Case books and the patient experience

It’s been a little tricky fitting in archive visits around part-time work and a toddler, so I’ve been delighted to find the Wellcome Collection have digitised some of the patient case books from Holloway Sanatorium, an asylum for middle-class men and women which opened in 1885. The asylum was housed in opulent buildings near Virginia Water in Surrey, and from the outset was equipped with the opportunities for recreation and entertainment that one might expect from its clientele. As most of the patients were unused to employment, recreational activities were all the more important in keeping them occupied and providing structure and discipline on a day-to-day basis. Concerts, choirs and bands were part of this, and the sanatorium employed ‘companions’ especially to help patients become engaged with a wide variety of activities.

Patient case books provide a rare opportunity for insight into the lives of individuals, their particular mental states and their responses to treatments and therapies. Each entry in the Holloway case books contains details of the patient’s background, age, marital state and occupation, together with a brief history of previous illnesses. There follows the two letters explaining the current complaint and reasons for certification. Finally, the asylum’s medical staff added a paragraph giving observations on arrival at the sanatorium. Following this, the pages were updated with relevant changes or, every couple of months, to note a lack of change. Case book A gives information on females certified between 1885 and 1887; reasons for illness include domestic trouble, inherited mental disorder and disappointment in love. One patient was convinced she was a steam engine. Women of all ages were represented, married women generally without occupation, but among the unmarried women were governesses and teachers.

The very first woman listed in the case book happened to be musical. Stella James was admitted in a state of Dementia, and took little part in activities. However, after a few months she began to sing and play the piano. Music was a sign of normality, engagement with others and mental functioning, but also became a subversive act for Stella: later on she is recorded as dancing and singing all night, her liveliness becoming ‘objectionable’. I find it interesting that music straddles the two sides in this way, reflecting both normality (for most women of this class would have learnt the piano) and disturbance. But this reflects in some ways the dual place of music throughout society. As an art form it could be refined, reflected in fashionable soirees or intellectual orchestral concerts; music was encouraged by philanthropists as a means of ‘rational recreation’ for the working classes. At the same time, music’s image suffered because of the link to the morally degrading activities of the music hall and tavern. Returning to health, music could both cause and cure madness. This dichotomy is one of the reasons music’s place in asylums is particularly interesting.

Link to Wellcome Collection digitised case books: