Psychiatry’s ‘Others’? Rethinking the Professional Self-Fashioning of British Mental Nurses c. 1900–20

Abstract

Despite facing manifold social and educational barriers, British asylum nurses across the long nineteenth century articulated distinctive professional identities as a means of leveraging their position in the medical hierarchy. This article draws upon a corpus of previously unattributed contributions to the Asylum News (1897–1919) – one of the first journals produced for the edification of asylum workers – to illustrate the diversity of medical personae developed and disseminated by these employees in the Edwardian era. Through scientific and creative works, nurses engaged with the pressing social and medical debates of the day, in the process exposing a heterogeneous intellectual culture. Moreover, as their writings attest, for some ambitious nurses these pretensions to intellectual authority prompted claims for medical autonomy, driving agitation on the hospital wards. The article thus strengthens claims for the ‘cultural agency’ of asylum workers and offers new insights into the cultural antecedents of professionalisation and trade unionism.

Writing in the December 1904 edition of the Asylum News – the first journal produced for the edification of mental nurses in Britain – the editor, George Shuttleworth, thanked the contributors to that year’s volume and petitioned his readers, ‘medical or others, who would be willing to write articles of an instructive character upon matters of practical interest to Asylum Workers’. ¹ This appeal, like many found in the publication during its print run (1897–1919), was directed primarily to its educated readers: the medical officers of asylums, who prepared nurses (or attendants, as male workers were often titled) for the certification examination of psychiatry’s peak professional body, the Medico-Psychological Association (MPA). Yet the ‘other’ asylum workers he acknowledged, including these working-class nurses, were eager contributors to the periodical; and while their articles lacked the technical polish that characterised the learned psychiatric journals of the period, taken together, they remain the largest printed corpus by these lower-status labourers in the period before the First World War and thus offer valuable insights into their professional aspirations.

The Asylum News was the print arm of the Asylum Workers Association (AWA), an organisation founded under the aegis of the MPA to facilitate the professionalisation of asylum nurses. After asylum attendants were rejected from the Royal British Nurses’ Association in 1895, it was determined that an organisation was needed to raise their status, albeit on their employers’ terms. The AWA was thus ‘a distinctly deferential organisation’, ² and the Asylum News served as its leaders’ mouthpiece until the Association dissolved in 1919 (the result of dwindling memberships). Edited by a succession of medical men, the journal staunchly promoted the interests of asylum officials, censuring the more radical demands of workers, including those made by the increasingly powerful National Asylum Workers’ Union (NAWU). Founded in 1910 to improve the economic position of asylum staff – and thus to address the failings of the AWA – the NAWU projected a militant proletarian ideology, which was at odds with the quiescent conformism of many of the Asylum News’s correspondents. ³ Perhaps for this reason, historians have undervalued many of the cultural or literary works published in the journal, instead surveying editions for more general information about institutional life or the political and economic interests of the AWA. ⁴

However, the editors were permissive in some areas, allowing the periodical to become ‘a forum for debate’ of pressing issues. ⁵ It also provided ambitious nurses with an outlet to promote their skills and intellect. Though more representative of popular periodicals than scientific journals – delivering essays, short fiction and poetry – the Asylum News nevertheless provided a print-space for the erudite elements of this workforce to demonstrate their knowledge; and in an effort to fill column inches, the under-resourced editorial teams showed themselves willing to print any submissions, however provocative the content. This eclectic array of literary productions provides unique insights into the accomplishments of mental nurses. Though Peter Nolan has argued that the Asylum News provided ‘little about training or the nature of the attendants’ work’, ⁶ a careful reading of all volumes undermines this claim: numerous poems and short stories detail nurses’ achievements and grievances, while periodical essays on the treatment of insanity highlight the heterogeneous cultural influences that shaped their therapeutic stances. This last point is particularly pertinent. Since the 1970s, several important studies have challenged the overwhelmingly negative stereotypes of asylum attendants perpetuated by Victorian-era critics, offering more balanced appraisals of these undertrained workers’ performances. ⁷ Yet, perhaps owing to the reliance of most of these studies on institutional records, historians have had more success in outlining nurses’ moral values and practical skills than their medical personae. ⁸ When therapeutic practices have been examined it has been generally assumed that attendants’ medical knowledge largely derived from the MPA-endorsed Handbook for the Instruction of Attendants on the Insane (1885), the standard text for trainee nurses. ⁹ While historians have not discounted the notion that different institutional training programmes may have encouraged distinctive therapeutic outlooks, ¹⁰ the influence of the workplace environment on the development of nurses’ medical knowledge has not been rigorously examined.

Evidence from the Asylum News can bridge this gap. As literary scholars have shown, working-class readers in the Victorian era were actively engaged in periodical commerce, utilising these publications to articulate political and intellectual identities. ¹¹ A close examination of mental nurses’ productions in the Asylum News can similarly reframe the study of their professional self-fashioning. The editors’ policy of printing reliable signatures for articles makes it possible to identify the names and locations of most regular contributors, thus offering a unique perspective into the experiences of particular nurses, as well as the influence of the institutional environment on their medical practices. That many of these contributions took conventionally ‘literary’ forms does not detract from their usefulness. In her study of literature and the early mind sciences Michelle Faubert has shown how Romantic-era psychologists used poetry to both communicate medical knowledge and represent their literary tastes and professional identities. ¹² By examining a wide range of writings by particular nurses, it is similarly possible to recreate their distinctive ‘scientific personae’ (i.e. the attitudes, traits and values that these writers believed essential to the production of scientific knowledge). ¹³

This article, then, will provide focused studies of two regular contributors from the nursing fraternity to the Asylum News to highlight the diversity of medical identities articulated by mental nurses in the Edwardian era. ¹⁴ In doing so, it will illustrate the cultural influences and gendered ideals that structured such personae, as well as the aspirations of the workers who entered this occupation. As their writings demonstrate, the more ambitious and educated subset of asylum attendants, at least, were actively engaged in the production and dissemination of medical knowledge, articulating far more novel and diverse ideas about psychiatric medicine and its practice than has been recognised in the existing scholarship. Moreover, by flaunting this intellectual knowledge, these nurses were following elite labourers in other industries in constructing a ‘skilled’ basis for their craft, from which other social and economic demands could be made. Such findings offer fresh insights into the professional self-fashioning of mental health workers and, consequently, the historical development of psychiatry’s medical hierarchies.

