Fair Mile Hospital
Page 9
John’s other claim to fame was that he was a serial absconder and had, uniquely, taken a graceful flying leap over the ditch surrounding the male airing court and escaped over the wall beyond – which wasn’t bad as he was recovering from TB at the time!
There was a classic case of echopraxia, a condition in which the sufferer mimics another person’s movements. Two male patients (one of them without the syndrome) would often be seen going about the hospital a few steps apart, so perfectly synchronised in every action that they might have been connected by strings. Neither acknowledged the other’s existence. The spectacle fascinated any onlookers and they were known as ‘Me and My Shadow’.
One male patient was prepared to take advantage of his station in life. When faced with a long queue for the bus back from Wallingford, he would elbow his way to the front, calling, ‘Make way for a Moulsford lunatic!’
Percy Walwyn
It has been the general rule in this account to avoid naming patients but an exception can be justified. Percy Walwyn had apparently been an engineer or draughtsman in professional life and worked for the famous Rudge motorcycle concern. In 1949, following the dawn of the jet age, he produced some intriguing engineering sketches that showed his ideas for swivelling the exhaust of a jet engine as a means of controlling an aeroplane in flight. The drawings were duly consigned to the Air Ministry in London, which pricked up its ears and sent a motorcar full of important people to talk to the inventor at the address neatly inscribed on the sheets. Arriving at the front desk of Fair Mile Hospital, the party was regretfully informed by Leslie Talbot, the Hall Porter, that there was no Mr Percival Walwyn at the hospital – unless they were seeking Percy, who was one of the patients. One can only imagine the feelings of the Air Ministry boffins who, with little further ceremony, turned on their heels and beat a hasty retreat to London.
We may never know for certain whether Percy was a prophet without honour, but it does not appear that anyone else in 1949 had hit upon the principle that came to be known as thrust vectoring and which, much later, made possible the Harrier ‘jump-jet’. The principle has since been employed in ways even more closely resembling Walwyn’s sketches. In 2009, the author deposited Walwyn’s sketches at the National Aerospace Library, Farnborough, Surrey, where they were received with interest and published in the house newsletter.
One of Percy Walwyn’s far-sighted sketches. (By permission of the Royal Aeronautical Society (National Aerospace Library))
Percy Walwyn’s later demise, although tragic, may or may not have been of the saddest kind seen at Fair Mile. He was fond of fishing, which he was allowed to do by the River Thames. A former male nurse related that Percy’s eccentric method of casting his fishing line was to whirl around on the spot – to the peril of anyone standing within the compass of rod and line – knowing that centrifugal force would carry float and hook far out into the stream. One day, Percy went missing from the riverside and was later found drowned. No one could tell whether it was accident or suicide.
Note
25 Not one of the classifications under the Idiots Act of 1886 but nevertheless an official term.
6
CARE AND TREATMENT
I found this institution in excellent order on my visit today. The wards were bright, and well supplied with objects of interest and amusement, and the dormitories were orderly and well ventilated, whilst the bedding throughout was all that could be desired. The gardens associated with the wards, in which there were many patients26, were well kept, pleasant in appearance and satisfactory in all respects. The general tone of the institution seemed to be one of homely comfort materially contributed to by the good feeling that obviously exists between the patients and the medical and nursing staff.
(Opening paragraph of a report by R.W. Branthwaite, Commissioner of the Board of Control, 1926.)
It is important to set the correct tone on this subject. Despite enduring problems involving buildings, equipment and staffing, there can be no doubt whatsoever that strenuous efforts were always made to make patients’ lives safe, comfortable, gainful and free from stress; the sentiments in the above statement were echoed year after year, but sometimes as a prelude to specific criticism.
The craft of psychiatric nursing was in its infancy when the Moulsford Asylum came into being. Psychiatry and its history are subjects far too involved for this book, as is the discovery and development of therapeutic drugs; at the outset, the county asylums had neither. Nor were admissions procedures refined. Although forms had to be completed, Superintendent Douty complained in May 1892, with signs of exasperation, that patients were brought to the asylum by persons unqualified and uninformed in the patient’s particulars and circumstances.
Care in the Victorian era was based on a routine of compassion, good hygiene, adequate nourishment and comfort, discipline, work and recreation. This approach, called the Moral Cure by some, was effective in many cases. Gainful employment was held to be an aid to recovery for many patients, who were offered ample opportunity to help in the asylum’s gardens, grounds and farm, sewing rooms, workshops, kitchen, laundry and bootmaker’s workshop and cleaning the wards. This tradition survived through the transition from ‘asylum’ to ‘hospital’ and made good economic sense, as it tended to keep costs down.
Long before the Welfare State, a significant number of patients arrived – sometimes from home but often from the parish workhouses – so stressed by exhaustion, malnutrition or disease that they were vulnerable to mental imbalance and the medical superintendents repeatedly complained about this state of affairs. The situation was exacerbated, around 1875, by a well-intended government subsidy of 4s a week per patient. In that year, 43 per cent of Moulsford’s admissions were from the workhouses.
