Tuesday, 7 March 2017
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.
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 firstname.lastname@example.org