INTRODUCTION (Abridged) by Letizia Gramaglia
DR. ROBERT GRIEVE (1839-1906)
An “Apostle of Science”
Long forgotten in the folds of history, Dr Robert Grieve enjoyed in his lifetime a justified reputation as one of the most progressive and insightful figures in the medical profession of British Guiana. A talented physician and keen public health reformer, Grieve was born in 1839 in Lilliesleaf, a secluded village in the Scottish Borders, and graduated in medicine from Glasgow. As a young doctor he served in military expeditions across Europe and China, and in 1875 he followed his medical vocation to British Guiana to take charge of the Public Lunatic Asylum at Berbice, the only mental institution in the colony. The refuge, isolated on the periphery of Guyanese society, echoed the medical periphery in which Grieve suddenly found himself, distant to the activity and research of Europe and America. But peripheries can also be frontiers, and the Asylum became the site of his pioneering work into the treatment of mental illness. As the Medical Superintendent of the institution, Grieve implemented a new humanitarian regime, a radical departure from the practices of his predecessors, which involved decorated wards, amusements, adequate nutrition, and most vitally, a policy of non-restraint and an emphasis on the recuperative power of productive labour.
Five years of the Asylum’s history, a period of unprecedented health, recovery and development, were chronicled in meticulous detail in Grieve’s Asylum Journal. This unique document contains a comprehensive record of all the statistics associated with the running of the Asylum, along with the doctor’s own research into the sanitary conditions, diseases and sociology of the colony.
The erudition, morals and humour of Dr Grieve emerge strongly from his writing, showing him to be a man of considerably generous and tolerant character in the capitalist, imperial British Guiana of the day. There is no doubt that the phenomenon of the Berbice Asylum, preserved in unusually precise form by the Journal, is a testament to the success of Grieve’s treatment strategies and an indication of this man’s remarkable legacy.

The Public Lunatic Asylum in British Guiana before 1875
In the decades preceding Grieve’s arrival in British Guiana public provisions for the mentally ill had been extremely poor.
Though improvements had unquestionably been made since 1850, the general and particularly the hygienic conditions of the new Asylum still failed to meet acceptable standards and were harshly condemned in the Digest of 1864. As a consequence, by Ordinance No. 4 of 1867 the facility was once again relocated; a new permanent site was established “on the fort lands outside the town of New Amsterdam”, adjacent to the Berbice Hospital,and the Asylum was placed under the government of a Board of Directors. A resident surgeon was assigned to the institution and, given the absence of a salaried government inspector on site, the surgeon was responsible for submitting a full report tothe Governor every six months.
Although still common to most of the Asylums under British colonial administration, the use of coercive measures in the care of the insane had been widely rejected in England and Europe for quite some time; following a more scientific approach to mental illness, chains and shackles had been largely abandoned in favour of a more ‘humanitarian’ treatment of the patients. Grieve’s greatest achievement was the establishment of a similar trend in British Guiana through the successful introduction and application of humanitarian treatment at the Lunatic Asylum in Berbice; he freed his patients from all forms of mechanical restraint, introduced a plentiful and regular diet for the inmates, and employed them in a system of light and regulated labour.
Having attained overall control of the institution, Grieve begun at once to implement his programme of reform. He rigorously banned physical restraints and firmly instructed the members of his staff to treat the inmates with kindness and compassion.13
Numerous architectural renovations were zealously planned and executed to remove the vestiges of the old prison style Asylum; the wards were redecorated, the walls were painted with lively colours and adorned with mirrors, pictures, statuary, and flowers. A new clean and beautiful setting was thus created with the aim of encouraging the inmates to respect the orderliness that surrounded them and to behave accordingly. Another milestone of Grieve’s reformist programme was the implementation of occupational therapy; as the doctor argued, idle patients would spend all day sleeping, eating and quarrelling, and this was the main cause of the “howling, yelling, and horrid clamour of all kinds which deformed the day and made the night hideous in “mad houses” of the olden times.”Regular employment was therefore created for the inmates both through farming and through the establishment on site of dedicated workshops placed under the supervision of several experienced attendants. An agreeable result of this system was the generation of a substantial revenue, used by Grieve to cover a great part of the expenses of the institution and to procure “many little luxuries and amusements” for the inmates. By the end of 1876 Grieve’s successful management had visibly increased people’s trust in the institution. Attempts to escape, which were almost daily occurrences at the beginning of the year, had become very seldom. Over the same period, there was an increase of 27 in the number of admissions, a fact which Grieve was confident to ascribe not to a rise in the level of insanity in the colony but to a more widely extended knowledge of the Asylum and of its methods of treatment. In his report for 1876 the doctor wrote with manifest satisfaction: “It may be of interest, as showing how easily and safely in some instances restraint or seclusion may be dispensed with, to state that before the 25th of September 1875, on an average there were 9 men and 2 women, confined all day in single rooms, or cells as they were more appropriately named. Some individuals had been so locked up night and day for years, and the same patients were after that date allowed to mix in the general wards without causing either injury or annoyance. The great change was that the work of supervision by the attendants became real instead of nominal.” The extraordinary transformation enacted by Grieve received commendations both in the official correspondence and in the local press. Governor Longden lauded the doctor’s achievements in his Annual Report for the year 1876:
No appointment could possibly have proved a greater blessing to the unhappy patients in the Asylum, or given more satisfaction to the Government, and to many of the public who take a great interest in the Asylum.

