Late 19th-century connections between Irish psychological medicine and the West Riding Asylum,Wakefield,England

Abstract

This paper traces the career trajectories of four Irish doctors – Edward Mazière Courtenay, Oscar Woods, Edward Levinge, and James Wallis – all of whom gained early clinical experience in psychological medicine whilst working at the West Riding Asylum in Wakefield, England, during the 1870s, the era during which this county asylum for paupers aspired to be a “research school” for the study of insanity. An attempt is made to examine whether, as a result of their experiences at Wakefield, these clinicians introduced research practices or any of the innovations of the West Riding Asylum, such as a dedicated pathological laboratory, into the Irish public system of district asylums. The evidence indicates that no such developments occurred in Ireland, despite two of the four clinicians, Courtenay and Woods, achieving positions of considerable authority within the profession on their return to Ireland. Possible reasons for this absence of research in Irish asylums during the latter part of the 19th century are explored.

Keywords

Ireland asylum insanity Wakefield Courtenay Woods research

Introduction

The public system of asylums in Ireland was established by an Act of 1817 (57 Geo III, c.106) and its 1821 amendment (1&2 Geo. IV, c.33). This legislation, which provided district asylums for the Irish poor, predated the public system in England and Wales: although a discretionary enabling Act (48 Geo. 3. c.96) for the erection of county asylums had been passed in 1808 (Wynn’s Act), it was not until 1845 (8&9 Vict. c.126) that compulsory legislation was passed (Finnane, 1981; Scull, 1979).

Ireland’s district asylums were built in roughly three phases: nine up to 1835 (Armagh, Ballinasloe [Connaught], Belfast, Carlow, Clonmel, Derry, Limerick, Maryborough [Portlaoise], Waterford) followed by others in the 1850s (Killarney, Kilkenny, Omagh, Mullingar, Sligo) and 1860s (Castlebar, Downpatrick, Ennis, Enniscorthy, Letterkenny, Monaghan). Pre-existing asylums at Dublin (Richmond) and Cork joined the district system in 1830 and 1845 respectively. Like their counterparts in England and Wales, these 22 Irish asylums experienced an inexorable increase in patient numbers over the latter part of the 19th century, whether or not consequent on a true increase in the incidence of insanity in Ireland (Anonyms, 1903: 107; Tuke, 1894).

Yet despite this inflation, treatment options and therapeutic success remained essentially stagnant (stagflation, then, perhaps?). As practiced in the last quarter of the 19th century, both in the district asylums of Ireland and in the county asylums of England and Wales, asylum medicine presented a relatively homogeneous picture of incarceration and custodial care. Research into the causes of insanity was largely non-existent. For example, an inquiry by Burdett (1891: 261) found that “To the mass of literature dealing with insanity in every aspect which has enriched the English physician’s library during the last forty years, Ireland has contributed, it may be said, nothing”. This state of affairs had arisen despite recurrent official statements voicing aspirations to advance and improve medical science in Irish asylums, such as the General Rules for the Government of All the District Asylums of Ireland, Made, Framed and Established by the Lord Lieutenant and Council of Ireland of 1843 and the Commission of Inquiry on the State of Lunatic Asylums in Ireland of 1858.

Despite the countrywide provision of public asylums, educational opportunities in psychological medicine were lacking in Ireland before the 1870s. Although medically qualified rather than lay asylum superintendents had become the norm by the 1860s, the possession of a medical degree did not equate to specialist training (Malcolm, 2003: 302). By 1875, only four Irish asylums had an Assistant Medical Officer (AMO), the key training post leading to appointment as the Medical Superintendent of an asylum (Finnane, 1991: 308). More than 10 years later, the number had risen only to nine (Woods, 1887–1888: 379).

Opportunities for training in psychological medicine were little better elsewhere in Great Britain. A possible exception was Edinburgh, where Thomas Laycock (1812–1876) had initiated (optional) instruction for medical students in medical psychology and mental diseases from the 1860s. These courses prompted a number of men [sic] to take an interest in the workings of the brain and the possibility of a career devoted to psychological medicine (James, 1996: 360–376), although Laycock’s own judgment of his classes was that “the attendance is . . . very small compared with the number of students” (Laycock, 1867–1868: 587).

