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.


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: 

  2. The New Zealand years.
  3. Montagu Lomax – 

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


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.


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 Tyranny of Corsets

In 1894, Montagu Lomax spoke to four hundred women of Christchurch, NZ about their corsets. It was a brave thing to do, and it resulted in a furore.

The lecture was part of a series of twelve given at the Christchurch Art Gallery with the aim of ‘helping women to put to the best use their newly acquired political rights’ [1]. They covered ‘Woman in all her chief relations of life: physiological, educational, domestic, social, economic, sexual, emotional, moral, political, intellectual, national and religious’.  Lomax published his contribution to the lecture series in a short book the following year because he had been told that his talks deserved to reach a wider audience and their content was ‘more or less inaccessible to the ordinary public’ [1].

As a doctor and a married man, Lomax considered that he was expert enough to explain the evils of corsetry and tight lacing. Lomax commented that the ideal corset should push the bust up without constricting the waist and that, like a man’s vest, it should cover the whole chest. He thought that the fashion for constricting the lower ribs to reduce the waist circumference was injurious to a woman’s ability to breath, and certainly ‘tight stays’ made athletic activity next to impossible. Lomax said that the average, uncorsetted waist of a woman under 25 years was 20-25 inches*. He believed that the hour-glass waists which were then in fashion were the ‘quintessence of deformity and ugliness’.

Lomax went on to rail against the use of feathers and fur in women’s fashion, and reminded women that they were made for a different purpose than men. He suggested that whilst some exercise was good, the sight of a woman with a gun or a fishing rod  was abhorrent to men, and women who played football have ‘lost all sense of decency and decorum’ [1].

The excellent ladies of Christchurch were outraged. There was mayhem in the Art Gallery. The correspondence columns of the Christchurch newspapers were filled with suggestions that the good doctor should keep his nose out of women’s business, especially their undergarments. Indeed, when the audience was asked at the subsequent lecture whether they were in favour of corsets, almost all of the four hundred women present held up their hands [2].

To be fair, Lomax had a point. The practice of lacing corsets tightly to produce the famous hour-glass waist of around 18-20 inches did seriously restrict a woman’s ability to move freely and to breath. Fainting was common amongst Victorian women, and such swooning was not because they were the weaker sex. Even before his ill-fated lecture, women themselves had started to explore the possibility of comfortable clothing. Dress reformers had been campaigning since the mid 19th century for less restrictive clothing, particularly foundation garments which would allow women to take part in sport. Wikipedia has a couple of fascinating articles on Victorian dress reform and Corset controversy which are  well worth reading. However, the trussing of women into whalebone corsets continued into the early 1900s until the corset firm of Symingtons released the ‘liberty bodice’ in 1908. This was  designed to flatten the bust and release the waist, and was considerably more comfortable than corsets. The liberty bodice soon became near universal wear amongst the women of Europe, and America where it was known as an emancipation waist.


1. Lomax-Smith, M., WOMAN in relation to physiology, sex ,emotion and intellect. 1895, Christchurch, New Zealand: Russell and Willis. 91.

2. Lectures to Women, in Lyttelton Times. 1895.

*   In 2019, young American women had an average waist size of 37 inches.

Ouida 1839-1908

Ouida – Marie Louise Rame

Ouida was the pen name of Maria Louise Rame, a Victorian writer who published more than forty novels and many short stories. She was enormously popular, outspoken, opinionated and considered rather racy in her day. Writing for a wide audience, her topics included observations of contemporary society and contemporary romance. Many of her novels were thinly veiled protests against social evils and a rebellion against moral ideals displayed in contemporary fiction [1]. She was an anti-vivisectionist, standing up for animal rights in a time when vivisection was considered perfectly acceptable to push the boundaries of medical knowledge. Ouida believed, that the line between experimentation on animals and experimenting on humans was easily crossed. She wrote a journal article entitled ‘The Scientific Torture of Lunatics. A Protest’ in 1897, expressing concerns that pauper lunatics were used as subjects for medical experimentation [2]. 

Ouida held a low opinion of the medical profession, perhaps because of their role in vivisection. Her 1892 essay proclaimed that doctors were only ‘intelligent artisans’, a parvenu profession, on a rank with ‘the merchant , the shipowner, the engineer and the banker all distinguished by their grasping dishonestly and insincerity’ [3]. She noted that physicians were not ‘gentlemen’. She claimed that doctors came from socially rising families who hid their modest origins behind the veneer of public school and university education purchased by their father’s success. Although this last comment was intended as an insult, it was certainly true for Dr Montagu Lomax.

Lomax was a great admirer of Ouida’s writings on female modesty, and referenced her several times in his lectures “Woman in relation to physiology, sex, emotions and intellect’[4]. 

