Institution Information - Lilybank House
Town/Parish/County: Musselburgh, Inveresk, Midlothian
Alternative Names: [none]
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Text from 1857 Royal Commission Report
“LILYBANK HOUSE, MUSSELBURGH; Robert Aikenhead, Proprietor; Visited 1st May 1855.
Mr. Aikenhead was formerly a victual-dealer, and entered upon his present occupation about six years ago, without any previous experience in the treatment of the insane.
The premises are situated in Fisherrow, close to the old bridge over the Esk, and are rented from the town of Musselburgh at £35 a year. They consist of a three-storied dwelling-house, with small plots of ground in front and behind; and of two outbuildings, one on each side of the front plot, which is entered from the street. The whole of these buildings are fitted up for the reception of patients, who are all parish paupers. At the date of our visit, there were 37 males, and 35 females.
The centre house is appropriated to the male patients, and to the accommodation of Mr. Aikenhead's family; the former occupy the two upper stories, and the latter the ground floor. The females occupy the larger of the out-buildings, which consists of two stories, while the other building, which is of one story only, is occupied both by male and female patients. This last out-house appears to have been originally a cottage, entered from the street. It consists of four apartments, three being floored with wood, and the fourth paved with brick. In each of the two larger rooms are seven patients; males in one, and females in the other. The fire-places of both are boarded up and not used. The other two rooms are small; two female servants sleep in one, and an attendant and a male patient in the other. There are fire-places in them, and, it is said, fires are lighted in winter; but the rooms are so small, and so destitute of furniture, that they can afford only very comfortless and scanty accommodation to the patients, who at that season must use them as sitting-rooms. There are no separate dayrooms in the buildings, and the patients are consequently obliged to pass a great part of the day in their sleeping-rooms, which are very ill adapted to serve this double purpose. They are crowded with beds, and generally contain no other furniture except one or two benches, totally insufficient to accommodate the patients, many of whom are thus obliged to sit on their beds. There are no tables.
The rooms have no means of ventilation except by the doors and windows, both of which are closed at night; and as the patients go to bed at seven, and do not rise till half-past eight, it is obvious that the atmosphere must become extremely contaminated, especially in those rooms of very limited size, which are occupied during the night by seven or eight patients, and serve, moreover, as sitting-rooms during the day. Another source of the impurity of the air in some of the lower rooms lies in their being paved with bricks, which become impregnated with the urine of the patients, and are thus almost constantly damp and offensive. As a general rule, the fire-places throughout the house are boarded up, and there are perhaps not more than two rooms in each building in which fires are lighted in winter. In these rooms the patients naturally congregate, and there is reason to fear, that the more feeble are prevented by the stronger, from approaching the fires.
There is only one room for a single patient—a small closet without a fire-place. The window originally contained six panes of glass, but three of these have been removed, and replaced with wire gauze, so that there is no protection from the cold in winter.
The bedsteads are principally of iron, and the mattresses are of straw; many of the latter are thin, hard, and uneven. The straw is said to be changed every six weeks, or as often as is required, but the stock kept for the purpose is very insufficient. The bed-coverings were scarcely sufficient for the comparatively warm season of the year at which our visit was made. Additional coverings were said to have been on the beds during the winter, but, as on repeated inquiries a very scanty stock only was produced, we have no doubt that, during the late inclement season, the patients were very imperfectly protected from the cold. This fear was further confirmed by the deficient dayclothing of the patients, and by their miserable appearance.
There is no water on the premises; the supply for cooking and drinking is derived from a well in the street, and that for washing from the river. The female patients are said to wash in a tub, which is placed in a cold and very damp washing-house, which serves also as the dead-house. The men, we were told, have two pails of water placed in one of their sleeping-rooms, for the purpose of washing—all making use of the same water. But inquiry led us to think that some of the patients often pass many days without being washed. There are no warm baths, but there is a shower-bath in the washing-house, which is used principally to calm excited patients; and as a punishment or threat, generally without the knowledge or sanction of the medical attendant. There were chamber utensils in the rooms, but not in sufficient numbers. The means for washing the bedding and clothing, and also for cooking the food, are very deficient.
The windows are all barred, and many of them are also guarded by wire. The panes in the cottage are also obscured with paint; and several panes that have been broken in the females' sleeping-rooms are replaced with wood.
There are no water-closets in the house, but there is a privy in each airing-ground, in which the excrement is allowed to accumulate till it forms a cartful for removal. We found them in a very filthy and offensive state.