One of Laycock’s students was James Crichton-Browne (1840–1938). In 1866, aged 25, he was appointed Superintendent of the West Riding Asylum at Wakefield (WRA) in West Yorkshire, an institution founded in 1818 under the auspices of Wynn’s Act. This initiated a brief but highly productive period at WRA during which Crichton-Browne sought to understand insanity as a disease of the brain and hence potentially amenable to medical treatment, following (at least nominally) Laycock’s suggested approach. Crichton-Browne thus established at WRA what has been characterised by posterity as a “research school” (Finn, 2012).

Crichton-Browne persuaded the local Committee of Visitors, the ultimate controllers of WRA finances on behalf of the local ratepayers, to fund various initiatives which brought about changes in both infrastructure and faculty. The former comprised not only the opening of a dining hall and new wards but also, in the early 1870s, a dedicated pathological laboratory and photographic studio. The latter comprised the employment of more junior staff, both a Pathologist and unpaid Clinical Clerks or Clinical Assistants, to contribute to clinical care and also to undertake research projects suggested by and under the supervision of Crichton-Browne. These research projects involved data collection by both personal observation and collation of information contained in the asylum case books and post-mortem books. In the classification suggested by Viets (1938: 483–487), papers reporting original research from WRA encompassed clinical, therapeutic (physical and pharmacological), and pathological observations as well as both animal and human experimental studies, indicating the broad sweep of investigations pursued (Larner, 2026: 194–224).

The research findings from WRA were disseminated both locally and globally. Annually between 1871 and 1875 a medical conversazione was held in the autumn at WRA, principally for practitioners from West Yorkshire, at which lectures, clinical demonstrations, and exhibitions of the work undertaken at WRA were given, along with food and musical entertainment in keeping with the ethos of a conversazione (Larner, 2025). Global dissemination of the research undertaken at WRA was through the publication of an annual journal, the West Riding Lunatic Asylum Medical Reports (WRLAMR) between 1871 and 1876 (Larner, 2023; Viets, 1938). Although nominally a house journal, WRLAMR was widely reviewed, not only nationally but also internationally, suggesting that it was both topical and of broad currency, perhaps in part because the later issues (1873–1876) contained papers by David Ferrier (1843–1928) and John Hughlings Jackson (1835–1911), two of the leading figures in the emergence of the brain sciences during the 19th century, and also both at different times students of Laycock.

The material in WRLAMR may have had an impact on practice in Ireland. Reviews of the journal were included in the pages of the Dublin Quarterly Journal of Medical Science (1871) and, as of the name change in 1872, the Dublin Journal of Medical Science (1873, 1875, 1876). Furthermore, individual papers appearing in WRLAMR were also noted and commented upon, including the seminal physiological work undertaken at WRA by Ferrier (1873) on the cortical localisation of motor centres (Anonyms, 1873a), as well as the observations on the clinical phenomena of epilepsy and their implications for brain function reported by Hughlings Jackson. The most assiduous author citing and reviewing papers from WRA in the Dublin Journal of Medical Science was Ringrose Atkins (1851–1898), AMO at Cork Asylum (Atkins, 1875a: 497; 1875b: 324; 1876: 426–428, 429–431, 436–439, 441; 1877: 44, 46, 52), but there were others (Smith, 1874: 145–146; Swanzy, 1877: 27, 28).

Hence, what was distinctive about Crichton-Browne’s WRA in the 1870s was the plenitude of opportunities for career development: novel clinical appointments with access not only to clinical cases but also to research studies with the possibility of presentation at local meetings and through journal publication. This combination of factors was unique in 1870s asylum medicine, in comparison to the usual solitary life of the asylum AMO, physically and intellectually isolated, poorly paid, unable to marry, and with restricted opportunities for career advancement, as acknowledged at the time (Dodds et al., 1890; Laycock, 1867–1868). Unsurprisingly then, numerous young clinicians aspiring to a career in psychological medicine and keen for the chance of clinical experience in the field were attracted to the possibilities of working at WRA. Of the 39 junior clinicians identified as employed at WRA as AMO, Clinical Clerk or Clinical Assistant during the period of Crichton-Browne’s Superintendency (1866–1876), many came from Scotland, particularly Edinburgh and Aberdeen, and some from London. Four originated from and/or had part of their initial clinical education in Ireland (Larner, 2026).

