Introducing Javi

 In this blog, we welcome Javi, who's already been really busy in his first month as Access Officer....

Hello, LHSA enthusiasts! My name is Javi García and I recently started my new role as LHSA Access Officer at the University of Edinburgh.

 While my goal was to break into the heritage sector, working in an archival and academic environment was not something I had previously considered. It wasn’t until I completed two internships at the Archives and Special Collections at the University of Glasgow and the Glasgow School of Art, respectively, that I realised the versatility of archives to reach out to different audiences and impact them positively. From cataloguing and digitisation projects that facilitate access to collections for everyone to research and enquiry work, those initially daunting volumes and documents became meaningful, unique, and, often, poignant primary sources that tell hidden personal stories and resonate with very diverse communities from all four corners of the globe.

 But… what is an Access Officer? I lost count of the number of times I have been asked this question in the last month. Broadly speaking, I am the person responsible for facilitating access to our collections both in-person and online. Amongst my tasks, I will be researching and replying to non-confidential enquiries, liaising with Heritage Collections staff and external stakeholders to increase audience engagement, delivering talks/workshops/tours, preparing and supporting seminars and teaching, processing digitisation orders… You name it. With this in view, and while it could be argued that LHSA collections present a number of challenges based on the sensitive information they contain, I see this as an opportunity to think of new ways to reach out to as many potential service users as possible; such as underrepresented groups, healthcare students and professionals, and local communities. Our team shares the goal of making our archive accessible to everyone and always encourages people to get in touch with us or make an appointment in our Reading Room to peek at some fascinating items. So, if our kind readers could help us spread the word, that would help us enormously!

To give everyone a flavour of the types of activities I have been involved with so far, I helped co-deliver a Summer School session during my first week for a group of 20+ students who are interested in pursuing a career in heritage. They were introduced to how to access our archive in contrast with the University’s Heritage Collections. They also had the opportunity to dive into (and handle!) some of our collection items to answer a series of real-life family history enquiries. It was great to see them engage with an array of written accounts, challenge their findings, and reflect critically on the differences between the records and present-day archival work. On a more personal note, it was a fulfilling experience as a recent graduate who finds himself “on the other side” for the first time and feels his journey has come full circle.

Nurse training records, like this page from a volume covering nurses trained in the Royal Infirmary of Edinburgh, were used by Summer School participants to track down enquirers' relatives (LHB1/97/1)

Similarly, our team participated in the recent Doors Open Days festival at the old Royal Infirmary of Edinburgh, which has been recently reimagined as the Edinburgh Futures Institute. We delved into the past and explored life as a patient or member of staff at the old Royal and displayed a fascinating selection of items drawn from the hospital’s archives including plans, photographs, letters and even recipes! Hats off to our amazing Archivist, Louise, for ensuring everything was in place for a smooth delivery of the event. The turnout exceeded our expectations with almost 700 people visiting our space, many of whom worked, were admitted to, or visited the Royal Infirmary at some point in their lives. We thoroughly enjoyed listening to them reminisce about their experiences and felt how their testimonies brought the archive to life. The event also allowed us to knock down some of the barriers we face daily as a team. Visitors got to know the faces behind their computer screens and enquired about the scope of our work. I felt it was an incredibly beneficial exchange for everyone. Archives can sometimes be seen as secluded bunkers of knowledge and the event helped us establish some new relationships and consolidate some existing ones with part of our online audience.

Visitors during Doors Open Day, 28 September 2024 @Chris Scott

My first month working with the LHSA team has been an intense and rewarding journey. I am really proud to be part of our small, yet mighty team and can’t wait to see what the coming months hold for me.

Stay tuned.

‘The problem must be simply one of management. One cannot speak of cure’. Attitudes towards homosexual patients at Jordanburn Nerve Hospital in 1930s

Please note that the historic case notes include homophobic and queerphobic views.

In this blog, I will cover the treatment received by a patient who was diagnosed as 'homosexual' at Jordanburn Nerve Hospital (JNH) in the 1930s while also exploring the contemporary views and attitudes held by JNH psychiatrists towards homosexuality.

