Mental Health in Colonial Pietermaritzburg
13 Jan 2010

On 27 July 1855, the Mayor, Counsellors and burgesses of the City of Pietermaritzburg resolved to grant a piece of land, in extent 50 acres, of that part of the City known as Townlands, to the Colonial Government of Natal, for the sole purpose of establishing a Public Lunatic Asylum, later known as the Natal Government Asylum or Town Hill Hospital, and more recently forming part of the Midlands Hospital Complex.

It was not till 19 November 1873, however, that the deed of transfer was signed in which the Mayor formally ceded the land to the Colonial Secretary. On 1 July 1876, the Colonial Engineer was requested to submit a suitable design for approval by the Legislative Assembly so that the necessary money could be voted for building a Public Lunatic Asylum. A week later he replied that he had written to the Colonial Office in England requesting plans and estimates of the latest and most approved design for hospitals and lunatic asylums in Great Britain. Although he had not had a reply, the Colonial Secretary urged him to submit plans anyway since no money could be voted by the Legislative Assembly in the absence of plans or designs. On 18 July three designs were submitted by the Colonial Engineer's office. The first design was estimated to cost about £20 000 and designs two and three about £15 000. On 5 August 1876, 16 days later, the Colonial Secretary authorized the acceptance of design no. 1 and instructed that the necessary provisions be made in the 1877 Estimates for the erection of the building on the 50 acres granted by the City Council of Pietermaritzburg. The commendable speed with which the local bureaucracy expedited the matter must have gratified the City Fathers. The necessary surveying of the site was equally expeditiously completed and further instructions were issued from the Colonial Secretary's office to plant a large number of trees on the site to create a parklike setting for the building.

In February 1880 the inmates were transferred to the New Asylum on Town Hill from the Temporary Asylum, which had initially been attached to the gaol and had subsequently been relocated to a house at what is now 525 Longmarket Street. The Temporary Asylum had been opened on 1 February 1875 with 37 inmates who were moved from the actual gaol. The Lunacy Law of 1868 had made provision for the detention of the insane in gaols. Only a few 'idiotic, epileptic and paralytic' cases were treated in hospitals in Durban and Pietermaritzburg.

By the time the Colonial Government of Natal was legislating for the care of the insane, through the Lunacy Law of 1868, there was already a well-established system of state and private institutions in Great Britain for the care of the insane. In 1815 the House of Commons appointed a committee to inquire into abuses in these institutions. This resulted in certain reform measures which were again reviewed in 1828. These measures were partly initiated by medical/psychiatric experts, based on their changing views of the origin of mental illness and the proper treatment of the insane. A major change in the treatment was, for example, the abolition of physical restraints like handcuffs. These restraints were replaced by 'external reorganisation, proper nourishment, good ventilation, baths, more and better-paid attendants'.

Social activities like 'outdoor entertainment, concerts, even dances were introduced and the public was invited'. In addition, physical work was encouraged and the 'moral welfare' of the inmates was attended to by regular Christian worship. Instead of the unacceptable methods of 'personal restraints', a system of surveillance by attendants, in a building constructed to enhance this watchfulness, was introduced.

In how far these practices were applied in the colonial setting of Natal, can be gleaned from the annual returns and the Reports of the Lunatic Asylum Board submitted to the Office of the Colonial Secretary. In the first report of 1877 it is noted that handcuffs were still being used, but only in 'extreme cases'. A year later the District Surgeon directed that the use of handcuffs be discontinued in future and only seclusion under lock and key be resorted to.

It is further noted that provision had been made for various sources of amusement. The Colonial Government donated musical instruments (two concertinas), a chess set, a draughts board, 4 lbs. of marbles and 6 packs of playing cards! Ministers of various denominations were conducting church services on Sundays but the attendance was no more than 6 inmates at a time. White inmates refused to do any physical work.

The diet of the inmates was recorded in these early reports. Separate diet sheets are noted for 'Europeans, Kaffirs, Coolies and Hottentots' for the three daily meals. Judging by contemporary nutritional standards, these rations were deficient in certain essential vitamins, proteins and minerals. The nutritional status of long-term patients must have been appalling and could have induced pellagra, a condition with known psychiatric complications!

The staffing and management of the Lunatic Asylum was a matter which required the attention of the colonial authorities right from the beginning. A Board of Management for the proper running of the Temporary Asylum was appointed in 1875, consisting of the Colonial Secretary, the Resident Surgeon, the Mayor of Pietermaritzburg (ex officio) and a private citizen. The Male Attendant of the Temporary Asylum, and later first Keeper of the New Asylum, was John Smithwick, formerly a sergeant in the 75th Regiment, and recommended for appointment on 19 February 1875. Within a month of his appointment on 20 March 1875 he wrote a letter to the Colonial secretary's Office requesting certain staff changes. In the same letter he recommended that the 4 'Coolies' employed as servants at the opening of the Temporary Asylum be dismissed and that two 'natives' be employed instead as general servants.