The primary aim of this paper is to trace the career trajectory of each of these four Irish clinicians before, during and after their time at WRA, and to assess, where possible, what effect, if any, their time at WRA had on their future careers. Emphasis is particularly focused on the two individuals who achieved positions of considerable authority within the profession on their return to Ireland and to examine whether they introduced any of Crichton-Browne’s innovations at WRA or the ethos of a research school into the Irish system of asylums. This aspect of the careers of these doctors has not been examined in standard histories of Irish psychiatry (e.g. Brennan, 2014; Kelly, 2016; Robins, 1986), nor does any one of them appear in the Dictionary of Irish Biography. The paucity of recognition of these clinicians justifies the current re-examination of their contributions in the hope of adding to the historiography of Irish asylum medicine in the latter 19th century. The secondary aim of the paper is to address the question of why Ireland, with its large asylum population (effectively a captive audience) potentially available for the purposes of clinical investigation, failed to become a centre for research into the causes and treatment of insanity.

Clinicians from Ireland attending WRA in the 1870s

Edward Mazière Courtenay (1845–1912)

Edward Mazière Courtenay’s role in the development of Irish psychological medicine has attracted some attention (Cox and Marland, 2022: 230n108, 239 and n156; Finnane, 1979: 116–117, 397; 1981: 69–73; Prior, 2012; Robins, 1986: 104) but with only passing reference to his time at WRA (Finnane, 1979: 397).

The son of the Rector of Glenarm and a nephew of the Lord Chancellor of Ireland, Sir Mazière Brady, Bart (Anonyms, 1913a), Courtenay, studied medicine at Trinity College Dublin where he was top of his class (AB TCD MB MCh 1871). Deciding on a career in asylum medicine, he was appointed Clinical Assistant at WRA in January 1872. He stayed at Wakefield for around 6 months, since in July 1872 he was appointed AMO at the Derby County Asylum: the notification of this appointment in the Journal of Mental Science gave his name as “Courtenay, E. Maguire [sic]”.

The Derby affiliation was noted in Courtenay’s solitary publication in WRLAMR, entitled “The use of opium in the treatment of melancholia” (Courtenay, 1872). This study reported on 91 melancholic patients, of whom 49 were treated with opium in the 15 months between 1st January 1871 and 25th March 1872. Hence, most of these patients predated Courtenay’s arrival at WRA; his information would have been extracted from the WRA case books maintained by his predecessors. Courtenay’s conclusion was that opium in small doses (“Fifteen minims of the Tincture combined with an equal amount of Sulphuric Ether”) acted as a tonic by inducing hyperaemia to counteract the anaemic state of the brain which was believed to occur in melancholia (Courtenay, 1872: 259). In a review of this issue of WRLAMR in the Dublin Journal of Medical Science, Courtenay’s paper was adjudged as amongst “several other valuable papers in this volume” and it was stated that “we may say that some of our Dublin physicians can bear a similar testimony to the value of this treatment” (Anonyms, 1873b: 429). During his time in Wakefield, Courtenay also acted as a subject for experiments pursued by a colleague, Wilkie Burman, using injections of conia (Anonyms, 1873b: 425–426; Burman, 1872: 16).

In 1872 Courtenay was elected to the membership of the Medico-Psychological Association of Great Britain and Ireland (MPA); the notification of this appointment in the Journal of Mental Science gave his name as “E. Maguire Courtney” (possibly the origin for the use of “Courtney”, rather than “Courtenay”, by Cox and Marland, 2022: 230n108, 239 and n156). He was also invited to attend the medical conversazione held at WRA in October 1872.

After Derby, Courtenay returned to Ireland, where he was appointed Medical Superintendent of the District Asylum at Limerick in June 1873. Here he “brought this antiquated institution [opened 1827] into line with modern requirements” by means including the building of dining halls, observation dormitories for epileptic and suicidal cases, and the first asylum bakery and slaughter-house in Ireland (Anonyms, 1913b). A vignette of Courtenay’s clinical approach at Limerick was vouchsafed many years later by Dr. M.J. Nolan, Resident Medical Superintendent at Downpatrick, who had first “seen the insane treated” at Limerick Asylum:

Dr. Courtenay spent his whole morning walking about the wards interviewing patients and ascertaining everything he could in connection with them. Next morning he went back to them, speaking to them in the manner which he found helpful in each case (Finnane, 1979: 329; 1981: 191).

