“He asked him if he had seen the doctor having connection with a nurse.”
Archives pose constant distractions. I’ve lost count of the number of times I’ve mentally stored away a snippet not directly relevant to the task at hand, but to be used somewhere, at some indefinable point in the future. It’s one of those snippets that I want to use here to show how the sexual lives of two staff members in a nineteenth-century institution had serious consequences for someone who exposed them. While doing my doctoral research on the body in the Victorian asylum, I came across the casebook record of Thomas S., a 63-year-old man admitted to the West Riding Asylum in Wakefield in January 1895. Dr. Shirley, who completed Thomas’s admission certificate, considered him to be senile and said that he should be considered dangerous. This was on account of Thomas apparently attacking Dr. Shirley “with a stick quite unprovoked” — echoing the testimony of nurse Sabina Wright at Hunslet workhouse, where Thomas had previously lived. Wright said Thomas was noisy, sleepless, and had struck her violently.
This isn’t an unusual set of facts to find in the admission records of an asylum patient. Individuals who proved noisy or troublesome in the workhouse were often transferred to the asylum, where staff were better able to cater to their needs. In Thomas’s case, though, it seems there was more behind his transfer than first met the eye. In his casebook record, the asylum doctor recorded in some detail Thomas’s account of the events leading up to his transfer:
It is an account with more than a little of the bawdy humor of the British Carry On films about it — the doctor and nurse disturbed rather unceremoniously — but the incident had severe consequences for Thomas:
On examining Thomas, the asylum doctor found that he had a fracture of the fourth rib on the left side. Though it was difficult to say with certainty if this had been caused by the workhouse doctor’s attack on him, the detailed account of the episode in the casebook seems to speak to its importance in the asylum doctor’s mind.
Thomas’s transfer to the asylum took place at a time when greater attention was being devoted to the prevention and detection of violence in psychiatric institutions. Following a series of scandals in the 1870s in which asylum patients had been found to have fractured ribs, asylum staff came under closer scrutiny. Post-mortem reports detailed the bodily condition of patients, noting bedsores or fractures, and asylum attendants were reminded in strong terms of their responsibility towards those under their care. The Medico-Psychological Association introduced the Certificate in Attendance and Nursing upon Insane Persons in 1891, marking a shift towards asylum nursing as a better-regulated occupation.
The Association’s Handbook of 1886 also noted the need for attendants to report to doctors any evidence of pain, bruising, or fracture. As well as detecting injuries that may need treatment, physical exam was viewed as an important defense for the asylum. Without it, asylum staff might be presumed guilty of any injuries that were discovered at a later date (especially if they had not been reported). The physical examination of Thomas S., then, and the careful recording of his story in the casebook, served to establish a strongly suggestive link between his injury and his treatment in the workhouse.
Thomas’s story has uncomfortable parallels with the modern day. A 2015 inquiry into the abuse of psychiatric patients at a Denbighshire hospital found that one patient had sustained a broken arm, only discovered by his daughter. And in 2014 the Guardian found that reports of sexual assault in UK hospitals had risen by 50% since 2011. Though the sexual act at the heart of Thomas’s tale took place between two staff members, it nevertheless raises the question of sexual abuse in institutions. We perhaps assume from the rather comical nature of the scene as described by Thomas that the sex between doctor and nurse was consensual, but we have no way of knowing this. In recent years, high-profile cases like that of Jimmy Savile at Stoke Mandeville and other hospitals have highlighted that the mere fact of sexual acts taking place by no means implies consent, particularly when a power differential exists in an institutional context.
In the nineteenth-century workhouse, this power differential was clearly manifested in the physical abuse and threats to Thomas following the incident and his quick transfer to the asylum: the diagnosis of insanity served a double purpose, getting him out of the way and casting him as an unreliable, delusional, witness. Yet it is clear from the casebook notes of the asylum that the doctor there placed some stock in Thomas’s story, and that not all patients were simply dismissed as troublesome or untrustworthy. Conversely, the workhouse doctor’s reaction to Thomas’s accidental voyeurism spoke to the lengths individuals may have gone to in order to defend their privacy regarding sexual activities; unfortunately for Thomas, his position in the workhouse made him unusually vulnerable to those abusive defensive measures.
Rather like the public interest in asylums of the 1870s, in recent years our attention has been drawn to instances of abuse within hospitals or other health facilities that have raised important questions about patient care, staff training, and accountability. We should be confident in placing our trust and faith in the majority of health professionals who provide dedicated, outstanding care to patients. But at the same time we should also be keenly aware of many patients’ vulnerability within institutional contexts — especially those who are physically frail, less able to articulate their wants and needs, and whose voices are often silent. We don’t want to uncover their experiences of abuse in another 150 years, via a historian reading an archival document.