by David H. Clark
2 – The Asylum Years
The state of Fulbourn Hospital in the early 1950s had its beginning in the treatment of the mentally ill in the eighteenth and nineteenth centuries. The opening of Fulbourn in 1858 (at the same period as most of the county asylums in England) marked the end of some 60 years of public debate, agitation and concern. The asylums were hailed at the time as a triumph of public benevolence; Lord Shaftesbury, the great Victorian reformer and philanthropist, saw them as his greatest achievement. They were a turning point in the management of the insane; from the early nineteenth century onward in England madness became a matter of public concern and action, rather than a private misfortune.
Madness has been known to every society that has left records. The tragedy and misery which occur when a useful member of society loses his wits, the problems that arise if he owns property or wields power and the fear of his violence are chronicled in all national histories – from the biblical Kings Saul and Nebuchadnezzar to our own Henry VI and George III. Primitive societies usually dealt with their mentally disordered members by killing or expelling them. Later came attempts to provide care; most settled societies had shrines, holy wells and places of refuge to which the disordered could be taken in the hope of cure. In Medieval Europe St Dymphna’s shrine at Gheel, Belgium and the Priory of the Order of the Star of Bethlehem in London were famous. After the Reformation in England some of this work was carried on by a few Charity Hospitals and London continued to be served by Bethlem. In the eighteenth century private care of lunatics in small homes developed.
However, at the end of the eighteenth century the care of the insane became a matter of growing public concern amongst the informed governing classes of England. There were many reasons for this. An increasing number of pauper lunatics were blocking the workhouses. The former madhouses were inadequate; in the 1820s conditions at Bethlem Hospital in London were so disgraceful that Parliamentary Committees of Enquiry were needed. The insanity of King George III had caused a major constitutional crisis in 1788. His later periods of insanity from 1801 until he died in 1820 kept the matter before the concerned public, especially as details of the brutal treatment he received from his doctors and attendants became known. Since 1793, increasing attention had focussed on the Retreat at York, a pioneering institution run by Quakers where humane treatment had achieved great successes.
All these considerations gave force to those who were pushing for the provision of good public asylums. Much legislation was passed. Forward-looking and prosperous cities set up Lunatic Asylums – Norwich in 1815 and Edinburgh in 1817. In the early part of the nineteenth century a series of scandals caused Parliament to set up Commissioners in Lunacy, at first for the Metropolis and then for the rest of the country.
Lord Shaftesbury interested himself in these unfortunates, as well as many others – children in factories, women labourers, barrow boys and chimney sweeps’ climbing boys. He sat on the Bethlem Enquiry, was one of the first Commissioners in Lunacy and pressed through a series of Acts about Asylums. Finally in 1845, came the Act forcing every local authority to set up an asylum.
General medical practice in the early nineteenth century was still based on the humoral theories of the Greeks and relied very heavily on bleeding and purging. Remedies were obscure concoctions of herbs, only a few of which were effective. The scientific revolution of medicine was just beginning with new instruments such as effective microscopes and new disciplines like chemistry (which began to clarify the physical basis of many diseases). Medical knowledge about mental disorder was unsophisticated. Little was known about the incidence of mental disorder in the population or how best to manage lunatics in institutions. There was even doubt over which profession was best able to manage lunatics. The care of the mentally disordered in England was in the hands of priests during the Middle Ages and even in the eighteenth century there was a general feeling that a clergyman might be the best person to understand and care for a disordered soul. George III’s physician, Dr Willis, was a doctor of divinity as well as of medicine. The Retreat at York had been set up and run by laymen. Most lunatics were treated harshly and left to the mercies of untrained and frightened attendants who beat and abused them and kept them chained and locked up.
Medical knowledge of insanity at the beginning of the nineteenth century was a collection of observations about the characteristics of disorder and accumulated experience about its likely outcome. Treatment was a muddle of traditional remedies and practices – many ineffective, some dangerous and some cruel. The considerable public interest and concern about insanity caused some doctors in the early nineteenth century to become interested in the subject, and it was they who became the superintendents of the new public asylums. They began to study the lunatics sent to them by the magistrates, to try out the various methods of treatment proposed – by people such as Philipe Pinel – and to publish their reflections. Pinel, a French mathematician, philosopher and friend of the Revolutionaries – as well as a doctor – had taken over the dreadful public hospitals of Paris in 1793, taken the chains off the lunatics and instituted humane treatment. His followers, led by Esquirol, studied their patients, classified them and published extensively.
John Conolly was one of the most famous asylum superintendents in nineteenth-century Britain. After a varied career as a militia officer, an unsuccessful country doctor, Mayor, University Professor and journalist, he took charge of the new Middlesex County Asylum at Hanwell for four years (1839–43) and by dramatic action, publications and lectures transformed the hospital. He established ‘non restraint’ and laid the foundations of a successful career as a specialist in mental disorder – or ‘alienist’. By the time that Fulbourn Hospital opened in 1858 there was a small group of English medical superintendents who were becoming recognised as experts on insanity.
Cambridgeshire’s response to the Act requiring the setting up of asylums was very much governed by its geographical situation. It was a rural backwater which had enjoyed a quiet eighteenth century with little change. The land was fertile and productive, the peasants settled and industrious. Authority was firmly in the hands of the squires and the clergymen of the Established Church. The ancient University at Cambridge was at its lowest intellectual ebb – there was little scholarship and it functioned mainly as a finishing school for the less stupid younger sons of the gentry, most of whom would become clergymen. Cambridge was a small market town whose politics were firmly in the grip of the corrupt Mortlock family.
The area’s prosperity was based on agriculture which flourished during the Napoleonic Wars and the protectionist period afterwards. Things changed with the repeal of the Corn Laws in 1846 which started an economic decline that blighted the area for a hundred years. This, however, had hardly started when the founding of the Asylum was being discussed in the late 1840s.
Cambridgeshire’s ‘pauper lunatics’ were lodged in the workhouses and the local jails. If a pauper lunatic was too difficult to handle in the workhouse the Cambridgeshire Justices had to board him out in a private asylum. In 1845 they were faced with a Lunacy Act which said that all rate-levying authorities must provide a Public Asylum. It was not a challenge which the Justices met with much enthusiasm.
