Hugh Welch Diamond

Richard Lansdown introduces Hugh Welch Diamond,one ofthe fathers of medical photography, whose imagesofthe insane both reflected and challenged prevailingideas about visually recording insanity.

PhotograpMadness

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Left: Hugh Weich Diamond in 1856. Above: one of hisphotographs of an inmate ofthe Springfieid asyiumin Tooting, south London.

One ofthe gems ofthe Royal Society ofMedicine's library is the Diamond(Collection, a set of 22 photographstaken by Hugh Welch Diamond

(c. 1809-86), a physician and founder member ofwhat is now the Royal Photographic Society. Theearliest British medical photographer, he was thefirst ever to take pictures of a wide range ofinmates in an asylum, images that were exhibitedin the first exhibition of photographs held at theRoyal Society of Arts in 1852. His work chimedwith the then fashionable view that one coulddiagnose mental illness from the face, a practicewhich hitherto had relied on drawings and paint-ings which he took to what was seen then as newheights: The Cornbill Magazine oí \S(>\ spoke of'I he dawn of a new day ... The faithful register ofthe camera ... will now render ... an actualscience." Diamond, however, went beyond diag-nosis; he put forward views on the therapeuticuse of images. Although much of what his photo-graphs stood for has passed, along withphrenology, his work remains as a landmark ofits time.

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Hugh Welch Diamond

The early years.Diamond was born at Goudhurst in Kent in about1809, the son of William Diamond, who claimed tocome from Huguenot stock. At one time a surgeon inthe East India Gompany, William later becamekeeper of a mad house, opened in London in 1820on the site of what is now St Paneras Station, Thefamily lived over the shop and both Hugh and hiseldest son. Warren Hastings Diamond, followedin William's footsteps.

For unknown reasons Hugh attendedNorwich Grammar School beforeembarking on his medical training.Details about his studies are sketchy.At the time the medical structurewas split into three orders: physi-cians (the élite of whom wereuniversity educated); surgeons(who were apprenticed likeany other craftsmen ofthetime); and apothecaries who,following the ApothecariesAct of 1815, could providemedical advice andprescribe drugs, Hughserved a five-year appren-ticeship in his father'sasylum. When the West KentDispensary opened in 1830he was appointed to theadministrative post of resi-dent apothecary with a salaryof £60 per annum. Ninemonths later he set up in privatepractice near Soho Square,London, where in 1832 he wasfaced with the cholera epidemic. Hegained his membership ofthe RoyalGollege of Surgeons in 1834 (the sameyear he was elected a fellow of the Society ofAntiquaries), However, the college has norecords of him as he was not, as is sometimesclaimed, a fellow. Further evidence suggests a link withSt Bartholomew's Hospital (Barts), where he probablyobserved patients and attended occasional lectures. In1842 he began studying mental illness at BethlemHospital under Sir George Tuthill, He also, it seems,acquired a medical doctorate in Kiel, the German citythat belonged to the King of Denmark, with a thesison insanity, though no trace of this can be found inrecords there. Nevertheless, in 1848 he was MrDiamond and in 1849 he was Dr Diamond, At theinaugural meeting ofthe Photographic Society in1853 he is listed as H, Diamond Esq, M,D,

Ideas about insanityDiamond lived through and observed the rapidincrease in the number of asylums which took place inthe 19th century. In 1774, when the Act of Parliamentfor Regulating Madhouses in England and Wales cameinto force, there were 16 metropolitan licensedmadhouses. By 1819 there were 40, but still the totalnumber of inmates in the asylums of England and

Another of Diamond'sphotographs from theSpringfield series.

France combined amounted to only a few hundred.By the late 1890s the figure had reached the hundredsof thousands.

It was not just that there was an increasing aware-ness of a need to cater for the insane; asylums werealso convenient places for shutting away members ofthe family. In his 1830 publication An InquiryConcerning the Indications of Insanity, with Suggestions

for the Better Protection and Care ofthe Insane JohnGonolly (1794-1866), the first chair of medi-

cine at the newly founded University ofLondon, notes: 'Let no one imagine that

even now it is impossible or difficult toeffect the seclusion of an eccentric

man; or easy for him, when onceconfined, to regain his liberty,'

Gonolly also observed, 'Duringthe term allotted to medicalstudy, the student never sees acase of insanity, except bysome rare accident. Whilstevery hospital is open, everylunatic asylum is closed tohim,' Diamond, of course,had doors opened via hisfather.

