In March 1873 the Parliament of Ontario approved an “Act to make further provision to the custody of insane persons” (SO, 1873, Chap. XXXI). This statute introduced important directions for the care of the insane in Ontario and it mainly dealt with the steps for confining people into public asylums. The fundamental novelty concerned the prescription of a large number of templates to be used for asylum admission and discharge throughout the province. At the end of the statute, in fact, there was a long appendix consisting in a list of eleven standardized forms. One of the most important templates introduced by the 1873 act was a new form regulating the medical certification of insanity in civil procedures. Because the list of eleven forms was provided in alphabetic order from A to K, this template was called “Form K Certificate of Medical Practitioner in Ordinary Cases”, or more simply, as it will appear in printed versions, “Form K Certificate of Insanity”.
The layout of the Form K was not a Canadian invention but rather an import from the English model (Bartlett, 1999). The Form K, indeed, reproduced in Ontario the same structure of the medical certificate of insanity that was used in English asylums after 1853 (Wright, 1998). A very similar template was also employed in Scotland, Wales, Ireland, Nova Scotia, and several US states including New York. Whereas the English legislation required two practitioners, the Form K prescribed the participation of three doctors who were supposed to independently examine the alleged insane. Each physician filled his own Form K and wrote down “Facts indicating insanity personally observed” and “Other facts of insanity communicated to me by others”. The certificate was deemed valid only if provided with the signatures of two witnesses. Certification of the insane in Ontario represented thus a very participated activity. The number of people involved in the process, indeed, varied from a minimum of three (in those rare instances where certifying practitioners also acted as witnesses) to a maximum of nine (in case each examination involved a couple of witnesses that was different from one practitioner to the other).
Relying on the archival records of the Toronto Lunatic Asylum, in this post I want to talk about the certification of insanity as it was conducted in Ontario from 1873 to 1883. In particular, I will highlight how doctors approached the examination, which domains were part of the inquiry, and how they reported information in their certificates. Furthermore, I will illustrate the different locations where the examination took place.
Starting with doctors’ approach, one might wonder: In what did the examination procedure consist of? Which domains were investigated? How did doctors write down this information when filling out certificates? From the records of the Toronto Asylum, it is possible to suggest that during the 1870s in Ontario, examination essentially consisted in pulse-taking, tongue-checking, and a conversation lasting around thirty minutes. We know these details thanks to certifying physicians who mentioned such practices in their documents. From the case of Mary H., for instance, a 24-year-old single teacher from Toronto, we get an idea of the general duration of the examination. Dr. Coleman came to Mary’s house on Jarvis Street on July 16 1873 and expressly stated that he had a conversation with the patient for about “half an hour” during which she appeared “visionary and making extravagant claims”. The physician recommending asylum treatment, Dr. Adams, wrote in his Form K that he had not examined Mary on a specific date but rather that he had “lately visited her in his office” in Toronto. The facts he observed were: “For several months past, if not for the last two years, she has repeatedly consulted me for pain in her head, accompanied by sleeplessness. Of late her language has been incoherent, rambling with constantly increasing irritability of temper”. On the same note, Dr. Adams, who apparently knew well Mary and her family, reported some facts communicated to him by Mary’s mother who said that “her temper at home has been increasingly violent, going so far as to strike her mother. She has of late been ordering home quantity of goods, purchasing even a horse and carriage without having means of paying for the same”. Mary was admitted to the asylum on July 22 1873, a week after her certification (RG 10-268, B296098, Admission N° 4082).
Besides talking to the patient, doctors were also reported to perform some basic diagnostic operations. In the case of Lydia S., a 28-year-old “farmer’s wife” from Wellandport (Lincoln), described of “domestic” habits and who was previously confined, certifying practitioners struggled to examine her. On September 10 1873 Dr. Callum went to her father’s house in Wellandport in order to visit Lydia. He remarked that her insanity was evident because of “her melancholic appearance and defected [sic] manner”. Dr. Callum added that “she would not allow me to feel her pulse or see her tongue” and continued that she “laughed several times without any cause. Answered only a few of the questions put to her and some of them not rationally. Expressed a wish to go somewhere but when asked where, said that she did not know”. This portrayal was reinforced by the facts communicated by others. In this section, Dr. Callum wrote that “her father, mother, sister, and husband state that she has been unable to attend to her ordinary household duties since last March when she became insane. That she continuallywants to run away to the woods. That some days she talks much more rationally than others. That she pays little attention to her infant”. A similar depiction was reported by the other two certifying physicians. In particular, they both remarked that difficulties in getting responses from Alice notwithstanding, as Dr. Kirk stated, “every endeavor on my part and in as mild as possible manner [sic]”. Alice was admitted for the second time to the Toronto asylum on September 12 1873 (RG 10-268, B296098, Admission N° 4098).