In the early nineteenth century the Justices of the Peace (Magistrates) in each County were responsible for public affairs and for such public services as existed. These JPs were selected, respected members of the gentry – usually land-owning gentlemen and clergymen of the Established Church. They were responsible for gaols and for police; they discussed public health and government; they had power to levy rates. The task of building asylums, therefore, fell to the Justices and the records of the transactions that led to the founding of Fulbourn Hospital show how the Cambridgeshire gentry responded.
While in some areas Justices acted quickly, this was not the case in Cambridgeshire. They met and discussed, and were dismayed by the task ahead. Finally in 1848 there was an agreement to set up a Pauper Lunatic Asylum between the ‘Justices met in Quarter Session’ of the County of Cambridge, the Isle of Ely, and the Borough of Cambridge (later known as ‘The Three Bodies’) who would have to raise the money to pay for the Asylum. They set up a Committee with representatives from the three authorities to be known as ‘The Committee of Visitors’. The Visitors held their first meeting in Cambridge Town Hall on 28 December 1848 and elected Mr St Quintin as Chairman.
This initial meeting was followed by ten difficult years. Having acquired a well-drained site with a good water supply from a local farmer, in September 1850 the committee advertised for architects to compete. They received 50 entries and finally selected that of a Mr Kendall of London. His estimate for building was £26,250. This frightened them so much that they began to cast about for another solution. In 1852 they counted up the lunatics in Huntingdonshire to try to bring them in. They approached Bedfordshire to see if more patients could be accommodated there. However, Bedford Asylum was far too small and needed a new building. After making a series of consultations and references to the Commissioners in Lunacy in London, the committee was told that no asylum should contain more than 300 people, and that, therefore, there could be no merger with Bedfordshire.
Having wasted several years, in 1854 the Committee decided to go ahead again with building their own asylum. However, by this time the cost of Mr Kendall’s plan had risen so much that they dropped it. There are several Minutes referring to ‘the vast rise in the cost of materials and labour’. They offered Mr Kendall £150 for his trouble, but he refused and eventually took them to Law. He gained a Judgement for £l,000, and the legal costs to the Visitors were £2,279, so the asylum was three thousand pounds in debt because of ill-judged parsimony before building even began. They then invited Mr Samuel Hill, the Medical Superintendent of West Riding Asylum to prepare plans, which he did along with an architect named Jones. These were accepted and put out to tender. Mr Webster, a local builder, won the contract and the building was begun during 1856.
On 30 September 1856 Admiral The Earl of Hardwick, the Lord Lieutenant of the County and a member of the Visitors Committee, laid the Foundation Stone. An account of the occasion which appeared in a local paper gives a flavour of the times and indicates what people hoped of the Asylum when it was built.
‘Laying of Foundation Stone of the new Pauper Lunatic Asylum’, Cambridge Chronicle Oct. 4 1856, p.7.
The subject of a Pauper Lunatic Asylum for the County and Borough of Cambridge and the Isle of Ely has long been before the public; it is unnecessary therefore on our part to go into details of all the discussions that have taken place upon it, the law expenses that have been incurred, the differences between architects and builders and the numberless reports that have been presented upon the matter at Quarter Sessions and at Council meetings. It is sufficient that all these difficulties have been satisfactorily mounted, thanks to the increasing efforts of the Committee of Visitors with Mr St Quintin as their Chairman; and those poor creatures whom it has pleased the Almighty to affect with the loss of reason are at length likely to receive that comfort and attention which their sufferings require and where many of them may be restored to happiness and rationality.
Extracts from the Earl of Hardwick’s speech illustrate the attitudes and beliefs held by informed gentry in the mid-nineteenth century towards the mentally ill.
Ladies and Gentlemen, allow me to express one ardent wish on this occasion and that is that none of you whom I see present today, or anyone belonging to you may ever be compelled to go within those walls (hear, hear). One of the improvements of our age has been the desire on the part of the rich, of those who govern, to care for the comforts and necessities of those in a different sphere of life from themselves.
He spoke of the care of lunatics in the past and said
for some time their condition was regarded as incurable, and their acts were sought to be restrained by rules and violent means. The great advancement made by medical professors has convinced the public that insanity is not incurable; and that although there are idiots whose minds are entirely gone, in most cases the patient can be restored to mental soundness. This is a building which will be devoted to the pursuit of that science which has enabled members of the medical profession to effect a cure of insanity in almost every instance.
In January 1858 the architect reported that all was going well, and that he would be ready to hand over in May; he handed over in August. In August 1858 the committee interviewed candidates and appointed Dr Edward Langdon Bryan, MD of Hoxton Asylum, as Medical Superintendent and his sister Miss Bryan as Matron. They engaged staff, moved them in and arranged to bring to Fulbourn those Cambridgeshire people who were at present being maintained by their parishes in various asylums.
The estate the Visitors had purchased was a stretch of open chalk downland some three miles to the south-east of Cambridge. It was about half a mile square and lay to the north of the main road from Cherryhinton village to Fulbourn village. From the road the land rose gently to an east–west ridge on which they built the asylum. Behind the ridge the land sloped down toward the fen, being crossed by the new Cambridge to Newmarket railway (1832) and a lane, ‘The Old Drift’ which had run since Saxon times from Cherryhinton Church to Fulbourn Church.
The buildings they had erected stretched for 400 yards along the crest, two storeys high, built of the grey local brick with stone facings. In the centre stood a three-storey building containing the Board Rooms and the Medical Superintendent’s home; behind it lay the hospital Chapel and the battlemented water tower, at 60 feet the highest point of the building. The two wings contained the wards for the patients, men to the west and women to the east, two wards for each sex, day rooms on the ground floor, dormitories above, and attendants’ rooms in the attics. From the main road it was a fine impressive building.
The opening of Fulbourn Asylum was described by the Cambridge Chronicle for 6 November 1858:
Lunatic-Asylum Visitors met at the Asylum on Tuesday last. The main object of the meeting was to open the asylum for the reception of patients, Dr Bryan having been instructed to remove from the Hoxton Asylum the patients chargeable to Cambridge parishes on this day; accordingly shortly after the Visitors had commenced the business of the meeting, the porter announced the arrival of the train containing the poor unfortunates. Nothing could exceed the good arrangements made for removing the patients, by which all had arrived safely and without a single casualty. With the exception of three (who were carried) all walked from the carriages to the Asylum. It was a sad sight to witness, forty-six poor creatures, varying from sixteen to at least seventy years of age, each bearing the unmistakable impress of insanity. We understand several of the patients were very violent cases; but whether from their being accompanied by their own attendants, or from the change of scene, all were quiet and behaved well; in fact several of them took off their hats to the Visitors, and the females curtsied. There were about an equal number of each sex in the forty-six patients. Several of the females were very lively, and laughed heartily on walking across the grounds of the Asylum.