To better assess the wide-ranging interests and ideologies that shaped nursing work, writers from both sexes have been surveyed for this study. The first I will look at, the amateur poet and essayist ‘F.G.A.’, was the most prominent contributor among nurses in the journal’s formative years. He can be reliably identified as Francis George Allway, an attendant at Claybury Asylum, Essex, an institution opened under the auspices of the London County Council in 1893. Allway was a distinguished mental nurse, with strong links to the Asylum News. From 1908–10 he was listed as Claybury’s male Local Honorary Secretary to the AWA, and thus its correspondent to the journal’s editor. The other nurse I will examine signed her articles ‘A.E.M.’ and is undoubtedly Annie Elizabeth Macdonald, a Scottish nurse who moved between several institutions during the period she wrote for the Asylum News. ¹⁵ Macdonald was a regular contributor to the periodical in its later years, for which she was personally thanked by the editors in the final issue. ¹⁶ In both cases, these writers’ poems and short stories provide interesting insights into the social and intellectual milieux that shaped their occupational identities, thus offering a window into the lives of these medical ‘others’. ¹⁷

1 Social Darwinism and the Moral Economy of a Male Asylum Attendant

Francisco (Francis) George Allway was born into a working-class family in Horsley, Gloucestershire, in 1868. ¹⁸ The son of an agricultural labourer and domestic servant, Allway was employed as a baker early in life, before taking up a post at London’s St Luke’s Hospital, where he received MPA accreditation in 1894. ¹⁹ In 1896, after marrying Essex local Alice Faver, he entered employment at nearby Claybury Asylum, rising to the rank of first-class attendant within three years (a title bestowed on ward managers, and artisans on staff). ²⁰ By the time he stopped contributing to the Asylum News, around 1911, Allway had become one of Claybury’s highest-paid employees, earning £54 annually. ²¹

Allway was a regular contributor to the journal from his earliest submissions in 1904, supplying correspondence, essays and, his primary interest, poetry. That he was literary-minded is evident; Allway took second prize in the AWA Reading Union’s contest for a piece on Shakespeare’s The Tempest. ²² A subsequent poem, criticising nurses’ reading habits, earned him the moniker ‘Poet Laureate of the A.W.A.’. ²³ Tellingly, in a speech at the AWA’s Annual Meeting in 1908, Claybury’s Medical Superintendent, Robert Jones, mentioned his personal gratification ‘that one of my own staff, possessed of the true poetic spirit, delights the readers of the Asylum News’. ²⁴ Allway’s dedication to the Association and its periodical is evidenced by several articles lamenting the porous state of memberships: ²⁵ little surprise, then, that he took up the role as his institution’s Local Honorary Secretary.

Though Allway did not dwell on medical theory, he was well versed in contemporary scientific literature, offering commentary and advice to his peers. As would be expected, he cited the MPA Handbook as a core text for prospective nurses. ²⁶ However, when it came to a therapeutic ethos Allway displayed an attachment to a narrower conception of health and vitality; taken as a whole, his corpus was deeply indebted to social Darwinism and the associated doctrines of eugenics and degenerationism. Such philosophies would have greatly appealed to him. Shaped by the prevailing ideology of laissez-faire individualism, social Darwinism and evolution found widespread support, including from ‘respectable’ members of the working classes, like Allway, who adhered to the self-help ethos. ²⁷ Eugenics also appealed to ambitious medical professionals, offering them a new area of specialism to wield authority. ²⁸ Allway’s thinking was also, likely, shaped by his institutional environment. Claybury was a notable centre of Darwinist and eugenicist thought in its formative years. Superintendent Jones and his Assistant Medical Officer, Charles Ewart, published numerous articles on the associations between civilisation, degeneracy and insanity, ²⁹ while degeneration theory also shaped the findings of the London County Council’s pathological laboratory, operating at Claybury during the period of Allway’s employment. ³⁰

An important influence was Herbert Spencer, whose ideas about competition and social evolution (i.e. ‘survival of the fittest’) shaped Allway’s corpus. For Spencer, human development was driven by ‘increasing mechanical skill, intelligence, and morality’ ³¹ : a mindset that is evident in Allway’s 1907 article ‘Conquering Nature’, a wide-ranging essay on the progress of medical science. Opening with the pronouncement that ‘Science is engaged in an aggressive war with Nature’, he proceeded with a triumphalist narrative of medical science’s struggle with disease, humanity’s ‘active and powerful enemy’. This was explained as a survival of the fittest. Though lacking in ‘natural weapons’, its capacity for reason enabled humanity to break ‘the shackles of superstition’ and turn the sciences to advantage against germs and epidemics: the beginning of a providential march of progress, which would culminate in the prevention of ‘every form of disease’. ³²

In Allway’s view, insanity was a product of the corrupting influence of civilisation. Drawing upon degeneration theory, which held that industrial miasma fixed populations into cycles of moral and physical decline, ³³ he opined that the British working classes were suffering a ‘diminution of vital qualities’, which had subsequently created an epidemic of madness (illustrated by the sprawling asylums encircling the capital). ³⁴ Though acknowledging that degeneration was an inevitable process, Allway identified overcrowded cities as an accelerant, the squalor preventing workers from receiving the clean air and ‘healthy exercise’ that sanitation officials insisted was required for physical and mental hygiene. ³⁵

In a way, Allway’s critique reflected a Romantic conception of health, propounded by many contemporary social reformers. In their view, the lamentable degeneration of the working poor was a consequence of life in the urban slums, conditions which were attributed to the worst excesses of industrialisation. ³⁶ The figuratively ‘diseased’ could thus be conceived of as faultless in their condition; and, indeed, Allway was scathing of the system that condemned ‘sweated workers’ to work long hours in cramped conditions, while their employers, ‘enriched by their labour live in beautiful large houses amid invigorating surroundings’. ³⁷ Yet this was not boundless sentimentalism: the perpetuation of this purported underclass was, he believed, contrary to ‘the natural law of the survival of the fittest’, and Allway made clear that he saw the ‘enormous increase’ in this ‘forlorn mass of decadent human matter’ as a matter of grave concern, least of all for the maintenance costs. Though he refused to condone forced sterilisation, he did advocate for more ‘scientific’ methods of dealing with the threat of hereditary decline, namely the barring of ‘unfit’ adults from marriage and the forced removal of their children from ‘their unhealthy environment’. ³⁸ Given the medical theories propounded by Claybury’s officers, it is not difficult to see how Allway would come to adopt such views. ³⁹ Indeed, he was likely prompted by the officers: in a letter to the Asylum News, Claybury’s chaplain praised Allway’s writings on degeneration as being ‘full of common sense’. ⁴⁰ Whether many attendants shared these ideals is unclear: though existing studies of mental nursing highlight the convergence of eugenics with contemporary psychiatric doctrines, evidence of eugenicist thought among mental nurses specifically in this period is not well documented. However, given Allway’s obvious familiarity with social Darwinist ideologies, it is possible that such views were common among learned attendants before the passage of the 1913 Mental Deficiency Act, the most significant piece of eugenics-inspired legislation in Britain.

