As another year spluttered into life on New Year’s Day 1871, Amelia Thomas ought to have been counting her blessings. Within a few short years, most of her contacts had paid a heavy price for the trade they shared. Ellen Dane had fled the country to escape arrest; Margaret Waters had been hanged; and Ellis, Cummings and Hall were all serving time with hard labour. Dr Harding, with whom she had had, at the very least, a working relationship in 1869, had only narrowly escaped the ultimate sanction.
Amelia would have followed these cases avidly in the press; after all, they had been high-profile trials, which had, according to The Times, “excited much interest”. And those punished had been her colleagues. Several of the children she had sent to them were named in court; letters she had written were cited; her pseudonyms were printed in the national press.
If she took urgent action, she could still escape arrest: after all, her name was not Harding. Nor was it Smith. Her Totterdown address could easily be vacated. She closed her house of confinement, and instead searched the small ads of local papers for something very different. More by necessity than choice, Amelia Thomas sought once more to earn an honest living.
Eearly in 1871, Amelia became a nurse attendant at the Bristol Lunatic Asylum.
It was an odious prospect: for a salary of £1 a month, in addition to a uniform, meals and a beer allowance, Amelia would once again be working long and hard for her money. But it was a relatively easy job to come by for it was arduous and sometimes dangerous work, with no holiday allowance; few women remained in the post for a full year. But it offered Amelia accommodation and, for the moment, that was attraction enough.
The Bristol Lunatic Asylum in Fishponds stood on a commanding site, a long avenue of year-old limes extending across its grand, turreted frontage. The ten-year-old building was largely bright and airy; the wards were comfortably furnished with beds, heavy wooden tables and long wooden benches, and a smattering of comfortable chairs. The asylum Visitors saw to it that “objects of interest” – plaster busts, prints and vases – were scattered throughout the wallpapered wards, in order to “enliven”. It stood in stark contrast to the much-despised St Peter’s Asylum in the city, and quickly earned a reputation as Bristol’s “lunatic Pauper Palace”.
Amelia was to report to the head female attendant, Miss Louisa Yeames. Yeames was devoted to her post and had the respect of her employers. She was a thirty-year-old spinster from Yorkshire, and had been in charge of the nursing staff at the asylum since the previous year. It was an unenviable job. The attendants were not always the most professional. The sobriety of some was often in question (hardly surprising in an institution which budgeted more for the purchase of wine, spirits and beer than it did for medication), and the behaviour of others left much to be desired.
Nevertheless, the emphasis at the Fishponds Asylum was a liberal one, by the standards of the day at least. Dr Henry Oxley Stephens, the asylum’s first medical superintendent, had retired at the end of the previous year, but from the start had insisted his staff adopt that most current of maxims “Treatment Not Punishment”. He hotly disagreed with any thinking which suggested that a lunatic brought his condition upon himself by indulging in vices. He instead believed that lunacy was consequent to “a variety of troubles and misfortunes, mental, moral and physical, to which we are all liable”. Miss Yeames was keen that Amelia remain mindful of this sobering thought in all her dealings with the patients. Kindness, she insisted, was to be an attendant’s chief motivation. This wouldn’t always be easy, she realized; some patients had violent or self-destructive tendencies and these could be most testing to manage. Yeames assured her staff and Board of Guardians (the directors) that, despite the prevalence of mechanical restraint elsewhere, at Fishponds it was to be strictly a last resort, limited to those instances of the direst necessity. Indeed, its use had been entirely forbidden under Dr Oxley Stephens. Still, it had to be conceded that patient safety occasionally required a reliable method of restraint.
Amelia was made aware of the various means of restraint: preventive gloves, for example, which crossed the stomach and were tied behind the patient’s back, restricting arm movement entirely; metal cuffs, locking together the wrists; and straitjackets, for the restraint of excessively violent patients, such as the criminally insane. Miss Yeames was insistent that each and every instance of restraint was thereafter meticulously detailed in the asylum’s Medical Record, priding herself that this journal would bear witness to the sparing use of such measures on the female wards. But Amelia was soon to discover that if individual patient attention and a general enlightened tolerance were the much aspired to ideals of the medical superintendent and his esteemed head female attendant, they amounted to little more than an unworkable nonsense for the ward attendants.
In 1871, the wards were full to capacity and beyond. A few patients were being accommodated in the day rooms, or else in corridors. The workhouse would routinely transfer all incurable and unmanageable patients into the asylum, while the asylum superintendent tried in vain to secure the transfer of the criminally insane out. Added to this, the water supply was barely adequate and of dubious quality: gastro-intestinal disorders, enteric and typhus fever tested the medical capabilities of the institution still further.
It was undeniably a laborious way for Amelia to choose to earn a living. The care of the psychotic, the epileptic or the syphilitic was the grimmest part of her job. These conditions were little understood and hopelessly incurable: medical intervention amounted to a meagre attempt to manage symptoms, not treat causes. Sedation was prioritized for the epileptic and the psychotic, and the emetic was the most favoured sedative: even the most unruly patient could be forced into compliance by extended periods of vomiting. The emetic of choice at the latter end of the century was apomorphine, a narcotic so highly toxic that it brought on hours of vomiting. Some asylums still made use of the rotating chair, a mechanical means of achieving that same quietening nausea.
A military-style regime restricted the staff as much as the patients. Every door was to be kept securely locked. Every excursion, even down a corridor, was to be punctuated with head counts. Even patients’ footwear was subject to restriction: for those deemed liable to damage their shoes, lockable boots were issued, cumbersome things which could only be removed by an attendant with a key.
