1240 The Asylum as a Research Institute: Sir James Crichton-Browne and the West Riding Pauper Lunatic Asylum

INTRODUCTION: Societies throughout history have struggled with how to manage their mentally ill, particularly those individuals who are not of the monied class. Victorian England saw the treatment of its insane evolve from imprisonment to treatment within a medical institution. One asylum, the West Riding Pauper Lunatic Asylum, was led by James Crichton-Browne. METHODS: Crichton-Brown took umbrage at criticisms from the ranks of the medical community that asylum physicians were little more than caretakers, farmers, and prison wardens. He recognized that he had a patient population with all the medical maladies of the general population, as well as the specific mental illness from which they suffered. Further, many patients were at the institution for a long period of time, frequently for the balance of their lives, which allowed the opportunity for pathological study by autopsy. Put in modern terms, he had a closed patient population with diffuse pathology, and with virtually guaranteed long-term follow up. RESULTS: James Crichton-Browne saw the opportunity to utilize the asylum to further medical research as well as to improve the reputation of the asylum doctor. He took careful steps to transform this asylum into a research institution that produced significant medical research, particularly but not exclusively within the realm of neuroscience and psychiatry. This institute provided for the experimental work of Sir David Ferrier that led to widespread acceptance of the idea of cerebral localization, a topic which was hotly debated at the time by neurologists in England, France, and America. CONCLUSIONS: This paper discusses the steps taken by Crichton-Browne to establish this research institution, steps which are familiar to researchers of today. It uses the work of Ferrier as an example of the work produced by the asylum, work which arguably laid the groundwork for surgeons to be able to perform meaningful brain surgery.