I have recently been trawling through the mammoth, dusty, fragile patient casebooks of Caterham. I have numerous images of them saved on my pc, but missed having the dirt, the grime, and the feeling of the pages under my fingers. I also found that flipping through the pages physically allowed me to see was contained within the casebooks beyond that of brief notes as to their health, qualitative information which is hidden, or less evident when I scroll through them on my computer screen.
So there I was, sat in the archive room looking at the casebooks, items that are so very familiar to me after several years of using them, physically and digitally. However, on this occasion I was being purposely unfamiliar with them, wanting to rediscover them, and look at them as physical objects, as cultural products, beyond them being institutional entities and forms of administrative activity.
I wanted to think about them as objects that were interacted with in a number of ways, that were receptacles of snippets of information of the patients, both administrative, qualitative and quantitative. I could imagine the overworked medical officer bent over the casebook, as I was, hastily writing his notes, as I was more laboriously noting his notes. This tactile interaction made me realize, more acutely than I sometime remember to do so, that the casebooks are my only connection with some of the people who in many cases remain voiceless and hidden. The casebooks remain, in many cases, the only record of the patient’s life, an existence that is only recorded on the national registers, little more than an entry in the decennial census, or another name alongside the numerous others recorded in the Birth Deaths and Marriage lists.
These casebooks were dealt with regularly, possibly weekly or monthly, though judging by the Commissioners In Lunacy complaints that the patient documents were not very well kept at the asylum, it was not daily! Caterham had a medical team of three men, the Medical Superintendent and two Medical Assistants, to administer and care for 2,000 patients, a third of which at any one time were resident in the asylum’s infirmaries. There was little change in the medical staff, and correspondingly little changes in the handwriting, which at times was easy to read, and towards the end of the century fell afoul of the doctors handwriting and the script becomes almost unintelligible.
Patient casebooks reveal a number of examples, insights, and illustrations of how patients were classified, diagnosed and treated within the asylum. However, wider and deeper reading of the casebooks can reveal how patients were regarded in the asylum by the staff themselves, as humans, as persons, as individuals. References to their character, their behaviour, and even descriptions of their death give rise to the emotional connections and aspects of the asylum. They also provide a hint at the relationship between the doctors and the patients, both of whom were to some degree long-stay residents of the asylum. Caterham’s medical staff worked at the asylum for significantly lengthy periods, Dr Elliot joined the institution in 1870 as an assistant medical officer, before succeeding Dr Adams, the first Medical Superintendent, in 1880. Dr Elliot remained in post for 20 years until his retirement in 1900. During both Dr Adams and Dr Elliot’s time at the asylum they would have become familiar with patients, some of whom they were seeing daily or weekly, some of whom would have assisted in their offices, or within their homes, as maids and servants.
The intimacy that could develop between the staff and the patients is hinted at in the patient photographs that were pasted into the patient casebooks. Dr Adams requested that the Management Committee provide him funds to purchase photographic equipment in 1873. His request was granted, along with one for the purchase of meteorological observation equipment. In that year Dr Adams set up his photographic studio and processing room, as well as a mini weather station. Along with recording the weather, Dr Adams, and his replacements, visually recorded the patients in a variety of ways.
As with many nineteenth century institutions, there are few images of the internal world of the asylum. That is what makes the photographs contained within the patient casebooks so very interesting, and dare I say valuable on a number of levels. Firstly, the images were not for identification purposes, namely as not all patients were photographed, and not all casebook entries have a photograph attached.
Patients were photographed in a variety of poses, and in a variety of settings. Some were photographed inside the asylum, some were photographed outside the asylum building, in the vast asylum grounds. Some patients stare straight at the camera, others look away, some are sitting, others are leaning against a prop, some with a theatrical backdrop, some against a plain wall. There is no uniformity or universality to the images.
In one photograph a female patient, classified as chronic maniac, has a black and white cat perched on her lap. Both the patient and the cat look content, the patient is wearing the somewhat customary asylum shawl draped around her shoulders, the cat is repose on across her knees. In the numerous committee minutes, annual reports and official documents that make up the archive of Caterham I have never once found a reference to the cat.
It is the photograph of Emma Emmerson, one of the earlier admissions to the asylum that I found myself taken aback. Emma was 50 years old when she came to the asylum. The casebook within which I found her photograph begins in 1885, and the comments which circle and butt up to her photograph are dated 1892, so conceivably Emma was in her 70s when the image was taken. She sits in a chair, a large shawl is draped around her shoulders, and she has an elaborate cap upon her head. The quality of the image is poor, and due to age is faded, so it is difficult to tell if her eyes are open, or are heavy hooded. Emma appears to have a smile, or an attempt at a smile on her face, and what I found most arresting was the doll she was cradling in her arms.
