DISPLAY CASE
Victorian Cases: Physical causes
This table from the annual report of 1882 divides patients’ supposed causes of insanity into either ‘physical’ or ‘moral’.
This table illustrates the basic separation of Victorian mental health diagnosis. The moral causes might otherwise be defined as psychological ones, such as anxiety, domestic trouble, overwork or religious excitement. The physical causes were those that could be ascribed to some tangible experience, such as the menopause, drink, sunstroke or childbirth.
Female patients case book: Mary Holland’s notes
Reference: D/H10/D2/2/8
Forty-three year-old Mary Holland was admitted to Fair Mile from the Reading Union Workhouse (Battle Hospital) on 12 September 1881. She had been in the Workhouse for two weeks following the birth of her sixth child.
She had developed mania as a result of puerperal fever, a post-natal infection. This was one of the main causes of female deaths in Victorian Britain, though with modern standards of hygiene it is virtually unknown, and easily cured with antibiotics.
When she was admitted, Mary had a fever, complained of abdominal pain, and had swollen legs. She was noisy, excitable and delusional, believing her baby was dead, when in fact the child was healthy. She also refused food, believing that it was poisoned. She would spit it out or take an hour to eat a single mouthful.
Her fever was treated with quinine, one of the few drugs available to Victorian doctors, as well as with helpings of brandy. She was also given diuretics to remove water from her body. Within a month, her fever had subsided, and she was allowed home on 23 February 1882.
Male patients case book: William Woods’s notes
Reference: D/H10/D2/1/8
William Woods was admitted to Fair Mile in June 1887 with symptoms of tertiary syphilis. These included a bobbing head, a characteristic shuffling gait, unequal pupils and no patellar reflex, meaning that his lower leg did not extend when his knee was tapped.
Tertiary stage syphilis is now extremely rare, because the first stage of the disease is both easily diagnosed and easily treated with antibiotics. During the Victorian age, this treatment was not available, and over many years the disease could reach the third, or final stage. This caused degeneration of the spinal cord, tremors, seizures, and paralysis as well as brain damage, resulting in severe mental health problems. Eventually the patient would die.
Woods was a forty-nine year-old baker from Reading. According to his admission papers, he was violent, incoherent, used foul language, had delusions such as believing that he owned a great deal of property, and saw and heard imaginary things. The Medical Superintendent noted that he had periods of incontinence, and that he was confused, delusional and forgetful, and was sometimes noisy, violent and destructive.
Woods was obviously missed by his family, and eighteen months after his admission they asked for him to come home on trial. It was not a success. Within a month, his family admitted defeat and sent him back to Cholsey as impossible to control. It would be his final home. He gradually became immobile and died from ‘general paralysis of the insane’, meaning tertiary syphilis, on 27 December 1889.
Female patients case book: Mary Lewington’s notes
Reference: D/H10/D2/2/9
Mary Lewington was only nine years old when she entered the hospital on 5 October 1888. She was diagnosed as a ‘congenital imbecile’ since birth, and was also an epileptic.
‘Imbecile’ or ‘idiot’ were technical Victorian terms used to describe people with severe learning disabilities. ‘Idiots’ had more severe learning disabilities than ‘imbeciles’, and were considered to have no independence. The subjective nature of the diagnosis is evidenced in Mary’s notes, where the Superintendent has overwritten the word ‘idiot’ in his own diagnosis.
Mary was the fifth child of Moses and Ellen Lewington, who lived in the small parish of Woolhampton. Almost certainly, she ended up at Fair Mile because her parents found it hard to manage her as well as their working lives and other children. Mary did not have much awareness of danger, and at the age of seven had been run over by a horse and cart, breaking her leg. She had also burnt herself several times, and was unable to control her own bodily functions.
Mary was not the only child at Fair Mile, though their numbers were few. Virtually all of them fitted the circumstances of her case. Fair Mile did not have separate children’s wards, and their presence amongst adult patients was a cause for concern amongst the staff and the Commissioners in Lunacy. This was not just for the children’s welfare, but for other patients too, because her notes state that Mary often became excited and knocked down elderly patients.
Her case notes say that she could not be taught to read, sew, or do much for herself, and that her case was ‘hopeless’. She died on 18 May 1898 at the age of 18, after suffering from typhoid for two weeks. Typhoid is a water-born disease, usually caused by contaminated sewage entering the drinking water supply. It was an occasional problem at Fair Mile, and caused the Asylum to remodel its plumbing systems several times.
Male patients case book: Thomas Willoughby’s notes
Reference: D/H10/D2/1/8
Thomas Willoughby, a 75 year-old agricultural labourer from Lockinge was admitted on 11 February 1888 suffering from senile dementia. He had been ill for two years, and been in the workhouse for one week.
Old age, and mental health problems associated with it, was a common reason for a patient’s admission to Fair Mile. At any one time, roughly 40% of the patient population in the Asylum was of pensionable age. Superintendent Robert Gilland complained that the County’s workhouses had a habit of transferring elderly patients to Fair Mile once they had become ‘too troublesome, dirty or feeble’.
Willoughby was found to be very thin on admission, weighing only 8½ stone. He was suffering from memory loss and unable to say where he was or how long he had been there. His admission papers said that he believed that he was still at work and constantly chopping wood. He was also destructive, tearing his bed linen. He remained restless and weak until he died six weeks later, on 29 March 1888.