Rum, lunacy and the lash

This [around the 1820s] was a critical time for the treatment of mental health in the UK. Public attitudes were changing and there was growing outrage at the abysmal treatment of patients in the nation's mostly private and therefore run-for-profit mental asylums. It was the beginnings of 'moral management' – an approach that was far more progressive than it sounds and that essentially advocated the treatment of patients through therapy rather than restraint and medicine. One of the most notorious cases, which proved to be a turning point for mental health reform in the UK, was that of an American sailor incarcerated at Bethlem.

James Norris was in his early forties when he was admitted to Bethlem in 1800, and soon established a reputation as one of the most violent and dangerous patients in the hospital. In 1804, after stabbing a keeper with a knife and attacking two other men, he was put into solitary confinement. Various methods of restraint were tried, with little success. Thanks to his unusually slim hands and wrists, Norris seemed able to slip out of his manacles and used them as weapons to attack his keepers. The contraption that the resident apothecary John Haslam and his cohorts eventually devised to restrain him, and in which he was imprisoned for over 10 years, is the stuff of horror films:

'… a stout ring was riveted around his neck, from which a short chain passed to a ring made to slide upwards or downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar about two inches wide was riveted; on each side of the bar was a vertical projection, which being fashioned to and enclosing each of his arms, pinioned them close to his sides. This waist bar was secured by two similar bars which, passing over his shoulders, were riveted to the waist bar both before and behind. The iron ring around his neck was connected to the bar on his shoulders, by a double link. From each of these bars another short chain passed to the ring on the upright iron bar…'

It was in this hellish device that prison reformer Edward (Lord) Wakefield found Norris when he visited Bethlem in 1814. Appalled by this and the sight of other semi-naked men and women chained to the walls as if they were 'vermin', Wakefield commissioned an artist to make a drawing of Norris, which was turned into an engraving. It was an act of propaganda genius. The image of the unfortunate American sailor, 'confined in Irons in a manner repugnant to humanity', was published in several newspapers and widely distributed as a print. It led to a national outcry and prompted a Parliamentary Select Committee inquiry that ultimately ended the use of chains in the UK and elsewhere. The outrage Norris's case aroused is also credited with leading to the Madhouses Act of 1828, which attempted to regulate the treatment of mental patients in private hospitals.

The Admiralty must have been aware of this changing climate of opinion when it inspected its own facilities in 1812, and then transferred its mental patients to [Royal Hospital] Haslar [in Gosport] in 1818. No doubt spurred by the hammering the reputation of Bethlem was receiving at the hands of Wakefield and others, it ordered an inspection of its new premises in 1824, this time by one Dr Burnett. The report is a fascinating snapshot of a society in the process of change; of progressive Enlightenment thinking clashing with the outdated attitudes of the previous generation. It also explains the sudden increase in reports of mental cases to the Admiralty from 1824 onwards, which was unrelated to any increase in 'Naval Maniaks'.

For, while Dr Burnett admired the buildings and the grounds, he reprimanded its superintendent Dr Dods for not doing more for the patients. The doctor had, he said, a 'misunderstanding as to the difference between a place of confinement for Lunatics simply, and one in which measures were to be taken for their cure also' – a comment that goes to the heart of the new versus old-guard approaches to mental health.

Dr Burnett castigated Dr Dods for relying on outmoded cures (namely setons and tonics), for not attending post-mortems, and for not keeping a journal with details of his patients' symptoms and medical treatment.

'The treatment of Lunatics is of a nature to require more attention and patient investigation, than any class of disease to which mankind are liable,' he wrote. 'Of equal variety are the hallucinations of the Maniac, and it is of great importance that the Medical Attendant should be well acquainted with them, for by this means only will he be enabled to direct with effect the moral management of his patient…'

He recommended that 'a minute account of every symptom or hallucination' of new cases should be entered in the Medical Register, along with 'every circumstance which preceded or accompanied the disease previous to his admission', and that a copy of these reports should be sent to the Victualling Board within a fortnight.

The sudden increase in reports from 1824 onwards suggests Dr Dods complied with the second request, although of his journal there is no sign. Instead, the first page of the journal at the National Archives contained this sombre note:

'Thursday, 11th November, 1830, Charles Dods, Esquire, Senior Surgeon of the Royal Naval Hospital, Haslar, and Superintendent of the Lunatic Asylum, died suddenly; in consequence of which the temporary Charge of that Institution devolved upon James Scott, MD, Lecturer, Curator of the Museum, and Librarian. A List of the Patients, then in the Asylum, is subjoined.' 

The doctor is dead, long live the doctor! No sooner had Dr Dods had died, in unexplained circumstances, than his successor Dr Scott took over, and his very first action was to start a journal. Significantly, he backdated each entry to 1818, with a pointed comment that previous volumes are 'nowhere to be found'. His entries included detailed descriptions of each patient's symptoms and, where available, their past histories, and there were columns for both their 'medical treatment' and their 'moral treatment'. Not only that, but there were gruesome descriptions of post-mortems, or sectio cadaveris, including examinations of the patients' brains and innards. As an ardent phrenologist, Dr Scott was interested in how the different parts of the brain related to the patient's illness, and, while his conclusions might now be regarded as simplistic, this work did at least herald the start of a more scientific approach to mental illness. The modern age of rational neuroscience was on its way.

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Haslar was closed down in 2009 and the site offered for redevelopment as a retail, residential and business centre. Before that happened, however, a group of archaeologists was allowed in to excavate some of the graves in the Paddock. Some 8,000 or so bodies were buried here between 1753 and 1826, including many of the 1,690 British casualties from the Battle of Trafalgar, as well as those mentally ill patients transferred from Hoxton House who died while in Charles Dods's care. The bodies that were exhumed between 2009 and 2013 appeared to be mostly male, heavily built, with the strong upper bodies that would come from years of pulling ropes. Their injuries ranged from sword wounds to missing legs and teeth, and among them was someone with a crushed skull and broken jaw consistent with falling from a great height, such as ship's rigging, and landing face first on a hard object, such as a deck.

The findings confirmed what was already apparent: life in Nelson's navy was brutal and unforgiving. But they also suggested that it wasn't completely without heart. The archaeologists studying the remains of that unfortunate sailor who smashed his skull falling from the rigging concluded that he must have been kept alive for about three months, probably being fed through a straw, before dying from an infection. That such care was forthcoming at Haslar suggests a degree of compassion for one's fellow man that was clearly missing at Hoxton House. It would, however, take another 100 years for the mental health revolution to be fully sanctioned by the Royal Navy.

• Read more in Off the Deep End: A History of Madness at Sea by Nic Compton.