Claire Hilton's new book is a valuable addition to the historiography of psychiatry and mental illness over the past two centuries, forming part of the excellent ‘Mental Health in Historical Perspective’ series. Hitherto, scholars within the field have concentrated primarily on the psychological or psychiatric consequences of military service during the Great War and how these were dealt with. They have tended to overlook the fate of mentally disordered civilians during the period. Yet, as this book powerfully demonstrates, the War brought profound upheavals for lunatic asylums, for their staff and particularly for the very large numbers of patients who inhabited them.

Several previous historical studies have chronicled the state of psychiatric provision and lunatic asylums in the late 19th and early 20th centuries. The model county asylums, based on high ideals of ‘moral management’ and ‘non-restraint’, which emerged by the 1850s and 1860s, had developed into large sprawling institutions, with all their associated disadvantages of overcrowding, loss of individuality, demoralisation and stagnant or declining standards of treatment and care. As the book illustrates, this was already the situation in Britain on the outbreak of war in 1914.

Claire Hilton shows how these pre-existing difficulties were magnified sharply during the War. Deploying an impressive range of archival sources, she draws a stark picture. The demands of war had several serious consequences. No fewer than 24 public asylums were turned into military hospitals, to treat wounded or ‘shell-shocked’ service personnel. Over 20 000 civilian patients had to be relocated to other asylums, with consequent dislocation and heightened overcrowding. Many male attendants and junior medical staff either volunteered or were called up for military service. Financial constraints imposed by government led to expenditure on food, fuel and other key items being reduced to critical levels. Mortality rates among patients rose significantly, partly due to the increasing incidence of tuberculosis and other infectious diseases.

Dr Hilton hardly spares us in depicting a landscape of almost unmitigated gloom. Above all, the grim realities of life for asylum patients take centre stage, brought into clearer focus by individual case cameos and some evocative photographs.