From 1858 the annual Reports are our main source of information about the happenings in the Asylum. The Law required the Committee of Visitors to prepare every year a Report on the Asylum, send it to the rate-levying bodies and to publish it. The Visitors’ reports had mostly to do with building, finance and staff difficulties, and had numerous lengthy financial appendices. However, attached each year were the comments of the Lunacy Commissioners, who had made their visit during the year, and the report of the Medical Superintendent. From these, with occasional reference to the Visitors’ Minute Books, we can gain an idea of what happened in the Asylum during the early years.
At first all went well. Altogether 106 Cambridgeshire people were transferred from various metropolitan asylums by the end of 1858, and twelve new cases were admitted. The chronic patients (80 of them had been insane for more than two years, and 27 for more than ten years) reacted well to the new environment, and Dr Bryan noted that the physical health of many of them improved materially during the first few months; during the next year two of them were discharged.
The patients were busily occupied during the first few years laying out the paths, building a bowling green and bringing the land into cultivation. Dr Bryan’s report for 1859 indicates the active life organised for the patients in the early days.
From the Medical Superintendent’s Annual Report 1859
The requirements of a newly opened Asylum have directed my attention chiefly to out-door labour, namely, the cultivation of the land already under tillage, and the trenching, levelling and bringing into a fit state for farming or gardening, the remaining 5 or 6 acres, consisting of a large and deep clunch pit, and other broken and waste land.
I may also mention, that this kind of employment was indicated by the fact that the greater number of patients are agricultural labourers, the number of artisans being extremely small. The cultivated portion of the garden and farm, consisting of about 40 acres, has received due attention in reference to cropping, gathering the crops, and manuring. The roads and walks extending above a mile in length, have been levelled, rolled, and gravelled. While attending to the profitable employment of the Inmates of this Asylum, we have not been unmindful of their amusement and recreation. Thus, on referring to my journal, I find the following note:
‘At the hour of three in the afternoon, 57 of the male patients left their wards, and sides being chosen they commenced a game of cricket, which the lookers-on as well as the players appeared much to enjoy.
At tea-time they were joined by 43 of the female patients, and after tea various games were entered into, a few country dances were gone through with much mirth and spirit; the attendants and a few visitors to the patients (who requested to remain in the grounds) joining in the pastime; all parties appeared much pleased with their afternoon’s entertainment, every thing going off comfortably, and the patients retiring to their wards shortly after eight o’clock’.
This mode of passing the afternoon has been of frequent occurrence, and with walks in and beyond the grounds has formed our chief out-door amusements. Within the house, after the hours of labour, books and periodicals are freely distributed; bagatelle boards, drafts and cards have also been supplied, and are in great request; music and dancing have been among our evening amusements on the female side of the house, where one evening weekly is devoted to this very favourite recreation.
The Commissioners in Lunacy reported favourably on l December 1859 and noted that ‘Non-restraint is the rule of the establishment’. During the first years the Visitors found it difficult to fill the Asylum. This alarmed them because they could only keep the maintenance cost down by filling it. There were plenty of lunatics in the workhouses in the County, but provided they were quiet the Guardians kept them there for it was cheaper than maintaining them in the Asylum. The reports of the next few years are full of pleas urging on the Guardians the advantages of early treatment, and begging them to send the patients in before they became chronic.
Further building was necessary as early as 1860. The parishioners of Fulbourn village had begun to protest against the burial of pauper lunatics in the already overcrowded village churchyard. The Committee proposed to have their own graveyard; the Commissioners in Lunacy disapproved of this because they knew that relatives did not like visiting ‘asylum graveyards’, but the Committee went ahead. They dismantled the mortuary which had stood at the main gate, and re-erected it as a cemetery chapel in the north-west corner of the grounds. The paupers were buried two in a grave and the sad little burying ground continued in use until 1955.
In 1869 Dr Bryan married a local heiress and resigned from his position. The Visitors then appointed Dr George William Lawrence of Camberwell House as Medical Superintendent. Dr Lawrence began work enthusiastically and several Commissioners’ reports comment favourably on his energy.
During 1861 we find the first mention of staff misconduct and dismissals. An attendant John Barnes was discharged for leaving his razor on the window-sill of his room, where patient William Gittus found it and cut his throat. The tailor ‘responded to a patient’s challenge to a fight’ and was discharged. Robert Mills struck a patient, was cautioned and later discharged.
Dr Lawrence continued to improve things and amongst other changes started a library for the patients and a school for the men to learn to read. In 1862 he turned his attention to the diet. He states in his report his conviction that ‘The proportion of recoveries in this asylum is the highest (of 10 listed County Asylums) … this I attribute chiefly to diet.’ Brewing had been started that year and he notes ‘I have been able to reduce the medical extras this quarter from 31/2d per head to ld in consequence of the excellence of the beer brewed and supplied to the patients.’
We are fortunate in having a contemporary description of the hospital in its early days. Though eulogistic, it does give an idea both of how things actually were and how they were intended to be. In the Journal of Mental Science for 1862 is reprinted a lecture given in Cambridge by Dr J. Lockhart Robertson on ‘The Progress of Psychological Medicine since the days of Dr Caius’ (that is since the sixteenth century) (Robertson, 1862). Dr Robertson spent some time retelling the melancholy tale of earlier asylum brutalities and the lamentable state of affairs at Bethlem in 1815. He then says:
In order vividly to see the progress which medical science has made since Dr Caius’ time, let us look at one of our English county asylums of today. A very good specimen is the Cambridge Asylum at Fulbourn, under the able administration of my friend Dr Lawrence.
The first great fact observed is the entire absence of all means of mechanical restraint. Neither belt, strait-jacket, manacle, strong chair, or any other means whatever for restraining the patient, are to be found there. All appearance of a prison has also been removed. The windows have no bars, the doors no bolts, the entrance hall stands open, and apparently no external distinction is observed between this and any other large hospital for the treatment of disease. The whole asylum bears the aspect of some large house of industry. The female patients, seated at needlework in their day-rooms, or washing in the laundry, or cooking in the kitchen, or engaged in the various household arrangements, would hardly by a casual observer be recognised as persons of unsound mind. So, also, in turning to the male department. Parties of ten or a dozen working in the garden, or engaged in the detail of agricultural labour present little evidence of insanity. In the several workshops of the tailor, the shoemaker, the carpenter, the smith, the basket-maker, the baker, the brewer, are patients daily engaged at their respective trades. Employment and the confidence shown by the implements and tools entrusted to the patients have evidently replaced the old means of coercion and restraint. In visiting the several rooms at meal time the greatest order and quiet reign. … The windows apparently open at will (only the opening is so arranged that no patient can throw himself out of it), and look on a wide landscape, and, being generally with a south aspect, the house is filled with the brightness of the morning sun.