However, as for all asylum superintendents, it was administrative rather than clinical issues which occupied much of Courtenay’s time. Elected to the MPA Council in 1875, Courtenay subsequently became Secretary and Treasurer of the Irish branch when this was established (Anonyms, 1876–1877a: 165; Finnane, 1981: 69). At a quarterly meeting of the MPA in Dublin in November 1885 he presented on “The diet tables of English asylums” which later formed part of his publication on Irish asylum dietary as compared with some “similar institutions in England”, amongst which WRA was not included (Courtenay, 1886–1887; Finnane, 1979: 72n144; 1981: 53).

Despite his exposure to research practice in psychological medicine during his time at WRA, only a single clinical publication has been identified from Courtenay’s years at Limerick, a case report unrelated to brain pathology (Courtenay, 1888–1889). He had previously noted in one of his annual reports from Limerick in the early 1880s the difficulty of obtaining consent for post-mortems at the asylum. That he had some understanding of current ideas on cortical localisation may be suggested by his comments on “A Case of Chorea with Insanity” which was presented at an Irish MPA meeting in May 1888: that “more cases of a similar nature did not oftener occur in asylum practice always appeared to him to be a matter of wonder, considering how very close the connection was between the motor and intellectual area of the brain”.

Courtenay retired as MPA Secretary for Ireland in 1888. He was subsequently appointed in 1890 as one of the Inspectors of Lunatics and a Member of the Board of Control of Asylums in Ireland, based in Dublin Castle (Anonyms, 1890). This appointment, along with that of George Plunkett O’Farrell (1845–1911; Anonyms, 1911), with whom Courtenay worked in tandem for many years, was generally welcomed (Anonyms, 1890). They were both made Honorary MPA members in 1891 and authored a single joint publication (O’Farrell and Courtenay, 1892). They visited asylums together and their reports were much exercised by the overcrowding, lack of amenities for patients, and necessity for expansion of the existing asylum system. Their work led in 1891 to the effective abolition of visiting physician posts at asylums though natural wastage, leaving the Medical Superintendent in sole medical charge (Finnane, 1979: 399). They also presented a special report on the “alleged increasing prevalence of insanity” to the chief secretary of Ireland in 1894, suggesting that both an increase in insanity and in the demand for care were contributing to the ongoing problem of overcrowding (Prior, 2012).

The posthumous claim that Courtenay “did the work of his life” (Anonyms, 1913a) in his role as Inspector of Lunatics has been challenged. Finnane considered the Inspectorate to have displayed “little imagination . . .in administration or policy” and to have been narrow and inflexible, hostile to reforms such as auxiliary asylums for chronic and incurable cases and also to boarding out of patients (Finnane, 1981: 63, 71, 72). Certainly, there never seems to have been any expectation during Courtenay’s long Inspectorate, lasting until 1910, that Irish asylums should be sites of research inquiry into the causes or treatments of insanity, as per the model initiated by Crichton-Browne and experienced by Courtenay during his training at WRA.

Oscar Thomas Woods (ca.1848–1906)

Oscar Thomas Woods “began his studies in insanity, like so many men of his time, at the West Riding Asylum, Wakefield” (Anonyms, 1906). A Dublin graduate, it was reported in the Medical Press and Circular in October 1872 that Woods, late Clinical Clerk at WRA, was appointed AMO to the Warwick County Asylum. At WRA, he had been present at the conversazione of 15th October 1872, presiding over “Stall C” upon which were arranged a “large number of scientific and surgical instruments belonging to the Asylum, together with others” loaned from elsewhere (Anonyms, 1872). He was elected to membership of the MPA in 1873. He did not publish in WRLAMR but reported a case of tuberculous meningitis from his post in Warwick (Woods, 1874, 1874–1875).

Woods was appointed Medical Superintendent of the Killarney District Asylum in 1875. His annual reports showed the typical preoccupations of an asylum superintendent, for example:

Dr. Woods reports that only three escapes occurred, and evidently unwittingly strongly supports the system by which airing courts and boundary walls are abolished, for he says – “I am somewhat surprised that more escapes did not take place, as owing to the loss of our airing courts, the patients have been obliged to take exercise on the walk round the farm, quite close to the boundary wall, which is by no means high”.

The same year saw an outbreak of typhus, “causing the death of one patient and the gardener”.

