The Most Cruel and Revolting Crimes

Abstract

In 1860 the appalling conditions that patients at the lunatic asylum in Kingston, Jamaica, endured came under public scrutiny. The most notorious of the “most cruel and revolting crimes” which were exposed was the practice of tanking – forcibly holding patients under water. Following the death of a patient, the matron and two nurses at the asylum were charged with manslaughter. Although they were acquitted by the jury, the case erupted into a public scandal. This article explores the insights that this shameful episode offers on Jamaica's colonial past. First, it exposes the fractures between the Jamaican governing classes and the imperial government; second, it reveals the internal divisions within colonial society; and third, it highlights the low level of government commitment to the health of the Jamaican people. It concludes by suggesting that the conditions at the asylum were a legacy of slavery and thus looked back to that period; but it also argues that at the same time the scandal acted as a trigger to the metropolitan government to improve colonial hospitals throughout its empire.

Introduction

“The most cruel and revolting crimes”,¹ so described by Henry Taylor, head of the West Indian Department at the Colonial Office in 1861, were the physical abuses that appeared to have been commonly inflicted on the patients at the Kingston lunatic asylum in mid-nineteenth-century Jamaica.²

In 1860 a pamphlet, Seven Months in the Kingston Lunatic Asylum, and What I Saw There, that ex-patient Ann Pratt reputedly authored, was circulated throughout the island, depicting conditions in the asylum. The exposure of these conditions precipitated a major enquiry into the state of Jamaica's public medical institutions, which ultimately led to an investigation into the condition of such institutions throughout the entire British Empire.

In her pamphlet Ann Pratt graphically described the worst of these “acts of cruelty and ill-usage” – the practice of tanking – after Judith Ryan, the matron of the lunatic asylum, had ordered that she be tanked:

I was … seized by Antoinette, Julian Burke, assisted by Lunatics, Rosa Lewis, Eliza Scott, and one called Mary. I was stripped; my arms held behind me; my legs extended and forcibly separated from each other; 1 was plunged into the tank, and kept under the water till all resistance, on my part, ceased; their grasp was then relaxed; I rose to the surface and breathed as if it were my last. Scarcely, however, had I drawn my breath when I was again subjected to the same horrible treatment, with the addition of having my head hurt against the sides of the tank, and my poor body beaten and confused with blows, till the fear of murder prompted them to desist.³

She claimed that she tried to alert the authorities. She did not manage to inform Mr Trench, the director of hospitals, because she had been tanked so often that on the day that he came to the asylum, “I was unable … to complain to him about this treatment, by drinking so much water; all the dirty water which they wash these people with, that I was too sick to speak.”⁴ However, she alleged that when she tried to tell Dr Scott, the chief medical officer at the hospital, of her treatment, Mrs Ryan interjected that the “madness was strong upon” her and retaliated with a further tanking. Pratt added that her complaints were “laughed at by Dr Scott, and made light of”, and that Dr Keech, the other medical officer, “again and again put me off, by saying have patience and you will soon get out”.⁵ Pratt's pamphlet contained a catalogue of physical and mental abuse which she claimed she and other patients had suffered at the hands of Mrs Ryan and other attendants at the asylum, and to which the medical officers appeared to have turned a blind eye.

A government commission of enquiry held in 1861 found that her accusations were largely true and that the practice of tanking was the “established punishment and means of coercion of the place”; that whenever a “female lunatic was contumacious, or incurred the displeasure, though only the capricious or vindictive displeasure, of the matron, she was ordered to be tanked”. Furthermore, the commissioners came to the “painful conclusion” that death had “on more than one occasion, been accelerated, if not actually caused by this cruel practice”, inflicted as it was even on those in “extreme old age”, the “sick and ill”, and those “far advanced in pregnancy”.⁶

The conditions in the Kingston asylum were not exceptional in the casual neglect, inhumane care, and unhealthy environment evident there. As the 1861 Jamaican commission concluded, many of these defects also existed in the Kingston public hospital. Even more revealing was the empire-wide investigation that the Colonial Office carried out in 1863, which revealed that similar conditions existed in many colonial hospitals and asylums, and particularly those of the West Indian colonies.⁷ The abuses in the Kingston and other colonial asylums were reminiscent of the conditions in British asylums before the reforms of the early nineteenth century, and thus their existence in colonial asylums in the 1860s stood out as an indictment of the so-called “civilising mission” of imperial rule. The “moral management” regimens of English asylums – based on “occupation, organised leisure pursuits, religious participation” and personal interactions between medical men and patients – were nowhere in evidence. The regimen of treatment at the Kingston asylum was still firmly based on custody and restraint rather than cure.⁸