One constant, careful, and anxious system of watching pervades all this apparent freedom. No patient is ever left at any time alone; the sense of moral control of his attendant is never away from his mind. By night the wards are hourly visited, and the slightest noise or restlessness seen and attended to with the prescribed remedies.
The nurses who thus tend the insane are of the stamp of the St John’s Sisterhood, who now have charge of King’s College Hospital. They are generally selected young, it being found by experience that young girls of twenty-three or twenty-four better adapt themselves to the varying character of their patients than those who commence the work with more formed mind and opinions.
Alas, things began to change not long after this glowing account appeared. In the course of 1866 Dr Lawrence had become rather more irritable and difficult, and had needed a period of several months’ sick leave. During this time the asylum was looked after by a young medical graduate from Guy’s, Dr George Mackenzie Bacon. Dr Lawrence returned to duty but things were far from well, and in September the Commissioners in Lunacy had to write to the Visitors a hesitant and regretful letter pointing out he was no longer fit to be Superintendent and that ‘he exhibited unequivocal symptoms of incipient general paralysis’. General Paralysis of the Insane (GPI) was in those days a mysterious mental disorder which struck down men in their prime and killed them a few years later (in 1910 it was shown to be a form of syphilis of the brain). The Committee tried to get Dr Lawrence to retire but he refused and they had to dismiss him. The Minutes contain a long rambling letter from him protesting at their decision. They granted him an annuity of £50 a year, but he was dead within two years.
The Committee then appointed Dr George Mackenzie Bacon as Medical Superintendent. He was at that time travelling on the Continent perfecting his French and Italian and visiting foreign asylums, but the Visitors sent for him forthwith and offered him charge of the hospital.
Dr Bacon is one of the few early figures in the hospital’s history of whom we can gain a picture for he was extensively commemorated in obituaries. He was a bachelor and had independent means. He was a prolific writer and contributed articles to the Lancet, the British Medical Journal and the Journal of Mental Science. He published many case reports, wrote on GPI and Criminal Responsibility and published a small book on the handwriting of the insane.
In 1868 Dr Bacon started clinical lectures for the students at Cambridge, on which the Lancet commented favourably. They were so much appreciated that in 1877 the University awarded him an Honorary MA. He seems to have been a quiet, shy man, though within the hospital he pursued his ends with considerable tenacity. Dr Bacon started well and in 1869 redecorated the Recreation Room at his own expense for the Christmas festivities. In 1869, however, there was a serious row which involved the whole principle of management of the Asylum. Miss Bryan, Dr Bryan’s sister, had been Matron and housekeeper; she stayed on after her brother resigned but left in 1865. The Visitors then rather unwisely decided to appoint as Matron Mrs Norman, the wife of the resident Clerk and Steward. This created a situation whereby the Normans had complete control of all the housekeeping and all the female staff. In June 1869 the laundress alleged that Mrs Norman was sending to the hospital laundry not only her own washing but also that of her relatives. Dr Bacon took this up and the matter went before a Subcommittee of the Visitors. Dr Bacon finally accused the Matron of ‘habitual inebriety’, and at an adjourned meeting in July proved his case by bringing signed depositions from a number of nurses. The Subcommittee came to the opinion that ‘great laxity of discipline has for some time existed, and still exists in the Asylum’. Mrs Norman was allowed to resign provided she left within the week; Mr Norman was to resign within the month, but only after his accounts had been audited. Dr Bacon was told to enforce stricter discipline; the post of Matron – that is, housekeeper – was abolished; a female head attendant was appointed to be in charge of the women attendants; all the ordering and household management was placed under the Clerk and Steward who was to live out of the grounds (and thereby lose the perquisites which accompanied residency in the hospital – free laundry, free domestic servants, free food), and he was to be answerable to the Medical Superintendent. Several other people were dismissed. The Committee appointed as first Female Head Attendant an experienced woman from Hanwell Asylum and in 1875, after various changes, Miss Williams was appointed to the post and held it for the next 19 years.
Although there were other rows between senior officers, this was the last change to be made in the formal relationship of the senior members of the hospital hierarchy until 1948. From now on the Chief Officers were a head male attendant, a head female attendant and a Clerk and Steward, all subordinate to the Medical Superintendent. He, in turn, was answerable to the Committee of Visitors for everything that happened in the house and at law for everything that happened to any patient.
During this period too, the Committee of Visitors changed and took shape. The first Committee consisted of interested and philanthropic members of a heterogeneous group of magistrates and gentry. The composition of the Committee gradually changed, with the previous dominance of the clergy diminishing, until the Local Government Act of 1889 set up elected County Councils. This produced a radical change: only three of the 1889 visitors appeared among the 20 for 1890 and from then on all were elected Councillors.
By 1870 the Asylum was full, and infectious diseases began to appear. In 1874 there was an epidemic of erysipelas, an infectious skin disease, in which four patients died; in 1875 one of diarrhoea in which two patients died. In these years one quarter of the deaths of patients were due to phthisis (pulmonary tuberculosis). In 1877 the gardener Joseph Scott died; shortly afterwards his widow and five children sickened and were all removed to Addenbrooke’s where typhoid was diagnosed. She died but the orphans survived. Investigations at the Lodge revealed that the well from which they drew their water was ‘very foul and full of vegetable matter and impurities’ so a piped supply was laid from the main hospital. In 1878 the Commissioners wrote ‘We cannot report the general bodily health of the patient as being satisfactory. The high rate of mortality and the recurrence of erysipelas and diarrhoea point to a defective sanitary condition, which we think results from the present overcrowding of the Asylum.’
During this period defects of the building, too, became apparent. On 12 March 1872 the asylum caught fire. Fortunately the fire occurred during the daytime, and the engineering staff were able to put it out, although the Chapel was gutted. In 1872 the Committee recorded their opinion that ‘the Asylum building was constructed in a very insubstantial manner which has been, and still continues to be a source of great expense…’.