Woods was active in the affairs of the MPA. He registered his opposition to the Dangerous Lunatics Act of 1838, which “set the tone for asylum care in nineteenth-century Ireland” (Kelly, 2016: 50), because it tended to criminalise what Woods considered to be acts of providence (Finnane, 1981: 102). He noted the great difficulty of keeping the asylum case books, emphasised the absolute necessity that an AMO should be appointed to every asylum, and objected to appointment of asylum staff by governors rather than by the medical superintendent (Woods, 1887–1888). In the clinical sphere, he more than once adverted to the relative immunity of Ireland from general paralysis of the insane, noting only two deaths from this cause in 11 years at Killarney Asylum. In August 1887 he was Vice-President of the Section of Psychology at the Annual Meeting of the British Medical Association held in Dublin, and a read paper on folie à deux in several members of a family (hence, folie à plusiers) which was later published, apparently his only clinical publication from his years at Killarney (Woods, 1888–1889).

In 1890 Woods moved to the superintendency of Cork Asylum. A highly critical report by the new Inspectors in 1891 absolved Woods of any blame or responsibility for the state of affairs but it was acknowledged that “Woods has a very onerous and troublesome task before him before he succeeds in reorganizing this asylum and removing the many admitted structural and administrative defects”. At Cork, Woods again noted the low numbers of patients with general paralysis of the insane, and likewise with epilepsy, but his only publication related to the criminal responsibility of the insane (Woods, 1894). He became divisional MPA Secretary for Ireland in 1895 and President of the MPA in 1901, thus following in the footsteps of Crichton-Browne (MPA President 1878). Woods’ presidential address was delivered at Queen’s College, Cork, in July 1901 (Woods, 1901).

Woods died aged 58, an obituary recording that his written contributions were “less numerous than they would have been could he have commanded more leisure and more detachment of mind” (Anonyms, 1906).

Edward George Levinge (1852–1929)

Edward George Levinge qualified in Dublin in 1871. He was Clinical Assistant at WRA in the first part of 1873, noted as an unpublished correspondent to the Lancet from Wakefield in September of that year. In the same month he was appointed AMO to the Borough Lunatic Asylum, Newcastle-upon-Tyne. During his time at WRA he neither published in WRLAMR nor attended a conversazione. He was elected to membership of the MPA in 1874.

Levinge then moved to a Junior AMO post at the Hants [Hampshire] County Lunatic Asylum, resigning the following year. The authors of a case report from this asylum published in 1877 stated that they were “indebted to Edward G. Levinge, M.B., late Assistant Medical Officer, Hants County Asylum” (Anonyms, 1877: 164). By 1877 Levinge was Assistant Medical Superintendent to the Bristol Asylum during which time he published a case (Levinge, 1878) in which the pathological details were provided by “My friend, Dr. Bevan Lewis, of the West Riding Asylum”, the noted neuropathologist and later WRA Superintendent William Bevan-Lewis (1847–1929). Levinge later resigned his post in Bristol.

He may then have returned to Ireland since in 1883 obligations were expressed to “Dr. E.G. Levinge, of Lucan, for kindly affording me valuable information” on the subject of Graves’ disease in lunatics (Fitzgerald, 1883: 300, footnote a). Some years later Levinge was appointed Medical Superintendent to the Sunnyside Mental Hospital, Christchurch, New Zealand, the first mental asylum to be opened in that city. He apparently remained in New Zealand until his death in 1929.

John Augustus Michael Wallis (?1844 or ?1846–1897)

John Augustus Michael Wallis was, according to some sources, born in Waterford, to others in Cornwall, his family only later moving to the south of Ireland (Anonyms, 1898; Mellett, 1981: 250). He studied medicine in Dublin and subsequently gained his medical qualification and later his MD from Aberdeen. He was AMO at the Durham County Asylum from 1867. After some years there, he travelled on the Continent and in the United States before his appointment as AMO at WRA in 1874.

Wallis “superintended” one of the tables at the WRA conversazione of 1874, “An excellent table of photographs, illustrative of cases at present or formerly in the Asylum” (Anonyms, 1874). He also contributed a single paper to WRLAMR, “On the therapeutic value of chloral hydrate in epileptic convulsions” (Wallis, 1875). Chloral hydrate, a compound related to chloroform, was a drug of interest to Crichton-Browne (Crichton Browne, 1871, 1875). In Wallis’s case series, including patients from both WRA and Durham, he noted that “in the great majority of instances a marked and almost immediate effect was produced by the administration of a full dose of the drug” (Wallis, 1875: 268). Of note, he adopted Hughlings Jackson’s definition of epilepsy “as being a sudden, occasional, excessive, and rapid discharge of grey matter of some part of the brain” (Wallis, 1875: 269).

