Hilton C. Civilian Lunatic Asylums During the First World War: A Study of Austerity on London’s Fringe

London: Palgrave Macmillan, 2020. — 294 + xix p. — ISBN 978-3-030-54870-4, 978-3-030-54871-1 (eBook).This open access book explores the history of asylums and their civilian patients during the First World War, focusing on the effects of wartime austerity and deprivation on the provision of care. While a substantial body of literature on ‘shell shock’ exists, this study uncovers the mental wellbeing of civilians during the war. It provides the first comprehensive account of wartime asylums in London, challenging the commonly held view that changes in psychiatric care for civilians post-war were linked mainly to soldiers’ experiences and treatment. Drawing extensively on archival and published sources, this book examines the impact of medical, scientific, political, cultural and social change on civilian asylums. It compares four asylums in London, each distinct in terms of their priorities and the diversity of their patients. Revealing the histories of the 100,000 civilian patients who were institutionalised during the First World War, this book offers new insights into decision-making and prioritisation of healthcare in times of austerity, and the myriad factors which inform this.Foreword.

Abbreviations.
List of Figures.
List of Tables.
Introduction: Civilians, Lunacy and the First World War.
Historiography of the Asylums.
From Broad Theories and Generalisations to Specifics and Diversity.
Shell Shock: Historiography and Change.
Placing the Patients Centre Stage.
Standards of Care and How to Measure Them.
The Language of the Asylums.
Other Methodological Considerations.
Infrastructure: Rules, Walls, Obstacles and Opportunities.The Lunacy Act 1890: "Red Tapism", Admissions, Finance, Reform and Change.
The Board of Control, Asylum Leadership and Their Challenges.
Special Care? Service Patients and Other Groups.
Creating Military Hospitals from Asylums.
Reconstruction.
Conclusions.
Certified Insane: Concepts and Practices.
Introduction: Lily’s Story.
Air Raids and Other War Stresses in the Community.
Understanding Mental Disorders: Classification.
Researching Mental Conditions.
GPI: Clinical Challenge, Research and Cautious Responses to Innovation.
Nature and Nurture: Biological, Social and Psychological.
Treatments: Moral and Medical, Restraint and Seclusion.
Recovery, Convalescence and Discharge.
Conclusions.
Personnel: Staffing the Asylums and Serving the Colours.The Staff on the Asylum Front Line.
Hierarchies.
Gender, Status and Staff Education.
Medical Staff: Doctors and Dilemmas.
Serving the Colours.
Towards the End of the War.
Conclusions.
Food, Farm and Fuel: An Inequitable Supply Chain.The National Food Context.
Asylum Diets: Supply and Demand.
Asylum Diets and Nutritional Understanding.
Communal Eating for Patients and Staff.
Food Distribution in the Asylums.
Asylum Farms.
Fuel.
Conclusions.
Patients and Their Daily Life.Seeking the Patients’ View.
In-Patient Life.
Clothing.
Cleanliness.
Night Times.
Patients’ Links with People Outside.
Patients at Work.
Conclusions.
Difficult Diseases: Tuberculosis and Other Infections.
Introduction: Elsie and Mohammed.
Death Rates and Post-mortems.
Tuberculosis.
Tuberculosis at Claybury and Hanwell: Case Studies.
Other Infections: Dysentery, Typhoid and Influenza.
Conclusions.
Accidents, Injuries, Escapes and Suicides.
Introduction: A Culture of Kindness or Harm?
Abuse in the Asylums: Allegations and Outcomes.
Broken Bones and Cauliflower Ears: Facts and Fictions.
Escapes.
Suicides.
Conclusions.
Shackles and Chains: Some Concluding Thoughts.
Then and Now.
Leadership: Attitudes and Standards.
Patients, Outcomes and Austerity.
Making Change.
Final Word.
Index.