In 1875 an event occurred at Fulbourn Hospital which was to have national repercussions. For the previous half century humanitarians had slowly been bringing to an end the abusive systems of child labour in Britain – the use of children in factories, as barrow boys, chimney sweeps’, climbing boys and so on. Lord Shaftesbury had pushed a series of Bills through Parliament, starting in 1834, limiting and regulating the use that chimney sweeps made of their boy apprentices. Charles Kingsley’s famous book The Water Babies(1863) was part of the campaign. In February 1875 a twelve-year-old boy, George Brewster, was sent up the Fulbourn hospital chimneys by his master, William Wyer. He stuck and smothered. The entire wall had to be pulled down to get him out and although he was still alive, he died shortly afterwards. There was a Coroner’s Inquest which returned a verdict of manslaughter.
Everyone was shocked; the Coroner bound over Dr Bacon to prosecute the master sweep. The Committee’s Clerk handled the prosecution and at the Cambridge Assizes Wyer was found guilty of manslaughter and sentenced to six months’ imprisonment with hard labour. Lord Shaftesbury seized on the incident to press his campaign again. He wrote a series of letters to The Times and in September 1875 pushed another Bill through Parliament which finally stopped the practice of sending boys up chimneys.
During these years Dr Bacon’s work proceeded; he wrote a number of interesting reports making much of the correlation between pauperism and lunacy. In 1879 Dr Bacon comments in his Medical Superintendent’s report on the use of Extract of Hyoscyamus. He says he finds it a useful sedative, but that he had never obtained the ‘sudden creative results that had been reported’. This entry is noteworthy as the only remark on the medical treatment of the patients’ mental condition between Dr Lawrence’s comments on the benefits of beer in 1860 and Dr Archdale’s first report in 1919.
In 1883 Dr Bacon died at the age of 47 of peritonitis following intestinal obstruction. The obituaries were effusive and fulsome; the Journal of Mental Science said he ‘effected numerous alterations and improvement in his Asylum, so that it was more healthy, commodious and cheerful and it will now bear favourable comparison with the majority of English Asylums’. The British Medical Journal remarked ‘The improvements effected while he was in charge of Fulbourn Asylum were very great … so that Fulbourn Asylum became an asylum which for its arrangements and for the employment of patients in work conducing to their mental and bodily health, may rank with the first.’
By the end of Dr Bacon’s time, Fulbourn Asylum had settled down into a pattern that would show little change for the next 60 years. As successor to Dr Bacon the Committee appointed Dr E.C. Rogers, aged 33. In reporting the appointment the Committee said they ‘have every reason to hope that they have secured an energetic and efficient officer’. It seems that they were mistaken; Dr Rogers’ period of office marks the lowest ebb of the institution. No very clear picture emerges of Dr Rogers himself; his annual reports were very brief, merely reporting staff changes and statistics; he published no articles; he remained in post until the Asylum Officers Superannuation Act became law in 1909 and then retired to enjoy his pension for another 20 years. He was chiefly remembered as a keen gardener and tennis player.
For 30 years, 1880–1910, the Asylum was dominated by a group of men who grew old in office together. Mr E.M. Thorne, who had come to Fulbourn a few years earlier from Broadmoor, was appointed Head Male Attendant in 1876 after his predecessor had been caught giving brandy to the construction workers on the new wing; Mr Thorne was already notable as a fine bass singer who took a lead in the hospital entertainments; for years he was leader of the hospital band. His fine flowing moustache and noble paunch dominate the few pictures we have of that time. Mr Henry Archer was appointed Clerk and Steward in 1872 and held the post until 1911. George Miller emerged about this time as the Foreman of Works, though he had been on the Asylum staff for a number of years, coming originally as a journeyman carpenter. Several architects refer to his energy and skill. Miller was a self-educated working man with a great interest in politics. He was said to have been a notable public speaker; he apparently never voted in an election, but he was always ready to address a meeting of any political party at any time on any subject with eloquence and conviction.
A major activity of these years was building. The number of patients increased steadily; as soon as the wards became overcrowded the Lunacy Commissioners insisted on the boarding out of patients – a costly procedure. Building of new accommodation began in 1876 and by 1903 places had been provided for altogether 225 men and 378 women. This was the first major building necessary since the opening, and the Visitors had considerable difficulty in raising the money from the Three Bodies.
However, during this period the conditions of the patients declined. The Visitors, under pressure to build more with inadequate money, perhaps saved too much on the running costs. The wages that they paid to staff are frequently noted in reports as being too low to attract good recruits. The Commissioners commented sourly in 1897 ‘The duration of service is not satisfactory, indeed it can hardly be expected that attendants will stay here long when they can get higher wages and more comforts and amusements in Asylums at no great distance.’ There is no evidence during the long years of his office that Dr Rogers showed energy, therapeutic enthusiasm or marked concern about the welfare of his patients, and this attitude may have made itself felt within the hospital. There had also been a change in the public attitude toward the mentally ill. The enthusiasms of the 1850s had faded away as more and more lunatics became a burden on the rates. Misreading of Darwin’s theories and the phrase ‘survival of the fittest’ became a reason for moral and ‘scientific’ disapproval of those who failed in life’s competition. In 1889 the Local Government Act set up the County Councils and transferred to them many of the functions of the Quarter Sessions including Lunacy provision, so a new Committee of Visitors took over. From now on there were no philanthropic clergy on the Committee; all members were representatives of the rate payers and guardians of the public purse, vigilant that pauper lunatics did not absorb too much of the dwindling rates of the rural county.
The decline shows most clearly in the yearly comments of the Lunacy Commissioners. For the first decade of the Asylum they were all praise; towards the end of Dr Bacon’s time they were becoming critical, and in the next years they were often quite harsh.
In 1892 they said
we still have to report that many matters considered by the whole of our Board to be essential to the proper management of the Asylum and the welfare of the patients have not been carried out…. All these matters have been so often and ineffectually urged upon the consideration of the Committee that we merely mentioned them again to show that they have not escaped our notice … rather than with any sanguine hope that any great alteration will be effected.
In 1896 they said
We have today visited all parts of this Asylum, of which we regret that we cannot write in terms of unmixed praise. In regard to cheerfulness and reasonable decoration it contrasts unfavourably with most County Asylums; and in the older parts the limited amount of window which can be opened prevents that thorough ventilation of the rooms, particularly the dormitories, which is so important, and the absence of which today was very apparent.