The practice of tanking, itself, did have in part a medical pedigree. In the first half of the nineteenth century more than one expert in mental afflictions advocated the benefits of the sudden immersion of the head in cold water. For instance, Hermann Boerhaave, the Dutch physician, asserted that the near drowning of patients often had “a salutary effect”. According to Andrew Scull, it was also used as a disciplinary measure, which led to medical practitioners engaging in what he termed “linguistic contortions” in order to justify its use and to indulge in the “disingenuous insistence that disciplinary measures were, in fact, ‘medical treatment’”.⁹ As will be seen, the chief medical officer of the hospital also used such justifications. However, Colonial Office officials perceived the tanking practised at the Kingston lunatic asylum as nothing more than deliberate cruelty and, as such, it prompted a reforming impulse, albeit limited and hesitant, from the imperial government. The result was the instigation of hospital inspections and medical reports in the colonies which had far-reaching implications for the generation of health policies in the empire.

This episode in the colonial history of Jamaica is significant because, first, it gives insights into the state of colonial medical institutions during the period under review; second, it reveals some of the fractures of post-emancipation Jamaican society; and, third, it illuminates the relationship between Jamaicans and their imperial governors in the period immediately before the institution of Crown Colony government in 1867. The sources used are official documents and correspondence but, to an extent these include, through witness evidence and depositions, the voices of those on the bottom rung of the Jamaican social order as well as those from the colonial elites and the imperial masters.

The Medical Services in the Early Post-Slavery Decades

The ending of slavery and the granting of full emancipation after 1838 changed the political and constitutional context of Jamaica only marginally. The governing body of Jamaica continued to be the elected Assembly which largely represented the interests of the planter class, and which frequently opposed any attempt by the imperial authorities to mitigate their self-interested control of power. Governors, who were the representatives of the imperial government, were frequently forced to dissolve Assemblies that refused to cooperate, in the hope of a more amenable successor. The essential problem, as Governor Sir Charles Grey outlined in 1850, was that “there is no system or consistency whatever in the conduct of the financial affairs of the colony, nor any recognized organ of government or legislation which has the power to bring about effectual and comprehensive improvements”.¹⁰ In addition to these problems of governance, the economy of the island went into decline with the collapse in the price of sugar and the ending of protection by the imperial government in the late 1840s and early 1850s. This meant an even smaller financial cake to be shared by an increasingly beleaguered economic elite. Therefore, provision of adequate medical services for the island's population was not high on the agenda of the Assembly.

On emancipation the rudimentary medical services that the plantations had offered were withdrawn. As far as the political and economic elites were concerned, there was little benefit to them in providing medical services for freed workers. Furthermore, the ending of even that modicum of employment security for medical men led to the exodus of many of them from the island to England or to North America, and many more of those that remained gravitated to the towns to make a living, In 1937 Dr T.J. Hallinan, Jamaica's medical director, estimated that about 200 doctors were practising in the island before emancipation. He estimated, further, that by 1861 the number had declined to a mere 50, “so that the majority of the population were without medical aid”.¹¹ By 1900 there were still only 121 names on the Jamaica Medical Register.¹² Dr Hallinan was, of course, referring only to what he considered to be professionally qualified and registered medical practitioners, that is, European practitioners. Folk medicine thrived in post-emancipation Jamaica, as it had done under slavery. Apart from the obvious cultural affinities of Jamaicans to African medicine, the lack of Western medical services, except in the towns, made recourse to traditional healers inevitable.¹³

Official health services in the decades following emancipation were sparse. The Dispensaries Act of 1845 was intended to provide a network of dispensaries throughout the island offering free treatment to those unable to pay. This failed as there were insufficient doctors in the island or insufficient incentives to those who were still practising to make it viable.¹⁴ Between 1852 and 1854 a Central Board of Health, set up after the cholera epidemic, enjoyed a brief existence. There was also the public hospital and the asylum in Kingston, and a number of small parish hospitals. However, it was not until Crown Colony government was instituted in 1867 that any real attempt was made to establish an island-wide health care system.

