St Patrick’s Hospital was the first psychiatric hospital to be built in Ireland and one of the very first in the world. Its foundation was brought about by the will of Jonathan Swift, satirist, essayist, political pamphleteer, poet and cleric who, upon his death in 1745, left £12,000 to ‘build a house for fools and mad’. He was keen that his hospital be situated close to a general hospital because of the links between physical and mental ill-health, so St Patrick’s was built on a site between Bow Lane and Dr Steevens’ Hospital in the west of Dublin city.

The motivation for Swift’s legacy grew from his involvement with the day-to-day problems of the Irish people, not only as an individual but also as dean of St Patrick’s Cathedral in Dublin. In the eighteenth century, there were no specific provisions for the mentally ill. The first record of public provision for the mentally ill were the cells erected in the Dublin City Workhouse in 1708 and three years later ten cells were allocated for insane soldiers at the Royal Hospital, Kilmainham. Mostly, if not being cared for by their families or found wandering the streets or countryside, the mentally ill would be confined with criminals in prisons, with the poor in a workhouse, or with the sick in a hospital. Swift had firsthand knowledge of these conditions having served as a workhouse governor and as a trustee of several hospitals.

Bethlem Royal Hospital in London had been the first to house the mentally ill in 1377. By the eighteenth century, it had become infamous and known as ‘Bedlam’. It had a reputation for cruelty, neglect and poor living conditions, with an inadequate diet, rough clothing and inactivity. Worse still, the patients were displayed as entertainment – as a ‘freak show’, a ‘spectacle’, a ‘menagerie’ from which ‘both provincial bumpkins and urban sophisticates could derive almost endless amusement’ for a fee.

After a visit to Bethlem Royal Hospital, Swift got himself elected one of its governors in 1714. By 1731, Swift had decided on his legacy, intending his hospital to be charitable and more humane than Bethlem Royal Hospital.

Following the layout of the seventeenth century updated structure of Bethlem Royal Hospital, architect George Semple designed St Patrick’s with a basement, first floor, and second floor. Each ward was a long corridor with an iron gate, a keeper’s room at the entrance and cells opening from it. The eight by twelve-foot cells had sturdy doors and high windows.

St Patrick’s Hospital opened in 1757 with sixteen patients and a staff consisting of a master, male and female keepers, cook, laundry maid, housekeeper, porter, and surgeon. Lack of funds quickly required admitting chamber boarders (paying patients) along with pauper patients.

By 1793, two expansions provided more rooms and more staff but they had no special training to deal with the mentally ill and treatments were limited to baths, purges, bleedings, drugs or restraints and care was still primarily custodial. However, conditions for the comfort of patients in the early decades at St Patrick’s were superior to those at Bethlem Hospital.

On each ward, two apartments of sixteen feet by twelve were for the accommodation of chamber boarders who, in 1825, paid sixty guineas per annum. There were seven other apartments for the use of chamber boarders in the front of the building. In 1825, the occupants of these apartments paid one hundred guineas per year and had a servant for their own use exclusively.

Heating came from coal fires in the corridors and the cleanliness of patients and their surroundings was a priority. Paupers were supplied with stools, wooden beds, and bedding (straw was only used for violent patients). Meals consisted of porridge at breakfast, potatoes plus meat three times a week at dinner, bread and milk at supper and beer occasionally. Chamber boarders brought their own furnishings and would have had a higher-quality diet.

The hospital grew significantly throughout the 19th century. By 1817, two building extensions saw the patient population rise to over one hundred and fifty and by 1872, the number of staff was over fifty.

Dr Richard Leeper was appointed medical superintendent in 1898 and was largely responsible for transforming St Patrick’s from an asylum for the maintenance of the mentally ill to a modern hospital for their treatment and cure. Dr Leeper abolished the use of restraints, introduced the segregation of female and male wards and oversaw the construction of bathrooms and day rooms providing work and leisure activities for the patients.

Dr Leeper’s successor, Norman Moore, removed the old prison-like doors on the cells, introduced occupational therapy (including crafts and farm work) to the patients and challenged the assumption that the mentally ill were a danger to themselves and society and should be locked away.

After the introduction of deinstitutionalisation in the late 1980s, the hospital went into a period of decline but in 2008 the hospital announced the expansion of its outpatient services to a series of regional centres across Ireland. Today, St Patrick’s Mental Health Services is Ireland’s leading not-for-profit mental health organisation, with over 700 staff members delivering 12% of the country’s total inpatient care and treatment needs.