In 1897 they said
The rooms are still dull and cheerless as compared with the majority of County Asylums. Means of amusement in the wards are scanty; pianos are needed and billiard and bagatelle tables for the male patients and attendants. The staff of attendants is only barely sufficient when all are on duty, and as there are no supernumerary attendants to take the place of the sick and on leave, today we found the staff too weak …
In 1898 they said
The Asylum generally presented a dull, cheerless, and untidy appearance … With reference to the bed linen, many of the old brown counterpanes are quite worn into holes, and are all thin and threadbare. The sheets were of a poor colour, and in one case we found one of the quilted sheets in a single room, in which a female patient had slept, dirty and fouled.
In March 1908 a local weekly paper, the Cambridge Express, filled a complete broadsheet page with a feature article on the Asylum, headed by a photograph. An air of dreary resignation hangs over the article; the feeling behind it being this is how things are, these people are a permanent charge on the community. At no place amongst five thousand words does the article mention treatment or the possibility of cure. It starts:
Of all the public buildings and institutions in the County, there is probably not one – except it be His Majesty’s Prison at Chesterton – of which the great ratepaying public, who have created and supported them, know as little as they do of Fulbourn Asylum. And yet the affairs of the publicly supported Institution have been a great deal before us of recent years, and are at the present moment largely occupying the attention of the Councils of the Borough, the County, and the Isle by reason of the additional money these bodies are having to raise to meet the enlargement rendered necessary for the accommodation of the increasing numbers of cases of mental disease, the price we have to pay our higher civilisation and the ‘hustle’ of our modern industrial life.
The writer goes on to give his first impressions on visiting the Asylum:
The Asylum stands in spacious grounds, laid out as gardens – on which men were at work when I arrived – with a large green, used for a cricket ground, directly in front of the building … Though the Asylum is so fine a place seen either from the road or near to, and has as neat a drive and main entrance as any house of the quality in the County, it is, after all, a prison, and everybody and everything in it is under lock and key. This knowledge has a depressing effect upon the individual who enters for the first time – knowledge which he cannot shut out, for there is an unlocking and locking of doors before and after him wherever he goes. …
Having duly satisfied the Medical Superintendent as to my identity and business, the building was literally thrown open to my inspection. … Circumstances obliged me to betake my steps eastwards, under the courteous guidance of Mr Thorne, the principal male attendant, who, however, was extremely pessimistic as to the possibility of my finding anything worth writing about. I had my own opinion as to that, and his did not discourage me, and so that key which for the next hour and a half was to be industriously employed by him in opening barriers for me began its work, the first door was passed, and we commenced a round of visits to the day rooms, or apartments occupied by the men when not at exercise work, meals or repose. …
After visiting the men’s wards, I turned my attention to those set apart for the women, which are situated in the opposite wing of the building. They are similar in character to those occupied by the men, but more extensive, it being a melancholy fact that insanity is more prevalent amongst the weaker sex. … Cleanliness and neatness were, of course, even more noticeable here than in the west wing, though that is not saying a great deal…
In both wings large walled-in exercise yards, officially termed ‘airing courts’, adjoin the day rooms, with broad asphalt paths and grass plots… One of the first things to rivet my attention on visiting the exercise yard was a long string of men and youths, hand in hand, walking ponderously and in a pitifully aimless fashion, backwards and forwards along one of the paths. It was only by such companionship I was assured, that these patients could be induced to take any exercise at all. Left to themselves, they would prop their persons against the walls. It was very pitiable to see so many young people amongst the patients.
As Mr Thorne told the reporter, little of note had happened at the Asylum during the previous 30 years. The typhoid epidemic of 1905 was an exception. Infectious diseases always presented a grave danger to the closely packed inmates of an asylum, especially since many were undernourished. At Fulbourn there had been many minor epidemics, but none had ever got out of hand. On 18 March 1905 the first patient sickened with typhoid; on l April ten patients went down and by 14 April 39 patients and eleven staff, including Dr Rogers himself, were all seriously ill. Further cases continued into May and there were finally 68 cases – 11 per cent of the Asylum population. Altogether 16 people died. The whole burden of dealing with this emergency fell upon Dr McCutchan, the Assistant Medical Officer, and all praise him. As soon as he saw it was an epidemic he got in touch with the Medical Officer of Health and they managed to check the outbreak.
In July the Medical Officer of Health and Professor Sims Woodhead made a report to the Visitors analysing the whole outbreak. The water supply was exonerated; it seemed almost certain that the infection came from the Asylum milk supply. It also emerged that the drains were blocked, leaking and incompetent. As a result of all the investigations the drainage system was extensively overhauled. A melancholy footnote to the story is the death of Dr McCutchan in June 1906 from a ‘lingering illness’ that had followed the stress of dealing with the epidemic.
Dr Rogers retired in 1910 and there followed an unsettled period of 15 years. During that time there were three Superintendents and the First World War came and went, bringing much readjustment with it. In 1917 the institution changed its name from Asylum to Hospital and in 1914 the first woman came on to the Committee, Mrs F.A. Keynes. (Mrs Keynes was a notable Cambridge citizen, the mother of Lord Keynes, the economist; in her time City Councillor, Alderman and Mayor and Chairman of the Visitors (1930).) After 1914 there was always at least one woman on the Committee and as the years went by their numbers increased.
There was little building during this period. By 1910 the overcrowding was again bad, but the Committee decided to wait and see if there would be any relief from the passing of the new Mental Deficiency Act (1910); then came the First World War and all building stopped. After the war they built a Nurses’ Home for women staff, which began the process of separating the sleeping accommodation of the staff from that of the patients. When the Asylum was first built everyone had lived together. The Medical Superintendent’s House was an integral part of the main building, the head attendants’ bedrooms were on the wards, and the junior attendants slept in the attics above the wards. In the early days of moral treatment this was regarded as good practice, to produce the ‘family atmosphere’ so much emphasised by early writers on asylums. As custodial attitudes developed, however, many disadvantages became apparent. Potential recruits, medical and nursing, were put off by the enforced close contact with the patients.