Diamond wouldundoubtedly have heard ofand observed the methods ofdealing with the insane thatprevailed into the 19th

century in many institutions:not only the need to beat and

chain at least the wilder inmates,who were seen as no more than

animals, but also of how efficaciousit was to make patients vomit or to

take their blood. He would probablyalso have known of the newer approach

of electric shocks. The first ElectricalDispensary in London had been founded in

1793 and treated 3,274 patients in its first year,allegedly curing 1,401 and'relieving' 1,232,

The association between human mental and phys-ical dispositions can be traced back to Aristotle andthe four humours. By the mid-18th century philo-sophical thinking about the treatment of madness inthis area was gathering apace, William Battie's A Trea-tise on Madness published in 1758 had shifted theemphasis towards a need to observe and then managethe individual patient, who would often get betterwhen purging and bleeding ceased, Thomas Reid's AnInquiry into the Human Mind, on the Principles ofCommon Sense, published in 1764, argued that the keyto understanding insanity was the direct study ofmind in action by means of introspection andanalysis, Reid predicted that there would be an'anatomy ofthe mind' as indispensable as the anatomyof the body. This view was supported by JohnGregory's 1765 plea to consider the mental and phys-ical relationship: 'the Mind and Body are so intimatelyconnected,,, that the constitution of either, examinedapart, can never be thoroughly understood,'

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Hugh Welch Diamond

Diamond would also have heard ofthe sweepingchanges that took place coincidentally with the FrenchRevolution, when the chains, the cruelty and theneglect ofthe madhouse were, to some extent,replaced by more benign approaches.The French physician PhillipePinel's Traite médico-philosophique sur l'aliénationmentale: ou la maniepublished in 1801 (and inFnglish as Treatise onInsanity in 1806) hadanenormous influence onboth French and Anglo-American doctors duringthe 19th century. Thiswas not simply becausePinel advocated theremoval of chains frompatients, he alsoattempted to apply seien- •tifie principles to psychi-atric observations ratherthan merely speculating.His gathering of practicalfacts formed the largest body ofits kind to date, based on observa-tions of up to 800 patients in the BicètreHospital, Paris. He also stressed mental over physicalcauses of insanity and his preferred 'moral' methodof treatment was directed as much at the emotionsas the intellect.

In Britain, too, a series ot House of CommonsSelect Committees and Parliamentary Enquiries from1807 to 1839 marked a shift from the notion oflunatics as animals to one in which they were seen ashumans, many of whom could be cured. But there

were still those who argued for an approach to aeti-ology based on the state ofthe body rather than themind. Writing in 1828, one doctor noted:

Some ...have suffered their attention tobe led astray by psycbological

disquisitions... tbey contend wemay penetrate tbat internal

disorganization wbence theaberration originates...Tben tbe science ofreasoning or logic being tbeproper remedy, a cure willbe tbus effected... Istrongly deprecate theimpression that none butpbilosopbers can cureintellectual derangement... Tbe attempt at treatingan insane person in tbismanner would end inaggravation ofthe

patient's state.

Diamond at SpringfieldIn 1849 Diamond was

appointed medical superintendentofthe women's department ofthe Surrey

CCounty Lunatic Asylum where he was in charge of 400pauper patients. He had originally applied in 1848 tooversee the men's section but a Mr Snape was thepreferred candidate. Evidence of Diamond's lifestylein this role is suggested by records relating to MrSnape. The latter enjoyed gifts of coal and candles aswell as produce from the asylum's farm to supple-ment his income of £350 per annum. Snape wasable to support his wife, three children and an

An engraving after aphotograph by Diamond,entitled'ReiigiousMeianchoiy'and pubiishedin the Medical Times andGazette, 1858.

A douche for the treatmentof the insane, from Cases ofMental Disease with Practical

Observations on theMedical Treatment byAlexander Morison,1828.

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Hugh Welch Diamond

unmarried female family member and to keep afootman, a lady's maid, a governess and a nurse.