Ouida may have written to shock, or perhaps to promote discussion. Her novels sold well making her a fortune which she squandered on a lavish life style and entertaining. She attracted some of the greatest literary minds to her soirees, including Oscar Wilde, Wilkie Collins and Robert Browning. She never married. The latter part of her life was spent in Florence, Italy where she died in penury in 1908


1. Shaw, B., Bernard Shaw’s Book Reviews: 1884-1950, ed. B. Tyson. 1991: Penn State Press.

2. Ouida, The Scientific Torture of Lunatics. A Protest. Humanity, 1897. 2: p. 82-4.

3. Ouida, The Medical Profession and its Morality, in The Modern Review. 1892, Snow & Farnham.

4. Lomax-Smith, M., WOMAN in relation to physiology, sex ,emotion and intellect. 1895, Christchurch, New Zealand: Russell and Willis. 91.

The Idiot Child and Public Policy

The previous blog outlined how mentally handicapped children in the Victorian era were removed from their families and placed within the confines of lunacy asylums, private madhouses or if they were lucky, in dedicated colonies. By the mid to late nineteenth century, the medical profession had appropriated the care of the feebleminded, possibly for research purpose, perhaps for financial gain. In doing so they created a problem for society as the numbers of children, and adults deemed to have mental impairment rose rapidly. The increase in numbers paralleled the rapid rise in British population growth, but it began to cause severe problems for the Exchequer, and for policy makers who were required to build appropriate accommodation to house these cases.

Two influential concepts ran through British culture from the mid to late nineteenth century – the ‘Degeneration Theory’ and Eugenics. The ‘Degeneration Theory’ was proposed by French doctor, Benedict Morel in the 1850s and suggested that certain constitutional disorders ran through families. This lead to the belief in ‘hereditary taint’, which proposed that a mentally handicapped child resulted from impurity in the parent. Scientific papers outlining the transmission of a degenerative taint through families were printed in respectable medical journals [1]. Prominent psychiatrists such as Dr Henry Maudsley and Dr Fletcher Beach supported the theory of degeneration which began to trickle in to popular culture [2]. The ‘hereditary taint’ of a handicapped child thus became a social  embarrassment, and great efforts were made to hide such children from polite society. The Queen’s cousins were placed in the Earlswood Asylum for idiots, a fact only recently uncovered by journalists. It is not surprising that Dr Montagu Lomax gave his son, Armine into the care of Dr Fletcher Beach at age seven, and Lomax never once referred to the boy in any of his prolific writings.

Eugenics, or the concept of pure breeding to improve a population ( and conversely, preventing unsuitable people from breeding) was popularised in late Victorian times by Francis Galton, a distant relative of Darwin. Galton used Darwin’s theories of natural selection as the basis for his eugenic theories which were both popular and influential until they were adopted by the Nazi Party in their search for the pure Aryan race.

By the end of the nineteenth century, ‘Hereditarism’  formed from the theory of degeneration and the eugenics movements had begun to inform public policy.   Dr Fletcher Beach suggested segregation of idiots and imbeciles on the grounds that if breeding were prevented it would reduce the numbers of such ‘incurables’ in future generations [1]. Ellen Pinsent* who founded the National Association for the Care of the Feebleminded in 1896, believed that lifelong segregation was the kindest option for the feebleminded. She was an influential eugenicist, serving on the Royal Commission on the Care and Control of the feebleminded of 1908. This lead to the Mental Deficiency Act of 1913 which proposed that mental defectives should be removed from prisons and Poor Law institutions and segregated by sex within newly established colonies

 Custodial policies resulted in severe overcrowding of the imbecile asylums and colonies. Concerns were also   raised over the drain on the public purse as Britain teetered on the brink of  the Depression between the two World Wars.  Compulsory sterilisation of imbeciles was suggested on purely economic grounds by the Eugenics Society in their 1926 Manifesto [3]. Debate raged in the medical journals of the time over custodial segregation vs sterilisation[3].  In 1926, the argument spilled over into the popular press when eugenicist, Harold Cox wrote an article in the Spectator suggesting that lifelong segregation of mental defectives was  an act of ‘callous cruelty’. Cox believed that mental defectives should be released from captivity but only after sterilisation to prevent their ‘terrible taint’ from being passed on [3]. Cox’s controversial beliefs engendered a six month public debate through the correspondence columns of the Spectator. However, at the end of the day, Britain was not ready for such drastic measures, perhaps because of the rise of Nazism, perhaps because of religious opposition. The 1913 Act remained in place until it was repealed by the 1959 Mental Health Act.

*Ellen Pinsent (1866-1949) was married to Hume Pinsent, a prominent Birmingham solicitor. Ellen was made a dame in 1938 for her work in the care of mentally impaired children. Prior to the First World War, the Pinsent family lived at Lordswood House, in the Birmingham suburb of Harbourne. By strange coincidence, Lordswood House was built by Montagu Lomax’s father, the reverend Thomas Smith, and Lomax lived here until he was 9 years old.

Sale of Lordswood House. Birmingham Daily Post. 18/12/1869


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., A Lecture on the Influence of Hereditary Predisposition in the Production of Imbecility. Br Med J, 1887. 1(1378): p. 1147-8.

3. Crook, P., Darwin’s Coat Tails: Essays on Social Darwinism. 2007: Peter Lang.