In line with his evolutionary ideals was an equally strident assertion that asylum nursing was a ‘hard’ science, subject to utilitarian principles. ⁴¹ In a poem titled ‘The Evolution of the Male Nurse’ Allway gave a potted history of his occupation, describing a gradual progression from the stereotypical ‘keeper’ of popular dread to the ‘era of male nurses’, a label that came into usage at Claybury at around this time. ⁴² This new generation of efficient ‘male nurse’ – the product of ‘modern scientific training’ – was viewed, quite literally, as a triumph of ‘evolution’, with the ‘older species’ of boorish attendant being ‘condemned to go’ by ‘the laws of natural selection’. ⁴³

Establishing a scientific basis for psychiatry was a necessary step towards its legitimation among the biomedical sciences, and, by the close of the nineteenth century, interested observers had worked to distance neuroscience and asylum medicine from metaphysics. ⁴⁴ Contemporary psychiatrists saw tangible benefits in the application of medical science to nursing. The framers of the Handbook incorporated basic medical treatments from its inception, and asylum officers experimented with courses of scientific and first-aid training, Claybury’s Robert Jones prominent among them. ⁴⁵

‘Scientific training’ in this period, particularly as it concerned amateurs, involved training in rudimentary skills of observation and classification. ⁴⁶ Such aptitude was thought paramount to work on asylum wards; as part of their regular duties attendants were required to scrutinise the physical and mental state of the patients under their care and report any disturbances to their medical superiors. ⁴⁷ Allway soundly endorsed such views, claiming scientific observation as a basis of human evolution. This principle was disseminated in a two-part essay, published in the Asylum News in 1906, which effectively set out his scientific ideology. As he argued:

It is the power to observe and act on the knowledge gained thereby which places man pre-eminent in the scale of creation, and enables him … to make the apparently unintelligent forces of nature his servants. ⁴⁸

Apart from the material benefits accrued through careful attention (the ‘best observers’ securing ‘the most honourable and lucrative positions’), ⁴⁹ the training of nurses in scientific observation was praised as a means of intellectual progress. Using Newton’s observation of the falling apple as an analogy – a demonstration that simple observation could uncover ‘important facts, which are far from being obvious to ordinary observers’ – Allway called upon workers to carefully scrutinise their charges, so as to provide practical assistance to their superiors. ⁵⁰ This emphasis on the accumulation of ‘facts’ was hardly innovative: the Handbook directed nurses to report signs of ‘failing health’ to medical officers to assist with their treatment of disease. ⁵¹ Such training served a conservative purpose, providing attendants with enough skills to competently staff the wards, without encouraging independence. ⁵²

Yet this was not a case of Allway kowtowing to his betters; he simultaneously challenged nurses to develop more innovative uses of their observation. He advised workers to educate themselves on the diagnosis of mental disorders and to compare a patient’s observable symptoms with the diagnostic criteria published in the medical literature as a means of independently verifying the material. ⁵³ This depiction of a nurse critiquing medical hypotheses adheres more closely to the ‘positivist stance’ effected by elite scientists of the day; in this sense, Allway could be seen to be coaching his peers to cultivate the diagnostic talents of their superiors. ⁵⁴ Certainly, there is evidence to suggest that the Asylum News’s readers took this view. In one illustrative article, published mere weeks after Allway’s essays, nurse Edith Owen described an unorthodox study she conducted into the prevalence of epileptic ‘Fits’ among her patients (documenting, for instance, the effects of environmental factors on the incidence of fits, including barometric pressure, wind direction and phases of the moon). In a passage that echoed Allway’s remarks, Owen explained that, after hearing some ‘observations’ made by her ‘superiors’ on the topic, she became determined to enquire ‘how far these statements were based on fact’. ⁵⁵

Allway’s effort to develop attendants’ diagnostic talents also reflects a desire to assert a ‘skilled’ basis for asylum nursing – a method by which artisans and trade unionists historically justified status or economic demands. ⁵⁶ While he did not provide systematic advice on the classification of patients, Allway did, in another instance, demonstrate said skills through a retrospective diagnosis of the biblical Saul. In the first book of Samuel, the king was shown to become increasingly mad with jealousy at his servant David’s growing popularity (1 Samuel 16–19, KJV). For the observant Allway, such actions indicated an ingrained depravity:

I am led to look upon [Saul] as a mental, moral, and physical degenerate, who suffered from attacks of temporary insanity which increased in duration and intensity as time went on, and resulted in his becoming afflicted permanently, because he developed fixed delusions of persecution and conspiracy, which occasioned attacks of homicidal mania. ⁵⁷

Allway was insistent that mental nursing was a respectable profession, and his claims for the latent skill involved were often paired with denunciations of his less dedicated peers. Criticisms of their purported intemperateness and degeneracy had long dogged working-class attendants, with little respite from medical officials, who viewed them as useful scapegoats for the failures of the curative asylum. ⁵⁸ Allway’s remarks in the Asylum News echoed these sentiments, and it is not too much of a stretch to suggest that he may have internalised these views. As Lee-Ann Monk has illustrated, in her study of asylum nursing in colonial Australia, self-consciously respectable attendants were willing to pronounce their moral superiority over less officious peers as a means of establishing status. ⁵⁹ Several of Allway’s poetic works similarly denounced the purported degeneracy of his colleagues, counselling attendants to sharpen their mental and physical qualities. ‘Philosophical Musings on Keeping Christmas’ chastised those ‘folks [who] spend Christmas time / In rivalry [sic] and riot’, while ‘Thoughts for the New Year’ implored apathetic readers stop squandering their talents (‘Better to work … / Than let our talent in the damp soil rust! / The world needs workers! wake from out your trance!’). ⁶⁰

To thrive in a respectable medical post required erudition, and Allway took great pains to recommend his true love, reading. Literature had long been regarded as a source of moral and aesthetic improvement for the working classes. ⁶¹ Such sentiments would have been particularly close to Allway’s heart; in the speech where he praised the attendant’s ‘poetical spirit’, Robert Jones explicitly linked this literary sensibility to his purported skill ‘as a kind, orderly, and conscientious mental nurse’. ⁶² Allway consciously bolstered this persona, reiterating through his poetry the moral benefits of literature. In ‘Lines on Neglected Literary Privileges’ he railed against those who did not ‘keep abreast’ of the ‘golden age’ of literature he saw around him, while elsewhere he lamented that workers might waste their energies in periods of ‘gluttony and tippling’, endorsing instead the healthier option of an ‘overdose / Of Byron, or of Kipling’. ⁶³

