The Doctor's and the Patient's
Experiences of an Asylum

Copyright © 2006 Bruce Tober - All Rights Reserved

Early Whistle-blowing Journalism at its Best

Two volumes which form a set, though not published as such. The first volume is Montagu Lomax's (M.R.C.S.) 1921 The Experiences of an Asylum Doctor: with Suggestions for Asylum and Lunacy Law Reform.

Lomax was an assistant medical officer at Prestwich (Lancashire) Asylum from 1917-19 and published his book two years later. "Condemned by the psychiatric establishment," according to TW Harding of the Institut de Medecine Legale, Geneve, Switzerland, "for his description of inhuman, custodial, and antitherapeutic conditions. ... Senior Ministry of Health officials regarded Lomax's book as 'temperate', 'well founded', and an opportunity to secure public support for long-needed legal and administrative reforms.

"Through his book, Lomax made a lasting contribution to the cause of mental health reform." Harding was writing in an article in The British Journal of Psychiatry 156: 180-187 (1990), published by The Royal College of Psychiatrists.

Likewise, in his foreword to the book, THE STORY OF A MENTAL HOSPITAL: FULBOURN, 1858-1983 by David H. Clark, Roy Porter notes, Lomax "was appalled at what he found: gross overcrowding, demoralising institutionalisation, brutalisation, neglect, lack of beds, poor food, apathy. He felt compelled to blow the whistle in The Experiences of an Asylum Doctor; so great was the stir his book created that it sparked a series of official cover-ups and whitewashings."

A year after Lomax's book, the second volume in this set was published. It was Rachel Grant-Smith's (a pseudonym) The Experiences of an Asylum Patient.

Lomax's criticisms led to a Royal Commission of the Ministry of Health, Committee on Administration of Public Mental Hospitals, chaired by Sir Cyril Cobb. Its findings, set out in the Report of the Committee on Administration of Public Mental Hospitals was written by R Percy Smith. The report in Appendix. III, noted that Dr. Lomax, "in accepting an invitation to the Committee to give evidence, set out ten questions into which he thought it should particularly enquire, but from an account of a speech of the Minister of Health, which he claimed pre-judged the issue and other reasons, subsequently declined to give evidence. The National Asylum Workers' Union also declined, on the ground that the enquiry should be a wider one conducted by a Royal Commission able to protect witnesses."

Amongst Dr. Lomax's criticisms, according to an abstract of the report were that: "the insane were housed in gloomy and often dilapidated barracks, were poorly clad and unkempt; there was want of proper classification of patients and of segregation of epileptic and tubercular cases; lack of overcoats and use of a distinctive garb; the absence of proper facilities for surgical cases; defective feeding; the constant drudging and purging of patients; insanitary arrangements at Prestwich Asylum. Most of the evils were due to the dual elements in the Medical Superintendent's Office, as Chief Medical Officer and executive head of the institution, while some Assistant Medical Officers were appointed at £150 rising by £10 to £350, with a signed agreement not to marry on pain of dismissal.

"The Committee found many of the charges untrue, others grossly exaggerated, but grounds for criticism in others. They recommended that the future size of hospitals be limited to 1,000 patients, that in classification some account should be taken of home conditions, that in future appointments of the Superintendent, preference should be given to those who had been house-surgeon or house-physician in a general hospital. The number of assistant medical officers should be increased. Mental nursing requires co-ordination with the general body of nursing, and every institution should have at least one fully qualified hospital nurse on the staff. Seclusion should be precisely defined, diets and employment improved; after-care work should be strengthened and facilities for early treatment would be a great value. Higher research should be considered; visiting committees should be strengthened and additional assistance given to the Commissioners of the Board of Contro."

Although Lomax's criticisms led to a Royal Commission and the 1930 Mental Treatment Act, many of the circumstances he described could still be observed at Prestwich in the 1960's and 1970's according to an article by Hopton J., "Prestwich Hospital in the twentieth century: a case study of slow and uneven progress in the development of psychiatric care" in Hist Psychiatry. 1999, Sep;10(39 Pt 3):349-69. PMID: 11624009 [PubMed - indexed for MEDLINE]".

Full description of this set is here.

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