The male attendants are— Mr. Aikenhead; a paid attendant at £26 per annum; and one at £12 per annum. The female attendants are— One at £8 per annum; one at £7 per annum; one at £5 per annum.
A cook at £8 completes the establishment. The patients receive three meals a day. For breakfast, they are said to have porridge and butter-milk, those who prefer it getting coffee. For dinner, broth and meat; and porridge again at night; but there were no means of ascertaining the quantity of food allowed to each patient. As there are no dayrooms, and no tables, the patients take their meals in their sleeping-rooms, or squatting in the yards, in a most comfortless manner. There were only three drinking mugs for the whole of the patients.
The male patients presented unmistakable signs of deficient vital power. Their skins were cold, their circulation feeble, and their flesh wasted. They were poorly clothed, generally without flannels and drawers, and were evidently under-fed. The females were better clothed, and in better condition.
Restraint is in common use. One man, J. R., was handcuffed, and is habitually chained by the leg at night to the bedstead. Another man, D. W., was also handcuffed. Another, A. S., is frequently in restraint. Another, R. R., is occasionally leg-locked at night. The attendants have handcuffs, straps, and strait-waistcoats in their keeping, and apply them as they see fit, without the knowledge or sanction of the medical attendant. The female attendants put out the straitwaistcoat at night to be ready for use.The patients are rarely, if ever, taken beyond the bounds of the premises, and the means of exercise are limited to the two small airing-yards. In that of the men, a bowling-green, occupying almost its entire surface, has been lately constructed, but no bowls have as yet been provided. The female airing-court measures about 18 yards in breadth, and about 40 in length, but a considerable portion of it is occupied as a garden, leaving the patients only two short walks as exercise ground. The men's airing-ground is of the same breadth, but scarcely so long. The patients are restricted to the walk round it, not being permitted to go on the grass, which has only recently been laid down.
There is an almost entire want of the means of occupation and amusement; only one or two of the men occasionally work a little in a small garden to the left of the premises. This garden is separated from those of the neighbours by a broken hedge, so that the patients do not enter it unless under surveillance; which, with the small number of attendants, cannot be afforded.
The rate of payment is £20 a year, which sum includes clothing and every incidental outlay, and also the expense of removing patients. A large proportion of the patients have been brought from the chartered asylums.
The records are very defective. Indeed only one book is regularly kept, and it contains simply the names of the patients, with some casual remarks. There is no register of restraint. We were informed that until 1850 a record of this kind was kept; but, as it was never examined by the official inspectors, it was discontinued. The Madhouse Register is sent to the Sheriff at the end of the year. Mr. Aikenhead is totally unacquainted with the provisions of the statutes, and, indeed, has never seen the acts of parliament relating to lunatics.
Mr. Laurie, the medical officer, attends daily.
On the 25th of May we made another visit to this house, and found its condition very much as above described. Nearly all the male patients were in their airing-yard totally unoccupied, except two who were reading. J. R. and D.W. were handcuffed as before. Several of the patients complained of the want of occupation. A few of the females were sewing and knitting.
On again making inquiry into the store of winter clothing, we were shewn eighteen pairs of blankets and five bed-covers, which constituted the whole supply beyond what was on the beds. We likewise examined into the stock of underclothing for the male patients, and found it to consist of forty-two old thin flannel jackets, eight Guernsey jackets, and twenty-nine pairs of old thin drawers of flannel or tweeding; a supply totally insufficient for the wants of the patients.
In order to ascertain precisely the degree of overcrowding, we obtained the following measurements of some of the rooms:—
Room No. 8, in an out-building, with seven beds and eight patients; contents, 1814 cubic feet, being 226 6/8 cubic feet to each patient. The fire-place is boarded up.
Room No. 10, in an out-building, with three beds and six patients; contents, 1123 cubic feet, being 187 1/6 cubic feet to each patient. The fire-place is boarded up.
Upper Room, in an out-building, with five beds and nine patients; contents, 1719 cubic feet, being 191 cubic feet to each patient. The fire-place is boarded up.
North room, upper floor in same building, with seven beds and eight patients; contents, 1642 cubic feet, being 205 1/4 cubic feet to each patient.
These rooms are in separate buildings on the east and westside of the garden in front of the main house, and the average height of the ceilings is 7 feet 1 inch.
No. 1, main house, top flat; a closet with one bed and one patient; contents, 344 cubic feet.
No. 6, second floor, main house, with eight beds and eight patients; contents, 2245 cubic feet, being 280 5/8 cubic feet to each patient.”