P/PL7/B/J/001 photo of the exterior of Jordanburn hospital, with nurses on the porch by the beds, c. 1920s.

Homosexuality was included in the World Health Organization’s list of the International Classification of Diseases (ICD-9) in 1977 and wasn’t declassified as a mental health problem until 1990. In Scotland, homosexuality was finally decriminalised almost ten years earlier in 1981. Edinburgh in 1930s was a rather hostile place if you were queer, as William Merrilees 'War on Homosexuality' would suggest (here is an excellent blog post about this disturbing part of Edinburgh's history). 

Jordanburn Nerve Hospital opened in 1929 to treat voluntary patients (also known as ‘informal patients’, voluntary patients give their consent to receiving in-patient treatment at the psychiatric hospital) in the early stages of mental illness. Over the last few weeks, I have read most of the case notes relating to men who were diagnosed as ‘homosexual’ within the JNH admission register (1929 – 1964). I was struck by one man, David (not patient’s real name), who was admitted several times throughout 1930s, suffering from severe depression and suicidal thoughts. The diagnosis column of every one of his admission entries, is populated by the word ‘homosexuality’.

LHB7/38/1 The JNH admissions register (11 Apr 1929–21 Mar 1951), note the word 'homosexuality' under the 'Diagnosis' column - just underneath 'Melancholia' and 'Mental Depression'. 

When David was first admitted, a psychiatrist recorded his impressions of his case and writes about potential ways to ‘cure’ homosexuality.

LHB7/CC1  Case notes detailing the psychiatrist's impression of David's case. The JNH psychiatrist notes that David identified himself with the female sex at an early age. He goes on to theorise that this may be due to an 'endocrine or chromosomal factor'. 

The psychiatrist also mentions that 'several attempts have been made to combat homosexuality by grafting healthy testicular tissue either of man or monkey into the patient with favourable results'. The case notes reference the work of Eugen Steinach (1861 - 1944), an Austrian physiologist who studied the relationship between hormones and sexuality. Steinach also sought to develop a “cure” for homosexuality. During the inter-war period, Stienbach conducted a testicular transplantation on a homosexual man using the testes of a heterosexual man - allegedly “curing” the patient of his homosexual tendencies.  
Image courtesy of the Wellcome Collection. 

The psychiatrist states that: ‘We have no means of telling just how much of his condition is organically and how much is psychologically determined and even though the latter be the more important such an authority as Havelock Ellis states that he knows of no case in which an analysis was successful in changing a homosexual condition into a heterosexual one.’

 Havelock Ellis (1859 – 1939) was a sexologist who wrote the first, serious and comprehensive textbook on homosexuality (which he called ‘sexual inversion’) in 1897. The book sought to present homosexuality not as a vice nor a crime (not even necessarily a disease) but as a natural part of human sexuality with Ellis even advocating for homosexual practices to be made legal.
Image courtesy of the Wellcome Collection.

Within the case notes relating to homosexual patients the idea of ‘constitutional’ or ‘acquired’ homosexuality is often put forward. Below is a transcript where the JNH psychiatrists are discussing another patient, George – to whom they are decidedly more sympathetic. Interestingly, the psychiatrists draw comparisons between David’s case and George’s. 

LHB7/CC1 - extract from case notes. JNH staff discuss the patient George as well as their views on homosexuality. They are supportive of George marrying in the future and seem to believe that his 'anxiety state' is caused by homosexuality. Prof Henderson makes a case that there is a link between constitutional and environmental factors which may then result in homosexuality. To illustrate his point, he states that people who have a 'predisposition to crime' who may also live under poor environmental conditions, can then 'set the train alight' (i.e they may become criminals). 

LHB7/CC1 - extract from case notes. According to Dr Jones, George 'is in such contrast to the usual homosexual. The usual homosexual has nothing approaching an anxiety state about his condition'. According to Prof Henderson, however, homosexual men do have 'a definite feeling of remorse... when they find themselves in awkward situations, when they see themselves getting into the hands of the police, or coming into undue publicity'. 