The Asylum Journal
The primary source for the investigation of Grieve’s work in Berbice remains The Asylum Journal, printed at the institution between 1881 and 1885. Grieve’s distaste for intellectual inertia, which he often condemned as one of the highest faults of colonial life in the tropics, and the urge to overcome the isolation compelled by the geographical remoteness of the Asylum, prompted the zealous doctor to devise new means of intercourse with the external world. Knowing no limits to his determination, he set up a small Printing Office at the Asylum and, in February 1881, he launched the publication of The Asylum Journal, a monthly pamphlet aimed at increasing public interest in the institution and adding to the knowledge of local medicine.
His numerous papers, mainly on medical and sanitary subjects, are always characterised by a clear and pleasurable style, intended to attract the interest both of the member of the medical profession and of the common reader.16 A small number of inmates were employed in the process of making and stitching the Journal, of which 120 copies were regularly printed and circulated both in the colony and abroad. Its format aspired to be professional, yet highly accessible, offering a well thought combination of scientific and practical information; each issue opens with one or more thematic articles, followed by an overview of the life of the institution and by a detailed account of the Asylum’s industrial and financial activities for the month. Grieve’s methodical and thorough recording of every single item produced in the Asylum betrays a fastidious character and testifies to the almost obsessive care with which he supervised and managed all aspects of the institution. Equal meticulousness was applied to the registration of scientific and clinical data in order to produce valid and usefulstatistics.
As a scientist, he was generally persuaded that the main causes for the development of insane neurosis in British Guiana were to be found in some physical imbalance induced either by
natural causes or by human intemperance; much space is consequently afforded in the Journal to the investigation of physiological diseases and to the study of the relationship between bodily and mental deterioration.
In 1886, when Grieve was promoted to the post of Surgeon General and transferred to the capital, the publication of The Asylum Journal was suddenly interrupted. In a warm valedictory note printed in the last issue of the Journal the doctor formally takes leave from his readers and expresses his appreciation to the world and the colony for the “kind reception given to the little paper”.

The Georgetown years
Having distinguished himself for his exceptional medical skills and for his proficient administration of the Lunatic Asylum, Dr. Grieve was asked, in November 1885, to take on the appointment of Acting Medical Officer to the Immigration Service and Acting Surgeon General in the place of Dr. Manget, who had taken leave of absence for three months from October 1.
At the inaugural dinner of the New Government Medical Service, held on September 1, 1886 in the ballroom of the Garrison in Georgetown, Dr. Grieve “presided, having His Excellency the Governor on his right, and the Hon. Attorney General on his left”. The new structure of the medical system, however, caused strong resentment on the part of the Immigration Agent-General, Mr Alexander, who saw Irving’s policy as an unjustified interference in the administration of immigration matters and remained overtly hostile to the new Medical Department. Tensions grew when the Medical Inspector of the colony, Dr. Alfred D. Williams, who was now in charge of the duties formerly performed by the Immigration Medical Officer and accountable to the Surgeon General, undertook a round of inspections in order to make himself acquainted with medical provisions on the estates and produced a detailed report on the sanitary state of the immigrants. Williams’ report for the year 1886, submitted in August 1887, pointed to a large number of malpractices within the immigration system and exposed the unsatisfactory conditions of the hospitals provided for the care of Indian immigrants. Estate hospitals were found to be overcrowded, badly designed, not sufficiently ventilated and generally lacking in provisions. The poor and unsanitary state of the immigrants’dwellings on the estates was also severely condemned; disrepair, defective ventilation, and contamination of water supply by excremental matter, were faults found in the majority of the cases. Williams also denounced an excessive mortality rate among the immigrants; aside from a high percentage of suicides and wife murders, he suggested that large numbers lost their lives as a result of unsanitary conditions both on board the immigrant ships and on the plantations, or in accidents attributed to unprotected machinery.