Given his intellectual pretensions it should not surprise that Allway held high ambitions for his occupation. As noted above, he had taken to referring to his position as ‘male nurse’, a contentious label in this period, yet one which held connotations of respectability, due to the association between female general nursing and middle-class gentility. ⁶⁴ The presence of female nurses on male wards created ongoing tensions in the early decades of the twentieth century; apart from the concern that these women were ‘threatening men’s jobs’, ⁶⁵ many male workers patently feared ‘coming under the authority of women nurses’. ⁶⁶ Allway sought to distance himself from the paranoia of some of his peers, asserting that while the ‘ladies’ were the ‘vanguard’ of the occupation, male nurses were equally capable, and that the only men who needed to fear these ‘warriors Amazonian’ were ‘sluggards’, who deserved their ‘thorough shaking’. ⁶⁷ Allway was exhaustive in articulating a rhetorical ideal of the ‘respectable’ asylum nurse, an issue of especial importance for him, as it was the stereotypical barbarity of male attendants that aroused so much animosity towards the occupation. ⁶⁸ In a 1909 poem, addressed to attendants who did not subscribe to the Asylum News, he spoke of the ‘proper pride’ felt by certified mental nurses, while praising the periodical for strengthening the occupation’s claim to a skilled trade. In appealing to his less officious colleagues to sign up, he contended that the ‘progressive times’ demanded a more professionalised corps, and slovenly workers risked being consigned to the ‘dust-heaps of the past’ – a further nod to his evolutionary ethos. ⁶⁹

Allway was acutely aware of his occupation’s low status. In selecting an analogy to describe asylum workers he chose the doormat: ‘down-trodden’ and ‘slowly wear[ing] away’ upon bearing the ‘degradation / Unthinking feet heap on me’. ⁷⁰ As a means of exciting the dignity of his (male) readers he penned a light-hearted biblical exegesis titled ‘The Ancient Order of Male Mental Nurses’, in which he claimed King David as the historical figurehead of their profession, the former shepherd having been called in to comfort the distracted Saul with his harp playing. As the reputed author of the twenty-third Psalm, David showed a ‘gentle and lovable personality’; however, Allway was quick to reiterate his suitably masculine qualities: ‘self-restraint, fearlessness,’ and ‘quickness in an emergency’. ⁷¹ Such a figure was thus praised as an exemplar for all attendants, and Allway exhorted them to ‘feel more pride in our occupation, and cease belittling it in our secret thoughts … know[ing] that such an immortal name is written at the head of the list’. ⁷²

Broadly speaking, these appeals to respectability (including his moralising remarks on his fellow employees) implied a tacit endorsement of the economic and social ideals of his superiors: ideals which ran counter to the perceived interests of the working classes. Several of his pieces endorsed the MPA-driven push for contributory pensions, the unpopular scheme that precipitated unionisation. ⁷³ Other articles praised the Asylum News and its editors, a problematic stance given the publication’s editorial priorities. ⁷⁴ When, in 1906, ‘F.G.A.’ defended the journal’s editor, as well as the leadership of the AWA, against criticisms that they had failed to promote the interests of regular workers, a fellow attendant accused him outright of being an asylum official under a pseudonym. ⁷⁵

Though I have no evidence to suggest any collaboration, it is certainly possible that Allway’s superiors advised on, or at least encouraged, the publications. Yet, for all his apparent acquiescence, it would be wrong to simply pass off Allway’s apparent deference as ‘false-consciousness’. ⁷⁶ These attitudes of moderation and self-improvement were typical of the so-called ‘labour aristocracy’, the more ambitious and educated subset of the working classes. Obsessed with independence and respectability, this class of labourers strove to embody middle-class values in all facets of life. ⁷⁷ This does not simply indicate their embourgeoisement; rather, it encouraged a militant self-respect, which in turn underpinned political and status claims. ⁷⁸ Consciously ‘skilled’ workers were more likely to be radicalised than their semi-skilled peers, and so to combine in defence of their economic interests. ⁷⁹ For all his stated moderation, Allway displayed a tough edge when discussing the value of nurses’ labour. From his earliest writings on superannuation benefits he asserted that pensions were a right afforded to workers who were broken down by years of service. ⁸⁰ Moreover, he was not averse to stronger methods when required. Perhaps stung into action by his aforementioned critic, in December 1906 Allway published a poetical ‘Plea for Justice’, in which he called upon ‘frightened’ workers to ‘Rouse up, and start a vigorous agitation’ against perceived hardships. ⁸¹ In a later issue, following revelations that the officers of Cornwall County Asylum had rescinded their contractual obligation to provide employees with winter coats, Allway put to verse a spirited defence of the attendants’ ‘rights’. At a time when ‘more skilful work’ was demanded of nurses – and so, logically, ‘more pay’ was expected for their labour – the idea to cut this wage substitute was ‘unjust and retrograde’ and unbefitting of an ‘enlightened age’. ⁸² Consequently, Allway endorsed a militant response, calling upon the impacted workers to ‘Strive manfully this backward move to stem’:

Mick Carpenter, the pioneering historian of nursing reform and trade unionism, has distinguished the demands and aspirations of unionised labourers from those of workers like Allway, raised to ‘professional’ status, asserting that the agitation of the former emerged as a response to the failure of professionalisation to raise the economic position of health workers. ⁸⁴ Carpenter is certainly correct in suggesting that a ‘proletarian ideology’ worked most forcefully on the more marginalised workers in the mental health system, denied social and economic mobility (for instance, uneducated, male asylum attendants). Yet the writings of Francis Allway suggest that, for some professionally minded workers, yearnings for status and financial independence worked in concert, with the former perhaps heightening anxieties about the latter.

Indeed, it is telling that, following the establishment of the NAWU in 1910, Allway shifted allegiances, taking up a prominent role in Claybury’s branch. He was delegated to attend the union’s Annual Conference in 1913 and, evidently, he even pondered contributing to its Magazine. ⁸⁵ One poem was actually published in his name (‘The Trade Unionist’s Psalm of Life’), which, with characteristic condescension, prompted wayward colleagues to find the ‘courage’ to join the movement. ⁸⁶ A conflict with officials from other branches put an end to this undertaking. ⁸⁷ Nevertheless, the fact that a self-styled professional would so involve himself in labour agitation testifies to the radicalism of elite labourers in the asylum workforce. In an ‘enlightened age’, hard-working and self-improving attendants felt entitled to adequate reimbursement for their ‘skilled’ labour.

