[xviii] Micale, ‘On the “Disappearance” of Hysteria’, p.501
[xix] Andrew Scull, Hysteria p.187
Further Reading:
Joanne Begiato, ‘Punishing the Unregulated Manly Body and Emotions in Early Victorian England’, in The Victorian Male Body, Joanne Ella Parsons and Ruth Heholt (eds) (Edinburgh University Press, 2018) pp.46-64
Martha Noel Evans, Fits and Starts: A Genealogy of Hysteria in Modern France (Cornell University Press, 1992)
Mark S. Micale, Approaching Hysteria: Disease and Its Interpretations (Princeton University Press, 1994)
Mark S. Micale, ‘On the “Disappearance” of Hysteria: A Study in the Clinical Deconstruction of a Diagnosis’, Isis , Vol. 84.3 (Sep, 1993), pp. 496-526
Andrew Scull, Hysteria: The Disturbing History (OUP, 2009)
Elaine Showalter, ‘Victorian Women and Insanity’, Victorian Studies, Winter, 1980, Vol. 23.2, pp. 157-181
Staffordshire's Asylums 