Pauper and Private: Early Mental Health Care in Wiltshire
The care and provision for people with mental health issues is a current high-profile concern, but how have people been cared for historically in Wiltshire? The availability on Ancestry of the Lunacy Patients Admission registers from 1846-1912 (held at the National Archives MH 94) – an index giving the name of each patient, date of admission, discharge or death and name of institution - the census returns from 1841-1911 and death certificates –have led to numerous enquiries about ancestors in Wiltshire institutions. The County Asylum at Devizes ( Roundway ) opened in 1851 and we have extensive detailed patient case records; similarly for Fisherton House , later known as the Old Manor Hospital, Salisbury. Visitors can use these records to find out more about their ancestors’ treatment (although they are subject to a 100 year closure period), but what of mental health care before this time?
The term ‘lunatic’ is a pre-20th century word used to describe someone who was mentally ill or emotionally disturbed; it was a very broad term. Many so described were perhaps eccentric, very intelligent, physically or mentally handicapped in some way, senile ,or suffering from conditions that today would be treated with drugs and in the home such as epilepsy or post natal depression – few were ‘mad ‘ but their behaviour was such that they could not be cared for at home.
The earliest asylum, Bethlem or ‘Bedlam’ Hospital in London was established in the 13th cent but generally provision was not widespread until the 18th cent. Private asylums or madhouses were set up to cater for those who could afford to pay. Pauper lunatics were dealt with locally by their families or ended up in workhouses or prisons; however, if the parish agreed to pay the fees they could be treated in the private asylums. The first Act to regulate madhouses was in 1774 by which the institutions were licensed by the local magistrates; a further Act of 1828 appointed committees of visitors to inspect and report on the premises and the medical care provided. In Wiltshire 7 private asylums were licensed:- Laverstock House, Laverstock ; Fiddington House, Market Lavington ; Fisherton House, Fisherton Anger ; Kingsdown House , Box ; Belle Vue , Devizes ; Fonthill Gifford and Calne.
The records that survive consist of admission registers, minutes of the visitors, annual reports and plans. The admission registers record the name, date of admission, parish, marital status, occupation, by whom sent, whether pauper or private and date of discharge or death. No treatment records survive. They do show how Wiltshire’s institutions attracted patients from a wide area of the south-west and London- whether this was because of the ‘facilties’ offered and reputation or simply because families did not want their ‘lunatic’ relatives close to home.
An advertising prospectus survives for Laverstock House from the 1830’s which extols its virtues. ‘The situation of Laverstock House is peculiarly eligible. Surrounded by large Gardens and Pleasure Grounds in the midst of a fine and extended Country, it is at once retired and cheerful, and affords the most ample means for indulgence in those exercises which are so essential to the happiness and health of the Patients’… Male and female patients had separate apartments, subdivided by disease, habits and ‘station in life’ with superior accommodation for ‘Persons in the higher walks of Society’…’ Every possible kind of amusement was provided for them; billiards, backgammon, cards, books etc indoors; bowls, cricket, greyhounds, riding on horseback and in a carriage, out of doors; a Chapel on Sundays’
Plans of the various establishments clearly show the distinction between the private and pauper patients; for the former there were separate sitting rooms and bedrooms with provision for private patients’ servants and ornamental gardens and exercise areas. Pauper patients were in wards and were expected to work in the gardens, farm, kitchens and washrooms.
The minutes of the Official Visitors report on the provision of religious services, opportunities for intellectual improvement, amusement and recreation. At Fonthill Gifford amusements included a hand organ and cards and ‘canary and other singing birds for the gratification of those who are attached to such domesticated living objects’ The key function of the Visitors however, was to inspect the general conditions of the patients- the manner in which they were fed and treated, their cleanliness and the use of restraint. Increasingly they were to find conditions far from satisfactory in particular with regard to the pauper patients. With the opening of the County Mental Hospital in 1851 for the benefit of pauper patients and further regulation many of the smaller private asylums were to close. The remaining larger institutions were able to focus on providing care for those with the ability to pay- a two tier system of healthcare that remains today.
Margaret Moles, Archivist
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