2 Patriotism and Spiritualism: A Female Mental Nurse at Wartime

Annie Macdonald was another asylum nurse with pretensions to respectability. While biographical information relating to her early years is scarce, her public works indicate a distinguished asylum career. Macdonald was active in the pursuit of state registration for mental nurses and contributed to the militant British Journal of Nursing – the periodical of the International Council of Nurses. ⁸⁸ During the 1920s she would go on to present numerous lectures to the Royal British Nursing Association Club, London. Undoubtedly, Macdonald aspired to the gentility attached to the more steadfastly middle-class general nursing; however, given that her sole qualification was a less prestigious mental nursing certificate, it is probable that she was of a lower status than hospital nurses of a similar public standing.

Macdonald’s contributions to the Asylum News spanned from 1914 to the journal’s final volume, in 1919, during which time she changed workplace regularly. Originally a nurse at Bangour Village Hospital, near Edinburgh, she lived through that institution’s transition to a war hospital in May 1915, before moving to Norfolk War Hospital in June 1916. With her psychiatric training, Macdonald appears to have taken particular interest in ‘shell-shocked’ patients among the varied combat injuries she observed. Following her stint at Norfolk she moved to London’s St Luke’s Hospital in September 1917, where she provided home care to psychiatric patients, following the closure of the asylum’s primary site. ⁸⁹ As we will see below, her varying experiences of these institutions were also reflected in her writings, with key anxieties and life events explored through anecdotes and short fictional pieces.

Like Allway, Macdonald was an active member of the AWA and an avid reader of the Asylum News. She too was awarded an essay prize, for a contribution titled ‘Nursing the Insane in Private Dwellings’, written during her time tending to boarded-out patients at St Luke’s. Furthermore, as noted above, other regular submissions were personally praised by the editors. No doubt owing to this ongoing correspondence, Macdonald was elected to the AWA’s Executive Committee in 1918, before being selected to represent the Association’s female members before the Select Committee on the Economic Position of Nurses the following year. ⁹⁰

The overwhelming preoccupation of Macdonald’s writings was the European war – the ‘all-absorbing topic’ of the time, as she put it, and one that she was deeply invested in. ⁹¹ Indeed, her first signed article, published shortly after the outbreak of hostilities, described the ‘latent excitement’ experienced by an asylum’s nursing corps at the rumour that a colleague had been ‘summoned to “duty at the front”’. ⁹² Such remarks reflect a blossoming patriotism, evident among women of all classes in the early stages of the war. ⁹³ Though a deeper pessimism towards the conflict emerged in her writings as the war progressed, Macdonald’s core message was reiterated in a succession of articles and short stories: Britain’s ‘bravest and best’ were sacrificing their lives on the battlefields of Europe, and as ‘citizens of a great empire’ it was the duty of all remaining at home to assist their efforts. ⁹⁴ This was not a controversial posture; in its opening phase, at least, the war received broad support from asylum workers, from officials to union leaders. ⁹⁵ Institutions regularly came together to trumpet the war effort; Bangour Village, for instance, held patriotic entertainments to commemorate employees who had enlisted. ⁹⁶ Macdonald’s writings reflected these sentiments, mobilising a rhetoric of sacrifice to bolster popular support for the war effort. ⁹⁷

Though personal attachments influenced this advocacy, institutional politics likely played an important part. The issue of the national interest was regularly invoked by asylum officials during the First World War as they scrambled to retain functioning workforces during a period of severe labour volatility and deteriorating conditions. ⁹⁸ Faced with persistent staffing shortages and high turnover, visiting committees and medical officers sought to recast asylum work as form of national service, appealing to their workers’ ‘patriotism’ to encourage them to accept unpopular changes in working conditions (for instance, being made subordinate to new, hospital-trained nurses when their institutions were converted to war hospitals). ⁹⁹

A worker with aspirations to gentility, Macdonald readily echoed these sentiments. Female mental nurses, like general hospital nurses, were said to be more inclined to the ideal of vocation than their male counterparts (and, indeed, the male-dominated trade unions) and thus to self-sacrifice before workplace agitation. ¹⁰⁰ Macdonald exemplified this stereotype, calling on her peers to unite under the trying circumstances. In an article published in June 1915, the first edition of the Asylum News after Bangour Village was requisitioned by the military, she charged workers to embrace their new responsibilities in the face of anxiety and uncertainty, for ‘the true soldier in life’s battlefield falls into line … until the “Last Post” has sounded’. ¹⁰¹ More pointed was her later appeal for nurses to dispel the ‘spirit of captious criticism’ and embrace their duties ‘without thought of special consideration or reward, save the purifying and ennobling of our own natures’. ¹⁰²

As these comments imply, Macdonald’s occupational persona adhered to a conservative conception of the female nurse as pastoral exemplar. ¹⁰³ Asylum medicine was founded on the belief that a respectable nurse had a salutary effect on the morals of her patients. ¹⁰⁴ Macdonald reaffirmed this platitude through prescriptive anecdotes, advising weary nurses that ‘the high ideals of your noble profession will be reflected’ in the damaged patients. ¹⁰⁵ Several articles detailed purportedly affectionate relationships between patients and nurses in asylums and war hospitals, with wounded and neurasthenic veterans being shown as dependent on the women for moral and emotional support. ¹⁰⁶ In a lengthy tale, ‘Is it Worth While?’, Macdonald modelled an ideal temperament in the matronly nurse Nancy – ‘calm and brave … [with] conscious power in her steadfast grey eyes and determined bearing’ – which was contrasted with the ‘petulant’ nursing sister who ranted over workplace trivialities. ¹⁰⁷ From such anecdotes we can see Macdonald attempting to shape an ‘emotional community’ through print: ¹⁰⁸ that is, to articulate shared norms of emotional expression for female nurses, centred on the qualities of compassion and stoic resolve. ¹⁰⁹ Undoubtedly, such an exemplar was intended to invoke the gendered ideal of hospital nursing: ‘a respectable, high status profession for well bred young women’. ¹¹⁰