The allegations made by Dr. Williams caused much indignation on the part of the planters and led to a political crisis in the colony. The elective members of the Court of Policy, all of whom planters, denied the legitimacy and accuracy of the Medical Inspector’s report and urged the Governor to withdraw it. In response to Irving’s refusal to satisfy their request, on the 11th October 1887 the electives abstained themselves from discussions in the Court of Policy, thus producing a deadlock in the government of the colony.22 Their decision, however, proved to be a double-edged weapon; the political deadlock ensuing from the conflict between the Governor and the electives made only too evident the dangerous obsoleteness of the constitution and confirmed the necessity, supported by a majority of public opinion, for its urgent reform.23 Appeals were presented to the Colonial Office by both parties; the Secretary of State, Lord Knutsford, ultimately decided against the withdrawal of the report, but invited the Governor to make public the additional evidence that Dr. Williams had been asked to submit in support of his accusations. On November 22, 1887 the Court of Policy resumed its ordinary activity; yet, in reprisal, on December 15,1887, in the deliberation of the Estimates for 1888, the electives in the Combined Court reduced Dr. William’s salary to the ridiculous and provocative sum of one cent. Meanwhile Dr. Grieve, who had been absent on leave for several months, had made his return to the colony and had produced a second report, dated October 24th 1887, in which he reviewed the points raised by Dr. Williams and confirmed their accuracy. A copy of the report was forwarded by Grieve to the British Medical Journal, with the intent of bringing the matter to the attention of a wider and international audience, and in November 1887 Grieve, in the capacity of Surgeon General and Head of the new Medical Department, was requested by the Secretary of State to satisfy himself, as soon as possible, on the sanitary conditions of the estates. In his annual reports, Grieve repeatedly advocated the need for alterations in the system in favour of patients’ admission to the public hospitals free of charge. He regarded as a tremendous injustice the fact that those able to pay were permitted, in time of sickness, to avail themselves of provisions intended for the deserving poor of the colony, who were otherwise unable to assist themselves. Predictably, the matter was repeatedly ignored by the Government and was still being debated at the time of Grieve’s retirement.
In his activity in the Legislative Assembly Grieve met often with serious opposition and he was frequently the object of bitter attacks; yet, he always faced them with quiet dignity and with the courage of his convictions: The British Guiana Branch of the British Medical Association
Upon taking the appointment of Surgeon General, in 1886, Grieve was also elected President of the British Guiana Branch of the British Medical Association and he passionately committed himself to resuscitating this lethargic organ. A meeting to re-inaugurate the local branch of the Association was held on Thursday September 9, 1886 at the Colonial Hospital in Georgetown; in his opening speech Dr. Grieve stressed the importance of the revival of the branch for the progress of scientific medicine in British Guiana, and for the emergence of the local medical profession from the isolation to which they felt condemned in the colony. Confident that the sanitation of the country could only be achieved through the implementation of a joint programme of prophylaxis, education and sanitary reforms, Grieve considered of the outmost importance the establishment of a solid collaboration between the medical profession and the Legislature, and exhorted his colleagues to work together in that direction. Although fundamentally paternalistic, Grieve’s outlook reflected a strong political acumen and an essential practicality of character. Unfortunately, the circumstances of Grieve’s life were to take an unforeseen turn and in 1894 the doctor was obliged to retire having contracted syphilis whilst operating on an infected patient. At the quarterly meeting of the British Guiana Branch of the British Medical Association held on the very day of Grieve’s departure at the Public Hospital in Georgetown, the same where Grieve had contracted his illness, a pledge was made by the members to continue the medical work of the Society with the same zeal and enthusiasm that their esteemed President had infused into it, “so that it would continue to grow and to prosper as Dr. Grieve himself would have wished”. Grieve could not restrain tears when the following resolution was moved by the councillor of the British Guiana Medical Association, Dr. Wallbridge, and presented to him: That this Branch wishes to record its sincere regret at your compulsory retirement through illness acquired in the performance of your professional duties, and in wishing you good-bye on your leaving the Colony, and vacating the office of President of this Branch, desires to testify to the very high esteem in which you are held not only for your skill and ability in the practice of your profession, but also for your high scientific attainments. We are conscious that the Branch as resuscitated by you in 1886 has developed into one of the most important tropical, Colonial Branches, and that the work done at the meetings compares not unfavourably with that done at local Branch meetings in England. We feel that this success has been due to you, and earnestly hope that though you are leaving us the scientific and professional work so ably fostered by you may continue. The Branch wishes you a safe and speedy voyage, and hopes that your health will be materially benefited by the change to your native land.