Both the public hospital and the asylum had been established in Kingston at the end of the eighteenth century, at that time primarily for “poor transient Europeans” and the free population. After emancipation both institutions had to cater for the majority population, and the patient profile changed as the institutions cared predominantly for the Black and immigrant sick and mentally ill. The result for both was chronic overcrowding and increasing death rates.¹⁵ Based on English procedures, admission to the lunatic asylum was through the local courts. As was general in this period in the United Kingdom and her colonies, mental illness was defined legally, not medically. The Kingston asylum served the whole island, and took in those whom the courts decided needed institutional care beyond that which could be supplied by the local community (for example in the local jail). There was no classification of the mentally ill or those with disabilities, so that the criminally insane or potentially violent were housed with the temporarily ill, or those infirm through age. The confinement in an asylum was as much about social control as it was about care and treatment of the sick. Of course, the use of these institutions for such purposes had an added significance in the colonial context, being, as they were, an imposition from the imperial rulers.¹⁶

Conditions in the Kingston lunatic asylum in the years immediately following emancipation had provoked such concern that the Assembly was induced to vote funds for the construction of a new asylum in 1843. However, owing to the perennial inadequacy of Assembly grants, the building of this institution was not completed until the early 1860s.¹⁷ Conditions in both of Kingston's medical institutions continued to deteriorate and, moreover, the system of management presented major obstacles to their improvement. Up to 1859, their management had been under successive voluntary boards of commissioners who were not responsible to the governor – the head of the colonial administration – but to the House of Assembly, from which they were mainly chosen.¹⁸ As the secretary of state's 1864 Report pointed out, where “inspectors are committees of the managing boards” they are “not likely to be zealous in reporting their own neglect, or to be able to detect in one capacity faults which they cannot see in another”.¹⁹ In an attempt to provide more objective and effective supervision, the responsibility for inspecting these government institutions was transferred in 1859 to a salaried officer (D.P. Trench being appointed the first inspector and director).²⁰

The hospital and asylum of which he took overall control were in dire need of improvement, but conditions in the female section of the asylum stood out as exceptionally bad. Apart from tanking, patients suffered other forms of physical abuse and degrading treatment, as itemized in the official inquiry report.²¹ “To shorten the labor, and increase the leisure of the keepers”, the women spent a large part of the day sitting on benches, with the sun “beating on their uncovered heads”, and if they left without permission they were beaten. The report concluded that, in fact, random beatings from the matron, nurses and attendants, “with fists, feet, sticks, broomsticks, straps, umbrellas and any other weapon which happened to be in the way”, were common. Patients were “often violently dragged along the pavement till their bodies were bruised and torn, becoming afterwards a mass of sores”, and addressed all the time in “coarse, unfeeling, abusive, and shockingly obscene language”. Women patients were locked up at night, ten to twelve together, in “stone yard vermin-infested” cells in a “state of absolute nudity”, and in which state they “were habitually seen by the male labourers”. What clothes they had during the day were insufficient, no “shoes and stockings”, and in wet weather patients were often damp and cold. Their hair was cropped on admission and they were refused napkins when menstruating, with what the report described as “results of the most disgusting character”. Added to this, the poor diet and unsanitary environment meant that bowel complaints were endemic, and preventable deaths the outcome. One woman who became pregnant by one of the labourers whilst a patient received no medical care; she gave birth in a privy, and both mother and baby died. A second patient also died in childbirth from lack of care. The report acknowledged that curing the patients might be difficult with the facilities available but concluded that “it was at least possible to treat them with kindness and humanity”.²²

There was no question therefore that the Kingston lunatic asylum, even in the context of the standards of the time, stood out as a place of cruelty and barbarity. How was this situation allowed to develop and continue, and where did responsibility lie for such a state of affairs? The following section examines the parts played by the various participants in the drama, from those closest to the action (the staff at the asylum) through to the ultimate authority (the imperial government in London).

Roles and Responsibilities: Who Was to Blame?