However, this is not to suggest that Macdonald blindly submitted to her superiors’ wishes. These remarks on the dignity of nurses’ labours simultaneously point to her deep self-respect. In another of her anecdotes, Macdonald had a fictional nurse reflect on the ongoing stresses of the war hospital, pondering whether ‘the country fully realizes its indebtedness to its nurses…. It is a life work of self denial, to which clever hands and skilled brains are willingly given without thought of reward.’ ¹¹¹ In this (presumably semi-autobiographical) soliloquy, the patriotic nurse’s lowly status was transformed, with war work conceptualised as a ‘skilled’ occupation and thus deserving of respect. Such claims echoed the remarks of many leaders of contemporary women’s volunteer organisations, whose appeals for ‘doing their bit’ for the war effort reaffirmed pre-war demands for civic equality. ¹¹² Indeed, at times Macdonald was explicit in claiming for her sex the mantle of public servants:

The women of the land, from peeress to peasant, have responded nobly to the call for workers. All over Britain to-day, and in the war-stained lands of Europe, they are doing ‘war work.’ All honour to them! ¹¹³

This was not simply a case of Macdonald exploiting the favourable employment conditions available in wartime. Such comments on the respectability of her occupation mirrored earlier status claims by female mental nurses; as early as 1898 an essay in the Asylum News promoted asylum nursing as a suitable profession for university-trained women. ¹¹⁴ While few elite women took up nursing in any form before 1914, ¹¹⁵ caring occupations did offer ‘respectable employment’ to increasing numbers of lower-middle-class women. ¹¹⁶ Macdonald was certainly cognisant of the ‘woman question’, assuming a measure of independence for reliable nurses. In one light-hearted article, Macdonald depicted herself as the archetypal New Woman, the female cyclist; and, despite it carrying a self-deprecating tone, typical of cycling literature, contemporary readers would have identified a political subtext in her narrative: ‘round and round the grounds of our splendid institution we trundled, feeling several inches taller than our fellow-workers, buoyed up by victory!’. ¹¹⁷ Macdonald’s later support of state registration of mental nurses is illustrative of her overt aspiration: pitched as the realisation of occupational autonomy and status, the wider movement for registration initiated by general nurses was closely aligned with the suffrage movement. ¹¹⁸

Macdonald’s contributions to the Asylum News are notable for their elaboration of medical practices: primarily, three articles discussing the efficacy of ‘suggestion’ in asylum nursing, a healing art loosely allied to the then popular mental healing movement. Broadly speaking, suggestion was the practical intervention in a patient’s mood or emotional states, the goal being, as Macdonald put it, to stimulate the patient’s ‘interest in every-day life’ to the point that they adopted ‘old and familiar habits’. ¹¹⁹ When successfully implemented, this treatment was said to ‘have lasting effect on many who … suffer agonising mental torture’. ¹²⁰

Macdonald demonstrated her knowledge of psychiatric literature by identifying the practice as the basis for ‘psycho-therapeutics’, described by her contemporary Daniel Hack Tuke as the ‘application of the influence of the mind on the body to medical practice’. ¹²¹ As Sarah Chaney notes, the concept of ‘psycho-therapeutics’ gained traction in British psychiatry in the second half of the nineteenth century, following shifts in medical opinion which designated emotion as ‘the primary influence on a person’s physical and mental state’. ¹²² Whereas previously the goal of asylum medicine had been to excite a patient’s self-control, this new imperative required the psychiatrist to exert an ‘emotional influence’ over them; as Macdonald put it, suggestion represented ‘a transmission of one’s will temporarily to another’. ¹²³ This could be achieved through the ‘exercise of the stronger over the weaker will’; however, it was not necessarily intended to be a coercive practice. Rather, the mere influence of good ‘example and suggestion’ was shown to excite the patient’s desire to please, ¹²⁴ a process illustrated in many of her anecdotes. ¹²⁵

In Macdonald’s rendering, suggestion was an indispensable therapeutic practice, which could only be mastered by an experienced nurse. Far from being a basic art of persuasion, suggestion was a well-rehearsed regimen which ‘raise[d] mental work from the dull level of routine … to a highly ethical and intensely interesting study’. ¹²⁶ Not only was the prospective mental nurse required to personalise her therapy to the many patients under her care, she was to develop these skills into an intuitive practice, conditioning herself to constantly search the ‘mind for some means of stimulating’ them, while attending to other duties. ¹²⁷

As with Tuke’s ‘psycho-therapeutics’, Macdonald’s suggestion conformed to the general characteristics of ‘moral treatment’, the guiding paradigm of British asylum therapeutics for much of the nineteenth century. Moral treatment was predicated on the belief that mental derangement was amenable to persuasion through sympathy or moral instruction, and Macdonald made little attempt to distinguish her ideal from the ‘benevolent theory’ that underpinned this style of pastoral care. ¹²⁸ Indeed, ‘personal sympathy’ was praised as a firm basis for suggestion, an affective bond that excited the patient’s regard. ¹²⁹

However, her therapeutic model did depart from the medical orthodoxy in important ways. As with most contemporary writers on suggestion, she eschewed outright mention of the discredited art of hypnotic therapy, the practice in which the notion of suggestive therapeutics had been most deeply explored. ¹³⁰ Yet her writings still attest to the influence of these marginalised treatments. In her first essay on the topic, Macdonald variously defined sympathy as a ‘magnetic influence’ and a force of ‘telepathy’: descriptions which point to the influence of popular mesmerism on her thinking. ¹³¹ A more pervasive influence was spirituality, which Macdonald regarded as an intimate facet of the nurse’s character. ¹³² Earlier nursing pioneers had conceptualised their craft within the rubric of Christian vocation, and it is to this general model that Macdonald appealed. ¹³³ However, she was also influenced by more unorthodox spiritual systems, primarily the religious idealism of the American New Thought movement. New Thought is best known as a mental healing movement, which substituted orthodox Christian doctrine with more holistic understandings of divinity and faith. ¹³⁴ Though the movement’s various sects developed different beliefs, a central precept of the tradition was that illness and debility were illusory evils, produced by errors of the mind, which could be countered by ‘the power of thought’. ¹³⁵ By the time that Macdonald was writing in the Asylum News, such ideals had infiltrated both lay and medical writings on psychological well-being, thus popularising the use of suggestive therapeutics in mental healing. ¹³⁶

With its messages of self-help and self-improvement, it is just this type of literature that would have appealed to Annie Macdonald, a woman who aspired to respectability. ¹³⁷ From her earliest writings she grounded her notion of suggestion in the optimistic belief that ‘nature [provided] its own remedy’ to mental suffering, even describing the practice at one point as ‘applied faith’. ¹³⁸ Drawing loosely upon a conception of humanity’s innate divinity, popularised by contemporary mental healing movements, ¹³⁹ Macdonald explained health as deriving from an indestructible ‘Vital Spark’ that needed to be located to rediscover balance. ¹⁴⁰ Her evidence for this claim was New Thought luminary Harriet Emilie Cady, who asserted that: ‘All your happiness, all your health and power come from God … When you acknowledge and deny that outside things can hinder your happiness or health or power, it helps your sense nature to realise these attributes.’ ¹⁴¹ When considered in this light, the pains of mental illness were easily dismissed as works of the imagination, to be supplanted by contrary impressions; the nurse’s suggestion, then, aimed at creating an ‘atmosphere’ of ‘constructive thoughts’, in which the ‘wounded mind’ could be soothed to reason. ¹⁴² Far from relabelling orthodox medical practices, Macdonald was flaunting a novel intellectual basis of her healing art: an affirmation of her professional status.