Relief from anxiety and deprivation often arrested and reversed patients’ decline. Those who improved required less supervision and might progress to supervised activities outside the asylum; records held by the BRO show that up to 40 per cent of patients admitted in the asylum’s first five years of operation were able to return home within twelve months.
For some, mental illness owed little to a poor diet, as in the case of diseases that produced psychological side-effects. Again citing the early superintendent’s journals at the BRO, there are the examples of tertiary syphilis and post-natal infections – such as puerperal fever – that unbalanced the mind: remedies for these conditions, nowadays preventable or curable with ease, could not be depended on until the advent of penicillin and the advanced drugs of the later twentieth century.
Lilian Brignall (centre) with friends; quite possibly patients. Taken in the airing court next to Female 8 (Ipsden) in 1925. The structure on the right is one of the several external corridors that permitted discreet movement around the hospital. (Vera Wheeler)
Patient statistics for the years 1870 to 1896. (Reproduced by permission of the Berkshire Record Office)
Humane treatment was of paramount concern. The following directive appeared in the opening paragraphs of the 1904 ‘Regulations and Orders for the Management and Conduct of those engaged in the service of the Berkshire Asylum Wallingford’:
All the patients are held to be not responsible for their words or actions and must be treated with the greatest consideration, sympathy and forbearance by those who are placed in charge of them.
For the sake of space alone, this document will be referred to as the ‘Staff Regulations’ from this point onwards but the point was well made and the care staff sometimes had to draw on deep reserves of tolerance and forbearance, mixed with amateur psychology, to avoid breaking this cardinal rule.
Nutrition
With bodily health a prerequisite for mental recovery, some detail of the patients’ diet (regularly referred to as ‘the dietary’ in the archives) is appropriate. The author is indebted to a Fair Mile Hospital Newsletter of April 1974 for the following comparison of the dinnertime (that is to say midday) food allowances for patients:
1870
/> 1903
Sunday
7 oz meat, 4 oz bread, 12 oz potatoes
7 oz meat, 3 oz bread, 12 oz potatoes
Monday
3 oz meat
Men: 6 oz bread, 11/2 pints soup
Women: 4 oz bread, 1 pint soup
3 oz meat, 4 oz bread, 1 oz cheese, 1 pint soup
Tuesday
7 oz meat, 4 oz bread, 12 oz potatoes
6 oz meat, 3 oz bread, 12 oz potatoes
Wednesday
4 oz meat, 12 oz meat-pie
4 oz meat, 12 oz meat-pie
Thursday
7 oz meat, 4 oz bread, 12 oz potatoes
7 oz meat, 3 oz bread, 12 oz potatoes
Friday
4 oz meat, 4 oz bread, 1 pint Irish stew
4 oz meat, 3 oz bread, 1 pint Irish stew
Saturday
4 oz meat
4 oz meat, 3 oz bread, 12 oz potatoes
Occasionally, bacon was substituted for the fresh meat.
At first sight, the fare appears very plain but it represented an adequate and nourishing diet, one that some poorer patients might have found hard to scrape together in life outside. These rations were supplemented by foodstuffs from the farm, kitchen garden and orchard. Given that the asylum also attended to patients’ spiritual well-being, it is perhaps surprising to note that fish was not provided on a Friday, but this would have represented a considerable expense.
The newsletter continues:
In addition to this, men and women were each allowed 1/2 pint beer with their dinner. Breakfast and supper consisted of 6oz bread for men, 5oz for women, together with 1/3oz butter and 1 pint of tea. In 1903, breakfast consisted of 8oz bread for men, 5oz for women with 1/2oz butter and 1 pint of tea or cocoa.
Patients employed on the land, in workshops and laundry have 2oz bread, 1oz cheese and 1/2 pint beer at 10 a.m. and 4 p.m. Patients employed in the wards have the same at 10 a.m. only.
In 1903, currant cake was sometimes given instead of bread and butter. On Sundays, 1 gallon tea was made using 1oz tea, 4oz sugar and 1 pint milk. A 1lb plum or suet pudding was made using 8oz flour, 1oz raisins, 1oz treacle and 1oz suet or dripping.
Dr Gilland took an intense interest in the proper nutrition of his charges on a finite budget and in January 1872 expressed satisfaction with trials of New Zealand mutton – possibly shipped canned, since refrigerated shipping from the antipodes was not attempted until 1876. The Steward estimated that mutton-based dishes on three days would require some 120–150lb of meat per week. At Gilland’s request, and in line with other asylums, the bread allowance increased in 1875 by 4oz for men and 3oz for women. He commented that the patients ‘do not now eat so ravenously as formerly’.
In December 1886, while Dr John Barron was Acting Superintendent, a Mr Hargreaves of Maiden Erlegh donated 100 rabbits to the asylum and was thanked for this notable and welcome change to the menu.