Ann Pratt's principal charges of abuse were laid against Matron Ryan and some of the nurses at the asylum. Matron Ryan had been appointed superintendent of the female section in 1852, in the same year that her husband had been dismissed for similar kinds of abuse as superintendent of the male section.²³ This suggests that her style of management was entrenched within the mores of the institution and that it was notable only for the fact that it was given public exposure. Hence, although Pratt's testimony was disputed by Trench and the medical officers, her evidence was largely accepted in its fundamentals. It also received corroboration from other patients and servants, for example, ex-patient Emma Steele, who also claimed that she was held down under the water by a nurse, and Nancy Lloyd and three or four others, who were probably patients.²⁴ Mary Donaldson, a night nurse, testified that when she reported to Matron Ryan that Nurse Frances Bogle had beaten Ann Pratt and Henrietta Dawson, the matron turned her away with the accusation that she was a “lying devil”, told her that it was none of her business, and stated further that there was no need for a night nurse anyway as “they were standing very well before without a Night Nurse”.²⁵ As a result of an inquiry by Mr Trench in 1860, when he took witness statements from those involved (both patients and staff), Matron Ryan and two of her nurses were dismissed from the asylum in late July 1860. Trench also decided that since the alleged cruelties formed “in no degree the legitimate or sanctioned treatment of Lunatic Patients”, the “aggressors” were rendered “amenable to the statutory laws of the country”, and so he sent the papers relating to the matter to the attorney general.²⁶ The latter subsequently indicted Ryan and two nurses for assault and manslaughter.²⁷ If the authorities in Kingston hoped that by bringing the immediate perpetrators of the abuses to court investigations would spread no further, their hopes were misplaced.

For one thing, the high death rates in the asylum from preventable diseases also told a powerful story that could not be ignored. The Colonial Office sent the Ann Pratt papers to the Lunacy Commissioners in the United Kingdom in the summer of 1860; they undoubtedly thought there was a case to answer about conditions in the asylum. They pointed out that, for example, in 1859 there were 33 deaths out of an average number of 120 patients, which gave a death rate of more than 25 percent compared with an average rate of 11 to 12 percent in county asylums in England. Even taking into consideration the poor health conditions in Kingston generally, they concluded that the number of deaths in the asylum was “excessive”.²⁸ This alone made it unlikely that the indictment of Matron Ryan would quell the growing unease either in Jamaica or in London. However, tellingly, Matron Ryan and her co-defendants were acquitted. They were cleared of all charges by the verdict of the jury and thus “escaped all punishment for their crimes”.²⁹ If the staff at the asylum were not to be held accountable then who was guilty?

The next rung up the ladder of responsibility were the medical officers in charge of the public hospital and the asylum, and (after his appointment in 1859), Mr Trench. Dr Scott, the chief medical officer at the hospital and asylum, was the medical officer who had most to lose. He had been in government service for about seventeen years by the summer of 1860, and it was not just his government employment which was at risk but also the effect on his private practice, if he was found to be culpable.³⁰ Dr Keech, his assistant at the hospital, had been the apothecary there before his promotion to medical officer in 1857. He was a licentiate of the Apothecary's Company of England and supposedly a member of the Royal College of Surgeons, but Henry Taylor at the Colonial Office described him as an “illiterate and most disreputable man”.³¹ Trench was only in overall charge of the administration from 1859, but since these abuses had continued into 1860, after he had taken office, his career in the government service was also threatened.

The first defence these men put forward against the charges of neglect was a plea of ignorance. Ann Pratt had claimed in her deposition that she had “made complaints often to Dr Scott about the treatment I received in the tank. … He always walks on.” Pratt also claimed to have received a similar reaction when she showed Dr Keech the black eye she had received from Nurse Bogle: “he turned away, he looked shocked; he said nothing to me, but went away”.³² However, Scott denied that he had received any complaints from Pratt or any other patient. His attention, he admitted, had been drawn to the “slightly ecchymosed state of her eyelids”, which Pratt had informed him was the result of a blow. Initially, he had suspended the nurse but, on realizing that this was outside his authority, he had told the matron to report it to Mr Trench.³³ He owned that he had ordered patients to be bathed but then, as far as he was concerned, bathing and shower baths in the island's climate were “of great value in the treatment of insanity probably more so than in Europe and other cold countries”. Nevertheless, he claimed to have had no idea of the method used until he had read the testimony of one of the nurses; “a sense of delicacy”, he said, had prevented him from “personally witnessing the plan adopted by the nurses of holding patients who were unwilling to let the stream of water go over their heads”. That was “undesirable” and made worse, he acknowledged, by the “position of the gutter from which the water flowed”. This was “low down” and the “patient had to be almost recumbent to get the water over the head”.³⁴ Trench also claimed to have seen nothing amiss on his inspections.

