The treatment Ann could expect in the DCLA was profoundly different from the choices given to patients today. First of all, Ann did not have any opportunity to refuse treatment. Once hospitalised, she was expected to submit to a regimen of ‘conciliatory and gentle management, perfect freedom from mechanical restraints and occupation and employment’ (Medical Superintendent’s Annual Reports, 1848 and 1850). Such ‘moral treatment’ worked by emphasising discipline and a strictly regulated daily routine. This approach has recently received sharp criticism, being labelled a ‘gigantic moral imprisonment’ (Foucault, 1971) merely replacing physical chains with social restraints (Goffman, 1968; Rothman, 2001). The problem with this approach was that it required patient co-operation as well as close supervision. Bucknill was by no means averse to making patients amenable to this new approach through the application of medication, bleeding and purging (Bucknill & Tuke, 1879), and if required, punishment through prolonged baths or seclusion (Annual Report of the Committee 1848-50).

Ann’s initial case notes seem to confirm the success of moral treatment, as she was able to leave the DCLA after only five months. She did, however, return very quickly and this time her case notes tell a different story. Labour-intensive moral treatment was increasingly compromised towards the later 19^th century owing to the large influx of patients, staff shortages and high staff turnover. Under such continued pressure the DCLA resorted more often to pharmacological therapies from the 1870s – a move often sharply criticised as a shift from ‘cure to custody’. Morphine, hyoscyamine and hyoscine – often combined with atropine – could be turned into very powerful sleeping draughts used, it is claimed, as punitive measures (Finnane, 1981) and to improve behaviour on the wards (Fennell, 1996; Scull, 1993), thereby alleviating the strain on nurses. Ann’s second stay in hospital would therefore have been much less comfortable than the first one. Unfortunately, we have much less information on this second stay as well, as the Medical Superintendent’s role became increasingly managerial evidenced by a brevity of case note entries for which the DCLA was repeatedly severely criticised by the Visiting Committee. Ann’s case notes do not refer to any medication, but as entries were made roughly once a year, we cannot beyond doubt ascertain that she was not given any. Several mentionings of her becoming ‘maniacal’ or ‘excited’ suggest she was calmed down with medication.