James Robinson, MRCS, was an assistant surgeon in the Indian Medical Service of the East India Company (EIC) who during his brief tenure as superintendent of the European Insane Hospital, Calcutta (now Kolkata) was responsible for a radical policy shift in the management of British ‘insanes’; a policy that endured for 50 years.
At the time of his appointment in 1817 between 30 and 40 patients were resident in the hospital and although there were no more than 10 admissions each year inevitably there was a slow accumulation of long-term patients resulting in overcrowding and deteriorating conditions. Plans for the replacement of the old hospital with a larger, modern asylum were already well advanced but not content with this scheme Robinson was the first to come up with an alternative that, he argued, offered not only a far better chance of recovery for patients but significant cost savings for the EIC; namely the regular, yearly repatriation of groups of ‘insanes’ back to Britain. The new scheme avoided the accumulation of patients and the consequent need for a larger hospital. Instead, there would be a small ‘House of Reception’ which was also ‘the dwelling house of the surgeon’ providing treatment for patients who would live ‘as a family’ with the superintendent and a small number of staff for up to a year before discharge, repatriation or transfer to another facility.
His arguments were based on contemporary medical opinion and hard economics. The medical consensus was that the hot climate and the ‘excesses of hard living’ associated with it not only predisposed Europeans to mental derangement but also made recovery in that environment much more difficult to achieve. It was therefore logical and more humane to transfer patients back to a temperate region as soon as it was safe to do so. He reinforced the medical argument with detailed calculations demonstrating a 50% reduction in the EIC's costs comparing treatment in Calcutta with treatment in England including the shipping expenses of repatriation. Unsurprisingly the EIC endorsed Robinson's plan with enthusiasm.
The first cohort of 21 patients (minus 3 who died at sea) arrived in England in August 1819 bound for Pembroke House, a private lunatic asylum in Hackney. Sadly, James Robinson died in Calcutta 2 months before they reached their destination. He was just 33 years old. After his death the old hospital was retained but the systematic repatriation of ‘insanes’ continued and was extended to the Presidencies of Madras (now Chennai) and Bombay (now Mumbai).
The practice gradually fell out of favour and the EIC formally ceased to exist in 1874 but repatriation continued until the end of the 19th century. Pembroke House was superseded by the opening of the Royal India Asylum in 1870, which continued to receive the majority of ex-EIC employees until it too closed in 1892.
From 1819 to 1858 approximately 500 ‘insanes’ were repatriated from British India.
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