Each day was filled by a strict regimen of housekeeping, feeding, cleaning and exercising the patients in the “airing yards”. On bath days, patients were stripped in batches and taken to communal bathrooms. Amelia would help her fourteen patients, one by one, into a tub of water (the asylum aimed to provide fresh water for each patient but rarely managed this until it was connected to the mains supply in the 1880s). She would scrub each woman down from head to toe with a soapy, long-handled brush, until the skin was marked and red, afterward leaving each bather to stand naked until she had fine-combed her hair through with turpentine to kill off any infestations.
Before she could get her patients dressed again, Miss Yeames would inspect them individually, wanting her to account for every bruise, mark or scratch on their bodies. Then Amelia would hand out fresh clothes, in which the patients would remain, day and night, for the coming week. Finally she would dress their hair. Loose hair for the female patients was forbidden, but then so too were grips and pins, since they might be used as weapons. So Amelia and the other attendants fixed every woman’s hair in place with a needle and thread.
Mental health nursing was never a great calling for Amelia. In fact, she soon learned it was an occupation she did not much care for at all. She was one of only eleven female attendants set to nurse 136 female patients. Her patient care, in common with the work of all attendants, amounted to little more than crowd control. A wholesale restrictive routine was the easiest way she could manage fourteen women in her care.
If mechanical restraint appeared in Fishponds’ Medical Record to have been little used, on the wards it was very much part of the furniture; an indispensable means of managing dangerous or self-harming patients, used frequently, though rarely entered into the books. And any patient deemed too violent to be at large could expect to spend long stretches of their days cuffed into chairs or strapped into a straitjacket, being let out at brief intervals and only then once in seclusion. Whatever ideals the hospital boasted, then, the strain placed on the nursing staff created a stealthy culture of low-level aggression toward refractory patients. The annual Commissioners’ reports of the early years of the 1870s make it clear that the hospital Visitors recognized this. One Commissioner noted having seen a patient with a black eye and facial contusions, and was informed by him that he had been “set upon” by two attendants for arguing with another patient after leaving the dining hall.
If she was lucky, Amelia would escape the worst of her lot by supervising mostly melancholics, suicidal maniacs or those with “depressive agitation”. These women were generally calmer and more compliant, as they could be managed effectively with narcotics. Opiates were standard issue and they were indulged just as eagerly by the attendants as by the patients. They elevated melancholic spirits, rendered the agitated docile and induced sleep. One of the asylum’s suicidal maniacs in the 1870s, recorded simply as “E.W.”, made frequent and inventive attempts to end her life. She tried swallowing an entire box of dominoes, and, on another occasion, 14oz of pebbles. Most spectacular were the 24¼oz of iron screws, which she had dislodged from the window shutters over the course of one night and swallowed before breakfast the following morning. (Despite periodic painful stomach spasms, she was left largely unharmed. The thirteenth screw was finally passed six months later, at which point the annual Commissioner’s report noted that E.W. was transferred out of the asylum.)
All fit and able patients were expected to spend part of their day working around the asylum. Those with trades were put to good use: shoemakers and binders, carpenters, smiths, painters, mat makers, bakers, laundresses, cooks, dressmakers and seamstresses – all were expected to offer their specialized services, in exchange for an extra allowance of bread and cheese and a half-pint of beer at tea time. Such useful occupation was considered therapeutic; but every year, the annual report boasted an estimate of how much expenditure this policy saved the asylum.
For recreation, the asylum chaplain kept a ready supply of books which he distributed every week to literate patients. A programme of entertainments was introduced: cricket, piano and harmonica recitals, theatrical performances, picnics, outings to Bristol’s zoological gardens.
Amelia began to see that for the well-behaved lunatic a short spell at the asylum wasn’t so bad. It was certainly a more attractive proposition than the workhouse, where the harsher regime and extreme depersonalization made absolute economic, but created a living hell for the inmates.
In fact, it was possible for a female lunatic to work the system to her advantage. If she remained largely even-tempered, and was deemed to be suffering from a manageable, transient and therefore “curable” condition, the asylum might even represent a refuge, a respite. It offered a troubled woman a constant supply of dull but nevertheless edible food, free beer and tobacco, as well as time to read, to sew, to walk in the gardens, attend chapel and even enjoy in-house entertainments once in a while. Moreover, she had daily access to mood-enhancing narcotics. For Amelia Thomas, this may have come as something of a revelation.
The year 1871 turned out to be a bad one for the Bristol Lunatic Asylum. The annual report published at the start of 1872 contained a catalogue of complaints. It had been a year of increased overcrowding; the death rate had risen, and they had been forced to open their doors to a greater number of the incurably insane. To add to their unease, the asylum Commissioners complained of a worrying element of poor record-keeping throughout 1871. In particular, they listed instances of restraint which had gone unreported, and drew attention to the unrecorded deaths of two patients. Finally, they highlighted the failure of the medical superintendent to bring to their notice the case of a female attendant who had been dismissed following an unseemly incident with a patient. The attendant had been deemed overly aggressive: she had argued with the patient, wrestling with her and shoving her to the ground. That she had been rightly dismissed was not in question; that the incident had gone unrecorded was very much so.
The attendant went unnamed in all reports, but by the start of 1872, of the eleven female attendants at the Bristol Lunatic Asylum, Amelia Thomas was no longer on the payroll.