Community care around Edinburgh was very poor during the early 1850s. Insane paupers were often detained without warrant in poorhouses and private houses, with no official visits from the sheriff and no records of care kept. Accommodation was often bad, with scant furnishing, such that inmates might have to eat their meals off their knees. Where patients had dirty habits conditions were described as “very close and unpleasant”. Those who received a wash were those who were noisy or violent, using water that was likely to be cold. Only in the summer might a patient be allowed to bathe in the sea. Sexes were often imperfectly separated though restraints might be used, for example, to a bedstead at night. In some establishments, females might fare better in terms of clothing and food (Scottish Lunacy Commission 1857).
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