Institution Information - Royal Edinburgh Asylum
Parish/County: St Cuthberts, Edinburgh, Midlothian
Alternative Names: Edinburgh Royal Asylum; Royal Edinburgh Hospital
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Text from 1857 Royal Commission Report
“EDINBURGH ROYAL ASYLUM; Resident Physician—Dr. David Skae.
I.—Object, Origin, and History, and Date of Opening.
So far back as the year 1791, Dr. Andrew Duncan, Sen., first called the attention of his fellow-citizens to the want of an asylum at Edinburgh for the protection and care of persons labouring under mental derangement; and appears, at his own expense, to have printed and widely circulated "A proposal for establishing a Lunatic Asylum in the neighbourhood of the city." His object was, firstly, to provide for the care and cure of lunatics whose circumstances enabled them to pay for their maintenance and treatment in the asylum at certain fixed rates, according to the accommodation stipulated; and, secondly, to extend the benefit of the institution to persons in indigent circumstances, as soon as sufficient funds could be obtained for that purpose.
Although a subscription was immediately set on foot for carrying the plan into execution, so little encouragement did it receive, that, down to the year 1806, the whole contributions little exceeded £100. Notwithstanding this disappointment, its benevolent author still kept the scheme before the public, unceasingly advocating its claims on every occasion which seemed to afford a probability of success.
At length, in the year 1806 a grant was obtained from Parliament of £2000 out of the fund arising from the forfeited estates. In 1807 a charter was granted by the Crown, erecting the contributors into a body corporate; and in the following year, by which time many influential individuals had become interested in the undertaking, the subscription was again commenced, and vigorously followed up, not only in this country, but in the different Presidencies of India. A suitable piece of ground for a site was acquired at Morningside, about two miles to the south-west of the city, and the foundation stone of the future asylum laid on the 8th of June 1809.
Owing to the want of the necessary funds, and the very limited portion of the building which could at first be erected, the asylum was not opened until July 1813, and then under very disadvantageous circumstances. It was originally intended to receive patients at three rates of board; but the Managers having been enabled to complete only that portion of the Asylum appropriated to the reception of patients belonging to the middle ranks of society, no accommodation could be provided for paupers; and, for a long series of years, the want of funds, and the impossibility of duly classifying patients in a small establishment, practically excluded the poor from participating in the benefits of the Institution. Down to a recent period, the utmost effect which could be given to the charitable feature of the Institution, was the admission of patients in reduced circumstances, at barely remunerating rates.
In the year 1836, a negotiation commenced between the Town-Council and the Managers of the Asylum, with the view of transferring to it the whole of the patients then in the city Bedlam. An arrangement was concluded, whereby the Managers engaged to erect additional buildings, and provide accommodation for the whole of the lunatic poor of the city; and similar agreements were subsequently made with the heritors of St. Cuthbert's Parish, and also with those of the parishes of Canongate, South and North Leith, and Duddingston.
The funds at the disposal of the Managers being quite inadequate for enabling them to undertake the erection of buildings of the extent now contemplated, it was resolved again to have recourse to a public subscription, which was accordingly begun and pursued with considerable success. The Managers determined to proceed in the meantime with the work, in the full confidence of receiving support. It was at first contemplated to extend the existing buildings, but it was found necessary to abandon this plan, principally on account of the limited extent of ground belonging to the Asylum. About fifty imperial acres, immediately to the west of the old ground, were therefore feued by the Managers from the governors of George Watson's Hospital, and it was resolved to erect an entirely new building.
The leading feature of the new plan was the adoption of a series of dormitories, instead of single rooms, on a much larger scale than had before been adopted in such institutions. The western wing was commenced in 1840, and opened for the reception of pauper lunatics on 6th August 1842, at rates of payment varying from £15 to £20 per annum, according as the parties responsible for the payments had or had not acquired rights of presentation, by means of contributions of £10 and upwards to the funds of the Asylum.
From various causes, the cost of the new buildings greatly exceeded the original estimate, and, at the close of 1842, amounted to nearly £28,000, leaving a deficiency, or debt, of nearly £4000.
At 31st December 1843, the number of patients had increased to 284, and it was again found necessary to provide further accommodation. An additional portion of the buildings was accordingly erected in the course of the following year, at a cost of upwards of £6000.