In the review of this issue of WRLAMR in the Dublin Journal of Medical Science, written by Ringrose Atkins, Wallis’s paper was noticed (Atkins, 1876: 438–439), as also, somewhat unfavourably, in the Journal of Mental Science: “Dr. Wallis tries to make out a case for the use of chloral in epileptic convulsions. We fear he does not succeed. He says drachm doses are ‘quite safe.’ We predict that he will change his opinion if he gives many such doses” (Anonyms, 1876–1877b: 463). Despite these reservations, Wallis was elected to the MPA in 1876.

Wallis’s affiliation in his WRLAMR paper was given as “Medical Superintendent, Hull Borough Asylum. Late Assistant Medical Officer, West Riding Asylum”. At Hull, where he was appointed in 1875, Wallis “was a good superintendent but not personally concerned about the patients. He asked for an increase in salary when he married; it was refused” (Bickford, 1981: 51). He left Hull in 1878, becoming superintendent at the Lancashire County Lunatic Asylum at Whittingham, a post he held for 15 years. He may have retained some interest in epilepsy, reading a paper on “Bleeding in epilepsy” as a system of treatment to the MPA quarterly meeting in Carlisle in April 1886. However, only a single publication was forthcoming during these years (Wallis, 1894), related to asylum planning. Wallis eventually became a Commissioner in Lunacy (Mellett, 1981: 250).

Wallis suffered from heart disease and died suddenly at the end of 1897. His obituary in the Journal of Mental Science described him as “not a voluminous writer” (Anonyms, 1898: 452).

Discussion

These four Irish alumni of the West Riding Asylum at Wakefield – Courtenay, Woods, Levinge, and Wallis – worked there during the 1870s, its heyday as a “research school” under the leadership of James Crichton-Browne. All achieved the ultimate goal of asylum superintendency, two in Ireland, and one became a national Inspector of Lunatics. However, not one of them subsequently pursued a research agenda in any way comparable to that followed by Crichton-Browne at WRA. What reasons might be advanced to explain this disconnect?

It is of course possible that, as junior doctors, they may have undertaken steps to further their careers without any necessary commitment to the methods of their teachers. None may have aspired to a research career, or shared Crichton-Browne’s research ethos, although desirous of attending an institution perceived to be in the ascendant, and willing enough to conform to the strictures required for career advancement, such as collecting, producing, analysing, and disseminating clinical data under Crichton-Browne’s guidance. Little is known of their awareness of the work of leading brain scientists such as Ferrier and Hughlings Jackson: Levinge was the only one whose time at WRA (1873) might have overlapped with Ferrier’s attendance there in the Spring of 1873 and on 25th November 1873 (no evidence that Hughlings Jackson ever attended WRA has been found; Larner, 2026). Wallis quoted Hughlings Jackson’s definition of epilepsy, but little evidence has been found of any individual or collective awareness of the doctrine of localisation, other than the later verbal comments made by Courtenay in May 1888.

Laying aside personal proclivities or predispositions, what other factors might have inhibited the development of a Crichton-Browne-type research school in Irish asylums? Whilst appeal to the value of medical science might be made to justify the superintendency of asylums by medical graduates rather than moral governors, this was not matched by evidence of research in asylums, despite the apparent encouragement of “medical science” enshrined in official documents. If any Irish asylum medical superintendent had experienced the same realisation as Crichton-Browne at WRA, that “the mass of interesting material which is as it were going to waste . . . in this huge hospital for want of accurate observation & which might be of immense value” (letter to Charles Darwin, 1st June 1869: Darwin Correspondence Project, “Letter no. 6769”), none was able to put into operation the kind of research school which Crichton-Browne fashioned at WRA.

In the Irish context, Courtenay and Woods as Superintendents of asylums (at Limerick, and at Killarney and Cork, respectively) and Courtenay as Inspector of Lunatics in Ireland, were best placed to initiate or inaugurate change. However, at this time it was the case that “Irish Superintendents were required to perform so many and such various duties that little time was left to them for the cultivation of the scientific branches of psychology” (Anonyms, 1876–1877a: 164). As well as the lack of time and opportunity, one might also adduce other reasons for lack of research: poor record keeping, in part related to lack of junior staff; lack of post-mortems (indeed apparently discouraged by the Inspectors); and the unrelenting administrative burdens of superintendency.

