Forced-feeding, Food refusal, and the attitude to Food in the Garlands Asylum

A couple of weeks ago I gave a seminar as part of the University of Leicester’s History of Medicine series. The seminar detailed a small part of the research I have undertaken during my PhD studies. The focus was on the how food was viewed and utilised in the asylum, as both a way of treating mental illness, and how, in certain patients, an aversion to eating could exacerbate their condition. This blog post will provide some of the points which I discussed, with the key focus being on providing the patients with sufficient nourishment, and resorting to forcible methods of feeding in those that refused it.

Moral Treatment

To begin with, it is necessary to give a bit of background as to the treatment given at this time in the nineteenth century lunatic asylums. A growing era of philanthropy, an increased concern among society about humanity, and delivering humane treatments, led to the adoption of ‘moral treatment’ in the county asylums built after the 1845 Lunacy Act. Pioneered at the Quaker run York Retreat at the end of the eighteenth century, the asylum regime centred on providing patients with a good diet, regular exercise, useful employment, recreational entertainments, and regular religious services. Self-restraint was encouraged among the patients so that asylum doctors no longer had to mechanically restrain them using locks and chains. Discipline and enforcing a rigid regime was adopted widely to promote the notion of self-restraint. No longer were harsh punishments, violence, and an environment of brutality accepted in lunatic asylums. Psychiatry in this era was in its infancy, and little was known about the conditions which caused a mental breakdown. Therefore, there were few medical treatments to cure the patients who found themselves with mental illness in a lunatic asylum. Doctors instead focussed on curing the physical ailments of an individual, as it was believed this would promote a cure in their mental faculties. Central to this were the aspects of moral treatment outlined above, of which a nourishing diet was key.

Food as Medicine

Increasingly during this period, physicians reinforced the link between poor food intake, and patients suffering from conditions of the nerves. This was due to the contemporary understanding that the stomach as an organ was heavily related to the nerves. Thus, well cooked and varied meals, of a higher standard than pauper patients would receive at home, were provided in the asylum. In the 1863 Garlands annual report, Dr Thomas Clouston, medical superintendent of Garlands from 1863 until 1873, stressed that ‘a good dinner…generally [has] a far more soothing effect than any sedative’. Below is a picture of the ordinary patient’s diet that was administered to the male and female patients in 1863.

As can be seen from the picture, the asylum dietary was varied, albeit in a rigid, weekly format. Male patients received slightly more than the females, and some meals were also different for each sex. Meals were adapted depending on the time of the year, with meat pies being substituted for rhubarb and gooseberry ones in the summer months. The Commissioners in Lunacy, a body created to regularly inspect all the county institutions of England and Wales, judged the efficacy of each asylum on the standard of food it offered to its patients. For instance, in 1877 they said on their visit to Garlands, that: ‘There were today 91 men and 82 women dining together in the hall, and the dinner of soup, with fresh meat and potatoes, which was well served and in good taste, seemed to meet with general approbation’.

            Common in the treatment of certain mental conditions was tailoring the diet to each individual. For example, Dr John Campbell, medical superintendent in Garlands from 1873 until 1898, administered a milk diet for patients that were particularly violent and irritable, whereby animal food would be avoided for some weeks in an attempt to soothe them. For those suffering from an increased appetite, in particular patients with general paralysis, a restricted diet was advised; mincemeat and potatoes would be given on two days of the week, for the rest, the patient would receive only broth and milk. Whiskey and beef tea were especially prescribed for patients who were sick and bedridden, in an attempt to stimulate them back to health.

