Shell Shock And Lunacy Reform

Wilfred Owen (1883-1918), Treated for shell shock Craiglockhart hospital.

By the time Dr Montagu  Lomax wrote The Experiences of An Asylum Doctor (1) in 1921, the campaign for lunacy reform had been ongoing for over half a century. There had been some successes such as the 1890 Lunacy Act, designed to reduce the number of unregulated madhouses.  However, little had been achieved to improve living conditions for pauper lunatics in the asylums. This was partly because the campaigners were often ex-patients as in the Alleged Lunatics Friend Society, so had little status, and partly because  psychiatrists were resistant to change. Dr Lionel Weatherly published his ‘Plea for The Insane’ in 1918. This book was aimed at the medical profession and was largely ignored. Lomax’s book was written for the public. His writing style was clear, and direct, perhaps with an overtone of sensationalism. However, it could be understood by any lay person and more importantly, by members of the Press. The book set in motion a wave of public outrage. 

Cleverly, Lomax keyed into public concern over the treatment of shell shocked soldiers. He wrote about the plight of these young men who had been sent back from the trenches with shattered minds only to find themselves incarcerated within the lunatic asylums. Lomax allied himself with the Ex-Services Welfare Society (ESWS), and was a guest speaker at a number of the Society’s public meetings. The aim of the ESWS was to raise public awareness and funds to help these veterans, some 5000 of whom were still in the asylums five years after the end of the war. Lomax was a good public orator and the national press reported his speeches. The wave of public outrage became a tsunami.

It is worth considering what a diagnosis of ‘shell shock’ meant. On 12 December 1914, the British Medical Journal published an article on functional paralysis following shell explosions (2). The author noted that although there was no obvious physical injury, the proximity to explosions was seen as a causative factor and from the winter of 1914/15 ‘Shell Shock’ became a valid medical diagnosis (2). 

There was a running debate between the top psychiatrists of the day as to whether the diverse collection of signs and symptoms which contributed to the diagnosis of shell shock were functional (psychological) or had an organic (physical) origin. The psychiatrist, Dr Frederick Mott noted the presence of microscopic brain hemorrhages in post mortems of men with shell shock, and hypothesised that the condition was due to blast trauma. This lead him to believe that shell shock had an organic cause (3). The Maudsley psychiatrists believed that shell shock was due to a breakdown of psychological mechanisms. Doctors could find no identifiable organic pathology in 38% of admissions for shell shock (2). This dichotomy between psychodynamic and physiological explanations for shell shock was never resolved (3). There was however a military classification which attempted to distinguish between men who were physically damaged, categorised as ‘Shell Shock (Wounded)’ and a second category of ‘Shell Shock (Sick)’ (4). The Shell shock (W) cases were entitled to a wound stripe and a pension. If a soldier’s neurosis did not follow a shell explosion, he was to be labelled Shell shock (S) and was not entitled to a wound strip or pension. Many of the 306 British soldiers shot for cowardice would probably have fallen into this latter category, now recognised as Post Traumatic Stress Disorder (PTSD).

At the start of the Great War, the military hospitals absorbed psychologically damaged men, who could be treated by specialist doctors without the stigma of certification. As the war progressed, casualty number rose and young soldiers with shell shock were increasingly shunted into the County Asylums (4). Estimates vary, but one study found 63% of shell shock cases in 1916 were placed within the asylum system (3). These men were officially classified as private patients, so that their fees were paid by the government, but their private status was effectively meaningless in times of war and carried no special privileges  for the soldiers. The asylums were understaffed, and overcrowded with patient food reported as ‘starvation rations’ (5). The asylum medical staff were overworked, and had no facilities or specialist skills to treat broken soldiers. For those young men who weren’t insane, there was a significant risk that they would be made insane by their surroundings.

For relatives, there was a very real stigma to having a soldier son in a County Asylum. The asylums were viewed as the domain of the pauper lunatic. Admission was by ‘certification’ under the 1890 Lunacy Act, and a certified pauper lunatic in the family carried with it great shame. This was partly because poverty was a frightening spectre for the working class, but also because of the  strongly hereditarian discourse of mental health which dominated through the 1920s (4). 