Prof Henderson describes George as ‘being more an acquired than a constitutional homosexual’. The idea that a man's physical appearance could be evidence as to whether or not he was a constitutional or acquired homosexual is demonstrated through Dr Munro comments on George’s physical appearance:‘the narrow shoulders and broad pelvis - rather the constitutional homosexual type’. Dr McInnes, on the other hand, believes George to be an acquired ‘type’: ‘because it is in the constitutional type that you do get this attitude of superiority’. This perceived ‘superiority’ is recorded within another document in which Dr Jones comments on David’s own feelings regarding his sexuality:

LHB7/CC1 The JNH Psychiatrist records David's attitude towards his sexuality: 'He feels that his attachments have been something out of the ordinary, and one feels that he thinks them better than the more usual heterosexual attachments'. 

Within David’s case notes there is a transcript of a staff meeting which included Professor Henderson and Dr Jones, other JNH staff and the patient himself. After a brief interaction with David, the transcript notes ‘Exit Patient’ and the seven doctors proceed to discuss his case while also sharing their thoughts on the ‘issue’ of homosexuality. 

LHB7/CC1 - extract from case notes. JNH staff discuss the patient David as well as their views on homosexuality. Prof Henderson states that 'there are at the same time people who say "Oh well homosexuality is a thing that is natural to a certain group of people". Should we sanction it and allow it to go on? I feel that it is dangerous problem so far as the State is concerned to accept a point of view such as that, both for the individual and the race'. 

LHB7/CC1 - extract from case notes. Dr Spence states that 'these people are a social menace. But if you are going to put all homosexuals into mental hospitals, you will need a great many more mental hospitals than we have at present!'. Dr Jones comments that David 'doesn't want to get better'. 

LHB7/CC1 - extract from case notes. Dr Denholm Young offers her view on homosexuality stating that: 'I don't see why the man is such a danger - as long as he lives with a homosexual man. It would prevent two women being unhappy, since they are not fitted to marry. They would not harm anybody else, and if this physical relationship gives them relief, and helps them to get on with the work - why not? If the idea that it is a danger to the rest of the community is that it might spread in the community - well, I don't see how it could'. 

Portrait of David K Henderson 

Sir David Henderson, who was the physician superintendent of the Royal Edinburgh Hospital from 1932 – 1954, discusses the approach psychiatrist should have towards homosexuality, namely that they shouldn't sanction it. When asked whether David is the sort of man who would go after homosexual boys, or if he would harm 'normal boys', Henderson replies that he would harm 'normal' boys. He goes on to say that 'a person who preys on others like that should not be altogether at large in the community. One has no idea who will be affected, or how. He is a danger, a man of this active type'. 

Henderson’s feelings towards the ‘condition which serves no biological purpose’ remained consistent throughout his tenure at Jordanburn as can be seen in this section on homosexuality within Henderson and Gillespie’s Textbook of Psychiatry.

Henderson and Gillespies's Textbook on Psychiatry For Students and Practitioners (1962). The section on 'homosexuality' (under the section on bestiality) is found in the chapter on 'sexual anomalies' along with masturbation, Scoptophilia and Exhibitionism, Transvestism and Fetishism. The full textbook is available here: https://edin.ac/3M71tCg

Dr Jones discusses his anxiety around discharging David – he would like to help David using ‘more heroic measures’ and states that ‘to be in a mental hospital for life is worse than unsuccessful castration’.

These more heroic measures involved the Physiologist Dr Bertold Wiesner (1901 – 1972) who at the time was head of Sex Physiology at the University of Edinburgh's Institute of Animal Genetics.

Bertold married the obstetrician Mary Barton and together they managed a Fertility Clinic in London during which time Bertold’s sperm was used to artificially inseminate women - it was alleged that he was the biological father of over 600 children.

It appears that Dr Jones contacted Wiesner due to Wiesner’s work around endocrinology, believing that David’s homosexuality, as well as his identification with the female sex, was due to some kind of hormonal, or endocrine, issue.