Food refusal and Forced-feeding

Great importance was placed upon the value of asylum patients receiving a good diet, therefore cases which refused all nourishment posed significant problems for the asylum doctors, as they had to resort to feeding via forcible means. When we think of force-feeding we conjure up images of the hunger-striking suffragette, and we seem to forget that this practice was made commonplace in the county lunatic asylums of the nineteenth century. The adoption of this calls into question the efficacy of moral treatment, as patients had to be held down and restrained whilst liquid mixtures were forced into their stomachs via a feeding tube administered through the mouth or nose. Due to this, the practice was, unsurprisingly, surrounded by debate and controversy. Garland’s own Dr Campbell was equally incensed by the issue, and in 1878 wrote an article (‘Feeding versus fasting’) in the British Medical Journal. He outlined that at Garlands forced-feeding would only be resorted to if patients had refused food for two consecutive days. However, for those already weak and in an emaciated condition, force-feeding may be utilised sooner. From 1873 until 1878, thirty-five patients had had to be force-fed, in one case continuously for two years. In the article, Campbell described the features that were common in food refusing patients;

silly emotional excitement, alternating with trance-like or cataleptic-like state, in which the patient would lie for hours, taking no notice of what went on around, and apparently unconscious of pain or discomfort, and refusal of food for considerable periods.

He also explained, that in some circumstances, simply by explaining the method of force-feeding via the tube was enough to bring patients to eat. Liquid mixtures, usually containing beef tea or milk and brandy, were administered down the tube to provide nourishment to self-starving patients. Forcible feeding was therefore employed to prevent as many deaths as possible through food refusal. However, the brutality it inflicted upon patients called into question the ability of asylums to use moral treatment to effectively bring about recovery.

Thank you for taking the time to read this snippet from my research conducted on the Garlands Lunatic Asylum, which forms the basis of the PhD thesis I am currently working on. My aim is to write the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com

Murder at Longtown Workhouse

Throughout my PhD research of the Garlands Lunatic Asylum, Carlisle, I have come across many extraordinary stories of the patients that came through its doors from its inception in 1862, until the end of the nineteenth century. The story I am going to recount through this post is one of a patient that committed a most brutal and terrible crime ten years after his release from the asylum. This calls into question the ability of the authorities of the time to judge a patient fit for release, and whether discharged patients were properly monitored in the years after their confinement in an institution.

            This blog post centres on Michael Edward Carr, who was a patient of the Garlands Asylum on five separate occasions between 1870 and 1888. His visits to the asylum for treatment varied in length; the first being one year two months; the second three months; the third was six months; the fourth was for five months, and his final stay lasted only four months, with his final date of discharge on 12 July 1888 – almost ten years before the dreadful event briefly outlined in the West Cumberland Pacquet[1] below.

 

On the evening of 31 May 1898, in the hospital ward of Hallburn workhouse in Longtown, Carr and six other inmates were asleep, and had been since 8 o’clock, when he suddenly became somewhat excited and accusatory of James Nichol, at around midnight. Carr was adamant that Nichol was in his bed, when in fact it was the correct bed and Carr’s laid empty next to him, therefore he was in a delusional and confused state. Nichol was aged 79, had completely lost the use of his legs, and was partially blind. Carr himself had deformity of both his legs, and had to walk with the aid of two walking sticks. Inmates of the hospital ward who witnessed the incident said that Carr set about Nichol with both his walking sticks and beat him to death, all because he believed he was in his bed. One of the witnesses, a fellow inmate, recalled how: ‘blood spattered on to me, I was terrified that he would strike another old man’. This same witness stated that for two days prior to the incident Carr had been somewhat depressed and refused to speak to anyone. However, the master of the workhouse stated that they did not have any inclination as to Carr’s mental state, and the incident came completely out of the blue. Carr had only been an inmate of Hallburn workhouse for seven days, thus possibly not enough time for the master to fully assess his condition. Carr had instantly killed Nichol with the first blow to the head with his stick, but had kept on beating him. The result, as reported by the Doctor who arrived about an hour after the incident, was that ‘his face was a mass of pulp, his right arm was broken and there were bruises on his body…his head was practically beaten in’. He also stated that he had treated Carr a couple of days previous for bronchitis, and that he noticed nothing wrong with him mentally.