If the claim of ignorance of what was happening in the asylum which they supposedly visited daily appeared somewhat disingenuous, Scott and Trench appeared to be on much safer ground when they attacked the credibility of the witnesses against them. Women who had already been committed to an asylum for the “insane” made an easy target. Scott claimed that, on careful observation of Pratt after her admission, he had detected “undoubted signs of mental derangement”, and within a week these had developed “in such unquestionable form as to leave no doubt as to her insanity”. Indeed, the “paroxysms were sometimes violent, and then she was with difficulty restrained”. Such a degree of exhaustion had followed one of these attacks that a “fatal termination” was threatened, but fortunately this was “averted by treatment”.³⁵

Additionally, Trench went to some pains to assemble detailed documentation on Ann Pratt's history for his inquiry. He had letters from William Browne, a justice of the peace in her home parish of Hanover; J.S. Trench (a relation?), who was clerk of the peace for Hanover; and William Brebner, the medical attendant of Hanover jail. They all testified as to Pratt's poor character and her “madness”. Brebner claimed to have known her for several years. In the past, he stated, she had cohabited and borne two children with a Jew called Levi, but during the previous year she had been supported at parochial expense.³⁶ Furthermore, for some years she “had not attended any place of worship, but to her other sins, had added desecration of the Sabbath”. (He did not specify how this occurred.³⁷) A pauper, an unmarried mother and a non-attendee at church, her character was thus established even before the question of her sanity or otherwise was considered. On this question, William Browne had consulted Mr Sharpe, the magistrate; Dr Brebner and his assistant; Mr Cort, the clerk of the peace; the superintendent of prison; Mrs Crooks, matron of the Hanover jail; the churchwardens; the sergeant of police; and other persons in Hanover. They were of the “unanimous opinion” that “Ann Pratt was mad, and dangerously mad too”. Even her mother was cited as saying that she “was mad some years since”,³⁸ Brebner diagnosed her as suffering from “mania alternating with melancholia. During the paroxysms of the former she would utter the most indecent language, strip herself naked, eat her own excrement”, and had to be strait-jacketed. She would then enter into a period of “quiet melancholy”. Although her mother “attended on her all the time”, Brebner had decided that she could not be cared for properly in the local jail and so he had sent her to the Kingston asylum on the first available ship.³⁹ The fact thai the imperial authorities largely accepted Pratt's story, despite this total demolition of her character and credibility as a witness, suggests that the evidence of abuses at the asylum was overwhelming.

A third line of Dr Scott and Mr Trench's defence was to attack the motivation and probity of Dr Lewis Bowerbank, their chief accuser. Dr Bowerbank, a Jamaican-born and Edinburgh-trained physician, was dedicated to reforming what he saw as the ills of Jamaican society and in particular the backwardness of its medical institutions.⁴⁰ He had first raised the question of conditions in the hospital and asylum in 1854, and his views had been instrumental in the passing of the 1855 Act which amended the hospital management system. However, as we have seen, this did not rectify its fundamental lack of accountability.⁴¹ In 1860 he adopted Ann Pratt's case as the focal point of his campaign for reform. Scott and Trench accused him of more self-interested motives than altruism behind his championing of Ann Pratt. Pratt was repeatedly described as illiterate and yet her written accounts of her time in the asylum were articulate, well-constructed and literary. Hence, they argued, Dr Bowerbank was using and exploiting her for his own ends. Trench asserted that the “entire pamphlet” was “evidently a disingenuous contrivance to convey to the public mind, a prima facie corroboration of the numerous random charges which have been published from time to time by Dr Bowerbank against the officers and nurses of the asylum”.⁴² Dr Scott went even further when he appeared before the commission of inquiry in 1861. He attributed Dr Bowerbank's campaign to a case of personal pique. Bowerbank had wanted the post of chief medical officer at the hospital in 1857 but had not been appointed, and there, argued Scott, “may be said to lie the foundation of the hospital controversy, in all its malignity”.⁴³ How far Bowerbank was pursuing his own interests is open to interpretation. Certainly, Henry Taylor at the Colonial Office reserved some criticism for him. He had no desire, Taylor wrote, to “undervalue the results which Dr Bowerbank's certainty and perseverance” had achieved. However, he thought that they were made with a “want of candour and bitterness of feeling”, and with some “personal animosity”, and that “had they been otherwise made there is reason to suppose that they would have been met in a spirit of cooperation”.⁴⁴ Moreover, Governor Eyre in 1863 confirmed the existence of bitter divisions within the medical establishment when he commented on the “extreme professional jealousy among some of the medical men of Kingston”.⁴⁵ This evident discord was exacerbated, no doubt, by the dearth of government employment and the limited opportunities for private practice.