Dublin, Ireland, 1881. Isobel Fitzgerald ’s mother, Martha, marries solicitor James Ellison but an unexpected guest overshadows their wedding day. Martha’s father is dying and he is determined to clear his conscience before it is too late. Lewis Greene ’s confession ensures the Ellisons’ expectation of a quiet married life is gone and that Isobel’s elder brother, Alfie Stevens , will be the recipient of an unwelcome inheritance.

When a bewildering engagement notice is published in The Irish Times, the name of one of the persons concerned sends Will and Isobel on a race against time across Dublin and forces them to break a promise and reveal a closely guarded secret.

Read an Excerpt from Chapter Two…

They got out of the cab at the gateway facing St Patrick’s Hospital. Will paid the cabman then introduced himself to the porter, explained their reason for visiting and they were admitted to the grounds.

The porter escorted them to the seven-bay, two-storey over basement hospital which had further buildings to its rear she could only partially see as they approached. The area in front of the hospital, separated from Bow Lane by a substantial wall, was planted with trees and had a lawn surrounded by a gravel path. Outwardly, it all appeared very serene.

They went inside, up a beautiful cantilevered staircase and she and Alfie waited in the entrance hall while Will and the porter went in search of the matron. The sounds of a man sobbing echoed towards them and Isobel exchanged a nervous glance with Alfie.

“…No, Dr Fitzgerald, Miles is not on one of the wards.” They turned as Will, the porter and a middle-aged woman dressed in a black dress and a white nurse’s cap walked towards them. “I am Matron Rice,” she said, shaking first Isobel’s and then Alfie’s hands. “You are very welcome to St Patrick’s Hospital. Miles is what is known as a chamber-boarder. He has his own apartment and a servant.”

“An apartment and a servant?” Isobel exclaimed and the matron nodded.

“Oh, yes, Mrs Fitzgerald. Miles is very comfortable here.”

“How…” Isobel tailed off, racking her brains. “Is he?” she concluded the question feebly.

“Miles is a very gentle soul. Although, he is not as sharp-witted as you or I, he is certainly not considered an ‘idiot’ or a ‘lunatic’.”

“Then, should he really be here?” she asked.

“To be quite honest with you, Mrs Fitzgerald, Miles is here simply because his parents did not want a ‘dim-witted’ son.”

“We did not know of his existence here until yesterday,” Isobel said quietly.

“So your husband told me. It is nothing to be ashamed of, many families tuck their husbands, wives, sons and daughters away in establishments such as this. Please, come with me,” she said and they thanked the porter as he took his leave.

They followed Matron Rice along a gallery with windows situated high enough to be out of the reach of patients until the matron halted outside a door to their left.

“It would be best if you went in one at a time. Perhaps, you first, Mrs Fitzgerald. Miles, it’s Matron,” she said, opening the door. “I have a visitor for you.”

Isobel went inside, her heart thumping as Matron Rice closed the door, and couldn’t help but gaze around the parlour in a mixture of pleasant surprise and relief. The large window was sited at a standard height which could only mean the occupant was not deemed to be either at risk of trying to escape or taking their own life. The walls were papered with a pattern of green leaves on a cream background and on the floor was a rug, also with a leaf design.

To the right of the door was a small dining table and two chairs and to its left was a tall mahogany bookcase overflowing with volumes of all sizes. Two armchairs upholstered in green velvet stood on either side of the fireplace, above which hung a huge mirror. Sitting at a walnut writing desk at the window and reading a book was her uncle. He twisted around in the chair and looked her up and down, taking in her coat and hat’s leaf pattern and she smiled. Like his father, he had a beard but wore no spectacles.

“Good afternoon, Miles,” she said softly.

“Are you a new nurse?” he asked, getting to his feet and doing up the buttons of a black morning coat.

“No, my name is Isobel. What are you reading?” she asked, edging forward.

“Jane Eyre.”

“Are you enjoying it?”

“Yes, I am. Do take a seat,” he said, gesturing to one of the armchairs.

“Thank you.” She sat down, trying not to make it obvious she was staring at him as he retook his seat at the desk. Dark-haired like her mother, he also had her mother’s high forehead and brown eyes and reminded Isobel of Mr Parnell, leader of the Home Rulers and president of the Land League.

“If you are not a nurse then, who, may I ask, are you?”

“Has anyone spoken to you about your family?”

“I have no living family,” he replied, turning his attention back to the book.

“That is not true,” she said and he lifted his head. “Miles, you are my mother’s brother – you are my uncle.”