When Dr Jones initially contacts Wiesner he described David as ‘a man who, as long as he can remember, has identified himself with the female sex. This man is a passive homosexual who wishes to play the female role in the sexual sphere’. According to Dr Jones, homosexuals who, like David, display ‘physical signs of femininity’, are more difficult to change. Whether the change he refers to is from gay to straight or whether he means change in the sense of an alleviation of mental suffering is unclear but I feel the former is more likely. He does refer to other cases of homosexuality responding fairly satisfactorily to psychotherapy (again, I’m not sure if the positive response to psychotherapy refers to the men feeling better about themselves or if they somehow became straight). Dr Jones goes on to write about the ‘hopelessness’ of the situation stating that he had ‘seriously considered the question of castration. Professor Henderson, however, vetoed the idea’ (in one of the case notes Dr Jones writes that the patient himself considered castration, however, the ‘uncertainty of the psychological effect of such a procedure, the ethical aspect and the physical caused this to be abandoned’). Jones continues: ‘I am convinced that there is more than the psychological factor here, I think I am justified in approaching you as to the possibility of any glandular therapy being beneficial in this case’. The letter indicates the patient was, at this time, ‘intensely miserable’ and ‘prepared to try anything’.

LHB7/CC1 Extracts from case notes: Wiesner agrees that 'castration in a case of this description would be of no objective advantage' and scraps the idea of a 'rational glandular therapy', writing that 'we do not know enough about the factors which direct the sex drive, even though we can state that these factors are of a chemical nature.' Wiesner agrees to carry out some tests stating that 'it is of great value to investigate at least some such cases with the methods usually applied in hormonic analysis'.

LHB7/CC1 - extract from case notes. Dr Jones relays his conversation with Dr Wiesner regarding David's treatment. In it, he mentions 'an extract' which was to be administered to David with the idea of stimulating 'the staticula secretion' and so counteract the female tendency.' 

LHB7/CC1 - extract from case notes. Wiesner's secretary send one bottle of 'gondatropic extract' which was then injected into David in order to 'counteract the female tendency'. 

It would seem that these extracts made no difference to the patient as Dr Jones sends a letter to Wiesner saying that the extract which Wiesner sent was almost finished but that the‘situation remains as difficult as before’.

LHB7/CC1 extract from case note

Wiesner writes back to say that there would be no benefit in continuing the treatment and states that ‘there remains one desperate remedy’ which he asks to discuss with Dr Jones on the phone as it is ‘rather involved’.

LHB7/CC1 extract from case note

What this remedy is can be gauged from a later document written by Jones. 

LHB7/CC1 - extract from case notes.  It would seem that Wiesner did not find any abnormality in the hormone content of David's blood. Wiesner debunks the effectiveness of testicular grafts for 'curing' or 'treating' homosexuality, instead believing that the 'direction of the sexual drive is dependant upon the anterior pituatory hormone'. He also stated that 'a certain control of the sexuality of rats is now possible by the use of anterior pituatory hormone or the surgical removal of the anterior part if the pituatory'. Wiesner also believed that in 'the next year or two it might be possible by the use of anterior pituatory hormone to control the sex drive sufficiently to make such a case socially adaptable'. 

The location of the Pituitary Gland (mispelt 'pituatory' in Dr Jones' case notes).

Wiesner therefore proposes two modes of treatment: the first being deep x-ray therapy of the sella turcica (where the pituitary gland is located). Wiesner admits this method is ‘not very scientific in that we did not understand exactly what might happen’. The second, ‘as advocated by Hirschfeld, no scientific method should be tried at all and the patient should be encouraged to practice overtly his aversion’. 

Wiesner mentions Magnus Hirschfeld (1868 – 1935) who was a German physician and a LGBT rights activist who set up the Institut für Sexualwissenschaft ('Institute of Sexual Research') in Berlin in 1919.