The Springfield inmates were, to a large extent,those whose prognosis was not good; the curablewere sent to St Luke's or to Bethlem. Many went toand from the local workhouses, as Diamond himselfnoted: 'It frequently happens that an inmate who isa little troublesome in the workhouse is threatenedto be sent back to the Asylum ... They are oftenreturned to us as sane in their minds as at the timeof their discharge'.

His approach to treatment can be inferred from hiswriting to the Commissioners in Lunacy in 1854 tothe effect that: 'In a properly constructed building,with a sufficient number of suitable attendants,restraint is never necessary, never justifiable andalways injurious in all cases of lunacy whatever.'

However, while chains had largely been discardedwhen Springfield opened in 1840 and while there wasan emphasis on moral therapy, socialisation andlabour, inmates were still subjected to cold baths andshowers, isolation and the rotating chair (which wasspun around until the patient vomited). Diamond'smedical superintendent's duties included 'To bleed,cup and perform all surgical operations and to readprayers morning and evening.'

Picturing madnessTo understand Diamond's photography one mustconsider the notion of photographic objectivity andsee how it meshes with prevailing ideas of physiog-nomy and psychiatry.

In Essays on the Anatomy of Expression in Painting(1806) the physician Charles Bell (1774-1842) argued

that the key to diagnosis is in the face: the mad man isan outrageous maniac, little more than a savageanimal and so lacks some essential human quality inthe face. To Bell, eyebrows and eye muscles, whichdenote the mind, were inactive in the faces oftheinsane. With fixed eyes and a raging mouth. Bell's madman became a grotesque stereotype. Pinel's Treatise onInsanity ofthe same year incltided two plates, the firstcomparing the skulls of normal and idiotic patients,the second depicting a maniac and an idiot.

The French artist Théodore Géricault (1791-1824)produced portraits often patients at the Salpêtrièrebetween 1821 and 1824, some of which have becomewell-known portraits in their own right. They werecommissioned in 1820 by Etienne Jean Georget, afollower of Pinel, who maintained that direct observa-tion ofthe insane is essential if one is to understandtheir physiognomy. Géricault himself, however,claimed that he could not distinguish between thediagnosed insane and an average person.

In the second edition of his Outlines of lectures onMental Diseases {1826) the Scottish physicianAlexander Morison (1779-1866) included 13 engrav-ings based on those from the Salpêtrière, with a noteto the effect that: 'The appearance ofthe face, it is wellknown, is intimately connected with, and dependentupon, the state ofthe mind.'

Alongside this was the development of phrenology,a form of physiognomy created around 1800 by theGerman physicians Franz Joseph Gall and JohannSpurzheim, which became hugely popular. As aschoolboy. Gall had noticed that one of his classmates,who had a remarkably good memory, also hadprotruding eyes and from this simple observation

A rotary machine in whichthe chair was spun until thepatient vomited, fromCases of Mental Diseasewith Practical Observationson the Medical Treatment,1828.

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Hugh Weich Diamond

came the idea that the brain was a jigsaw of separate'organs' occupying specific cortical areas. Since anorgan's size governed the exercise of its functions andsince the contours ofthe head signified the contoursof the brain configuration, so a reading of the skullcould give information on personality.

Diamond's interest in photography started remark-ably early: he made his first photographic print, of astrip of lace and two feathers, on April 8th, 1839, onlythree months after William Fox Talbot had announcedto the world his negative-positive process. Throughhis contact with others Diamond made a significant,albeit indirect, contribution to the development ofphotographic techniques, since it was he who taughtphotography to Frederick Scott Archer, a formerpatient from his general practice days. Archer went onto invent the wet plate collodion process, whichproduced results of much improved detail andreduced exposure times ftom minutes to seconds,arguably the greatest contribution to the developmentof photography within the first 20 years of its exis-tence. Archer shared his method with Diamond in1850, before it was made known to the general publicthe following year.

Once at Springfield he put his skill to good use,photographing patients. It appears that despite themove towards greater privacy for patients in the early19th century, the question of asking their permissionto take or display their pictures did not arise.

Although the method of photography that he usedenabled Diamond to employ shorter exposure timesthan had been available in the 1830s it was still neces-sary to ensure that the sitter remained still for up to aminute or two and it is noticeable that his images wereall of people in repose and not moving. There aresome similarities here to the portraits of Diamond'sfriend Lewis Carroll.

