Weskoppies Hospital, founded 1892--the early years

The Krankzinnigengesticht te Pretoria (Pretoria Lunatic Asylum) was established in 1892 as the first and only psychiatric institution in the Zuid-Afrikaansche Republiek (now the Transvaal). The asylum was later renamed Weskoppies Hospital. The first 10 years of the hospital's history, including the turbulent years of the Anglo-Boer War, are described. Attention is given to the institution's management, the diagnosis and treatment of patients and the effectiveness of such treatment. The hospital's medical director followed an enlightened approach to caring for the mentally ill, in line with the policies of psychiatric hospitals in contemporary Europe. However, his ideals of no restraint and minimal confinement of patients could not be maintained during the war years owing to insufficient accommodation and a lack of suitably trained attendants. It is concluded that the humane care of the institutionalised psychiatric patient was (and is) not guaranteed by enlightened policies, but depends on sufficient resources to put such policies into practice.