            It seems strange that in light of this brutal murder the people that had come into contact with Carr had not noticed any strangeness in his character or suspected anything wrong with his mental state. It also seems strange that none of the people interviewed in Carr’s trial new of his history in the Garlands Asylum. Each time he had been admitted to the asylum he was chargeable to Longtown Union, thus they paid for his maintenance. Also, being incarcerated in a county lunatic asylum at this time carried with it a great stigma, therefore I find it hard to believe no one in this area knew of his previous treatment for mental illness. In suspecting that he was insane at the time of the murder, due to his strange belief that Nichol was in his bed, Dr Campbell, medical superintendent of Garlands was called to examine the prisoner at Carlisle Gaol. On 24 June, Campbell remarked of his examination of Carr:

 

‘He complained to me that he had been assaulted and nearly murdered by 8 men in the Longtown workhouse. He denied that he had ever killed a man or even attacked anyone…I found his memory as to long past occurances excellent, but as to matters which took place within the last month his memory was very defective, almost a blank…I do not believe the man to be feigning insanity. In my opinion the man is insane, holds and expresses delusions of persecution and is not in the full possession of his senses so as to be pleading to the indictment’.

 

Michael Carr was charged with, ‘having on the 31^st day of May last at the parish of Arthuret in the said County feloniously and of his malice aforethought killed and murdered one James Nichol’. After being examined by Dr Campbell Carr was found guilty but insane at the time of the murder, and was sent to be detained in Broadmoor Criminal Lunatic Asylum, where he remained until his death in 1924.

What is apparent from the murder committed by Michael C, is that the monitoring of discharged asylum patients was none existent. The fact that Michael had been in Garlands several times should have resulted in him remaining longer in Garlands each successive time he was admitted, however the inverse occurred. Of particular concern was the fact that Michael was continually referred to as dangerous and violent in his case notes, which seem to have also been failed to have taken in account.

 

Thank you for taking the time to read this somewhat brutal story from my research conducted on the Garlands Lunatic Asylum, which forms the basis of my PhD thesis I am currently writing. I am working towards writing the history of such a fascinating institution through the experience of its pauper patients. If you have any stories relating to the asylum, or would like help in tracing your ancestors that were in this particular institution, please don’t hesitate to contact me at caradobbing@gmail.com

 

All material for this blog post relating to the trial of Michael Edward Carr comes from the national archives, ASSI 52/38.

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[1] Dated 8 July 1898.

Voices of Madness Conference 2016: ‘The Pauper Experience of Insanity, 1862-1902’

Last week, I gave a twenty minute presentation at the ‘Voices of Madness’ conference at the University of Huddersfield for fellow academics, based on my PhD research over the last few years on the Garlands Lunatic Asylum Carlisle.

In the talk, I explained the key focus of my research so far; the fact that mentally unwell paupers in the latter half of the nineteenth century were continually shifted around the different institutions of care. Through using examples from the Garlands patient records, I gave four stories of individuals who were transferred numerous times in and out of the asylum from either the workhouse or the family home. Through this blog post I want to share these stories with you.

The first two examples I recounted were those transferred several times from the family home to the asylum and back again. To begin with I told the story of Jacob C, whom I have mentioned in my previous blog post, therefore I will not repeat his story this time. Next, was Thomas S, who was admitted to Garlands by his family when his condition became erratic and unmanageable; and was admitted on seven separate occasions between 1878 and 1905.

His intermittent bouts of insanity were caused by religious mania and the fact that he was always deemed to be ‘weak-minded’.  His mother Ann was his main carer, as his father had died shortly after Thomas was born in 1861. His siblings do not seemed to have been involved either, as when Ann died in 1903 Thomas ended up in the workhouse shortly before his final admission to Garlands. On his first admission on 8 June 1878, Thomas was aged just 17, described as an errand boy who was smart and active from Penrith. The trigger for his admission was his noisy and out-of-character behaviour. He suddenly became very religious, and refused to sleep or eat. He also began having fleeting delusions of a religious nature. It was these delusions which were a common factor of his bouts of insanity on each occasion he was admitted to the asylum. For instance, on his second visit in August 1889 he was described as thinking he was Christ; he had began preaching to the neighbours; and he thought he was the saviour and was going to pull down the walls. This behaviour clearly upset his mother enough to seek the assistance of the asylum doctors, and on his third admission in 1895 she was noted as stating that he was unmanageable and that she will not stay in the house alone with him. On each of the seven occasions Thomas came to the Garlands Asylum, he was discharged recovered back to the home he shared with his mother after three to four months. His final admission however, in September 1905, lasted until his death in the asylum on 28 November 1928.

