Henry R Rollin

Yorkshire’s influence on the understanding and treatment of mental diseases in Victorian Britain: The golden triad of York, Wakefield, and Leeds

ABSTRACT In the late-eighteenth and nineteenth centuries, a more humane approach to the care of the insane in Britain was catalyzed in part by the illness of King George III. The Reform Movement envisaged “moral” treatment in asylums in pleasant rural environments, but these aspirations were overwhelmed by industrialization, urbanization, and the scale of the need, such that most asylums became gigantic institutions for chronic insanity. Three institutions in Yorkshire remained beacons of enlightenment in the general gloom of Victorian alienism: the Retreat in York founded and developed by the Quaker Tuke family; the West Riding Lunatic Asylum in Wakefield led by Sir James Crichton-Browne, which initiated research into brain and mental diseases; and the Leeds Medical School and Wakefield axis associated with Sir Thomas Clifford Allbutt, which pioneered teaching of mental diseases and, later, the first Chair of Psychiatry. Three other Yorkshiremen who greatly influenced nineteenth-century “neuropsychiatry” in Britain and abroad were Thomas Laycock in York and Edinburgh, and Henry Maudsley and John Hughlings Jackson in London.

Smallpox and royalty

[ reproduce his chart showing the incidence of the disease in the Royal House of Stuart (Figure 1). According to Dr Baxby, Queen Anne suffered from smallpox but survived and so Dr Rollin can add this to her long series of complaints. However, it was the death from smallpox of Queen Annes heir, William, at the age of 11 years in 1700 that gave rise to the constitutional crisis. This would seem to tic in with Dr Rollins comment that Queen Anne acquiesced to the Act of Settlement in 1701. If this is so, smallpox did indeed bring to an end the Stuart dynasty.

Changing face of administration of mental hospitals.

The era of enlightenment, which pervaded the latter part of the 18th century, gave rise to a more humane attitude to insanity than had prevailed until then and led in turn to the founding of institutions for the insane by voluntary public subscription in London (St Lukes) and in the provinces in, for example, Newcastle, Manchester and in York (The Retreat). But for economic and social reasons, particularly the rapid increase in population from seven to twelve millions during the reign of George III (1760-1820), the existing facilities for the care of the insane were swamped. They spilled over into the streets as vagrants and found their way into the workhouses and houses ofcorrection. There can be little doubt that the gaols of the time contained, inadvertently or by design, a goodly proportion of lunatics. The treatment or more precisely, lack of it became a public scandal which was exacerbated by the revelations of abuses and cruelties at the York Lunatic Asylum and at Bethlem. In 1815 a parliamentary Select Committee was set up to consider: Of provisions being made for the better regulation of madhouses in England. It found that: If the treatment of those mentally disordered in the middling or in the lower classes of life shut up in hospitals, private madhouses or parish workhouses is looked at, your committee are persuaded that a case cannot be found where remedy is more urgent. As a result, an Act amending an 1808 Act was introduced in 1815 which provided for money to be borrowed by the counties for the purpose of building asylums. This Act certainly stimulated the county asylum movement, but the counties themselves dragged their feet as the local authorities drag theirs today in the provision of community care facilities until 1845 when they were not exhorted but compelled to build asylums. The county asylums were conceived in an atmosphere of therapeutic optimism and benevolence towards these doubly disadvantaged, i.e. the pauper lunatic. They served initially as receptacles for those swept back from the streets and out of the prisons and workhouses. It was a matter of extreme good fortune that there were men of genius and of goodwill around at that time