At the close of 1844, the total cost of the new establishment was about £36,000, and the deficiency or debt at tljat period was somewhat under £12,000. This extension provided accommodation for nearly 100 additional patients; but it was no sooner completed than it was filled, so that many applications for admission were necessarily refused.
Notwithstanding the great and increasing debt, the Managers felt that they had no alternative but again to extend their operations. Accordingly, a farther portion of the building was completed and opened for the reception of patients, in the spring of 1847. As on the former occasion, it was immediately fully occupied.
The situation of the Managers was now one of peculiar difficulty. On the one hand, their position seemed to impose upon them a certain duty to the public, while on the other, they were paralyzed by the weight of debt they had already incurred. This debt amounted to upwards of £19,000, which sum they had borrowed on their credit as individuals; for although the property of the Institution had cost not less than £62,000, and might be considered worth that sum for the purposes to which it was devoted, it was obvious that the buildings of a lunatic asylum formed no proper subject of security for borrowed money. In these circumstances, the Managers deemed it their duty to lay the matter before Her Majesty's Government, praying for a loan from the public funds, of such an amount as would enable them to discharge their existing obligations to private parties, and complete the Asylum buildings; and undertaking to repay it by instalments with interest, within a fixed period. To this application, which was repeatedly pressed upon the Government by the Lord Advocate, the late Lord Rutherfurd, no answer was ever received.
Failing in their endeavours to procure assistance from Government, the Managers resolved to apply for a special act of parliament, conferring upon the corporation powers to borrow such sums as should be sufficient for the desired purposes. Advantage was at the same time taken of this application, to modify the constitution of the Asylum; and an act was obtained, with clauses to accomplish the following purposes :—(1.) To re-incorporate the Institution under the title of "The Royal Edinburgh Asylum for the Insane," with the usual powers. (2.) To ratify the constitution of the Asylum, as laid down in their Royal Charter of Incorporation, but altering the day of the annual meeting from the last Monday of January to the last Monday of February: adding both members of parliament for the city to the list of Extraordinary Managers, and increasing the number of Ordinary Managers from twelve to fifteen. (3.) To provide for a rotation in the office of Ordinary Managers, by the retirement of two annually from the head of the list, who shall not be re-eligible for a year thereafter. (4.) To define and extend the duties and powers of the Medical Board, which had been left undefined in the original charter. (5.) To establish a separate charitable department of the Asylum for the administration of all legacies and other donations granted to the corporation, including lapsed rights of presentation. (6.) To aid in providing a suitable fund to be at the disposal of this department, enabling the Managers to set aside towards it, until such time as it should amount to £10,000, one tenth part of the income derived from payments on account of patients not under £50 per annum; and lastly, to authorize the corporation to borrow a sum not exceeding £80,000, to be applied in paving off their subsisting debts and liabilities, and in completing the Asylum buildings according to the original design, as well as in erecting such other buildings as might be deemed necessary, and to establish a sinking fund for the gradual liquidation of the debt within a period of thirty years.
Early in the year 1855, the Managers proceeded with the erection of a farther portion of the buildings of the western department, which had been delayed from time to time, in consequence of the great rise which had taken place in the cost of building, and of building materials of all kinds. Independently of this difficulty, it now appeared that they had greatly under-estimated the sum which would be necessary for the entire completion of the -Asylum in all its departments. After maturely considering the whole subject in connection with their available means, the Managers resolved to content themselves at present with erecting the centre octagon and southern portion of the west wing, together with the separate building to the west for refractory patients, leaving the northern end of the wing and a new laundry, to be executed when other means shall be provided. The new buildings being only now in the course of erection, it is impossible to state what their entire cost may be; but looking to the estimates, it is probable that, including other incidental expenses, they will exhaust the whole available sum of £30,000, which was authorized to be borrowed under the act of parliament.
II.—Constitution, Government, and Management.
In terms of the original charter, the management of the Asylum was conducted by twenty Extraordinary Managers, appointed ex oficiis, and twelve Ordinary Managers, nominated in the charter, who held office for life, or till they resigned. Vacancies were directed to be supplied by a majority of votes at special meetings of the Extraordinary and Ordinary Managers. By the act of parliament, the number of Extraordinary Managers is increased to twenty-one, and that of the Ordinary Managers to fifteen. Two of the latter retire annually, and vacancies are filled up at the annual meeting.