Another important departure from conventional moral treatment was the stated aim of suggestive therapeutics. As Andrew Scull has shown, moral treatment, as articulated by nineteenth-century theorists, became a ‘mechanism for enforcing conformity’ in large mental institutions, by incentivising self-restraint and thus encouraging the internalisation of accepted norms. ¹⁴³ Macdonald did not discourage this view: in her early writings she championed suggestion as a means of instilling ‘meekness and docility’ in a stubborn patient. ¹⁴⁴ However, in her later description of the craft she asserted that suggestion was designed not merely to impose conformity but to encourage ‘mental freedom or independence’, conceived of as an honest and forthright display of free will. The surest sign that a nurse had instilled such healthy independence in their patient was conflict; by voicing displeasure at their carer’s presence or attentions, the patient proved that their ‘spirit seeks once more its God-given altitude’. ¹⁴⁵ Here we can see New Thought’s individualist ethos explicitly colouring medical ideals. ¹⁴⁶

Macdonald was acutely aware that her pronouncements would be met with cynicism. While her ideas may have been well received by other nurses who were attuned to Macdonald’s style of pastoral care, ¹⁴⁷ key figures in the medical sciences were inclined to view spiritualism’s allied practices as ‘quackish and fringy embarrassments’. ¹⁴⁸ In promoting suggestion as a healing art Macdonald reaffirmed the beliefs of its proponents that mental healing was a ‘scientific undertaking’, ¹⁴⁹ and her attempt to legitimise the practice bears some resemblance to Francis Allway’s rhetorical fashioning of his own style of psychiatric nursing as a ‘hard’ science. In her first essay on the topic she emphasised the potential of suggestion to ease the burden of human suffering, if ‘scientifically practised by skilled and sympathetic physicians’. ¹⁵⁰ Apparently emboldened by her experience working in war hospitals, she would later claim that suggestion had become ‘an integral part of all psychological work’. ¹⁵¹

No doubt this was an optimistic assessment, and Macdonald was careful to reinforce the claims that this system conformed to the requirements of a medical science. For one, its effects were believed to be quantifiable, with ‘conclusive results’ assumed to follow the ‘continuous and systematic application’ of its core principles. ¹⁵² Moreover, suggestion, when properly practised, was shown to be the very antithesis of charlatanism. She explicitly distanced the practice from the charismatic postures stereotypically adopted by mesmerists, denouncing the use of any ‘falsehood or sophistry’ in the curative practice and affirming plain-speaking as the basis of legitimate therapeutics: ‘Never suggest to your patient that you possess supernatural power. Be simple, candid, straightforward, and true.’ ¹⁵³

To counteract any concerns about the use of this sympathetic ‘telepathy’ in the curative process Macdonald sought to place the practice on empirical grounds:

suggestion is thought systematically and scientifically applied. We all know how sound travels. A sound is emitted, the air surface is disturbed, and forms itself into air waves, on the crest of which the sound is carried to its destination. … So it is with scientifically applied thought. It is carried on the crest of the intervening air waves, if you like, from the nurse to her patient. … The lines of thought will be indicated by the patient’s need, and these will circle round the main objective, i.e., the patient’s recovery. ¹⁵⁴

Whether her readers would have been convinced by this analogy is debatable; however, given that Tuke had posited a physiological basis for psychotherapeutics, it is plausible that some would have been receptive to her general premise.

More problematic was the link established between spiritualism and medical practice. Physicians were more than happy to accept that pious nurses could have a salutary effect on disordered patients; few medical men, however, would eagerly reconcile spiritualism with the scientific practice of medicine. Macdonald’s justification of this point was less than impressive, merely citing the American poet James Russell Lowell’s contention that ‘Science was faith once’ to support her claim that ‘suggestion must be linked with strong faith in the Eternal if its scientific application is to avail’. Recognising the weakness of this position, she continued with the assertion that this was ‘no sentimental idealising, but a hard-headed practical fact’, supported by evidence. ¹⁵⁵ The significance here is not the strength of the evidence put forward (the aforementioned quote from Cady) but the emotional posture she adopted; in refuting the influence of sentimentalism on her judgement, Macdonald was aligning her therapeutic outlook with the martial and austere values typically associated with scientific progress. ¹⁵⁶ This was made explicit when she elaborated upon the temperament necessary to effect a cure in difficult cases. Doubt and fear of failure had no place in her regimen, the advice being, rather, to ‘hold right on with unflinching belief in your power to eradicate the [patient’s] obsession, and, sooner or later, success will be yours’. ¹⁵⁷ Stoic, resolute, earnest and plain-speaking; the nurse that applied suggestion was a disinterested healing agent: a product of the medical modernity.

Such comments marked an explicit status claim. Whereas institutional norms designated mental nurses as entirely subservient to their superiors, Macdonald sought to legitimate a form of medical knowledge independent of higher authority and thus define a sphere of influence in the medical hierarchy. Though conceding that patients should be placed under the review of ‘a psychologist or other recognised authority’, she made the claim that ‘doctors are foremost in admitting that suggestion, as an applied science, is the nurse’s job’. ¹⁵⁸ This purported endorsement, coupled with the aforementioned description of suggestion as a type of intuitive knowledge, represents a significant development in the mentalité of marginal asylum workers. By the close of the First World War, even the most dedicated and loyal nurses were willing to question the expertise of qualified medical officers and thus claim autonomy on the wards that they staffed.