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As well as the asylum, the workhouse remained an important receptacle for the care of the mentally unsound, and provided those without any family support of their own with a place of care. Similar to when in the family home, the trigger for a patient’s removal to the asylum was the display of particularly unruly and unmanageable behaviour in the wards of the workhouse. This transfer of care was present in the next two examples. The first, Sarah M, was admitted to Garlands in May 1890, aged 26, and was transferred directly from the workhouse at Brampton.

She was suffering from mania, and was becoming unmanageable due to her constant delusions that her food had been poisoned. Sarah had been in the workhouse since the death of her mother in 1884, who she had lived with and had been her sole carer. Her father was described as having ‘a violent temper’ in her case notes, and this seems to explain why in the 1871 and 1881 census’ her father Patrick was not living with her and her mother Mary in the family home. Sarah had two brothers and one sister living at the time of her first admission to the Garlands, but they seemed to have distanced themselves from her and her unruly behaviour, as the stigma of an insane relative was a great source of shame.[1] Sarah remained in the Garlands for five years, during which time she showed no signs of recovery. On 5 July 1895 she was deemed harmless enough to be transferred back to Brampton workhouse to receive care in its infirmary. This often happened when the asylum experienced periods of overcrowding, and to relieve pressure those deemed ‘harmless’ to themselves and others were transferred to workhouses to carry on their treatment. The effect of this shift may have freed up spare beds in the asylum wards in the short-term, but in the long-term it had a detrimental effect on the health of the transferred patients. Sarah was returned back to Garlands in July 1897 for her obscene behaviour, running about the wards with her ‘clothes tied up to her waist’.[2] What is interesting to note in her case record from 1897, is that she is stated to have no known relatives, whereas on her first admission in 1890 it mentioned both her mother and her father. This suggests that her family further alienated Sarah from their lives as the poor law authorities were not aware of her living siblings; and we can firmly assume that they were not in contact with each other through letters or visits. Her second stay in the Garlands did not last as long as her first, as she was again discharged back to the care of Brampton Workhouse on 25 Aug 1898. This time Sarah remained in the workhouse for a substantially longer period, but still suffering from the mania she was first troubled with in 1889. On 27 January 1913 Sarah was admitted to Garlands for the final time, once again being transferred from Brampton workhouse, aged 50. She was to remain in the asylum until her death in 1930. Sarah’s case is not unique, it is one of many I have come across which portray the transitory nature of asylum provision in the latter half of the nineteenth century. We can never know for sure if Sarah’s condition was curable had she remained in the care of the asylum for a longer, sustained period, rather than being continually transferred to and from the workhouse. Sarah even came to prefer the asylum to her life on the outside, as stated in her case notes in October 1891; ‘[she] has no interest in her former life, [and is] contented and happy to remain here’.[3] Thus, the asylum provided a familial context to those who otherwise lacked this supportive framework.

The final example is Matthew G, admitted to Garlands for the first time on 20 September 1901, aged 66.

He was transferred from Fusehill workhouse in Carlisle to the asylum, where he had been suffering with mania for six weeks. Like Sarah, Matthew was listed as having no known relatives, and he was noted as being single. However, Matthew offers us a somewhat different set of circumstances, as he migrated to Carlisle from Ireland where he was born. Irish migrants posed a problem for poor law authorities in this period. Migrants who had settled in a county were not liable to be paid for by the authorities of the poor law unions in which they now resided. The cost of maintenance of a pauper in either the workhouse or the asylum whilst receiving treatment for their mental affliction was paid for by the poor law union from which they were born. In the case of a patient who was born in Ireland, such as Matthew, the costs for their care and maintenance could not be recovered from their home country, as they had a different system of relief. ‘Alien patients’, as such cases came to be known as, were viewed with contempt as they became a burden on the poor law rates. The close proximity of the Garlands Asylum to Ireland, and the attraction of casual labourers to the coastal towns of Cumberland, meant that the ‘problem’ of alien patients was a persistent one during this period. A high number had migrated to England to escape the famine of the late 1840s and since then had been employed in seasonal, low-skilled jobs, finding it hard to support themselves and their families. In the 1889 Garlands annual report Dr Campbell, the medical superintendent, explained the problem of alien patients in monetary terms:

