Asylum In The 19th Century

Concern for the well-being of those suffering from mental illness gradually increased and was particularly embraced in the charitable social and political policy of the Victorians. County asylums were the recommendation of a House of Commons select committee, which had been set up in
1807 to enquire into the state of lunatic- Legislations in support of the establishment of asylums followed, including Wynn's Act of 1808 for the better care and maintenance of lunatics, being paupers or criminals and the Shaftesbury Acts of 1845 for the regulation of the care and treatment of lunatics.
Most asylums were built on the outskirts of major cities, in order to provide a rural retreat for patients. Most operated as self-sufficient communities with their own water supplies, farms,
laundries and factories. They were therefore isolated from the local community and psychiatrists working with them were isolated from their colleagues in other medical specialties. The Lunacy Act of 1890 set the parameters for admission, providing a legal system in which a patient had to be certified as insane in order to be admitted to the asylum. Under the Act, asylums became a last resort for the insane rather than a means to their recovery. No psychiatric opinion was sought prior to admission. The parish doctor declared patients insane and they were then placed on a compulsory reception order by a local magistrate and taken to the asylum. As Henry Rollin describes in his autobiography:
Medical officers in mental hospitals had no control over the selection of the patients they were called upon to treat, nor was there any opportunity to follow them up once they had been discharged into the community.
There was no legislative provision for patients to be treated voluntarily in the asylum, but the situation was different for registered hospitals such as the Bethlem where admissions could take place free from certification.
The Bethlem stopped admitting parish patients in 1857 and, from the late nineteenth century, prided itself on being one of the pioneers of uncertified cases. By 1900, only
3% of patients were certified when compared with 97% of the asylum population.3 Admission policy at the Bethlem during this period specified that no patient could be admitted if they had been unwell within the previous 12 months and the length of stay should not exceed 12 months.
These differences in admission criteria contributed to an exponential rise in the asylum population.
Colney Hatch Asylum, the largest in Europe, was originally built to accommodate 1250 patients but was enlarged within 10 years to take 2000 and in 1937 (when it was renamed Friern Hospital), there were 2700 patients. The rising population was due to a number of factors including the admission of many severely disabled patients who could never be discharged and the expanding Middlesex population. There were also a large number of poorly understood and untreatable conditions presenting with psychiatric symptoms such as metabolic disorders, lead poisoning, syphilis and intracranial tumours. Once admitted to the asylum,
medical