The colonial government castigated Trench for his negligence, although he escaped lightly in terms of punishment. Indeed, the commissioners of inquiry described him as a “zealous, intelligent and fearless public officer”. This verdict caused some disquiet for Henry Taylor, who thought that it was his distinct lack of zeal that meant that for a “year and a half his services were utterly ineffective to detect the daily and habitual commission of the most cruel and revolting crimes”. The outcome for Trench was a reprimand and an admonition to be “more successful hereafter in preventing abuse”.⁴⁶ However, the colonial government dismissed Drs Keech and Scott from their posts.⁴⁷ Scott defended himself vigorously against the charges but his case was rather hopeless, given the fact that he was known to be in debt to Matron Ryan's husband, and hence his integrity was fundamentally compromised.⁴⁸ Belatedly, the colonial government did take some action against those responsible for the conditions in the hospital and asylum. However, this was two years after the first exposure of the abuses in the asylum. Why had it taken so long for the administration to respond and why did it do so eventually?

The Colonial Administration

Such was the vested interest in the status quo in the hospital and asylum that no redress would come from the legislature since, as has already been pointed out, it was from its members that the board of commissioners of the hospital were appointed, Moreover, as the commissioners of inquiry into the hospital discovered, the board of commissioners invariably offered lucrative contracts for hospital and asylum supplies to one of their own number. Corruption was thus rife in the management of both institutions.⁴⁹ Henry Taylor's verdict was that it was in no small part the “apathy and niggardliness” of the Assembly and the “corruption” of some of the members that had allowed the “barbarous evils” to fester.⁵⁰

The governor was the ultimate authority responsible for the state of the hospital and asylum. The first and obvious explanation for his inaction was his lack of interest in the two institutions, which had no material contribution to make to the prosperity and order of the colony. He never visited them so he had no first-hand knowledge of their conditions. As Henry Taylor commented, in England hospitals were generally supported by voluntary contributions and therefore supervised by those who funded them. Moreover, after the Lunatic Act of 1845 in the United Kingdom, all institutions for the mentally ill were subject to annual inspections. In the colonies, no such safeguards existed and, as Taylor added, governors still considered that “the care of such institutions is no part of the business of government”. He concluded that “Governor Darling should not have met the charges against the hospital in the way in which … he did meet them”; rather, he should have dealt with the charges in the same way he would have done “if they had been charges against any other department of the public service”.⁵¹

Governor Darling's first response to the exposure of the abuses was to presume them totally groundless and to propose an action of libel against the publisher of Pratt's pamphlet. Fortunately, at least in Taylor's opinion, Edward Kemble, the acting attorney general, had advised against this “injudicious course” and had decided instead to indict Matron Ryan and the two nurses.⁵² Darling's justifications to the Colonial Office of his actions were remarkably revealing of his attitude towards those whom he governed. He reported that the matron and nurses had been acquitted but that he had not allowed them to be defended at public expense. They had been dismissed before the trial but had not been reinstated despite their acquittal. However, he added, this decision had been “guided by a spirit of precaution and expediency” rather than the “dictates of justice”, because he thought that:

there are few people for whom so much allowance should be made in respect to the occasional loss of temper and exhibition of force as those whose natural passions have been moderated by civilising influences, and who being of themselves of what may be called an African temperament are charged as subordinate servants with the duty of handling and restraining violent lunatics for the most part of the same excitable race.⁵³

The Imperial Government

The imperial government's interest in its colonies lay primarily in their economic importance to the so-called mother country. However, by the mid-nineteenth century there was also developing at the metropolitan centre a notion of “trusteeship” which, although limited to ideas of the rule of law and a just administration, encompassed an acceptance of the government's responsibility for its imperial subjects. Hence, such blatant abuse of the sick and powerless provoked some officials at the Colonial Office, notably Henry Taylor, into a more proactive response above and beyond the usual hand-wringing. Thus, it was only on instruction from the Colonial Office that the governor instituted the public inquiry into the affairs of the asylum and the hospital. The resulting report fully exposed the inhumanity, negligence and corruption that lay at the heart of both institutions, such that the colonial administration had no choice but to institute reform. In 1862 the Public Hospital Act outlined new rules and regulations for the management of the hospital and asylum. It established a board of visitors responsible for regular inspections, and laid down rules for the medical staff, the nurses, the warden and the steward. The safeguards in this act were that members of the board of visitors did not all come from within the administration and the power of appointing medical officers resided solely in the governor.⁵⁴ In 1862 the new asylum at Bellevue was also finally completed and the last of the female patients were transferred there.⁵⁵