Towards the end of the war, the British public were growing increasingly uneasy that ex-soldiers were being treated as ‘ordinary lunatics’ (4). The Ex-Services Welfare Society (ESWS) was founded in 1919 to support the ex-servicemen who were effectively trapped within the County Asylum system. The aim of the Society was to set up residential homes for traumatised veterans so that they could be released from the totally unsuitable environs of the lunatic asylums. It was an ambitious project which required enormous financial input. Fundraising and a prominent public profile was therefore crucial to the success of the ESWS. The Society appointed Captain Charles Loseby, to speak on its behalf. He was a lawyer by training and had a distinguished military service record. As an MP between 1918 to 1922, he concentrated on veteran welfare, eventually taking a keen interest in the plight of shell shocked veterans detained within the lunatic asylums. He took the ESWS under his wing, organising and speaking at a number of public meetings on their behalf. Dr Montagu Lomax used the ESWS public platforms as an opportunity to drive forward his case for lunacy reform. Unfortunately, the ESWS’s association with the  campaign for lunacy reform was subsequently viewed as controversial, and after a series of financial scandals, the Society’s supporters quietly distanced themselves. By the mid 1920s, the British Legion had assumed responsibility for much of the practical support required by veterans including liaison with the Ministry of Pensions, and the ESWS was sidelined. 

It is heartbreaking to read Lomax’s account of the shell shocked soldiers in his book The Experiences of An Asylum Doctor. Men such as these were usually ‘other ranks’, whilst the officer class with shell shock were sent to exclusive military hospitals such as Craiglockhart. For the interested reader, Pat Barker’s Regeneration trilogy portrays shell shock amongst the officer class at Craiglockhart.

Bibliography

1. Lomax M. The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. [S.l.]: Allen and Unwin; 1921.

2. Linden SC, Jones E. ‘Shell shock’ revisited: an examination of the case records of the National Hospital in London. Med Hist. 2014;58(4):519-45.

3. Jones E. Shell shock at Maghull and the Maudsley: models of psychological medicine in the UK. J Hist Med Allied Sci. 2010;65(3):368-95.

4. Reid F. Broken Men: Shell Shock, Treatment And Recovery In Britain 1914-30: Bloomsbury Publishing; 2011.

5. Crammer JL. Extraordinary deaths of asylum inpatients during the 1914-1918 war. Med Hist. 1992;36(4):430-41.

Hospital Scandal

JH Murray-Aynsley

In the spring of 1895 The Christchurch Hospital was in trouble. A series of complaints about the standards of care at the hospital had resulted in an inquiry which dragged on for several long months. It was covered in excruciating detail in the local press, and syndicated across New Zealand. Amongst the many complaints from the citizens of Christchurch was the callous attitude and rudeness of the house surgeon, a certain Dr J.H. Murray-Aynsley. It was alleged that he had often arrived on the wards drunk, sometimes in his slippers and dressing gown if he was called at night. He  smoked during his ward rounds. He was accused of insisting that  the prettiest probationer nurses assist him in theatre and was prone to peculiar behaviour such as placing patients on a bread and water diet, and squirting water in the face of an injured  child to stop it screaming. The inquiry drew to a close  in August 1895, and for lack of convincing evidence, Dr Murray-Aynsley was cleared of all charges.

However, that was not the end of the story.

John Henry Murray-Aynsley was born in Lyttleton, New Zealand but studied at Christ’s College Cambridge , and St Georges Hospital, London before returning to Christchurch, to work as the house surgeon at the hospital. His job was to look after patients who had been operated on by the honorary  surgeons including those of Dr Montagu Lomax-Smith (later Montagu Lomax).

The two doctors shared the same year of birth – 1860 – but they had little else in common. Lomax-Smith came from three generations of tanners, Murray-Aynsley  had an English aristocratic background, his great, great grandfather was the third duke of Athol. Lomax-Smith’s father was a Church of England Vicar. Murray-Aynsley’s father was a wealthy business man who kept a string of race horses and was a member of the New Zealand Parliament. Lomax-Smith was raised to service and duty, Murray-Aynsley had little sense of the professionalism that his role required. It is not difficult to imagine that Murray-Aynsley would have rubbed Lomax-Smith up the wrong way.

Lomax-Smith must have been appalled that Murray-Aynsley was vindicated by the hospital Inquiry in August 1895. Less than two months later, Lomax-Smith brought further charges against Murray-Aynsley, alleging that he was drunk on duty and neglected the care of his patients. The Hospital Board was reluctant to get involved in another inquiry. Lomax-Smith resigned as honorary surgeon, claiming that Murray-Aynsley had systematically neglected his surgical cases. A series of vicious letters were published in the local and national press with both sides making claims about the other which would be considered libellous today. Lomax-Smith was accused of unethical behaviour for complaining about a brother doctor. Two doctors resigned in support of Murray-Aynsley. Eventually, the Hospital Board agreed to another investigation.