It's worth mentioning that JNH staff would adopt hormonal treatment on homosexuals at JNH later on in 1940s as Roger Davidson wrote in his paper Psychiatry and homosexuality in mid-twentieth-century Edinburgh: the view from Jordanburn Nerve Hospital:

In the late 1940s, Professor Henderson had collaborated with Derrick Melville Dunlop, Professor of Therapeutics at the University of Edinburgh, on research at the Royal Infirmary into the use of hormones in the treatment of homosexuality, following American reports of advances in this field. A group of JNH’s patients ‘who had proved resistant to psychiatric treatment and who were anxious to have their homosexual tendencies reformed’ had been referred to Dunlop. However, the results of the treatment had proved ‘completely negative’, although the therapy was claimed to have induced ‘marked feminine changes physically in practising sodomites.

During David’s first stint at JNH he decides to leave, and his case notes reveal the psychiatrist’s thoughts on his future wellbeing stating that although his ‘agitation’ has subsided ‘the outlook in a case like this is extremely grave’. The perceived gravity, according to the psychiatrist, was due to David’s ‘type’ of homosexuality which prevented him from ever becoming heterosexual. David’s hope for the future ‘lay in his ability to resign himself to such a situation and sublimate his energies’. 

What strikes me about this case is the psychiatrist believing that David will probably never get better because there was no chance he could ever ‘recover’ from his homosexuality. In the mid-1950s David was referred to JNH once more and the psychiatrist who examined him described him as a ‘long-standing homosexual, with features of inversion going well back into childhood’. In his mind, an ‘emotional adjustment seems barely possible in a man of his age with such history. The problem must be simply one of management. One cannot speak of cure.’ 

LHB7/CC1 extract from case note ater David's first admission. 'Patient left today of his own accord. He was advised to stay longer but this he refused to do'. 

The psychiatrisation of homosexuality is an extremely disturbing and poignant part of queer history. David was just one of the homosexual men who sought professional help for their mental health. It is deeply unsettling to read that, instead of getting the mental health support they much needed, the professionals they turned to would scrutinise and pathologise their sexuality. It is also upsetting to read the psychiatrist’s insistence that if these patients would simply ‘change’ or ‘manage’ their sexuality they could alleviate some of their mental suffering. 

The Lothian Gay and Lesbian Switchboard (the UK’s first gay helpline and Scotland's first gay charity) collection often provides some light and optimism when it comes to queer history and counteracts the disturbing and biased voice within some of our historic institutional records. 

The Lothian Gay and Lesbian Switchboard (LGLS) was a key source of support to LGBT+ people across Scotland and the UK. They campaigned and advised on sexual health, mental health, and equality issues, and worked with the NHS and Scottish Government in health education and social and economic research. LGLS provided a listening service and in-person befriending service to people struggling with issues or difficulties relating to their sexuality. Volunteers were available to listen to callers concerns as well as provide practical information, which included passing on details of gay-friendly organisations, counselling professionals, and sexual health advice.

The helpline was established after the gay rights organisation, the Scottish Minorities Group (SMG, founded in 1969) received a request from the Samaritans, who wanted to refer their clients to a specifically LGBT+ organisation. SMG also conducted an inquiry in their opening year, which looked into the views of people who were likely to be concerned with the gay community (including psychiatrists, social workers and clergy) to find out more about the social needs of homosexuals. The results confirmed that loneliness and isolation was the major problem facing homosexuals in Scotland at that time.

The below document found within the LGLS collection, dated 1978 (30+ years after David’s first admission, and a year after homosexuality was added to WHO’s list of International Classification of Diseases), shows how the Scottish Minorities Group were invited to provide a one-day workshop to staff at the Royal Edinburgh Hospital on Sexual Attitude Reassessment - which included a session on homosexuality. 

GD61/5/2/1 a one-day workshop on Sexual Attitude Reassessment held at the Royal Edinburgh Hospital, 27/05/1978.

The diagnosis ‘Insanity of Masturbation’ within the Royal Edinburgh Hospital case books, 1862 - 1866

The 19th century case notes contain some derogatory and offensive language and themes of a sexual nature.

Page from one of the Royal Edinburgh Hospital 19th century Case Books

Edward Henry Hare begins his impressive 1962 article Masturbatory Insanity: The History of an Idea by stating ‘A hundred years ago it was generally believed by the medical profession…that masturbation was an important and frequent cause of mental disorder. Today no one believes this; and the masturbatory hypothesis (as we may call it) has in all probability been finally abandoned.’