3 Periodical Publishing and the Self-Fashioning of Edwardian Mental Nurses

In the three decades since Anne Digby described attendants as the ‘hidden dimension’ of British asylums, historians have made great strides in recovering their ‘cultural agency’. ¹⁵⁹ This article contributes to this literature by demonstrating that these institutional ‘others’ were active participants in the Edwardian-era psychiatric print trade, utilising periodicals to articulate occupational identities, while also contributing to the construction and dissemination of medical knowledge. Evidence from the Asylum News thus revises core assumptions about the development of mental nursing in the era of professionalisation. By identifying previously anonymous contributors to the periodical it is possible to highlight the cultural and environmental influences that shaped the authors’ therapeutic personae. The infiltration of Darwinian thought into Francis Allway’s writing undoubtedly reflects the ideologies disseminated by his superiors at Claybury, as well as the dominant norms of his class. Though her medical persona conformed to traditional ideals, Annie Macdonald drew from disparate cultural sources when articulating her unique bedside craft. Furthermore, this analysis supports the argument that gendered ideals ‘profoundly shaped [psychiatric] nurses’ professional identities’. ¹⁶⁰ As we have seen, while he rejected the outright misogyny of other male attendants, Allway was preoccupied with the notion of the ‘male nurse’, and it is likely that his identification with the principles of social Darwinism stemmed from that doctrine’s association with middle-class masculinity. ¹⁶¹ Macdonald too was preoccupied with the issue of gender. Her nursing identity adhered to conservative notions of genteel femininity, while simultaneously reaffirming claims for women’s civic engagement.

Pervading the writings of both nurses was their social aspiration. While articles in the Asylum News cannot provide a reliable account of these individuals’ occupational competency, they do highlight latent appeals to ‘skill’, typical of the yearning for status and economic independence of elite labourers. As noted above, such appeals problematise conventional interpretations of the professionalisation of nursing, which typically treat cultural and economic aspirations as distinct drives. More interesting, though, is the assumption that nurses possessed unique knowledges, which provided them with special insights into the medical treatment of insanity. Such a notion undermines the assumption that ‘professionalised’ mental nurses were more likely to acquiesce to the absolute authority of their superiors. ¹⁶² Though Lee-Ann Monk has demonstrated that asylum attendants in colonial Australia strengthened claims to ward authority through appeals to their practical knowledge, ¹⁶³ historians of British asylum nursing have largely overlooked early challenges to asylum superintendents’ medical authority, instead focusing on the negotiation of institutional power and the disciplining of the lesser servants. ¹⁶⁴ Certainly, the rudimentary scientific training provided in asylums may have submitted some workers to ‘an evermore profound subservience’, as Chung and Nolan suggest. ¹⁶⁵ However, as the cases outlined above attest, by the First World War aspirational mental nurses were challenging medical dogma and seeking to evolve their medical role on their own terms.

While Allway and Macdonald were unique in terms of the volume of their writings, they were not the only nurses to utilise the Asylum News to assert such views. Of course, as the mouthpiece of the paternalist AWA, the journal’s readership would have been largely confined to the consciously elite labourers who shared Allway and Macdonald’s self-improving ethos. Many prominent non-medical contributors were established figures in the hospital hierarchy, including chaplains or hospital matrons: middle-class figures who rarely challenged the orthodoxy espoused by the journal’s editors. Moreover, many attendants who wrote to the journal framed their expertise as ‘practical’ knowledge, so as not to challenge the status quo. Yet others appeared compelled to express their independence by publishing their own medical knowledges, with some taking an even more combative tone than Allway and Macdonald. Illustrative in this regard is the case of Yorkshire attendant Charles Best. He courted controversy in an article titled ‘The Influence of Music on the Sane and Insane’ by arguing that music’s sensual properties effected ‘intellectual deterioration’ ¹⁶⁶ and thus had little therapeutic value for those suffering under mental disorder: a claim at odds with contemporary medical theory, which generally acknowledged that at least some ‘Beneficial sounds’ could promote health. ¹⁶⁷ The Asylum News’s readers thought he had ‘a screw loose’, prominently the medical officer, Arthur Sykes, who scorned Best for holding opinions ‘diametrically opposed’ to his own. ¹⁶⁸

Significantly, this criticism was directed at Best’s rank. Sykes censured the impertinence of a supposed inferior commenting on medical matters, repeating the purported remark of one of his employees that Best should ‘[attend] to his duties’ rather than voice such ‘fallacies’. ¹⁶⁹ This supposed impudence was similarly condemned by fellow attendant W.W. Lishman: ‘I am convinced that neither … [Best] nor myself is able to adequately tackle this subject, and for either of us to attempt to do so would be an act of unbounded arrogance and presumption.’ ¹⁷⁰ Evidently, not all nurses desired medical autonomy. Yet Best – like Allway and Macdonald – was determined that his opinion be heard, and his forthright defence typifies the self-assurance of ambitious asylum workers in this period: ‘I am quite aware from what Dr. Sykes says, and your other correspondent, that my opinions have only issued from the pen of an attendant – hence their conclusions; but at the same time I am convinced by what I have stated, and am not ashamed of it.’ ¹⁷¹ Far from considering himself an ‘other’ of the medical hierarchy, Charles Best staked a claim to legitimate knowledge. That such comments were published in an establishment publication only further highlights the ‘cultural agency’ of this subset of asylum workers.

The importance of the periodical form to these nurses’ occupational self-fashioning should not be overlooked. Historians have identified the specialist journal as a formative element of the medical sciences, providing both intellectual ballast for subsequent claims to specialisation and a space for the development of an affective esprit de corps. ¹⁷² Though the Asylum News was more popular miscellany than ‘scholarly’ journal, it served a similar function for undereducated attendants. Indeed, the characteristic periodical form provided a potential site of identity formation, involving readers in a defined ‘textual community with its own ideologies, social aspirations, and cultural assumptions’. ¹⁷³ That ‘star’ contributors, like the ‘Poet Laureate’ Allway, could play a defining role in this process seems evident. With their regular engagement with topical issues, such contributors ‘offered their readers not only information, advice and entertainment but models of the self’. ¹⁷⁴ As we have seen, there is evidence to suggest that at least some discerning readers adopted the scientific personae represented in the periodical. Regardless of whether correspondents like Allway were widely influential, though, the presence of such contributions in the Asylum News testifies to the ease with which heterodox scientific ideas could be articulated and circulated through Edwardian-era periodicals and highlights the opportunities that these journals presented for otherwise marginal workers.

Given the varied medical interests pursued by correspondents to the Asylum News – eugenics, spiritualism, acoustics and epilepsy – it would appear that Edwardian mental nursing sustained as many specialisms as the recognised medical sciences. More research is required to determine the diversity of nurses’ medical personae and the literary and environmental influences that shaped their medical knowledge. Publications like the Asylum News and the similarly under-explored National Asylum Workers Union Magazine offer a wealth of insights into the cultural and social backgrounds of these workers, and a closer reading of their contents could prove fruitful. In committing their experiences to print, early asylum nurses sought to broadcast their selves to a wide audience; by examining these self-writings, historians can begin to revive their personal and professional identities.