Hence, any expectation that the experience of Courtenay, Woods, Levinge, and Wallis at WRA might have subsequently effected a dramatic reorientation of Irish asylums towards scientific research into insanity was not realised. Whilst this might therefore be deemed a negative connection, some conclusions may nevertheless be drawn, for example that exposure to new thinking and techniques did not necessarily result in similar outcomes, because those thus exposed were either unable and/or unwilling to pursue these goals. Furthermore, the findings emphasise the magnitude of Crichton-Browne’s achievement in establishing a “research school” in an isolated county asylum during his Superintendency at WRA between 1866 and 1876. Similar changes elsewhere took longer: it was not until 1887 that the Scottish Asylums Laboratory was opened through the efforts of Thomas Clouston (James, 1996: 370), and not until 1897 that the pathological laboratory at Claybury Asylum, the fifth Middlesex County Asylum serving London, was opened under Frederick Mott. Thus, WRA was a uniquely attractive destination within the professional networks of asylum medicine extending across the Irish Sea in the late 1860s and early 1870s, not only for research opportunities but also for the purposes of credentialing, reputation-building and subsequent access to desirable asylum appointments (many WRA AMOs, aside from the Irish contingent, were subsequently asylum superintendents; Larner, 2026: 163).

The one asylum physician in Ireland evidently pursuing research into insanity during these years, as well as writing review articles, was Ringrose Atkins. This was noted both contemporaneously (“although young, has already gained for himself a wide reputation in medical science”; Anonyms, 1878: 208) and later (“Literally nothing has been done in the great field of pathology, saving by Dr. Ringrose Atkins, of the Waterford Asylum, who has published a few excellent papers, though working under the disadvantages of a small institution, situated far from any medical centre”; Burdett, 1891: 261). In fact, contra Burdett, Atkins’ studies were principally pursued whilst AMO at Cork (e.g. Atkins, 1875a, 1877, 1878a, 1878b) and his publication output declined noticeably after his appointment as Superintendent at Waterford in 1878. From his publications, it is evident that Atkins was both aware of and influenced by the activities at WRA and adopted the “doctrine of localisation” promulgated by Hughlings Jackson and Ferrier (Larner and O’Caoimh, 2025). Indeed, Levinge’s solitary publication was offered as “a sequel to . . . the interesting series of pathological illustrations reported by Dr. Ringrose Atkins” (Levinge, 1878: 52, referring to Atkins, 1878a).

Atkins’ formulation of, and suggested solution to, the problem of research in Irish asylums was articulated at a meeting of the MPA in November 1888, as reported in the Journal of Mental Science (1888–1889;34:629):

the fons et origo of the comparative absence of scientific work in Ireland was the absence of organization. He suggested that the medical officers of asylums should endeavour to arrange to meet together in a friendly way, examine each other’s work, and compare notes. Dr. Atkins also suggested that each member should take up some particular topic and endeavour to work it out, the results to be published subsequently in a form like the West Riding Reports [sic]. An increased number of assistant medical officers would be needed if any really good medical work was to be done.

The impracticality of these suggestions renders the failure to import the Crichton-Browne “research school” asylum model to Ireland entirely unsurprising. Indeed, that model could not even be maintained at WRA following Crichton-Browne’s departure in 1876: the conversazione of 1875 proved to be the last, and WRLAMR folded after the sixth volume, dated 1876 but not issued until 1877, under the joint editorship of Crichton-Browne and his successor as WRA Medical Superintendent, Herbert Major. The WRA pathological laboratory did continue and some neuropathological work was published by Major, Bevan-Lewis, and others in the late 19th century (William Dudley, Frederick St John Bullen, Edwin Goodall, William Lloyd Andriezen, Wakelin Barratt). But Ireland was still lacking any asylum-based pathological laboratory for further research in 1903, as the call for one was amongst the resolutions emerging from the Conference of the Irish Asylums Committees in that year (Kelly, 2016: 130). In Ireland, as in England, administering the efficient running of the asylum, not research, was still seen as the core business of the asylum doctor.

Footnotes

ORCID iD

Andrew J. Larner

Ethical considerations

There are no human participants in this article and informed consent is not required.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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