He stared at her and she smiled again as he digested her words. “I am your uncle,” he stated and she nodded. “Why have you not visited me before?”

“Because until yesterday I did not know you were here. Out there,” she gestured to the gallery, “are my brother and my husband. Would you like to meet them?”

“Are you going to bring me home with you?” he asked and she stared at him in consternation.

“Matron Rice says you are very comfortable here,” she said instead of answering. “You have a lovely parlour and a lovely view,” she added, stretching her neck and catching a glimpse of the lawn and gravel path.

“I am lucky. Some of the other patients have cells. I am really your uncle?”

“Yes, you are,” she said. “My name is Isobel Fitzgerald and I have one brother called Alfie. My husband is called Will. Would you like to meet them?”

“Yes, I would, thank you.”

“I’ll go and fetch them.” She got up, went to the door and opened it. “Come in and meet Miles.”

They followed her into the parlour and she caught Alfie glancing around the room in surprise, having expected, like her, for it to be far more austere.

“Miles,” she said and he got up from the chair. “This is my brother, Alfie Stevens. And this is my husband, Will Fitzgerald.”

“I am delighted to meet you.” Miles greeted them formally. “Do you live in Dublin?”

“We all live on Fitzwilliam Square,” Alfie replied. “And I am studying medicine at Trinity College.”

“I am a doctor,” Will told him. “But I’m off duty today.”

“Are you going to bring me home with you?” Miles asked again and Alfie threw her a startled glance.

“No, we are not,” Will replied gently and Miles’ face fell.

“But we shall come here and visit you regularly,” she added. “I would very much like to take a walk with you around the lawn.”

“Why will you not bring me home with you?” Miles persisted.

“When did you last leave this hospital?” Will pointed to the gates.

“I…” Miles tailed off and his shoulders slumped. “Never.”

“We will come here and visit you,” she repeated, hesitantly reaching out and squeezing his hand. “Now we have met you, we will not forget you.”

“Promise?”

“I promise.”

“Good. That’s settled, then.”

“Is there a book you would like me to bring you when I come to visit?”

“Well.” Miles’ face creased as he pondered her question. “I have almost finished Jane Eyre and I would like to continue with the Brontës – perhaps Wuthering Heights?”

“Wuthering Heights it is,” she said.

“When will you visit again?”

“In the next few days, I promise.”

“Thank you.”

Isobel returned to the gallery and rejoined Matron Rice with Will and Alfie following, hoping she wouldn’t cry. Alfie closed the door to the apartment and they went downstairs.

“You will visit again?” the matron inquired.

“Yes, we will,” she replied.

“Good, because we have had promises before.”

“I don’t make promises I will not keep,” she said. “Miles has asked for a book – Wuthering Heights – is it suitable for him?”

“Yes, it is.”

“And mince pies?”

Matron Rice smiled. “He will enjoy them very much.”

They walked in silence to James’ Street where Will hailed a cab. They climbed in and sat down but she couldn’t stop the tears coming.

“There is barely anything wrong with him,” she sobbed.

“Matron Rice explained that he appears to have the reasoning of a fifteen-year-old boy,” Will said, putting an arm around her. “When we return during the week, I will speak with Dr Harrison the medical superintendent.”

“When he asked me if we were going to take him home with us, I didn’t know what to say.” She fumbled in her sleeve for a handkerchief and blew her nose. “We can’t take him home with us.”

“But I could take him home with me,” Alfie said and grimaced. “What I mean is – if it would benefit Miles not to live in a hospital, then, number 55 would be ideal.”

“I shall mention it to Dr Harrison,” Will told him. “But there is the small matter of your mother and James, who are expecting to return from honeymoon to a quiet married life. As well as that, your grandmother doesn’t want anything to do with Miles, so we must not tell her husband we have seen him in case it causes friction between them. There are many things to take into account but first and foremost is what Dr Harrison has to say. We do nothing until I have spoken to him.”

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Cover photo credit: Wilhelm Roentgen (1845-1923), German physicist, received the first Nobel Prize for Physics, in 1901, for his discovery of X-rays in 1895: Everett Historical/Shutterstock.com and Portrait of a man in a top hat and morning suit holding a cane: Everett Historical/Shutterstock.com

Cover photo credit: Florence Court, County Fermanagh, Northern Ireland: phb.cz/Depositphotos.com

St. Patrick’s Hospital, Dublin. Photo credit: DubhEire [CC0] via Wikimedia Commons