Medical examination thus likely consisted in interviewing the patient, checking his/her tongue, and feeling his/her pulse. Let’s now turn our attention to the different domains that characterized an episode of certified insanity. From the information presented in surviving certificates, several themes of confinement emerged, such as religious hallucinations, sexual propensities, suicidal attempts, violence, silence, wandering around or escapes, sleeplessness, incessant talk, failure in domestic duties, destruction of clothes or furniture, loss of memory, and others. However, there were three domains that particularly attracted physicians’ attention. These were speech, actions, and appearance. The production of consensus amongst doctors and witnesses gravitated around these three areas of investigation. Tribunals of reason prêt-à-porter, therefore, pronounced a common statement focused on what the patientsaid or did not say, what the patient did or did not, how the patient appeared ordid not appear.
To use the vocabulary of the time, certification might have been justified on the basis of “waving conversation, stupid appearance, and fantastic actions”. These facts of insanity were personally observed by a physician who examined Mitchel R., a 28-year-old single housekeeper of Normandy. She was described of “sedentary habits of life” and with propensities of “religious nature” supposedly originated by a “uterin cause [sic]” since it was said that she “never menstruated right” (RG 10-268, B296100, Admission N° 4340). A similar depiction was offered by a certain Dr. Forrest in his examination of Letitia L. on April 14 1876. Letitia was a 54-year-old “farmer’s wife” described of “active” habits of life. For Dr. Forrest, certification could be decided quickly since he simply stated in his Form K that “her manner, look, & conversation are all highly indication of insanity” (RG 10-268, B296101, Admission N° 4485).
Many physicians were more loquacious than Dr. Forrest. Words, actions, and appearance were also subject to more careful examination as it can be noted from the case of Mary Jane D. Mary Jane was a 38-year-old “farmer’s wife” living in Chinguacousy, a small town near Brampton. The certification was requested by her husband, Andrew D., who was willing to pay $ 2 a week for her staying at the asylum. The certification took place at Mary Jane’s house located at “Lot 14-61 Cor. M. in Chinguacousy”. Dr. Mullin, one of the three examining practitioners justified her insanity: “from her history and from her appearance which has the sharp, distrustful, earnest look of the insane. Her conversation is contradictory and violent charging her husband with vices which from all I can learn is false and ridiculous. She has a mania for managing all the affairs and in purchasing articles not consisting with her wants”. Mary Jane’s certification, therefore, depended on her “distrustful appearance”, on “her contradictory” conversation, and on her “maniac” gestures of purchasing pointless articles (RG 10-268, B296102, Admission N° 4572).
General practitioners thus approached the examination of the insane with a particular emphasis on patients’ conversation, actions, and appearance. It is also interesting to consider the different writing styles showed by physicians when filling their Forms K. At times, indeed, physicians listed facts personally observed as if they were answering to the question: What makes you think he/she is insane? For example, in the case of John B., a 19-year-old farmer’s son from Brooke, described of “regular habits” and of propensities of “religious characters”, Dr. Banskat, the physician recommending asylum treatment, manifested a peculiar writing style. On November 21 1873, he described John’s facts of insanity imagining he was being questioned by a judge. Dr. Banskat wrote: “His peculiar, vague expression. His strangeness of department. His thoughts oppressed by gloomy melancholy. His deranged state of feelings (admitted by himself). His disordered reasoning faculties as manifested in conversation”. Such a defensive writing style was also repeated in the next section including facts communicated by others. Here Dr. Banskat stated: “His strange and at times violent actions and incoherent language. His sleeplessness. His propensity of destructiveness of property. His threatening attitude to do bodily harm to his father and sister”. John was admitted to the Toronto asylum on November 28 1873 (RG 10-268, B296098, Admission N° 4128).