Philippe Pinelreleasing lunatics fromthe Bicêtre asylum inParis in 1793, byCharles Louis LucienMuiler, C.I 840-50.Right: a page fromPinel's1801 Traitémédico-philosophiquesur l'aliénationmentale; ou ia manie,showing the crania andheads of the insane.

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Hugh Weich Diamond

In May 1856 Diamond presented a paper to theRoyal Society entitled On the Application of Photog-raphy to the Physiognomy and Mental Phenomena ofInsanity. The paper proposed three medical uses ofphotography. First was recording the physiognomy:

The Photographer secures with unerring accuracy theexternal phenomena of each passion, as the really certainindication of internal deivngement, and exhibits to theeye the well known sympathy which exists between thediseased brain and organs and features ofthe body.

Second was photographs as an aid to treatment, aradical idea. He described a woman with delu-sions who thought she was a queen, so heshowed her photographs ofthe severalother patients who imagined themselvesto be queens and royal personages, 'thefirst decided step in her gradualimprovement'.

He noted also that simplyshowing a patient her photographcould be therapeutic. 'In verymany cases they are examinedwith much pleasure and interest.'It seems that the photograph as ameans of increasing self-esteemhad found its place.

He referred also to an image ofa young woman 'tormented bysuicidal monomania', which hadbeen described by the French jour-nalist Ernest Lacan thus:

And yet what sadness, how manycomplaints, how many disappointments areto be found in those eyes.... How much bitter-ness and restrained grief how many swallowedsobs, are in this mouth, whose smile must have beenso graceful in the past.

The third use of medical photography proposed byDiamond was the identification of patients in case ofreadmission. He regarded photographs as more usefulthan written notes in recalling the essential character-istics of his patients.

Wider impactDiamond's work aroused considerable interest in themedical as well as the photographic world.T.N. Brushfield ofthe Ghester (bounty LunaticAsylum confirmed the therapeutic value of images,reporting in 1857:

Patients are very much gratified at seeing their ownportraits... Last week a patient begged for a portrait ofherself that she might send to her son, who was inIreland, to show how much better she was.

In his papers On the Physiognomy of Insanity in theMedical Times and Gazette in 1858 and 1859, JohnGonoUy argued that there was a readily identifiable facefor every type of madness. Diamond's photographs did

The Madwoman or theObsession of Envy, byTheodore Gericauit,1819-22.

not easily lend themselves to reproduction and soGonolly used lithographs based on them, sometimesnot totally faithfully. Nevertheless he was aware of theirshortcomings. 'There is so singular a fidelity in a wellexecuted photograph that the impression of very recentmuscular agitation in the face seems to be caught by theprocess, which the engraver's art can scarcely preserve'.

Gonolly also added case notes from which one cangain some inkling of Diamond's medical approach. Inone sequence we see four stages in the progress ofonepatient, suftering from puerperal depression. Thesecond portrait was taken eight days after the first, the

third four to five weeks later and the fourth two orthree months after that, on her discharge.

In The Expression ofthe Emotions inMan and Animals ( 1872) f)arwin, greatly

influenced by Gharles Bell, presented anevolutionary account of the face of

insanity. Darwin saw expressions ashaving evolved, like other parts ofthe human body, arguing that eventhe most human of human charac-teristics, facial expressions, werederived from animals. He focusedon the insane because 'they areliable to the strongest passions,and give uncontrolled vent tothem'. It was one ofthe firstscientific books to be publishedwith photographs.

A key figure in compiling thisbook was James Grichton Browne

(1840-1938), one ofthe most distin-guished psychiatrists of the 19th

century. Himself a photographer, hemust have been aware of Diamond's

work. He sent Darwin 41 photographs ofhis patients, many of them annotated. Darwin

reproduced only one in his book, perhapsbecause, like Gericauit, he could not see how thepeople portrayed as insane differed from thoseperceived as normal.

Springfield and the aftermathDiamond resigned from the Surrey asylum position in1858. The reason is often glossed over and the story isnot happy. In April 1856 his colleague Mr Snape wasstruck by a patient. Snape ordered that he be given ahalf hour cold shower bath, which involved an esti-mated 618 gallons of cold water being poured overhim. This was followed by the administration of'agood dose of tartar emetic'. A few minutes later thepatient had a fit and died.

