The Experiences of an Asylum Doctor: with Suggestions for Asylum and Lunacy Law Reform,1 authored by the English doctor Dr Montagu Lomax, is a unique book that was donated to the Hong Kong Museum of Medical Sciences in June 2001 (Fig). The controversial book, donated by Dr Fat-im Tseung (蔣法賢, 1903-1975), is stamped on the first page with his personal seal. Published in 1921, the book is a recollection of Lomax’s own experiences while working at two mental asylums in Bracebridge, Lincolnshire and Prestwich in Lancashire, England. Lomax’s reflections on the conditions at the two asylums were described in his obituary in Lancet as “sensational”.2 It aroused public debate about the lives of mental asylum inmates in 1920s England and the subsequent reform of mental health services. Nonetheless what it meant to Dr Tseung and Hong Kong society is ineffable without looking into its historical context.

In 1989, the Hong Kong TV programme “The Common Sense” broadcast the conditions at Castle Peak Hospital—filmed earlier on site—and raised consequent public concern about and fierce criticism of the discrimination and poor hospital environment of mentally challenged patients in Hong Kong.3 This situation appeared similar to the situation in England seven decades ago. Montagu Lomax, who worked temporarily as an assistant medical officer at the two asylums mentioned in his book, illustrated how life in an asylum was hopeless, inhumane, and heavily regimented.4 For this reason, he prescribed several therapeutic interventions to encourage patients to return to the community. Lomax’s prophetic vision was criticised for being scarcely evidenced, unpractical, and merely based on his conceited assumption.

When Lomax’s book began to attract attention in England, the practices at mental asylums in Hong Kong had persisted for almost half a century, ever since their first provisional presence in 1875. Nonetheless the manner in which mental asylums were managed at home and in the colony were dissimilar due to differences in the rationales of the two administrations. While psychiatric sciences began to develop in asylums in England towards the end of the 19th century, the same did not occur in Hong Kong until after World War II. In the closing decades of the 19th century, “insane” individuals were kept at the Victoria Prison or chained in a cell at Tung Wah Hospital, depending on the patient’s racial background. Despite the passing of the Asylums Ordinance in 1906 and the opening of the Victoria Mental Hospital, mental hospitals remained custodial due to a lack of specialist care. In addition, the management of mental patients, including segregation of European and Chinese inmates and the repatriation of patients to the United Kingdom and Canton, reflected the highly racialised and “out of sight, out of mind” mentality of urban governance.

Dr Fat-im Tseung was a renowned physician, educationist, and philanthropist in Hong Kong. Graduating with an MBBS from the University of Hong Kong in 1925—shortly after Lomax’s book was published—he became clinical assistant to Professor John Anderson before going on to study in London at the Government Civil Hospital. Prior to the establishment of the Victoria Mental Hospital on High Street, lunatic asylums for both Europeans and Chinese belonged to the Government Civil Hospital.5 Nonetheless during Dr Tseung’s time, psychological sciences were still marginalised, despite being incorporated into the practice of general medicine. They were not officially taught at the University of Hong Kong, even though occasional interest was shown by several individuals. Professor Lindsay Ride, who taught physiology and later became Vice Chancellor of the university, once debated the need to develop comparative racial psychology, a popular racial science based on the obsolete and unscientific theory of body degeneration.6 Dr Alexander Cannon of the Government Civil Hospital, who also taught at the university and later became a controversial oculist and hypnotist back in England, once introduced the Freudian concept of dream interpretation.7 Nonetheless these ideas were only discussed on paper.

Similarly, Lomax’s description of the horrifying conditions in asylums was not based on solid observations. Notwithstanding, perhaps the biggest contribution of his self-righteous “attack” on the two asylums was to make things public, resulting in increased public pressure that demanded mental health reform.8 Although Lomax was questioned by a special committee formed by Britain’s Ministry of Health, he was reluctant to produce robust evidence to support his vivid descriptions. It was instead the lack of hospital staff to “witness” actual life in the asylums that worried the public.4 Subsequently, mental health reform in England began with strengthening of professional staff and sound financing of institutions. Interestingly, 40 years later, the American sociologist Irving Goffman’s book, Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates, conjured up another round of debates.9 Despite being based on his ethnographic work in an already notoriously disparaged hospital, his sensational portrayal of the vastly different lives of the staff and inmates said nothing about mental disorders, rather only hospital management. Nevertheless Goffman’s book became a driving force in sending patients back into the community in the United States. In Hong Kong, despite a gradual improvement in psychiatric services, the general situation for mental patients did not change until a violent incident at a kindergarten in 1982 caused six deaths and 44 injuries.

Lomax’s account revealed a long and hidden chapter in the history of medicine in Hong Kong. Because of the shortage of psychiatric resources, the fact that he was able to obtain the book meant that either the book was influential or that Dr Tseung read extensively. From the historical perspective, the book did not have the same impact in Hong Kong that it did in England. Nonetheless it foreshadowed what was to come over the next several decades regarding the city’s mental health reforms.

1. Lomax M. The Experiences of an Asylum Doctor: with Suggestions for Asylum and Lunacy Law Reform. London: Allen and Unwin; 1921.

2. Obituary of Dr Montagu Lomax. Lancet 1933;i:668.

3. Li SW, Poon PL, Poon YF. Oral History of the Development of Psychiatry in Post-war Hong Kong. Hong Kong: Commercial Books; 2017.

4. Harding TW. “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. Br J Psychiatry 1990;156:180-7. Crossref

5. Ho FC. Dr Tseung Fat-Im’s notebook of Professor Anderson’s Lectures, 1924. Hong Kong Med J 2016;22:298-9.

6. Lindsay R. Human genetics and its relation to medical problems (continued). The Caduceus 1935;14:181-216.

7. Cannon A. Mental mechanisms, dreams and their interpretation. The Caduceus 1927;6:333-56.

8. The Lomax Affair. Lancet 1990;335:264-5. Crossref

9. Goffman I. Asylums: Essays on the Condition of the Social Situation of Mental Patients and Other Inmates. Garden City, N.Y.: Anchor Books; 1961.