Twenty-five years on: outcomes of a longitudinal evaluation of the NSW Rural Resident Medical Officer Cadetship Program

The circumstances attending the dismissal of Br. Foote from the post of medical officer to the Norfolk County Asylum afford a striking proof that an extended publicity in matters affecting the welfare of the insane poor is much needed. A publicity which without delay may inform all who are entrusted with the care of the insane, of the most recent ameliorations in their treatment, and may thus remove from abuses the excuse of ignorance: a publicity which may expose abuses as they arise, and prevent their growth and their continuance: a publicity which can only be secured by a journal devoted to the purpose, and aided by the adherents of the new system throughout the kingdom. The new system of which non-restraint is the key stone, but only the key stone, and which comprises kindly treatment, sufficient diet, decent clothing, cleanly and wholesome lodging, and the skilful application of remedial agents; this system could not in every particular have been set at nought in the Norfolk County Asylum, had not its Visiting Justices been ignorant of the extent to which they betrayed the sacred duties they had accepted; nor could the abuses we shall describe have sheltered themselves under the ignorance of the Visitors, had the public been aware of their existence. Before the new treatment of insanity was discovered or at least developed into common practice, the immediate care, or to speak more correctly, the immediate control of the insane was entrusted to persons distinguished by strength of body, firmness of nerve, and inflexibility of temper. The governors also of the places in which the insane were immured, were selected without reference to their possession of any medical skill, or knowledge of mental diseases. They were, indeed, not unfrequently chosen from the ranks of those who were then rightly called keepers, but who are now more properly called attendants. Far be it from us to detract from the merits of any man who has raised himself by his own merits from a menial position to one of honor and responsibility. If the Superintendent of the Norfolk Asylum after having held the situation of attendant in the wards of Hanwell had studied medicine, and having so qualified himself to undertake the care and treatment of some hundreds of insane persons, had then been appointed to his present office, we should have admired and applauded his honorable ambition and his success. His appointment in default of such qualifications we refer to only as a proof that the Visiting Justices of the Norfolk Asylum were under the influence of opinions which are now recognized as erroneous, and which in other parts of the kingdom have become obsolete. In 1843, the Norfolk Asylum, with those for Bedford and Pembroke, were the only county asylums in England Wales without a resident medical officer. The following extract from the Report of the Commissioners in Lunacy for 1844, will shew the value which the Visiting Justices for the Norfolk Asylum then placed upon medical skill in the treatment of the unfortunate persons placed under their jurisdiction.

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