Dr Alexander Day Thompson came to Fulbourn as First Assistant Medical Officer in April 1909; when Dr Rogers retired the Committee offered the Superintendent’s post to Dr Thompson. Dr Thompson’s first report immediately strikes a different note. Its 15 pages are in marked contrast to the last by Dr Rogers, of only three pages. Dr Thompson states ‘it shall be my aim to reach the highest efficiency in every department of the Asylum’. He gives a considerable disquisition on the annual statistics; he states that some of the information about the cause of the disease is misleading ‘especially so that relating to heredity’ – this being because the relatives tended to conceal the facts of previous mental illness in the family. He ends this portion of his report:
It seems not improbable that a great deal of the increase of certified insanity is due to the marriages of mental defectives in the lower strata of society. In that relation there is at the present day sober truth in the words of the Latin poet –
Aetas parentum, pejor avis, tulit
Nos nequiores, mox daturos
(Worse than our grandsires, sires beget
Ourselves yet baser, soon to curse
The world with offspring baser yet.)
In this report Dr Thompson also reports that a patient escaped from a ward walking party on 29 September. He was brought back within a few hours, but ‘the Charge Attendant who was in command of the party was deposed to the position of second charge attendant for at least six months’.
Dr Thompson’s later reports continue in similar vein, full of high-flown language, studded with quotations and calling for more repressive social legislation; within the hospital there are reports of disciplinary action and dismissals. In 1912 he wrote:
In this convention-riddled and hypocrisy-bound England of ours, where the chief mental nutrient of almost all grades of society is the pursuit of a thousand inanities; where the ‘blight of respectability’ still falleth; where Vice, all painted to allure, stalks brazenly along the highways and builds her myriad nests in the cities; where crime and insanity, first cousins, are lurking everywhere; the forces of Reason are at last winning all along the line in the matters that concern us alienists, whose business is the prevention and cure of insanity and the building up of a sounder race.
Something is to be done, though tardily, as the result of the findings of the Commission on the Feeble-minded, and the trend of influential scientific and expert public opinion, towards the prevention of the increase of insanity. The tackling of the problem of prevention and the further efforts to cure will go on side by side. Prevention will be brought about by the legal control and segregation of the unfit, so that defectives will not be added to the community, for the simple truth is that after all law is the main check upon abnormal bias and proclivity; necessary too are early recognition and early treatment of mental disorder before cases become certifiably insane. Cure, so far as is possible, will accrue in time from all the laborious and admirable research work on the nature, causation, and treatment of insanity, that is going on in so many laboratories and asylums, and which should be fostered by every asylum committee, …
This period saw considerable changes in the status and functions of the attendants, or nursing staff as they were now called. During the 1880s and 1890s there had been difficulty in recruiting suitable staff and comments of the Commissioners indicated that their work was not very satisfactory. There had been talk for many years of pensions for the staff, but the Committee had not taken any action on the matter. In 1910 Parliament passed the Asylum Officers’ Superannuation Act which made Asylum employment a good deal more attractive, especially to men with families. Instead of being an unpleasant, insecure job with risk to life and limb, long hours and low pay, it now offered retirement at 55 with a pension – a comparatively rare benefit in those days. This Act was one of the first gains of the recently founded Asylum Officers’ Union; in later years they did much to improve pay and conditions of mental nurses.
As soon as the Act took effect in 1910 a number of senior hospital servants claimed the pensions they had been waiting for. Dr Rogers, the Medical Superintendent, Mr Thorne, the Head Male Attendant, Mr Miller, the Foreman Artisan, and ten other staff with a total of 433 years of service between them all retired in the one year. The Head Female Attendant had left to get married at the beginning of the year, so that in this one year there were new heads to both nursing departments as well as a new Superintendent. In his first report in 1910 Dr Thompson said:
Miss Viney, the Chief Nurse, joined us on the first day of the year, and the condition of the female side has much improved under her experienced control. Mr Mitchell, the new Head Attendant, came on the 10th of October. His credentials were excellent and he has demonstrated their truth. Under these two last officers the discipline of the staff, which had been allowed to reach a very low ebb, is now in a fairly satisfactory condition, a state of affairs that will I am sure be further improved.
Dr Thompson, for all his rhetoric, was not a very satisfactory Superintendent; his firmness of discipline, at first welcomed, became harsh and erratic. There were frequent dismissals and difficulties. In 1917 the Visitors had to hold an inquiry into the circumstances under which he had dismissed a laundress summarily, and when another Assistant Medical Officer was appointed in 1917 matters came to a head. There was a major row and a Committee investigation. As a result of what emerged both doctors were asked to resign; the junior man complied but Thompson refused and the Visitors terminated his engagement.
Even 50 years later there were tales told of Dr Thompson’s erratic tyranny. When news of my appointment spread to Fulbourn village an aged pensioner remarked ‘The last Scotsman they had as Superintendent were a right bugger. He set off the Fire Alarm in the middle of the attendants’ Christmas dinner and it was all spoiled by the time we got back. You can’t trust Scotsmen.’ I have been told that Dr Thompson’s behaviour was largely due to morphine addiction and it was the exposure of that which finally brought his dismissal.
Dr Mervyn A. Archdale, Dr Thompson’s successor was a man of calibre. In 1909 he had published in the Journal of Mental Science a long and thoughtful article on ‘The Hospital (that is, Asylum) Treatment of the Acutely Insane’ in which he laid great stress on the advantages for the recently admitted patient of protracted bed rest and absolute quiet and isolation from all distracting sounds or experiences; he also discussed at length the different medicines necessary to produce complete elimination of the bodily and bacterial toxins which he believed were the cause of much insanity (Archdale, 1909).
The First World War caused considerable disturbance to the hospital and this is reflected in the reports. Forty-one patients from the Norfolk County Asylum were sent to Fulbourn in 1915 to make room for War Casualties, causing substantial overcrowding. The recreation hall was turned into a dormitory. There were few doctors, for much of the war only two. A number of male staff volunteered for the Army or were called back to the Colours. The new cricket ground to the west of the main building which had been developed just before the war in the early days of Dr Thompson’s enthusiasm was ploughed up in 1917 ‘at the insistence of the War Agricultural Committee’. The rations were cut, the patients lost weight and the death rate from tuberculosis rose.
Immediately after the war there were complaints of rising prices, shortages of materials and of staff. It was noted that women nurses were becoming difficult to recruit because ‘the necessary discipline of an Institution is irksome to the present type of young woman who during the War had the widest freedom, and who now show an absence of desire to learn their work and an excess of zeal for amusement’.