Various aspects of Superintendent J. Harrington Douty’s early reports show that he was a man of action and an improver. This 1892 submission to the Visitors shows that he was not only keen to improve the patients’ lot, but that he was prepared to go out on a limb to achieve his reasonable ambitions:
Your permission is asked to allow the Superintendent to make an alteration in the Friday’s dinner of the patients. This dinner had always been distasteful to a larger number of the patients who on that day constantly go without any dinner rather than partake of it. It consisted of a thin stew or soup made from stale bread collected from the waste of the dining hall, with meat and vegetables. During the summer it was frequently sour and disagreeable owing to the old and sour bread it contained. There was always the difficulty of expense in providing an agreeable substitute. For a few weeks past a stew has been made, which the patients greatly relish and of which they partake heartily. There is the same supply of meat and vegetables with the addition of rice and lump potatoes and the exclusion of the bread. This alteration entails a total increase in the expense of about one third of a penny per head per week. I trust that the Visitors will allow this change to be made permanent as the trifling expense is well spent in providing a more acceptable meal. The yield of potatoes this year is sufficient to meet this extra demand.
It is interesting to note that, in May 1887, several patients were removed to the Reading Union. Superintendent Douty’s report of that month recorded his satisfaction that they ‘are to receive extra diet at the workhouse’.
Beer is usually a cheerful subject and formed part of the diet of patients and staff alike. In such a large setting, the asylum might have had its own brew house but beer was part of the bought-in provisions and put out to tender. In 1908, the Wallingford Brewery Company quoted for supply of ale at 32s per barrel of 36 gallons and beer at 20s per barrel of 36 gallons. Both offers were accepted and the author craves the reader’s indulgence while he considers the current price of these beverages and wipes a small tear from his eye.
Beer, incidentally, was part of the allowances to staff, listed as ‘emoluments’ to their wage or salary until 1910, when a monetary allowance was substituted. In the days before treated mains water, drinking beer (often weak ‘small beer’) was a way of avoiding waterborne infections and it was commonly supplied to labourers and servants.
It can generally be said that care and forethought, sometimes modified by experience, went into feeding the patients. The Commissioners in Lunacy had high but realistic standards and recorded adjustments and improvements over the years – not always approving of what they saw, as in their April 1924 comment that patients appeared generally well nourished, but that ‘this was not previously always the case’. Commissioner Rollisham noted in 1925 that ‘The diet has been improved considerably over the past few years and still greater variety will be given when new cooking apparatus has been added to the kitchen plant’, while his colleagues Bailey and Branthwaite said in January 1926 that they were ‘especially pleased with the care taken to provide an adequate amount of fresh vegetables and fruit’.
If it’s Stew, it Must be Friday
Repetition and predictability in the dining hall had become an issue by 1932, when moves to re-sequence the dinner menu, advocated in several previous years, were considered overdue. This was finally achieved in time for the 1937 inspection!
Fish, not previously seen on the menu, became available with the arrival of a fish fryer late in 1934, although ready-made fishcakes were to be served, rather than fresh fish. The same Commissioners’ report observed:
Today’s dinner consisted of boiled heart and two vegetables & looked appetising but examining into the diet we came to the conclusion that it might be on a more generous scale and we discussed various methods of improving it with Dr Holder (Deputy Medical Superintendent).
July 1936, on the other hand, brought news that:
The patients’ diet is varied and generous & a particularly important and valuable feature is the ample supply of green vegetables and fresh fruit, grown on the estate. We understand that almost all the jams consumed by the patients are made on the premises from home-grown fruit.
The 1939 Commissioners’ report mentioned that dinners could be quite cold on arrival in the wards but, allowing for the fact that an inspector’s job is to keep an organisation on its toes, the temperature of meals was by this time less of an issue than the parlous state of the kitchen itself, related in Chapter 3. Some details of wartime catering issues are discussed in Chapter 7.
Comfort and Security
Most wards consisted of a ‘gallery’ or wide corridor with ample seating and daylight, which connected to a day room with tables and chairs. Doors along one side of the gallery led to offices, nurses’ sleeping accommodation, a ward kitchen and ‘side rooms’ for more disruptive patients. From some of the earliest photographs available, it is clear that the patients’ accommodations were designed to be comfortable although some of the interior features, such as panelling in the galleries, were added as part of Hine’s c.1900
alterations. Although dormitories were the norm throughout the life of the hospital, they were at least spacious and properly furnished, with high ceilings and plenty of window area.
This is thought to be Female 7 (later Goring) ward at Christmas 1913. This is the day room, with the gallery beyond. (Spackman collection)
The dormitory of Male 4 in about 1919. It is possible that the gentleman seated is Dr Edwin Lindsay Dunn, Superintendent from 1918 to 1920. (Spackman collection)
Taken from a used postcard, this is Christmas 1913 in a Male ward. The man on the left is Will Bunning, Charge Attendant, who wrote to his mother explaining that his short jacket was the result of a shortage of cloth. Will served from 1904 to 1938. The other men standing are probably doctors or senior officers. (Spackman collection)
Considerable trouble was taken to add homely touches to the wards, such as pictures on the walls, flowers from the hospital gardens, magazines, books and indoor games (such as bagatelle, draughts, Ludo and billiards), even pianos. Whilst the standard of decoration and home comforts was liable to vary over the years, the prevailing attitude was that some semblance of home life had to be provided.