Snape argued that the patient had died of adiseased heart and ordered Diamond's son. Warren,recently qualified as a surgeon, to remove the heart atthe post-mortem. Snape saw fatty degeneration;Diamond Senior saw a healthy heart and thought thatthe shower and emetic had caused the death. Snapewas eventually charged with manslaughter and it wasthen revealed that Diamond had, on his own initiative,kept the heart for a day or so, shown it to othermedical men and then burnt it. After trial at the Old

Hi

Hugh Weich Diamond

Bailey Snape was acquitted in July 1856, exoneratedbut financially ruined. The Committee of Visitorsthen wrote their report on the incident, castigatingDiamond who had 'made himself liable to severereprehension'. Diamond resigned and set up his ownprivate asylum for female patients in Twickenham.

Diamond's asylum seems generally to have cateredfor a small upmarket clientele. Many patients weredescribed in the census returns as'lady'or'of inde-pendent means'. Resident, at various times, was thedaughter of a field marshal and of a barrister, a fellowof a ('ambridge college and 'a mad peer'. On the otherhand, there was also the widow of a warehouseman,the wife of a grocer and the widow of a haberdasher.

Diamond stopped exhibiting photographs when heopened the Twickenham asylum. He had received hisfirst adverse review of his portraits. The PhotographicNews of February 4th, 1859 said that such photo-graphs'ought to adorn the walls ofthe physician'sstudy but certainly not the walls of a public exhibition... (they) are perfectly hideous'.

While this could hardly have pleased him it ismore likely that he stopped photographing hispatients when he moved from a public hospital withhundreds of inmates to a private one with only ahandful. As the Richmond and Twickenham Times ofJune 26th, 1886 pointed out: 'That which was allow-able in a public institution would not be so in aprivate establishment.'

Lingering visionsIf neither Géricault nor Darwin could really see thedift"erence between the images of the insane andthose ofthe average person, how can we explain theviews of Diamond and others? Simon Cross arguesthat each historical period has its own understandingofwhat madness is and, consequently, what sort otrepresentational identity it is given at any one timeand according to who is defining it. One sees whatone wants to see and the followers of physiognomy,lacking other supports for diagnosis, grasped at whatthey could. Despite the hopes ofthe Cornhitl maga-zine, the strength of Diamond's manipulated and

iMadness depicted in theAnatomy and Philosophy ofExpression as Connectedwiththe Fine Arts byCharles Bell, 1844.

Twickenham House,Diamond's private asylum,by Rosa Wallis, 1887. Thepainting shows the musicroom where some of thepatients slept.

Staged photographs was, as the hi.storian SharronaPearl has pointed out, precisely that they were notexact reproductions; they were reproductions madeby a photographer, who could emphasise physiog-nomically meaningful symbols, including theclothing, hair and liodies of his patients, not onlytheir faces.

As a professional psychologist and amateurphotographer, I like to contemplate the link betweenDiamond and Darwin, between photography, psychi-atry and psychology. We no longer respect phrenology,today the MRl scan tells us more about the brain thanthe photograph, but we can look back to Diamondwith gratitude.

Richard Lansdown was Head ofthe Psychology Department atGreat Ormond Street Hospital, London from 1971 tol994.

Further Reading J. Browne Darwin and the Face of Madness.W.F. Bynum, R. Porter & M. Sheperd [edsl The Anatomy ofMadness Vol 1. (Tavistock Press, 1985); A. Burrows & I. Schu-macher, Portraits ofthe insane: The Case of Dr Diamond(Quartet Books, 1990); S. Cross, Mediating Madness (PaigraveMacmillan, 2010); S.L. Gllman (ed). The Face of Madness(Brunner/Mazel, 1976); R. Hunter & I. MacAlpine, ThreeHundred Years of Psychiatry (Oxford University Press, 1970);S. Pearl, Through a Mediated Mirror: The Photographic Phys-iognomy of Dr Hugh Welch Diamond'in History of Photog-raphy, 33,288-305,2009; A. Scull, The Most Solitary of Afflic-tions: Madness and Society in Britain 1700-1900 (Yale Univer-sity Press, 1993).

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