In reply the Resident Magistrate agreed with some of the proposals, adding that it was not desirable that the Keeper should be the only European in charge since he would have to leave the patients under the protection of 'Coolie and Native' men should he leave the premises. When the matter was put to the District Surgeon for comment, he supported the Keeper's recommendation adding 'it is not in accordance with the arrangements which received the approval of the Colonial Government . . . to employ Coolies for the purpose'. He suggested that 'two intelligent Zulus, if procureable . . . should be employed instead of the Coolies'.

With an ex-army sergeant in charge, assisted by servants and guards, the care of the inmates could not have been much different from that of ordinary prisoners. It was not till the appointment of Dr J. Hyslop, as the first Resident Surgeon on 21 June 1882, that a more professional approach to the hospital care of the insane was instituted. Dr Hyslop came from the Royal Asylum in Edinburgh and would have been familiar with current care practices in Great Britain. He accepted the position at a salary of £400 per annum. In 1886 Miss E.M. Schaffer from England was appointed as Matron but only 'after some considerable difficulty owing to the smallness of the salary offered'. She arrived in Pietermaritzburg on 3 November 1886.

An Official Visitor, Brigade Surgeon Robinson, from the Fort Napier Garrison, was appointed in the capacity of Commissioner for Lunacy in accordance with the practice in Great Britain at the time. Some strained relationships developed between the Visitor and Dr Hyslop over the interpretation of the rules of visitation. The Colonial Secretary had to employ all his diplomatic skills to restore amiable relationships. The incident which started a minor feud between these two government officials arose from the fact that the Visitor wanted the identification of the inmates, according to race, to be done more frequently. He wrote on 16 August 1889:

'Identification of the Coloured people and Kaffirs is desireable more frequently than once a month as required by the instructions issued to the Official Visitor. The identification of European inmates and Africanders should not be of a formal character but each patient should be seen by the Official Visitor. . . The visits should be fortnightly'.

One such visit led to considerable distress amongst the patients and Dr Hyslop wrote a critical note to the Colonial Secretary's Office complaining of the practice. He suggested less frequent visits by the Visitor and that the visits should be by appointment rather than of the nature of a surprise. The Colonial Secretary cautioned that 'Common sense would appear to show that an identification carried out on the principle that obtains in a regiment on "general muster" day must have a deleterious effect on lunatics'.

The Lunacy Law of 1868 for the Colony of Natal made provision for procedures for the admission of patients via the office of a Resident Magistrate. Two medical officers had to examine the patient before admission could be finalized.

A very crude classification system was applied by the medical officers to identify the particular illness from which the patient was supposed to be suffering. The system provided for only four categories viz. (a) maniacal and dangerous (b) quiet, chronic (c) melancholy and suicidal and (d) idiotic, paralytic, epileptic. There was obviously great concern over 'dangerousness' since the Returns of the years 1877 and 1878 reflect the highest numbers of inmates classified in either category (a) or (b). This is not entirely surprising since the Custody of Lunatics Act No. 1 of 1868 provided mainly for the detention of the 'dangerousIy insane'. If seclusion and restraint did not prove to be effective, drugs were resorted to. From Case Books kept at the Public Asylum it is evident that potassium bromide, chloral hydrate and Cannabis indica (dagga) were frequently prescribed to patients who were 'wild and maniacal; restless and suicidal'. These drugs have potent sedative effects and are addictive if prescribed indiscriminately.

A particularly inhuman method of seclusion was devised by Dr Hyslop in 1887 to control female black patients. A large pit 30 feet long, 15 feet wide and 6 feet deep was dug, into which difficult patients were dropped daily. Hyslop found it necessary to justify this medieval method by saying that 'although at first sight it might appear a rather barbarous proceeding, the result fully justified the treatment adopted'.

An early example of a challenge to the system of classification/certification involved the rights of patients. It is to be found in a petition which a patient directed in 1901 to the Colonial Secretary requesting to see the papers by which he was committed. In refusing this request the Medical Superintendent wrote:

'I was following the universal practice at home. In this as well as in most cases where a similar request is likely to be made, the exhibition of the papers would have a most prejudicial effect on the patient'.

The Attorney-General, when asked to comment, concurred with the opinion of Dr Hyslop but at the same time wished to have the right of patients for access to their lawyers to be upheld. To settle the matter, the Colonial Secretary wrote to the Agent General for Natal in London asking for information about the practice in Great Britain and other countries on this issue. On 3 May 1901 the reply came from London:

'The Commissioners for Lunacy state that in this country there is no fixed rule about regulations on the point. The power is left to the Medical Superintendent to use his discretion. The request is rarely conceded.

With the increase in the number of patients (by 1901 there was a total of 366 of all races) extensions and new buildings became necessary. A new main building was completed in May 1891. By 1916 the number of patients was 746.

SOURCE: Pietermaritzburg 1838–1988: a new portrait of an African city, edited by John Laband and Robert Haswell (Pietermaritzburg: University of Natal Press and Shuter & Shooter, 1988), pp. 186–8.