However, the reforming impulse was not limited to Jamaica. Henry Taylor questioned whether such “abuses and evils” existed in the other colonies.⁵⁶ To find the answer he devised a series of questions which were sent out in an 1863 circular despatch from the secretary of state to all colonial governors. The opening sentence of the dispatch made quite plain what had inspired the initiative: “Certain evils and defects which have recently been disclosed in the Public Hospital at Kingston Jamaica, and flagrant abuses and cruelties of long-standing which have been detected in the Lunatic Asylum of the same place, have suggested to me the expediency of making enquiry into the state of similar institutions in other colonies.”⁵⁷

Replies came in from thirty-three colonies detailing the conditions in thirty-nine hospitals and twenty-eight asylums. As a result of this information, a report was compiled and sent out a year later with a set of suggestions to be followed in all colonial hospitals and asylums. The objective of curative hospitals and asylums, the report pointed out, was that the “greatest possible proportion of patients should be cured and in the shortest possible time”; and in the case of asylums “the normal condition and rights of the insane should be infringed upon in as small a degree as may be consistent with efficient management”. The report outlined “three cardinal conditions” which it was necessary to secure in order to achieve these objectives. First, “sanitary efficiency” should be the rule of thumb. Second, the management of hospitals and asylums should be in the hands of those who had the “necessary knowledge”, who were “in a position to give the necessary attention” to the institution, and who could be “readily made responsible to some other superior authority”. Third, effective visitation and inspection procedures should be implemented, supplemented by detailed written reports from those in charge of each institution and summary reports from the hospitals inspector or the chief medical officer of each colony. These reports were to be sent to the imperial government for scrutiny, and were also to be circulated to all colonies with the aim of spreading the best knowledge and practices throughout the empire.⁵⁸

These hospital returns and the accompanying summary reports from the principal medical officers of the colonies formed the basis of the annual medical reports which became the main source of information for the imperial government on medical institutions and public health in the colonies. They were instrumental in the overview of the health problems of the empire to which, if purely at first for economic reasons, the imperial government's attention was increasingly drawn.

Conclusion

The abuses in the Kingston lunatic asylum triggered reform not only in Jamaica but also throughout the British Empire. However, it would be rash to overestimate the extent of the changes made with reference to Jamaica only. The new asylum was completed and Dr Thomas Allen, who had at least some specialist experience in an English asylum, was appointed as superintendent of the new Kingston asylum to run it as a proper mental health institution.⁵⁹ Some physical improvements (for example, new operating rooms) were made to the public hospital, but in 1864 the Assembly went back on its promise of funding for completely new premises, so it remained without a sewerage plant and a proper water supply, and with unsatisfactory and insufficient accommodation.⁶⁰ New medical officers were appointed to the hospital but it was not until 1867, after the imposition of Crown Colony government, that a government medical service of any kind was established.⁶¹

Dr Bowerbank continued his crusade against what he saw as the inadequacies of the island's medical system, and in this he seemed justified. Notably, in 1872, for example, he exposed very similar inhumane conditions and treatment of patients in the smallpox hospitals in St Andrews parish. Patients were left without clothing, bedding and proper nursing attendance. Dr Ross, acting chief medical officer for the colony, issued instructions to the island's medical officers that one visit a day to the hospitals was enough and that there was “no necessity” for the medical officer to “touch the patient”, but that he could “stand at the entrance of the tent and ask questions and so satisfy [himself] as to its progress”.⁶² This is resonant of the callousness of a decade earlier. It suggests that, despite the institution of Crown Colony government and the establishment of a government medical service, which at least paid lip service to the idea of government responsibility for the welfare of those it governed, there had been little fundamental change in the establishment's approach (at best indifferent), to the majority Black population of the island. The hospitals and asylums of even the European metropolitan countries were not places which the sick entered willingly. They were viewed as places of death rather than places of succour and cure. Colonial hospitals were regarded even more so, being as they were under-funded, and badly maintained and administered. To the vast majority of the population they were a clear manifestation of an alien and oppressive culture. The hospitals of Jamaica were among the worst in the colonies, The conclusion must be drawn that this was yet another aspect of the enduring legacies of slavery.