The doll is dressed in a bonnet, and appears to be swaddled, but due to the quality of the image it is hard to tell. She also appears to have a small posy of flowers. My reaction to the photograph then, and now reflecting on it, remains to be highly emotional. There are a number of emotional and intimate hints in the image, Emma’s headwear firstly appears to be an attempt to make her look nice. This may have been done by the patient herself, or by the attendants and nurses. Clothing was highly regulated at the asylum, with the dress of the patients controlled by the asylum staff, and spare items were not left lying around, for fear of destruction, loss, or misuse. The photographs provide some insight and evidence of the agency of patients, namely that they were able to adapt, adjust and alter clothing to meet their tastes, choices, and desires, be it within tight constraints.
The fact that there was the opportunity for Emma to have a piece of head wear that was not a simple cloth cap gives rise to a number of interactions and activities that were taking place in the asylum, that are not always mentioned in the reports or casebook notes. In 1885 Emma collapsed, she recovered and no sign of paralysis, a major concern of the Medical Staff, was found. Emma was sent to the infirmary ward to recuperate, and the next case book note is revealing ‘Much better, but [it is] strange for her [to be] inclined to be quiet in bed’. On her admission notes Emma was described as talking in a ‘garrulous’ manner, delusional and ‘fancies we have sent for her to play the piano’. Emma soon recovered and her casenotes state that she was able to move about and do some light work.
The photograph and the brief notes about her quiet behaviour being ‘strange for her’ shed light on the staff and patient relations that fell outside of formal, or expected, interactions. That Emma was able to have her doll in the image suggests that the doll was a special object to her, and most probably an item that she carried about with her, for comfort or for security.
There were similar variances in the male casebooks. Some men were fully bearded, others clean shaven. Some were in three piece suits, others with a short cloth jacket and shirt. Some had neckerchiefs, others were had bare throats, unencumbered by scarfs or kerchiefs. One dapper young man had a hanky in the chest pocket of his jacket. Some stare straight at the camera, others looking away, down at their hands laid in their laps, some with arms defiantly crossed across the chest. Robert Campbell admitted in December 1890 has his hands lightly clasped across his stomach, and is grinning at the camera. A mirror placed behind him reflects the back of his head and torso.
For a significant period of time it would appear that a number of the male patients were photographed in such as manner, sat on a chair before a mirror, in what appears to be more formal and formulaic institutional images. That the images are not dated makes it difficult to draw comparisons, contrasts, and consistencies between the way that men and women were photographed. However in one of the male patient casebooks there were equally candid and familiar images, similar to Emma and her doll, and with similar differences and variances of patient dress.
Robert is wearing a light coloured corduroy jacket, and a spotted scarf is wrapped around his neck. As he was admitted in December, the image may well have been taken some time after his admission, the heavy textiles suggesting it was the winter wear of the patients. I was struck by Robert’s cheerful expression, his open appearance, which gave me the notion of a certain amount of trust, or of intimacy, between Robert and the person taking the photograph. It also alludes to a sense of ease, or intimacy, with the environment within which the photograph was being taken
In some of the photographs the patients do not look at ease, nor do they look comfortable with their surroundings. In other photographs the patients face is blurred, suggesting they were either unable or unwilling to sit still.
In one photograph a patient, his face is turned three quarters to the camera, stares cautiously, his shoulders hunched, and his body language appears guarded. A large number of the images from the male case book which includes patients admitted between 1890 and 1891 are closely cropped, however it is possible to see what appears to be a landscape backdrop of plants, trees and flowers. The chair upon which the patients are seated is not restrictive; it was a simple armless curved back chair. Some institutional photographs, from lunatic asylums, have shown patients seated in high backed chairs, their heads held in clamps. I have come across no images like this at Caterham, which was an asylum built to provide long-term accommodation to incurable insane paupers. Thus the intention and working remit of Caterham differed significantly to the county and borough asylums that dominate the historiography. This is reflected in the photographs, and the other sources, of Caterham.
With Caterham being a long-stay asylum, the longevity of the staff in terms of service and employment and the patients’ residency, in some cases being upwards of 30 years, gave ample opportunity for relationships, familiarity and intimacy to develop. The manner in which the patients were photographed provides visual evidence of this, which at times is hidden in the textual sources, despite them appearing alongside one another!