Grieve left the colony on Thursday April 19, 1894. The day after, The Daily Liberal recorded with sorrow the decline in strength of a man who had sacrificed his own health in the endeavour to relieve human suffering. Biographical note and family life
Dr. Robert Grieve was a remarkable exponent of an equally remarkable family. His father, Dr. James Grieve, was born in Dunbar on December 4, 1810. After qualifying in Glasgow, James worked briefly as surgeon on board a Scottish whaler and later became the assistant of Dr. Robert Weir of Galashiels. In 1836 he married Dr. Weir’s daughter, Elizabeth, and in 1839 the couple moved to Gifford, where the young doctor set up his own practice and earned a reputation as a most helpful and efficient surgeon. In 1843, as part of a schism in the Church of Scotland, most of the local congregation broke away to join the Free Church of Scotland; James Grieve was one of the few to remain loyal to the Established Church and in 1844 he was rewarded with the appointment of elder in the Church of Scotland.30 In 1850, in order to advance his professional career, the doctor permanently relocated with his family to Port Glasgow, where he took a keen interest in local public affairs. An earnest supporter of the Tory party and an ardent educationalist, he served on the Town Council in 1858 and was for some time Chairman of the School Board. On Sunday 29th October 1882, his wife Elisabeth fell whilst coming out of Newark Parish Church after the morning service; as consequence of the injuries reported in the awkward fall she passed away on November in their house at 65 Princes Street, the same where, after a long and active life, Dr. James Grieve also died on December 18, 1895 of cardiac complications caused by an abdominal tumour. James and Elisabeth’s marriage was blessed by the birth of five children, three daughters and two sons. Robert, the eldest son, was born in Lilliesleaf on March 4, 1839. Having inherited his father’s passion for scientific investigation, he graduated in medicine in 1861 in Glasgow and took the license of the Royal
College of Surgeons of Edinburgh in the same year. One of his first experiences as a surgeon was as House Physician of the Fever Hospital in Greenock, where he contracted typhus in attending the sick. Having fully recovered, he later served as Assistant Surgeon in the Royal Navy and took part in actions against the Taipings near Shanghai in 1861-62. Compelled by mal-de-mer to leave the Navy, in 1862 he entered into private practice at Howden, in Yorkshire, where he formed his first connection with the British Medical Association. In 1864 Robert married Annie Maria King (1842-1909), at Sculcoates Church in Hull. Annie was the only surviving child (her older brother having drowned at sea as a boy) of the late John Bird King, a master mariner, and Ann Maxwell, whose brother Thomas Bird was the proprietor of a sugar estate in Tobago.
In 1870 Robert was attached for a time to the Orangeries Hospital, Darmstadt, a base hospital of the German Army during the Franco-Prussian War (1870-71), to assist and study Military Surgery under professor Friedrich Daniel von Recklinghausen (1833-1910) and other famous surgeons of the time; on his discharge, Robert was awarded a German War Medal for noncombatants for his outstanding services.
Between 1870 and 1875 Dr. Robert Grieve worked as Medical Superintendent of the Metropolitan Asylum Hospital at Hampstead, London, one of the largest small-pox hospitals during the epidemic of the early seventies.32 In 1871 he became the target of a spiteful attack orchestrated by three of his subordinates who had been discharged from their duties. In a letter sent to The Times, and published on August 29 the three assistant medical officers made a number of serious charges regarding the improper treatment of patients and the inadequate provision of care and food for the sick at the Hampstead Hospital. Dr. Grieve, in his capacity as medical superintendent, was indicated as being responsible for the misdemeanours and, in response to the allegations made against him, he invited an official inquest into the matters. On the 29th September 1871 a public enquiry was opened into the management of the Hampstead Hospital. After 33 days of thorough investigation, Grieve was cleared of all charges and warm gratitude was expressed to him and the nurses of the hospital for their untiring and able work.
After the small-pox hospital was closed, he chose once again to follow his profession abroad.