For most of their existence, writes Dalrymple, mental hospitals were
custodial rather than therapeutic institutions.
Their methods could be somewhat crude. In The Experiences of An Asylum Doctor, With Suggestions for Asylum and Lunacy Law Reform (1921), Montagu Lomax, a medical officer at Prestwich Asylum,
described how he and his colleagues treated suicidal melancholics and agitated paranoiacs. They sat the melancholics against a wall, placing a bench in front of them to prevent them from moving, while an attendant watched them to ensure that they did not do away with themselves.
subdued the agitation of the paranoiacs, who became so preoccupied with the movement of their bowels that they had no time or energy left to act upon the content of their delusions.
A leading theory, Dalrymple notes, was that of focal sepsis.
One of the asylums of my city had the best-equipped operating theatre of its time, where an enthusiastic psychiatrist partially eviscerated his patients and removed all their teeth, on the theory that madness was caused by a chronic but undetected and subclinical infection in the organs that he removed.
used the theatre to perform lobotomies on patients who were scarcely aware of what was being done to them.
Doctors also tried
more ‘advanced’ treatments, such as insulin coma therapy, in which they gave schizophrenic patients insulin to lower their blood sugars to the point at which they became unconscious, sometimes with fatal effect.