“These patients are imbecile simply from decay of nature, and quiet in manners, and should, in the opinion of the committee, have been allowed to spend the little time left for them in the respective Workhouses, without compelling them to run the risk attending the journey to Caterham.”
– Report from the Committee for Caterham Asylum, sent to the Metropolitan Asylums District, 9th December 1871
This is taken from a report written by the Governors of Caterham Asylum in 1871. Caterham had been opened a year earlier in an attempt to relieve the burden on the main county lunatic asylums by taking on some of the ‘incurable’ cases who were thought to be unsuitable for mainstream asylum care. Its main purpose was supposedly to manage and train people diagnosed as ‘idiots’ (broadly, people who were thought unable to learn or process information properly, but who were not deluded or violent).
Training the inmates, producing useful members of society, and maintaining an orderly and efficient institution were the key aims of the Caterham governors. They were, however, confounded by the number of elderly and infirm cases sent to them from workhouses across London. Such people were not only unsuitable for training and education, but needed a level of care and attention which the asylum was not able (or prepared) to provide.
This was a problem in most, if not all, lunatic asylums, but Caterham was particularly vocal in its objections. The quotation above is one example of the many passive-aggressive appeals made to the powers-that-be to admonish the individual Poor Law Unions who acted in this way.
Caterham administrative block, c.1914.
© Peter Higginbotham
Often, objections were raised on the grounds of the physical condition of the patients when they arrived at the asylum – clearly unfit for travel (quite an ordeal in mid-Victorian London, even across short distances) and so affected by the journey that they died shortly afterwards. In this example, the dignity of the patient is also invoked, asking that they be allowed to “spend the little time left for them” in the Workhouse, without suffering the stigma of asylum admittance. However, I cannot help but feel that these reasons were used by the asylum to make their argument more compelling, and that the heart of their objection is that they felt that these cases simply did not belong in their institution.
The problem was, of course, that such cases did not really belong anywhere. As the nineteenth-century wore on, only the very toughest proponents of the doctrine of less eligibility (the idea that conditions for those receiving poor relief should be worse than the worst possible existence without poor relief) thought that those impoverished through old age belonged in the workhouse.
The governors of Caterham, like those in charge of most asylums at this time, felt that the aged did not belong in their institution because they were not really insane, they were not really ill, they were simply showing signs of the inevitable decay from advanced age. Calls to remove the elderly from the asylum for this reason grew louder as the century wore on, and as asylum physicians were faced with increasingly crowded institutions which seemed far removed from the therapeutic ‘utopias’ they were originally conceived as. One of the contentions of my thesis is that these practical considerations – the need for a manageable asylum population and the desire to show that they had the power to cure – played a role in changing medical conceptions of mental change in old age.
‘Senile insanity’, ‘senile dementia’, and a host of other old-age mental illnesses were described in books and articles about diseases of the mind, alongside other forms of insanity. Such cases were sent to asylums by their families, and admitted to asylums by doctors. Yet, as the consequences of public institutional care of ‘lunatics’ became apparent, the definition of what constituted ‘lunacy’ came to be more tightly defined. These elderly cases were no longer suffering from ‘senile insanity’, an organic disease of the brain, but ‘simply from decay of nature’.