Jennifer Wallis, Investigating the Body in the Victorian Asylum. Doctors, Patients, and Practices, (Cham, Switzerland: Palgrave Macmillan, 2017); xvi, 276 pages; 9 b/w illustrations; hardback £20.00; ISBN, 978-3-319-56713-6.
by Louise Hide
Skin, muscle, bone, brain, fluid – Jennifer Wallis has given each its own chapter in this exemplary mesh of medical, psychiatric and social history that spans work carried out in the latter decades of the nineteenth century in Yorkshire’s West Riding Pauper Lunatic Asylum. The body – usually the dead body – is at the centre of the book, playing an active role in the construction of knowledge and the evolution of practices and technologies in the physical space of the pathology lab, as well as in the emerging disciplines of the mental sciences, neurology and pathology. Wallis explores how, in the desperate quest to uncover aetiologies and treatments for mental disorders, there was a growing conviction that ‘the truth of any disease lay deep within the fabric of the body’ (Kindle: 3822). General paralysis of the insane (GPI) is central to the book. A manifestation of tertiary syphilis and a common cause of death in male asylum patients, it was one of the few conditions that produced identifiable lesions in the brain, raising hopes that the post-mortem examination could yield new discoveries around the organic origins of other mental diseases. Investigating the Body in the Victorian Asylum is, therefore, not only about how the body of the asylum patient was framed by changing socio-medical theories and practices, but about how it was productive of them too.
Whilst reading this lucidly written monograph, it soon becomes clear that West Riding was no asylum back-water. Its superintendent, James Crichton-Browne, was determined to forge a reputation in scientific research and West Riding became the first British asylum to appoint its own pathologist in 1872. Wallis has not only marshalled a vast amount of secondary literature, but made a deep and far-reaching foray into the West Riding archives, analysing some 2,000 case records of patients who died there between 1880 and 1900. Drawing on case books, post-mortem reports, administrative records and photographs, Wallis has created a refreshingly original way of conceptualising the asylum patient. Rather than exploring his – as it usually was in ‘cases’ of general paralysis – role within tangled networks of external social agencies and medical practices, she turns her focus to the inner unchartered terrain of unclaimed corpses. She shows how the autopsy provided different ways of ‘seeing’ as the interior of the body was ‘surfaced’ through a range of new and evolving practices and technologies, such as microscopy and clinical photography. Processes for preserving human tissue and conducting post-mortem examinations were enhanced, as were methods for observing and testing tissue samples, and for recording findings. None of these practices was without an ethical dimension, such as a patient’s right to privacy and anonymity.
Doctors, perhaps, gleaned most from the living as they examined and observed patients on admission and in the wards; pathologists could venture into the deep tissues of the body, which were out of bounds for as long as a patient remained alive. Yet the two states could not be separated quite so neatly and Wallis turns her attention to the growing tensions between pathologists and asylum doctors as both scrambled to plant their disciplinary stake in the ground, navigating boundaries between the living and the dead body. How, I wondered, were practices mirrored at the London County Council pathology lab, which opened at Claybury in 1893 and also investigated various forms of tertiary syphilis, including GPI and tabes dorsalis, as well as alcoholism and tuberculosis? Wallis does touch on other laboratories, but it would be interesting to know a little more about how they associated with each other.
One of the many strengths of the book is the way in which Wallis makes connections between social and cultural mores and the impact of wider political and medical developments. Germ theory was, of course, highly influential. Wallis touches on the ‘pollution’ metaphor but might have expanded on the trope of the ‘syphilitic’ individual as a vector of moral depravity in the western context – an unexpected swerve of narrative into the belief systems of the Nuer jars slightly. Otherwise, Wallis provides a fascinating investigation of the social framing of the male body with GPI, explaining how atrophied muscle and degenerating organs might be interpreted as an assault on masculinity in a period of high industrialisation. Soft bones could be equated to a loss of virility and femininity; broken bones forced asylums to ask whether they might be due to the actions of brutal attendants, rough methods of restraint, or of physical degeneration in the patient.
Investigating the Body in the Victorian Asylum provides a meticulously researched and thoroughly readable – for all – social history of an important development in the mental sciences in the nineteenth century, centring it around the evolving practices of post-mortem examinations. I particularly like the way in which Wallis writes herself, her research process and her thinking into the book. Her respectful treatment not only of the asylum patients but of the medical and nursing staff who cared for and treated them is threaded through from beginning to end. One might not expect to be gripped by descriptions of ‘fatty muscles’, ‘boggy brains’ and ‘flabby livers’, but Wallis reveals a fascinating story that is full of originality and tells us as much about nineteenth century medical practice as about the patient himself.
Louise Hide is a Wellcome Trust Fellow in Medical Humanities and based in the Department of History, Classics and Archaeology at Birkbeck, University of London. Her research project is titled ‘Cultures of Harm in Residential Institutions for Long-term Adult Care, Britain 1945-1980s’. Her monograph Gender and Class in English Asylums, 1890-1914 was published in 2014.