The Ordinary Managers, of whom five constitute a quorum, meet quarterly for the transaction of business, and hold other meetings whenever necessary. Four standing committees are elected at the general meeting, termed respectively the finance, building, visiting, and charity committees.
The Medical Board, consisting of the president and two other fellows of the Royal College of Physicians, and president and one other member of the Royal College of Surgeons, have, individually and collectively, the right of visiting the Asylum at all times, and of reporting thereon in writing to the Managers. The Medical Board may also, as occasion requires, be referred to and consulted by the Ordinary Managers, for advice and assistance in all matters of importance relating to the care and treatment of the inmates.
III.—Quantity and Appropriation of Land.
Attached to Eastern House.
Pleasure-ground, 1.445 acres; Garden, .845 acres, Roads, .354 acres, House and airing yards, 1.100 acres
Total, 3.744 acres
Attached to Western House.
Arable land, 25.592 acres; Plantations, .750 acres; Pleasure grounds, 4.601 acres; House and airing ground, 5.067 acres; Roads, 1.730 acres; Steward’s house and ground, 1.700 acres
Total, 39.440 acres
IV.—Amount and description of Accommodation for Patients of the several Classes and respective Sexes.
1. East House.
1.—Accommodation for 30 Gentlemen.
It consists of—
Three galleries, each containing a corridor 41 feet long, 9 feet broad, and 10 1/2 feet high, a parlour, and eight bedrooms.
Seven rooms in a detached wing, variously used as bedrooms and parlours, according to the requirements of the patients.
Five rooms on the ground-floor, between the wing and main building, variously used as sleeping-rooms for one or more patients, or as seclusion-rooms.
2.—Accommodation for 30 Ladies, similar to that for the Gentlemen.
Note.—At present a sitting room of this department forms a dormitory for gentlemen—the proportion of whom, at present, considerably exceeds that of the ladies.
Actual numbers on visit of Commissioners, 40 gentlemen and 24 ladies.
2. West House.
1.—Accommodation for about 200 Male Patients at pauper rates of payment. Actual number of patients on visit of Commissioners, 233.
The first male gallery contains accommodation for forty beds.
It consists of a corridor 138 feet long, 10 feet wide, and 11 feet high, two day-rooms, two large dormitories, each containing accommodation for sixteen beds, one small dormitory for five, and a bedroom for one or three beds.
The second male gallery contains accommodation for fifty seven beds, and consists of two corridors each 133 feet long, 10 feet wide, and 11 feet high, two day-rooms, one dormitory for eighteen beds, two dormitories for sixteen beds each, and one for seven.
The third male gallery contains accommodation for sixty-eight beds. It consists of three corridors, each 64 feet long, 10 feet wide, and 12 feet high, three day-rooms, two dormitories for nineteen beds each, and two for fifteen each.
The infirmary for males, consists of two rooms, one for seven beds, and the other for five beds, a bath-room, and a watercloset.
The detached building for refractory and noisy male patients, contains accommodation for thirty beds. It consists of two corridors, one 80 feet long, from 8 to 10 feet wide, and 14 feet high; the other 45 feet long, 8 feet wide, and 14 feet high; a day-room, a dormitory for twelve beds, four rooms for three beds each, and six single rooms.
2.—Accommodation for about 170 Female Patients at pauper rates of payment. Actual number of patients on visit of Commissioners, 238.
The first female gallery contains accommodation for forty beds. It consists of a corridor, 133 feet long, 10 feet wide, and 11 feet high, two day-rooms, two large dormitories, each containing accommodation for sixteen beds, one small dormitory for five, and a bedroom for one or three beds.
The second female gallery contains accommodation for thirty two beds. It consists of a corridor, 133 feet long, 10 feet wide, and 11 feet high, two day-rooms, and two dormitories, each for sixteen beds.
The third female gallery contains accommodation for sixty two beds. It consists of two corridors, each 133 feet long, 10 feet wide, and 11 feet high, two day-rooms, one dormitory for eighteen beds, two dormitories for sixteen beds each, and two small dormitories, one for seven, and the other for five beds.
The infirmary for females consists of two rooms, one for seven beds, and the other for five beds, a bath-room and a watercloset.
The detached building for refractory and noisy female patients, contains accommodation for thirty-two beds. It consists of two corridors, one 80 feet long, from 8 to 10 feet wide, and 14 feet high; the other 45 feet long, 8 feet wide, and 14 feet high; a day-room, a dormitory for twelve beds, four rooms for three beds each, and eight single rooms.
3.—Accommodation for 30 Female Patients of an intermediate class. Actual number on visit of Commissioners, 26.
This gallery consists of a corridor, 133 feet long, 10 feet wide, and 11 feet high, two day-rooms, and two dormitories, each for fifteen beds.
The day-rooms are nearly all the same size. Each contains from 6000 to 7000 cubic feet of air.
The dormitories contain on an average 600 cubic feet of air for each patient, and, at the same time, communicate freely with the adjoining corridor.
The single rooms contain from 1133 to 1700 cubic feet of air each.
V.—Sources and Amount of Income.
The Income for the year 1854 was as follows :—
1. Amount of payments for patients, £15,270 17 0
2. Profits on furnishings to patients, £304 3 11 1/2
3. Rents, £177 0 7
4. Produce, £301 3 0
Total, £16,053 4 6 1/2
VI.—Rates of Payment for Patients.
The rate of payment for the class of patients referred to in the first division of Head IV., varies from £60 to £300 per annum, according to the arrangements made with the patient's friends; but the usual rate is £60 per aunum. In the intermediate class for females the present rates of payment are £30 and £35 per annum, and those for the pauper class £22 and £25 per annum, according as rights of presentation have or have not been exercised in favour of the patients.
VII.—Medical and other Officers, Attendants, and Establishment, with Salaries, Wages, and Allowances.
1. Medical and other Officers.
Resident physician, £450 0 0; Allowances—£10 per annum, and vegetables and furnished house.
Senior assistant*, £70 0 0
Junior assistant*, £40 0 0
Consulting physician, non-resident, £25 0 0
Matron*, £105 0 0
Chaplain, non-resident, £80 0 0
House superintendent and steward*, £120 0 0
Gardener and assistant, (with board to head-gardener,) £88 18 0
Gate-Keeper, with vegetables, gas, and coals, £31 10 0
Honorarium to visiting committee, £110 0 0
Treasurer and Secretary, £380 0 0
2. Attendants and Servants.
(1.)—Eastern Department for Higher Classes.
Eight male attendants*, with wages varying from .£24 to £35.
Thirteen female servants and attendants*, with wages varying from £8 to £16.
One matron's assistant*, £25.
(2.)—Western Department for Poorer Classes.
Twenty-eight male attendants, with wages varying from £24 to £35.
One steward's assistant, £35.
Twenty-eight female servants and attendants*, with wages varying from £8 to £20.
One matron's assistant*, £40.
* With board and lodging.
VIII.—Total Capital Expenditure on 14th May 1855.
For House and Land†, £64,463 0 0
† Forty acres are feued at £10 an acre, which may be estimated as forming an additional capital expenditure of £11,428, 6s. 8d. A great part of the furniture having been made by the patients, it is impossible to fix any sum as its cost.
The proportion of this expenditure for each patient, on the estimated accommodation for 467, amounts to £138, 0s. 8d.
The Directors are presently engaged in the construction of additional buildings and other works, which will cost at least £15,565—in all, £80,028.
IX.—Condition of the Asylum and Patients when visited by the Commissioners.
The Asylum stands in a beautiful situation on ground sloping to the south, and commanding fine views of the surrounding country.
On the 7th of May 1855, the date of our visit, it contained 273 males and 288 females; a number which, in Dr. Skae's opinion, was greater than the house could properly accommodate.
Dr. Skae cannot, however, limit the number of patients, as he is obliged, according to the agreement referred to on page 59, to receive all patients that are sent in by the parochial boards of the city of Edinburgh, St. Cuthberts, Canongate, North and South Leith, and Duddingston. At the time the agreement was made with these parochial boards, the paupers to be accommodated under its provisions were estimated at a much lower number than they now prove to be.
There are other parishes and many private individuals who also possess rights of presentation, but the reception of patients sent by them is not compulsory on the Institution. The absolute right possessed by the Edinburgh and Leith parishes tends in a double manner to overcrowd the house, for it sometimes happens that where private patients have been refused admission, their relatives get them placed on the poor-roll, and they are then sent in by the parish, which, it is presumed, recovers the payment from the patient or his relatives. Thus, a few days before our visit, a paralytic private patient was brought to the gate, and on being refused admission was sent in next day as a pauper by the inspector of St. Cuthbert's.
