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In this ‘Introduction’ Wallis highlights the importance of the asylum patient’s body to the study of mental disease in the late nineteenth century. The chapter questions why the body is often left out of histories of psychiatry, arguing that this is due to long-standing perceptions of the Victorian asylum as a place of incarceration and harsh treatment. Wallis asks how we can bring the body more meaningfully into histories of the asylum and suggests that we may achieve this by looking at scientific practices in the asylum. ‘Introduction’ concludes with a case study of the West Riding Lunatic Asylum, showing that this was an institution that fostered a research culture that was particularly concerned with the links between the body and mental disease.

In this chapter Wallis discusses how late-Victorian asylum doctors investigated and treated skin conditions, and what they believed these told them about the impact of mental disease on the body. Against a background of the growth of dermatology in the nineteenth century, this chapter reveals how disorders of the skin could affect asylum patients’ subjective experiences of the world, as well as exploring the place of practices such as surgery and phototherapy in the asylum. In addition, ‘Skin’ considers the role of medical photography in the nineteenth century asylum—of photographs as important items for teaching and sharing information about mental disease—including contemporary and present-day concerns about the ethics of photographing asylum patients.

‘Muscle’ considers how late nineteenth-century asylum doctors incorporated physiological theories and methods into their work. This chapter draws attention to the wide-ranging physical effects of conditions such as general paralysis (neurosyphilis), which often had serious socio-economic consequences for patients and their families. In addition, ‘Muscle’ explores how—given contemporary associations between general paralysis and sexual immorality—the physical signs of disease were bound up with ideas about morality and willpower. Wallis recounts how Victorian asylum doctors investigated the muscles and their movements, considering contemporary medical technologies and methods of examination. This chapter concludes by looking at the role of the asylum patient in such examinations, arguing that in many cases the investigation of mental disease was a collaborative exercise between doctor and patient.

In ‘Bone’ Wallis shows how late-Victorian asylum doctors discussed and investigated bone fracture among asylum patients. Recounting the key contemporary explanations offered for such injuries, including violence by asylum attendants and the behaviour of patients themselves, this chapter goes on to explore how bones became the object of pathological investigation. It discusses the role of the coroner’s inquest and the post-mortem, as well as the role of new technologies that aimed to quantify the strength of bones. This chapter demonstrates that many asylum doctors found it difficult to conclusively prove that the bodies of asylum patients were fundamentally different to those of other people. The attention given to fractures in the asylum, though, is shown to have had practical effects on asylum care and administration.

‘Brain’ explores the centrality of the brain in late nineteenth-century asylum practice: it considers contemporary theories about the organ’s connections to the body, and how asylum doctors studied the brain in their search for physical evidence of mental disease. Wallis considers the key features that asylum doctors identified in the brain of general paralytic patients, exploring how these interacted with and shaped pathological practices. As the pinnacle of the investigation of the body in the Victorian asylum, the brain was an important organ. But, as Wallis shows, in examining and preserving the brain asylum doctors often had to evolve new practices to deal with the degenerated substance of the brain marked by mental disease.

In this chapter Wallis explores how post-mortem investigation in the late-Victorian asylum informed both treatments during life and new ideas about the basis of mental disease. Wallis shows how trepanation (making a hole in the skull) was employed by asylum doctors as a means of draining excess cerebro-spinal fluid, discussing contemporary rationales for the procedure and ethical concerns. The chapter goes on to consider how other fluids in the body, such as urine, were also analysed by asylum doctors. Finally, as asylum doctors began to evolve a ‘toxic’ theory of mental disease at the end of the nineteenth century, Wallis demonstrates how new bacteriological understandings of mental disease could co-exist with older models that stressed the patient’s family and life history.