People Australia

* Angela’s real name has been redacted. As a condition of access to patients’ records, the New South Wales Department of Health has required that I do not give the real names of any patient who died less than 110 years before the date of publication. 

'Angela'’s stay at Callan Park Hospital for the Insane in Sydney from October 1887 to July 1889 was marked by an episode of coercion using a galvanic battery. 'Angela', a single housemaid aged 25, an immigrant from Ireland, was diagnosed with ‘mania acute’ on admission. At this period there was substantial migration of poor single women from Ireland and Britain to Australia. These immigrants, whose employment options were generally restricted to domestic service, marriage or sex work, were often stigmatised as living ‘a loose kind of life’ and were over-represented in mental asylums and other welfare institutions as compared to Australian-born women. 

On arrival at Callan Park, 'Angela' was subject to a superficial physical examination, a frequent characteristic of such assessments at the period. She was found to be a ‘stout, healthy looking young woman with staring grey eyes’. Her heart and lung conditions were not recorded. The ‘supposed cause’ of 'Angela'’s mental illness was cephalalgia of two weeks duration. This term was used at the time to refer to any pain in the head of an episodic nature, irrespective of intensity. Before arriving at Callan Park, 'Angela' had been assessed for insanity at the Darlinghurst Reception House. At the House, she claimed that some power was compelling her to kill herself. She was said to be very violent and excited at times. 'Angela' would not answer questions. She was quite incoherent and very noisy, singing and crying out that she was ‘in Hell’. She appeared to be terrified. 

During her first week at the asylum, 'Angela' refused all food and had to be fed twice with a ‘stomach pump’. Force-feeding was a standard procedure for patients with eating difficulties. The patient was held down by several attendants and a feeding tube inserted via the nose or mouth. The procedure usually involved much obvious distress to the patient, a violent struggle and frequent regurgitation. It was known to be risky, since there was a danger of damage to the oesophagus or inhalation of food which could cause pneumonia. Strangely, there was no comment in the press of the day about the practice, although it was to become infamous during the frequent hunger strikes of imprisoned suffragettes in England during the early-twentieth century. There was still no mention of force-feeding of mental patients at the 1923 New South Wales (NSW) Royal Commission into Lunacy Law and Administration. 

After a few days, 'Angela' was prescribed ‘Mist. sed.’, probably chloral hydrate, which was then used by criminals to spike drinks in ‘Mickey Finns’. This sedative was stopped after a week when 'Angela'’s behaviour improved, and she began to occupy herself with ward work. But by November she soon became ‘as noisy and troublesome as ever’ and was force-fed daily. She was quietened by repeated applications of a galvanic (DC) battery. 

There were other examples of the use or threat of electrical devices at Callan Park to coerce patients. At admission in 1887, Martina M* (a pseudonym) would not answer questions ‘until a faradic [AC] current was sent through her then she spoke freely’. In 1904, Charles Harper, who had previously been subject to episodes of force-feeding, was induced to take food from a spoon by the threat of a mock ‘battery’. Due to his poor eyesight, he could not see that the ‘battery’ was made up of two combs. After Mary Gough sprained her ankle in 1907 and refused to move it after a week’s bed rest, a battery was ‘at last’ applied to induce her to get up. At the 1923 Royal Commission, Minnie Gullett, a prominent member of the Lunacy Reform League, testified that she had been told that a patient at Rydalmere, Lillian Hayward, had been punished for misbehaviour by Dr Clifford Henry’s application of a battery to her soles and ears. Gullett claimed that Hayward had ‘screamed in agony’ for some time afterwards. But Henry refuted these charges of wilful torture, stating that a galvanic battery was a standard, and non-painful, standard therapy for paralysis. He had never applied it to the head. Indeed the Royal Commissioners tested the apparatus on themselves and had found no painful effects. 

Electricity had been increasingly used for therapeutic purposes over the later nineteenth century. It was used to treat psychiatric conditions, neuralgia, headaches, menstrual disorders, paralysis and epilepsy. Currents were applied to the head with mixed results. While ‘galvanism’ could relieve the pain of neuralgia and headaches, it was noted that faradic current could be quite painful. But electrical treatments for mental illness lost popularity by the end of the century due to frequent failures to replicate grandiose claims of success. They were largely forgotten until the advent of the much more electrically sophisticated electro-convulsive therapy (ECT) in the late 1930s. 

But by early 1888, 'Angela' had become ‘very thin and miserable’ and was ‘as bad as ever’. She was quietened for a few hours by a very heavy dose of 11 milligrams (1/6 of a grain) of hyoscyamine. Modern tablets typically contain about 0.125 milligrams. Overdoses of hyoscyamine can have toxic effects, including hallucinations, nausea and possibly coma. We do not know if this treatment was continued, but by March, 'Angela' was constantly shouting and tearing up her clothing, although she was eating well and had put on weight. In early May she began a course of morphine hydrochloride, with the dose being increased weekly, from about 16 milligrams to 32 milligrams by the end of the month. The modern recommended dose for a morphine-naive adult is 0.3 mg/kg every 3 to 4 hours. It is sufficient to cause torpor in naïve patients. 'Angela' weighed about 58 kg at admission, so her initial dose would have conformed to modern practice, assuming that she had not lost weight. Evidently, this regime was ineffective. The morphine was discontinued by June and the hyoscyamine treatment was resumed, apparently continuing into the next year. There were only two further observations in 1888 for 'Angela', in August and November. They merely said: ‘much the same’. 

By February 1889, 'Angela' alternated between ‘bad as ever’ and ‘quiet’ days. A water treatment was tried in May. She was given a 15-minute daily bath in body temperature water. This had marked results. She became quieter and began to sleep better at night. By June, 'Angela' had apparently no further need for chemical restraint. Her behaviour had improved to the extent that she was ‘tidy, sensible & employs herself with needle work’. Having become ‘very well conducted, neat, tidy and rational’, she was discharged in July.