"He was young, handsome; his mother's fond hope". This illustration is from an 1830 book titled Le Livre Sans Titre (The Book with No Name). The book concerns the perils of masturbation and includes a sequence of illustrations showing a young boy's descent into ill health due to his indulgence in 'self-abuse'. Images courtesy of Dittrick Museum.

 

"At the age of 17, he expires, and in horrible torment"

The belief that there was a connection between masturbation and ill-health made its debut into Western popular culture after the publication of the best-selling book, titled (ready for it): Onania, or the Heinous Sin of Self-Pollution, and All Its Frightful Consequences, in Both Sexes, Considered, With Spiritual and Physical Advice for Those Who Have Already Injur'd Themselves by This Abominable Practice (c. 1712 - 1716). As you may have guessed by the title, the book is, in essence, a cautionary tale. It is mostly comprised of moralistic admonishments, but the author does touch on how the ‘heinous sin’ of masturbation carries physical consequences as well, even possessing the potential to induce madness or epilepsy. For men, the loss of semen incurred from the act of masturbation would lead their offspring being born ‘commonly weakly little ones, that either die soon or become tender, sickly people, always ailing and complaining; a misery to themselves, a dishonour to humane [sic] race, and a scandal to their parents." 

Michael Stolberg reflects in his article Self-Pollution, Moral Reform, and the Venereal Trade: Notes on the Sources and Historical Context of Onania that: ‘The work's original format was that of a moral treatise, which used medical arguments to support the basic notion that masturbation was a heinous sin against God and nature.’ The author of the book Onania does suggest some remedies and tinctures and a ‘prolifick powder’ for 12 shillings which could help the ‘Injur’d’s’ genitals recover from the ‘abominable practice’.

1756 edition of Onania. 
Courtesy of the Wellcome Collection.

The book was incredibly influential, even capturing the attention of eminent physicians like Samuel-Auguste Tissot who further proliferated information on the array of negative effects masturbation can wreak on the mind and body through his own 1758 book Onanism, or a treatise upon the disorders produced by masturbation.

Skip forward a 100 years and there’s a flurry of patients diagnosed with ‘Insanity of Masturbation’ within the Royal Edinburgh Hospital (REH) case books. You can find the majority of these cases within volume 15 (female patients) and 16 (male patients). These case books cover the years 1862 – 1866, coinciding with the period David Skae was Physician Superintendent of the REH. In fact, it was Dr Skae who was the first to maintain a specific type of insanity due to masturbation. Allan Beveridge wrote in his article Madness in Victorian Edinburgh that: 'Some of Skae’s categories, notably that of Masturbatic Insanity implied an aetiology that was debatable. In fact, although masturbation was repeatedly commented upon in the patients’ case notes, it was only occasionally used as a primary diagnosis.'

In his paper Of the Classification of the Various Forms of Insanity (1863), Skae describes the symptoms prescribed to the ‘masturbators’:

'...the vice produces a group of symptoms which are quite characteristic and easily recognized, and give to the cases a special natural history: the peculiar imbecility and shy habits of the very youthful victim; suspicion and fear and dread and suicidal impulses and scared look and feeble body of the older offenders, passing gradually into Dementia or Fatuity'.

Portrait of David Skae (1814-1873)

I have read all of the case notes relating to REH patients who were diagnosed with Insanity of Masturbation (IM).  It has been an interesting experience, although often rather sad and perplexing. 

It’s curious to note the differences in the descriptions of the symptoms of the female and male patients diagnosed with IM. The women are described as being extremely restless, talkative and sexually forward (reminiscent of the symptoms associated with the once common medical diagnosis of Hysteria). In several instances, the physician notes how the female patient would appear or act overly sexual:

‘Very salacious’

‘Expression very emotional, confused, sexual…’

‘…has an ugly lecherous smile on her face’; ‘The prurient expression of her face still remains’.

The male patients with IM however, are often described as taciturn, shy, physically weak, pale or ‘pasty’ with a strong aversion for making eye contact. There are a few examples of this description within the case books:

‘Pasty, unhealthy complexion…. Rarely looks at you when speaking’.

