Diary of an asylum superintendent

The digitised diaries of asylum superintendent Dr James Adam (1834-1908) offer a rare view of life inside a late 19th century mental health asylum for the poor.

Adam was praised for his energetic and humane approach to the role at the Metropolitan District Asylum in Caterham (1870-1879). He recorded in minute detail the daily ins and outs of life for both patients and staff.

Proposed asylum for the imbecile poor at Caterham, Surrey. Engraving in The Builder, 25 July 1868, p.551. Wellcome Images reference: L0011789.

Statistics abound in his diaries: a quick glance through the first year of opening at Caterham reveals an average of 1570 patients were cared for on a daily basis, they attended chapel regularly morning and evening and entertainment was scheduled on a weekly basis. Daily data figures reveal how many were “sick”, “wet and dirty”, “employed” or to be “discharged”.

If able, patients were employed in the asylum: typically women were put to work in the laundry, men in the farm or engine room (the source of steam for all parts of the asylum), or any other area requiring physical work.

As a reward, patients were regularly entertained with a range of recreational activities. Typical evening distractions included a “magic, mirth and mystery” evening of “drawing room entertainment” with tricks performed by the “renowned physician and prestigigitateur”, Mr Alfred Stodare, which was attended by one quarter of patients:

Mr Allen Lambert provided a “comic reading” on the evening of February 5th 1874, which included content such as “a cheap Jack’s courtship” and “love in a balloon” interspersed with “musical performances”. James Adam also contributed to the entertainment with a lecture on “The origin of the English language”, which was followed by “a vocal and instrumental concert” no doubt to wake the audience up.

Inmates sometimes played cricket matches against the stewards in attendance. At Easter a sports day was organised in which customary flat races ranging from 100 yards to half a mile were run along with “climbing a greasy pole for a shoulder of mutton”:

Sports porgramme in volume three of James Adam superintendent diary at Caterham asylum, 1874.

Some effort was put also into dinner arrangements at Caterham – on one occasion, an “Australian dinner” was delivered to all wards.

Despite such attempts to entertain patients, there were frequent attempts to escape, sometimes with success as in the case of Michael Driscoll. Telegrams were apparently the quickest method of communicating such a crisis. Other telegrams in inserted in the diaries record staff on leave who missed trains – this seemed to happen on a regular basis.

Working conditions were not great for the attendants who were low paid, often slept next to the wards and were responsible for many more patients than they could cope with (Norman, 2013). It was no surprise they were often ill. One attendant who had been off sick complained that he “had been treated like a dog” while he was off because he had received no visitors.

There were also children among the patients at Caterham. The mother of Fanny Melchior appealed for her return to the Newington workhouse where she could care for her:

Similarly Thomas Thompson, aged 11, was requested to return to Earlswood Asylum to join his mother. His discharge entry on 29 April 1872 reveals even trivial matters like the size of his boots.

There is little detail on the types of treatment offered to patients but they were sometimes transferred from other asylums for a change of scene if all other treatments had failed to work, as this letter from concerned relatives shows.

Adam went on to work at Crichton Royal Institution in Dumfries (1880 to 1883). His diaries from 1872-1888 are available online.

He retired from public asylum work in 1883, but went on to set up and run the West Malling Asylum in Kent for the rest of his life. His obituary in the British Journal of Psychiatry described him as someone with “untiring energy and zealous desire to improve the organisation of the institutions committed to his care”.