A different and nonetheless curious style displayed by certifying doctors involved directive quotation of patient’s own words. Although in these records patients’ voice was always filtered via the physician’s hand, sometimes doctors opted for a more authentic depiction and included their original statements. One of these cases was that of Alice W., a 33-year-old “laborer’s wife” from Peterborough with five children. Alice was described of “retired and reticent” habits of life “though apparently cheerful to herself and often singing” before her attack of insanity. For about five weeks she had been showing propensities of “roaming about, thinks herself unfit through ignorance, uncleanliness, and inferiority to associate with a fellow creature”. The cause of her insanity, stated Dr. Sullivan, was said to be “hysteria, believed to be induced in the first instance by want of proper nourishment and by society”. The same Dr. Sullivan received Alice in his office at Peterborough on August 141873. He personally observed facts related to “appearance, manner of acting, conversation, expressed fear” and supported these facts by quoting Alice’s own word. According to Dr. Sullivan, Alice pronounced these words: “I have lost all. I don’t care for anyone. I don’t care for my poor children. I am not fit to live. I must die. I am not fit to be with anyone. If I don’t kill myself what will I do [sic]?”. Such facts were corroborated by Alice’s husband who informed Dr. Sullivan of her “continually leaving home and roaming around indiscriminately, and accusing herself of being ignorant, and unfit to live in any society”. On the same day, August 14 1873, Alice was brought to the office of other two practitioners at Peterborough, namely Dr. Burnham and Dr. Burritt who, accompanied by a different couple of witnesses, examined and portrayed a similar picture of Alice’s. The day after she was admitted to the Toronto asylum (RG 10-268, B296098, Admission N° 4092).
Having looked at several aspects regarding the doctor-patient interaction, let’s now explore the place of certification. This point is particularly important since it gives us an idea of the territorial mobility of tribunals of reason prêt-à-porter. From the records of the Toronto asylum, it appears that the certification of insanity in Ontario during the Form K era constituted a very ambulant activity. In fact, examination was performed at the most different locations including a patient’s house, physician’s office, the asylum, the house of providence, and even at more casual spots such as hotel rooms. The production of consensus, therefore, did not depend on the neutrality of the location.
In most instances, certification happened either at patient’s home or at a physician’s office. For example, in the case of Eliza M., a 25-year-old spinster described to be affected by “erotic mania” caused by “masturbation”, certification took place at her residence. The first certifying physician, Dr. McBrien practising at Newtonville, clearly indicated in his Form K that the examination took place at “Mr. M.’s house” on June 19 1873. Similarly, a second physician participating in the certification, Dr. Rose practising at Newcastle in the county of Durham, stated that he visited Eliza M. on June 20 1873 at “James M.’s house”. Eliza was admitted on June 24 1873 at the Toronto asylum (RG 10-268, B296098, Admission N° 4068). In other instances, however, it is clear that examination took place at physician’s office. In the case of Hannah A., a 34-year-old “farmer’s wife” from Darlington described as “excitable, restless, loquacious, and variable”, was examined at one of the doctor’s office. Dr. Alfred Beith who graduated from University of Toronto and practiced at Bowmanville, observed such facts about Hannah: “A peculiar restlessness, and making enquiry about the different instruments in my office”. Hannah’s certification was completed between June 20 and 21 1873. She was admitted at the asylum three days later (RG 10-268, B296098, Admission N° 4069).
In a different scenario, patients received a certification in hotels. In the case of Ellen N., a 42-year-old “laborer’s wife” from Orillia with five children, she was examined by two physicians in a hotel room. Ellen was declared of “temperate and quiet” habits of life and she was reported to be “afraid that someone wants to kill her or her children”. Dr. Sanderson personally examined her on May 17 1873 at the “Albion Hotel in Orillia”. Here he observed facts of “restlessness, incoherence, and having offended God by not having attended Church”. On the same day and at the same Hotel Albion, a second physician, Dr. Robert Ramsey, observed just facts of “restlessness and religious views”. As for facts communicated by others, Dr. Ramsey included a “tendency to suicide as stated by those in the neighborhood”. Ellen N. was admitted to the asylum on June 27 1873, ten days after the hotel certification (RG 10-268, B296098, Admission N° 4072). In a similar case, William R. a farmer from Woodbridge was certified at the “Eagle Hotel” at Weston by three physicians on August 25 1877. At the time of his certification, William was 48, married, and with seven children. He was described as a “temperate and hard-working man” with delusions of “imagining conspiracy against him” caused by “lawsuit”. Particularly, Dr. Edward Aikin, one of the certifying physicians, personally observed that William “imagines that men get under his bed and wait till he is asleep and then get into bed where he and his wife are [sic]”. As for facts communicated by others, Dr. Aikin reported that “his neighbors tell that he has threatened to injure his wife and family”. In the same hotel room, on the same day, Dr. Thomas Savage examined William. He observed that “imagines that his family are conjuring to do him great personal injury and that the females of his family are habitually receiving men in the house for immoral purposes”. Dr. Savage also wrote that William reportedly showed “inability to sleep and not taking regular if any nourishment”. The third certifying physician, Dr. Irnell, entered the hotel room of the Eagle Hotel and observed that William suffered “from illusions” in a way that imagined “his wife is not virtuous and is about to do him harm”. Dr. Irnell was told from someone whose name is not mentioned, that William suffered “from hallucination”. William R. was certified on August 25 1877 and on the very same day he was admitted to the asylum (RG 10-268, B296104, Admission N° 4909).