‘His face is full and puffy, his complexion pasty and unhealthy, his eyes watery and his expression nervous, scared and downcast. His appearance and manner are strongly suggestive of a masturbator.’

‘This patient is a respectable looking lad, with a good, intelligent face but with a nervous, restless, anxious expression. His eyes do not look at you when he speaks but are constantly moving about and if you catch them, they drop almost immediately.’

‘He is an unhealthy looking lad with a pale, pasty complexion and is much emaciated. Does not look more than 16. When this was remarked to him he expressed…that it was all due to masturbation: this he has been observed to be addicted to, to a frightful extent.’

'A gaunt adolescent consults a weary specialist'. Colour process print after C. Josef, c. 1930. Image Courtesy of the Wellcome Collection.

This last patient recovered and gave up his ‘habit’ which the physician believes made a marked difference in his appearance: ‘there is a wonderful change in his appearance, is now stout, healthy looking boy with a fresh, pleasant face’.

For one man there is noted 'this patient's insanity was attributed to masturbation but he himself denies ever having been addicted to this vice'. In The History of an Idea, Hare discusses the difficulty physicians faced in ascertaining whether a patient has masturbated or not, this he says, 'was solved on the principle of Morton's fork: those who admitted masturbation were believed, those who denied it were disbelieved'. 

I was particularly interested in one female patient. Described as being a lady ‘of excellent education and steady industrious habits until her present illness’, her ‘insanity is to a very great extent dependent on her habits of masturbation.’ On her first admission she had shown some improvement ‘but relapses during the time of menstruation, when she behaves very stupid...’.

On this note, her menstruation, and the effects it has upon her person, is frequently remarked upon (which isn’t unusual within the case books):

‘Menstruation regular, habits very much improved; very bad woman when menstruating which is now the only time at which she masturbates’.

‘Sleeps very well except just before menstruation’

On her second admission the physician notes that he thinks she suffers from nymphomania.

There was one entry which I was rather shocked by:

‘Cauterization of the vagina has been tried, but with no good effect – previously her hands had been restrained at night by means of gloves; but although her bodily health certainly improved, no material improvement was noticeable in the mental symptoms. She also has delusions as to the identity of persons around her, and says her mind seems to enter the body of others.’

This is the first time I’ve come across mention of cauterization of genitals at the REH. I'm not sure why the procedure was performed in this instance - if the intention was that of preventing the patient from masturbating.

In the 1879 Manual of Psychological Medicine, there is a reference to cauterization as a way to prevent patients from masturbating: 'Blistering the prepuce we have found useful, but only for a time'. In the same excerpt, it is described how Dr David Yellowlees (who was the Physician Superintendent of the Glasgow Royal Asylum from 1874-1901) adopted 'wiring' as a treatment for male patients who masturbated: 'Dr Yellowlees rings the prepuce with silver wire, as the snouts of swine are wired to prevent their routing. The plan is ingenious and has been to a certain degree successful.' The author then adds 'In females even clitoridectomy has failed'.

Isaac Baker Brown's The Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females (1866). Brown's thesis presented in this volume was that nervous affections complicating diseases of the female genitalia were the direct result of "peripheral excitement of the pudic nerve" or masturbation. Brown proposes clitoridectomies as a cure to these afflictions and performed numerous such operations on women until his career ended in scandal when it was revealed that many of his patients hadn't consented to receiving the procedure. 

Comments within the case notes regarding patients masturbating are almost always written with a condemnatory tone, with the act being heavily stigmatised and pathologised. Although Skae's successor, Dr Thomas Clouston (1840-1915), initially agrees with Skae's belief that masturbration caused insanity,  he eventually concedes that masturbation and dementia 'cannot be put as cause and effect'. Hare writes in his article The History of an Idea: 'What is curious is the fact that until late in the 19th century no writer seems to have asked the question, "How prevalent is masturbation in the community?" and very few seem to have appreciated that the answer to this question might have a bearing on the validity of the masturbatory hypothesis.'