…up to the end of 1889…£15,761 has been expended here on Irish and Scotch patients who had no settlement in England…the Irish lunatic is more noisy, dirty, troublesome, and quarrelsome than the English or Scotch, he is more treacherous, and owing to this, more dangerous, and the more miserable his previous outside surroundings were the more critical and complaining is he about the food, clothing and bedding in the asylum…[4]

Matthew was viewed as a typical ‘alien’ patient and it is clear that with no family of his own he came to rely on the workhouse and the asylum when his health began to deteriorate towards the end of his life. Matthew was in the Garlands on two separate occasions, being discharged unrecovered back to Fusehill workhouse in the interim. On his second admission in October 1902 it was stated that in addition to his failing memory, he had become violent, had struck other inmates, and began experiencing delusions that there was a conspiracy against him. He continued his abusive behaviour in Garlands, and seemed to live up to the perceived reputation of the typical Irish lunatic. In his case notes throughout his second bout of treatment he was repeatedly described as ‘quarrelsome’, and received several bruises through fighting with other inmates. Matthew died in Garlands in November 1904, aged 69, of tuberculosis with no listed next of kin. From the cases of Sarah and Matthew, it is evident that those who lacked a family support came to rely on the poor law authorities for help, and remained life-long receivers of its provision, albeit in a number of different institutions, and for a number of different reasons.

These are just a small number of cases which I have come across in my PhD research into the Garlands Lunatic Asylum, Carlisle, which portray the transitory nature of mental health care in the latter half of the nineteenth century. My PhD aims to tell as many stories of the patients who underwent treatment at the Garlands during the latter half of the nineteenth-century. Please feel free to contact me (caradobbing@gmail.com) if you require assistance in finding your ancestors who were in the Garlands during this period, or if you have any interesting family tales.

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[1] Suzuki, Madness at Home, p. 121.

[2] CACC, Reception Orders 1897, THOS 8/4/1/39.

[3] CACC, Female Casebook 1888-1892, THOS 8/4/40/2, admission no. 3359.

[4] CACC, Annual Report 1889, THOS 8/1/3/27, p. 17.

The Role of the Family

Often overlooked by many institutional histories of the Victorian lunatic asylum is the role of a patient's family in their admission, discharge and treatment whilst in such an establishment. In my latest chapter of my PhD I am attempting to redress this imbalance by recounting the stories of patients at the Garlands Asylum, Carlisle, to ascertain the role their families played. This blog post is going to examine one part of the family involvement by looking specifically at the admission process.


The Family as Primary Caregivers
In the first instance of an illness, be it mental or physical, the family have always been, and often remain, the primary caregivers for their relatives. For centuries prior to the introduction and expansion of the county lunatic asylum network in the Victorian era, the treatment of a mental condition was administered in the family home. As the asylum as an institution of care became increasingly commonplace, families became increasingly willing to admit their relatives. Thus, as Adair, Melling and Forsythe assert, the lunacy legislation of the nineteenth-century signalled an intervention into family life, as it allowed for the lunatic population to be shifted from the private to the public sphere. (R. Adair, B. Forsythe and J. Melling, ‘Families, Communities and the Legal Regulation of Lunacy in Victorian England: Assessments of Crime, Violence and Welfare in Admissions to the Devon Asylum, 1845-1914’, in Bartlett and Wright, Outside the Walls, p. 165.)

The decision to commit a relative to the asylum was often signalled by a deterioration in their behaviour. Violence and erratic behaviour were seen as disrupting the accepted boundaries in society and the domestic sphere. For instance, in 1887, Ann C described her husband's behaviour which led to her having him admitted to the Garlands Asylum:

he wanders about all day, and comes home generally very dirty and without his shoes and stockings…this morning a man fetched him home having found him in a midden [compost] heap…he has torn up his clothes…and has set fire to articles of value. 

(CACC, Reception Orders 1887, THOS 4/1/29).