In April 1896, The Hospital Board found Murray-Aynsley guilty as charged and asked for his resignation. Lomax-Smith subsequently withdrew his own resignation. 

The outcome of this poisonous dispute was poor for both men. Murray-Aynsley left Christchurch for a small bush town where he worked for a short time as a GP. He tried to work in the UK, but never really established himself and returned  to New Zealand where he died aged 57. Lomax-Smith left New Zealand in the summer of 1896 to return to the UK. He left behind a prosperous, comfortable existence, and never really recovered the standard of life he had had in New Zealand. However, Lomax-Smith did learn about the personal difficulties faced by whistle-blowers.  He learned that attacking a person rather than ‘the system’ which allowed an incompetent to work within it, was  was personally devastating. Finally, he learned how to harness the power of the Press. These tribulations were  to stand him in good stead some thirty years later when he wrote his book: The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921.

More at: 

  1. https://en.wikipedia.org/wiki/The_Experiences_of_an_Asylum_Doctor
  2. The New Zealand years.
  3. Montagu Lomax – montagulomax.org 

Why Montagu Lomax matters.

Montagu Lomax (1860-1833) was a British general practitioner  who wrote The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921[1]. The book was an exposé of conditions within two English lunatic asylums based on Lomax’s experiences as an asylum medical officer between 1917 and 1919. 

The book became a cause célèbre [2]. The national press was outraged by Lomax’s revelations, with The Times publishing an article entitled “Asylum Horrors – A Doctors Indictment’ [3]. Within ten days of the book’s publication, questions were being asked in Parliament [4]. Whilst many attempts at asylum reform had been made previously, it was Lomax’s book and the associated newspaper articles that alerted public opinion on a wide scale [2]. The Ministry of Health decided to use Lomax’s book to start the process of lunacy reform, and to subsume the mental health services, previously managed by the Board of Control [2]. The Lomax affair was a significant prelude to the 1926 Royal Commission on Lunacy and Mental Disorder [5]. The recommendations of the Royal Commission were incorporated into the Mental Treatment Act of 1930 which opened the way to many developments in mental health services over the next thirty years [2].

Lomax had a successful publication which ensured him a place in the tradition of British social reportage [5]. It was an important book because it directed public attention to the defects of the asylum system which had hitherto been taken on trust [2]. Lomax’s vivid descriptions of patients’ behaviour and mental state in asylums and of the institutional process produced insights which were to be rediscovered 30 years later by researchers who themselves went on to influence mental health care from 1959 onwards [2]. However, Lomax did more than contribute to a process of mental health reform. His willingness to write frankly and to criticise provide an example to all mental health professionals who find themselves in settings where abuses occur [2].

More information at montagulomax.org

Bibliography

1. Lomax, M., The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. 1921, [S.l.]: Allen and Unwin.

2. Harding, T.W., “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. The British Journal of Psychiatry, 1990. 156(2): p. 180-187.

3. Asylum Horrors, in The Times. July 23rd, 1921.

4. Soanes, S., REFORMING ASYLUMS, REFORMING PUBLIC ATTITUDES: J. R. LORD AND MONTAGU LOMAX’S REPRESENTATIONS OF MENTAL HOSPITALS AND THE COMMUNITY, 1921-1931. Family & Community History, 2009. 12(2): p. 117-129.

5. Towers, B.A., The management and politics of a public expose: the Prestwich Inquiry 1922. J Soc Policy, 1984. 13(1): p. 41-61.

The problem of the ‘idiot’ child

The care of a mentally handicapped child has posed a problem to society for centuries. Prior to the 18th century, many of these children would have been looked after at home, perhaps by an older sibling. The more affluent might have employed a maid servant whose duties would have included care of a handicapped child. When the Industrial Revolution in Britain resulted in migration to the cities for work, a non-productive child became a drain on the families resources. Whilst there was a system of ‘boarding out’ where some parishes paid families to look after ‘idiot children’, this all but vanished with the introduction of the new Poor Laws of 1834. Idiot children who could not be cared for by their families were then required to be admitted to the workhouses as ‘pauper lunatics’. Workhouses soon began to fill up with the elderly, the chronic sick and the mentally disabled such that parishes had difficulty in obtaining places for their temporary paupers. The solution provided by the 1845 Lunatics Act was harsh – the Act decreed that all insane persons should be admitted to the County Asylums, and idiots were defined as a subgroup of the insane. Unfortunately, this just shifted the problem to the Asylums and they too began to fill up with ‘harmless and incurable idiots’ [1]. Families became reluctant to send their idiot children away from their own parish to a County Asylum, and kept them at home often resulting in significant hardship for the family. Some idiot children were retained in the parish workhouse, some from wealthier families were sent to private madhouses. By 1850, it was evident that there were more handicapped children in the community and the workhouses than in the County Asylums [1].

