Introduction

Although the two institutions were designed to care for different classes of patients, it is too simplistic to label Holloway Sanatorium a middle-class haven and Brookwood Asylum a stringent Poor Law asylum. This chapter examines the origins of the two patient populations and, in particular, provides an overview of the patients' journeys to institutional care, as well as their physical and mental condition on arrival. These factors had implications for the medical outcomes of both male and female patients, and thus the ‘success’ of both establishments in caring for and treating their patients.

The patients did not simply suffer from mental disorders; Brookwood admitted many patients who were in a poor physical condition that often was the result of poverty, intensified by either long-term or seasonal unemployment. At both institutions, patients arrived with evidence of having been mistreated or neglected by their carers. Some patients were also undernourished and some-times suffered from a range of additional illnesses at varying stages of severity. Yet others presented with a range of physical disabilities such as blindness or deafness which could prohibit an accurate diagnosis. These patients all required differing levels of care but it was the epileptic, dangerous and suicidal patients that provoked the most medical concern as these conditions could result in premature deaths in the asylum. Additional medical observations were implemented, such as a twenty-four hour watch or a suicide caution being issued for the actively suicidal.