Thus, her husband’s destructive and unmanageable behaviour had become too much for Ann to bear. The added worry that he had wandered off into the community and had to be returned by a stranger would also have been a great concern as his insanity was visible to the surrounding neighbourhood, which had a deep stigma attached.

Family as Causing Insanity

In this specific chapter of my PhD I will also explore a relatively un-researched aspect of insanity and its causes in this period. Some of the cases I have come across in the records in the nineteenth century are clearly caused by a disruptive home life, and directly by the family itself.

One example is that of Dinah L. She was admitted in June 1899 suffering from melancholia caused by ‘domestic trouble’ and ‘unpleasantness at home’. Four days before her admission, for reasons unstated in her admission records, she left home due to her inability to cope in the domestic setting and was found wandering barefoot in a friends garden by a neighbour. At the time, Dinah was living with her husband Thomas, and several of her ten children. Her last child, Edith, had been born in 1892 when she was 45. It was stated in her case notes that she had been feeling melancholic and frequently felt suicidal for the seven years since Edith’s birth. We cannot know for certain the exact trigger for Dinah leaving home which led to her admission, but in her notes she was described as having two black eyes and several bruises on her limbs. Along with the description of ‘unpleasantness at home’ and her injuries, we are led to assume that Dinah suffered some form of domestic abuse from either her husband or her children. Whatever the case, we can see from her asylum record that she was anxious to leave her home and in July 1899 in her Garlands case notes she was described as saying ‘she is very happy in the asylum…and has no desire to leave’.[1] She had been married to Thomas for 29 years, and since 1871 had given birth to 11 children, of whom 10 survived. Therefore it is reasonable to assume that the demands of what was clearly a hectic domestic life had taken their toll on Dinah. After receiving treatment in the asylum for some months, Dinah’s health improved and her suicidal thoughts subsided enough for her want to return home to her family. She was discharged recovered on 19 October 1899, and remained living with her husband in Kendal until her death in 1911, never returning to the Garlands with any further problems. Thus, the respite offered to her during those months in 1899 was enough to return her to her usual physical and mental health which had become so weak due to her domestic situation.

One additional example of the family causing insanity is that of Ruth A, who was admitted on 18 November 1891. Ruth’s insanity was caused by the death of her five month old baby. However, what is interesting about this case is that the passing of her child was caused by her administering a lethal dose of laudanum to the infant. To us in the twenty-first century this seems shocking, but in the 1890s laudanum, and various other derivatives of opium, were dispensed freely by pharmacists as a remedy to soothe a variety of illnesses in children, and also in adults. Riddled with the guilt that she had been the cause of her child’s death only one week previous to her admission, Ruth was described as being ‘a pale, depressed looking woman’. She had become very inattentive and neglectful of her other children as a result of her condition, and due to this depression, her husband, Robert thought it necessary to admit her to the Garlands for specialist treatment. Whilst in the asylum, Ruth told the doctors she thought she would be safer here because she was so afraid of herself. After three months of treatment, Ruth was deemed well enough to be returned home on 16 February 1892. Although, this did not last; and she was readmitted to Garlands on 8 April 1892, suffering from melancholia due to the ‘worry about the poisoning of her child’. Ruth’s mental health had clearly deteriorated, so much so that she felt suicidal and believed she would never be forgiven for the death of her youngest child. It seems that Ruth herself instigated her own readmission to Garlands as she did not trust herself and could not stay at home. I think that in her own mind, Ruth came to see the asylum as a place of refuge, similar to the previous case of Dinah L. In being incarcerated in Garlands she believed she was protected from being able to access the drugs she had once used recreationally and which had killed her child. Ruth remained in the asylum for three years, and was finally discharged as recovered on 17 December 1895.

These are just a small number of cases which I have come across in my PhD research into the Garlands Lunatic Asylum, Carlisle. My PhD aims to tell as many stories of the patients who underwent treatment at the Garlands during the latter half of the nineteenth-century. Please feel free to contact me (caradobbing@gmail.com) if you require assistance in finding your ancestors who were in the Garlands during this period, or if you have any interesting family tales.

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[1] CACC, Female Casebook, 1899-1902, THOS 8/4/40/5, admission no. 4754.