From the cases of Ellen and William we learn that tribunals of reason were assembled in very different locations. But why set the certification in a hotel room? A possible explanation is that hotels served as a sort of meeting point for people living in rural areas and for doctors practicing far from patients’ residence. This location, however, surely did not help the patient to feel comfortable in his/her environment and it might have worked only for well-off patients. For farmers and laborers, in fact, the price of a hotel room should have been quite expensive also considering the fee reserved for the three physicians.
Besides hotels, certification was also performed in other buildings such as the house of providence and the asylum itself. Beginning in April 1876, there are records of certification taking place at the house of providence located in downtown Toronto. It is likely that such a Roman Catholic institution run by sisters and nuns sheltered many Irish newcomers who asked for certification when conditions seemed extreme. The case of James H. is an example. James was a 60-year-old Irish farmer with one daughter. His habits of life and cause of insanity were unknown. Dr. Hobly observed that James “imagines that sisters are frequently lying and stealing his clothing, he will answer very few questions if any correctly”. He also wrote that “sisters in the house, states that frequently leaves his bed at all hours of the night and alarms the rest of the inmates”. Witnessing the examination were “sister M. Sheila and sister M. Philomena”. James was admitted as a pauper patient on April 26 1876 (RG 10-268, B296102, Admission N° 4539).
In other cases, however, examination took place directly at the asylum. The first record indicating this occurrence is dated 1877. It is reasonable to believe that around the same year, people from Ontario and other provinces started to bring their loved ones to the asylum’s doors requesting admission. In order to fulfill the certification requirements more quickly, we know that in 1877 one physician started to certify incoming people right at the asylum. This physician was Albert Bouverman who stated in his Forms K that he practiced at the “asylum of Toronto”. An interesting case of this occurrence is that of Jessie E., a 30-year-old married woman who was brought by her husband from Winnipeg Manitoba all the way to Toronto for the purpose of confinement. Jessie was described of “sober and industrious” habits and the cause of her insanity was associated with the death of her only child and her sister. Her husband, John E., reached Toronto on March 5 1877. On the very same day, Jessie was certified by three physicians and admitted to the asylum at the price of $ 4 per week paid by her husband. What is interesting about this case is not only the rapidity of Jessie’s certification but also the names of the certifying physicians. In fact, Jessie was certified by Dr. Bouverman (practising at the asylum), W. S. Metcalf, and Joseph Workman (former superintendent of the asylum). Moreover, the name of Charles K. Clarke, future director of the Canadian Association for Mental Hygiene and leading eugenicist (Dowbiggin, 2003), appeared as a witness in all Forms K. Dr. Bouverman wrote about Jessie that “in a short conversation I found that she is extremely depressed for the death of her child; that she is unable to recognize her husband”. Dr. Metcalf, on the other hand, wrote that the “patient is reticent and suspicious. Not inclined into conversation”. Dr. Workman, ultimately, stated that Jessie manifested “delusions on the subject of poisoning”. Besides the opinion of her husband, these practitioners included in the facts communicated by other section, a letter from Jessie’s physician from Winnipeg. This physician was named Dr. O’Donnell and wrote in his letter that Jessie “suffered from puerperal mania” (RG 10-268, B296103, Admission N° 4796).
The case of Charles B. is another example of examination at the asylum. He was a 22-year-old single farmer from York, of “regular habits” and the cause of his insanity was declared to be “not known”. On February 17 1877, Dr. Bouverman explicitly wrote in his Form K that the examination took place at the “asylum for insane Toronto”. Dr. Bouverman observed that Charles was “extremely incoherent in his conversation, continually dancing about while I was examining him. Considers himself remarkably clever, says he has a splendid brain &c. Pointed to the clouds and asked what they tell” and that “says he knows what the stars tell”. Moreover, Charles admitted that “he has been in the habit of masturbation”. These observations were accompanied by his father’s opinion communicated to the physician: “his father states that he has become childish”. Witnessing the examination were two other physicians, namely Dr. Metcalf and C. K. Clarke (RG 10-268, B296103, Admission N° 4790).
This section has explored how examination was actually conducted in everyday episodes of civil confinement in Ontario. Personal examination involved a short conversation possibly followed by tongue and pulse checking. The production of consensus amongst all participants, moreover, targeted three domains of interest, such as speech, actions, and appearance. The factual description of these three areas developed according to several writing styles with doctors sometimes directly quoting patient’s own words. Particularly important was the territorial mobility of the certification setting. Examination, in fact, could be performed virtually everywhere including patient’s residence, physician’s office, house of providence, asylums, and even hotel rooms. Certification, therefore, constituted a very participatory and itinerant activity.
Archives of Ontario
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