The plight of the handicapped child captured the attention of the Victorian philanthropists in the 1840s. Some attempt had been made to set up training schemes for the ‘educable idiot’ in France, and Dr John Connolly had also experimented at the Hanwell asylum. The philanthropist movement picked up and ran with the idea of schools for the mentally handicapped, setting up Asylums as ‘training establishments’. The Earlswood Asylum for Idiots came about through the efforts of Dr Connolly and the reverend Andrew Reid. It opened in 1847 and accepted private cases from wealthy families which helped to finance the care and education of pauper children. There was a general feeling that handicapped children would benefit from being with their own kind and that they would not have to endure mockery and bullying common in the wider community. Some of the milder cases of idiocy  were trained for domestic service or manual trades such as gardening. 

With the rise of the therapeutic Asylums in the mid to late nineteenth century, a small group of doctors began to specialise in idiocy. Dr Fletcher Beach was one of the early pioneers and highly influential in the field of idiocy. He believed that idiot children fared much better within training establishments away from their families, and should be admitted at the youngest age possible [2]. He may have had his own agenda, since it is clear from the records that he was a talented business man who wasn’t averse to bending the rules on advertising his own private establishment for the feeble minded. However there is no doubt that he and his colleagues made great strides in the classification and treatment of the idiot child. 

Bibliography

1. Wright, D., Mental disability in Victorian England : the Earlswood Asylum, 1847-1901. Oxford historical monographs. 2001, Oxford ; New York: Clarendon Press. vii, 244 p.

2. Beach, F., The Treatment And Education Of Mentally Feeble Children. 1895, London: J.A.Churchill.

Montagu Lomax – a detective story

Welcome to ‘Who was Dr Montagu Lomax’, and to my very first blog page.

I suppose I should explain why anyone should be interested in a man who died nearly a hundred years ago. 

If you put ‘Montagu Lomax’ into Google it will churn up plenty of references to his 1921 book – The Experiences of an Asylum Doctor’ (1), and you will learn that the book shocked the British public to the core by telling them how their relatives were being cared for in the lunatic asylums throughout the country. The ensuing scandal eventually resulted in a change to the law with the 1930 Mental Treatment Act, and the beginnings of the modernisation of our mental health services. That, although interesting in itself, is not the reason for my homage to the man.

Having read his book, it became apparent that there was a missing backstory. How did an obscure, retired GP manage to write a book which had such a profound effect, so that within weeks of publication, questions were being asked in Parliament? The conundrum had also occurred to a certain T.W. Harding  who wrote an appraisal of the  ‘Lomax Affair’ in in his 1990 paper (2). Harding commented that he had very little biographical information on Lomax, and he hoped that he might be able to trace Lomax’s family to ‘allow a more complete account of a remarkable man to be written’. I read this paper in 2010, and as far as I could ascertain, nobody had taken up Harding’s challenge in the interim. 

It has been a detective story – my entertainment through long winter evenings on and off for the past decade. I learned a great deal about Lomax’s background digging through ancestry.com. I was able to read contemporary accounts of his activities through the online newspaper archives, I visited the Public Record Office at Kew, the Bodleian Library in Oxford, the Warwick archives, and corresponded with the Alexander Turnbull Library in New Zealand, the Surrey Archives, and the archivists at Marborough and Gresham’s School. I read history books, medical papers, history papers and began to accumulate an enormous, disorganised collection of facts and ‘interesting snippets’ spread across three computers and spilling out of several drawers. I have always meant to ‘do something with it’ when I had the time. Then in March 2020, COVID-19 arrived and suddenly, I had plenty of time.

The story of Dr Montagu Lomax is laid out in chapters which are arranged in date order through the Home page. The Introduction page explains the background to the story. There are still some gaps in the narrative, so if you are able to help fill them in, dear reader, please contact me. 

 

1. Lomax M. The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform.: Allen and Unwin; 1921.

2. Harding TW. “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. The British Journal of Psychiatry. 1990;156(2):180-7.