The convalescent male ward contains seventy-five patients, but all are not considered curable, as the well-behaved incurable cases are associated with them. From twenty-five to thirty of this number work in the garden, and a few at carpentry and other employments.
For this ward there are six attendants during the day, and eight during the night. The day-rooms are on the ground floor, and are furnished with tables, and with benches with backs. Windows open from them upon the corridors, which run through the centre of the wards, having apartments on each side. These windows are unglazed at the top, and serve partly to light the corridor, partly to ventilate the day-rooms, which are provided with open fireplaces, this part of the house having no artificial heating or ventilating apparatus.
The dormitories of the convalescent patients are immediately above their day-rooms, and are constructed and ventilated on the principles just mentioned Some of them contain twenty-four beds, others seventeen, the space allowed each patient being about 600 cubic feet. Two attendants sleep in each of the dormitories, which contain no furniture except the beds and chamber utensils. The patients dress and undress in the corridors. The mattresses are of sea-grass, and the bed-coverings are sufficient.
There are two day-rooms in the ward for the intermediate class of females. One of them is used as a mess-room for the whole number, and as a sitting-room for the more noisy patients. The other serves as a sitting-room and work-room for those who are convalescent and quiet Both are comfortably furnished, and have open fireplaces. The dormitories are insufficiently ventilated. They have no fireplaces, but are warmed and ventilated by an apparatus which does not appear to work satisfactorily. The heated air enters near the floor, and escapes through an aperture, about a foot square, above the door. No windows in these dormitories or day-rooms open upon the corridors.
The pauper day-rooms are overcrowded, and frequently imperfectly ventilated. There are separate sick-rooms, two to each ward.
The refractory wards are placed in a separate building, one story high. They are not well arranged. Too many seclusion rooms are placed together in double galleries, and the number of patients, especially on the female side, considerably exceeds the proper accommodation. The patients generally sleep in troughbeds with canvas bottoms, and occasionally on mattresses laid on the floor. During the day they are crowded together in small day-rooms, where they become noisy and excited. This is particularly the case with the females, whose condition, on the day of our visit, was most unsatisfactory.
The corridors serve simply as passages. They contain no furniture, and are not used as places of exercise or as day-rooms. The number of large dormitories is too great in proportion to the single rooms to permit of proper classification.
There are four airing-courts of good size, two for each sex. One on each side is attached to the refractory wards, and the others are used as places of exercise for those patients of the other wards who cannot be trusted in the grounds.
The patients are supplied with books and newspapers, but apparently in no great quantity. They have also concerts, dances, lectures, and occasional country excursions. Some of the male patients are occupied in agricultural labour, carpentry, tailoring, &c, and some of the females in the washing-house, and laundry, and in sewing; but there is room for considerable extension in the means of employment, both for males and females.
The paupers appear to be sufficiently clothed and fed. The men are allowed flannel waistcoats and drawers, which are changed once a fortnight, and they have a clean shirt once a week. Canvas dresses, fastened by locks, are occasionally placed on destructive and paralytic patients.
The meals are not neatly served. No table-cloths, or knives and forks, are allowed the pauper patients, who are obliged to take all their food with spoons.
The patients go to bed at half-past seven and rise at six.
Some of the sleeping-rooms here are of fair size, but others are small, and very deficient in ventilation. A few openings made at the lower part of the door form the only means of admitting air during the night; and there are no fireplaces, nor any other opening to assist ventilation. The passages, or corridors, are heated with hot air, and the day-rooms have open fireplaces.
Each patient paying £60 a year has a separate bedroom, and the use of a sitting-room, which is common to ten patients.
There is a good-sized airing-court on each side, laid down in grass, and provided with covered seats. The patients are sufficiently supplied with the means of amusement and recreation, in the shape of books, writing materials, billiard-room, bowling green, &c, but there is a want of the means of more serious occupation.
The Sheriff, accompanied by a medical inspector, visits the house regularly in accordance with the provisions of the statute. In Dr. Skae's evidence further details on its management will be found.
The principal evil under which this Asylum labours is overcrowding, which tends in many ways to make its condition less satisfactory than it would otherwise be. The building, moreover, does not present due facilities for proper classification, and the condition of the Asylum is further injuriously affected by degraded cases of long standing sent from Highland parishes. Mechanical restraint is not used, but in its stead seclusion appears to be much employed.”