As well as developing his ideas of bed rest and medicinal treatment for the acute admissions, Dr Archdale was also concerned with the work and conditions of the long-stay patients; he persuaded the Visitors to introduce a system of rewarding the working patients with paper ‘money’ negotiable within the hospital; this was not, however, popular with the staff and was soon dropped. He was keen on patients being occupied with some kind of activity and in 1921 it is noted that there was a party of ten women employed on the land.
In 1919 Dr Archdale attracted to the hospital Dr John Rickman, a young Quaker doctor recently returned from Relief Work in Russia who later became one of the leaders of British Psychoanalysis. Dr Archdale says in his 1919 report … ‘Dr John Rickman of King’s College … a keen student of the mental methods of healing, has thrown the greatest energy into his medical work, and has been most assiduous in lecturing to the nurses.’ In the next few years increasing numbers of the nurses took the certificate of the Medico-Psychological Association; in 1920 two passed with distinction. Dr Archdale was also interested in providing further medical training for doctors. Just before the war the University of Cambridge started a Diploma in Psychological Medicine (DPM), and he was soon involved in the teaching of this. The Regius Professor of Physic at that time, Clifford Allbutt, had been a Commissioner in Lunacy and pioneering work was being done by Rivers and Myers at the Psychological Laboratory. Archdale arranged clinical demonstrations at Fulbourn and gave a certain number of lectures; in 1922 he took the Cambridge DPM himself.
In 1922 Dr Archdale took the opportunity to return to the North to open a new hospital. The Committee expressed their great regret at losing him and appointed Dr Arthur Francis Reardon, his Deputy, as Medical Superintendent. Dr Reardon announced his intention of carrying on Dr Archdale’s work. His particular interest seems to have been the development of domiciliary visiting and he visited a number of patients who were boarded out. In 1924 he began seeing patients at the outpatient department at Addenbrooke’s. In October 1925, however, he suddenly collapsed with heart disease and died a few days later in Addenbrooke’s hospital. To succeed him the Visitors appointed Dr H. Travers Jones.
In the period between 1925 and the end of the Second World War, little changed at Fulbourn Hospital. Nationally this was the period which saw the unsettled twenties, the General Strike, the Great Slump, the uneasy depressed thirties and all the upheavals of the Second World War. For English agriculture it was a period of steady decline which seriously affected Cambridgeshire; Fens were allowed to flood and farms and farmers to decay. Agricultural rates were low, the Three Bodies were poor and as a consequence the hospital was held to a restricted budget.
As far as treatment for mental disorder was concerned, doctors had not discovered much since 1800. They had clarified the more common disorders and sorted out a small group which were due to physical (organic) causes. They had clarified and elucidated General Paralysis of the Insane, discovered that it was due to syphilic infection and found a cure by 1917 by inducing severe malarial fevers in the patient. For most psychiatric disorders, however, little had been discovered in the way of treatment, let alone cure. Patients were brought to the Asylum, often furiously disordered; they quietened down and often stayed there for the rest of their lives. The disorders were given labels – mania, melancholia, stupor, delirium, paranoia, dementia praecox, schizophrenia. However, these labels made very little difference to how those suffering from such disorders were handled, nor to how their damaged lives developed and ended.
This mass of unresponsive apathetic misery aroused the compassion and therapeutic zeal of some of the psychiatrists, especially the ablest ones, those working in famous asylums or in private practice; many forms of treatment, often heroic and sometimes barbaric, were applied to the lunatics. Little of this influenced the practice of Fulbourn Hospital. There were some new ideas. The idea that people might seek treatment voluntarily for their mental disorder was being proposed. The Maudsley Hospital for voluntary patients only, and the Cassel Hospital for Functional Nervous Disorders had opened in the 1920s. In 1930 the Mental Treatment Act made it possible for a patient to enter a mental hospital voluntarily. Fulbourn’s response to the Act was most cautious. The yearly number of voluntary admissions from 1930 to 1939 were 0, 6, 14, 6, 8, 7, 11, 11, 24, 24. The tardy use of the provision was accompanied by guarded comments in annual reports; in 1933 the then Superintendent, Dr Jones, said that ‘on the whole, the results of “voluntary boarders” were not encouraging’ and later that these voluntary patients tend to discharge themselves before they are cured. It is clear that this new notion of allowing patients to decide whether to enter and whether to leave was found to be disturbing and unsatisfactory.
The 1930s also saw the advent of the physical treatments of mental illness which started the great changes in institutional psychiatry – insulin coma therapy for schizophrenia in 1935 and convulsive therapy for depression, first with cardiazol in 1934, then with electricity in 1937 – Electro Convulsive Therapy (ECT).
Although in the early 1920s Fulbourn Hospital was in touch with the active growing points of English psychiatry, by 1940 it was well behind. This can be ascertained from the Annual Reports, and from the annual comments of the Commissioners of the Board of Control. In 1924 the Commissioners spoke of the ‘manifest spirit of progress’ in Fulbourn and the improvements that there had been since the last visit. In 1937, the Commissioners commented that the disturbed women’s ward was too noisy, psychotherapy was not possible because the medical staff were too few, the ward gardens could be more attractive, was it not possible for working patients, at least, to have false teeth and could not the occupational treatment be more widely applied, and so forth. There were probably many reasons for the stasis of Fulbourn during this time. Lack of money was certainly important. Another factor may have been the rather conservative character of the senior staff.
When Dr H. Travers Jones took office in January 1926 he found Dr J.G.T. Thomas in post, Deputy Superintendent since 1923; Dr F.M. Deighton then joined them during 1926 as Assistant Medical Officer. This team remained together for the next 20 years; they were a quiet group of men who tried to make the hospital a pleasant and contented place. Dr Travers Jones, a little red-faced bachelor, got on well with the Visitors and was famous for his shooting parties. He reared partridges and pheasants in the corn fields surrounding the hospital and was reckoned to have one of the finest partridge shoots in the Eastern Counties. The patients regarded the day out beating as a rare treat. Dr Thomas, a genial giant, knew all his patients by name. He was devoted to the hospital cricket team of which he was captain for 30 years; he was also a most capable conjuror, and wrote, produced and acted in many Christmas pantomimes. There was great pleasure when he married the Deputy Matron in 1939. Dr Deighton, a quiet gentle figure, for years looked after the women patients. Between them the three maintained a peaceful institution, effectively isolated from the outside world – truly an asylum.
Miss Fossey was appointed Matron in 1923 and stayed until she retired in 1951. Mr Edward Mitchell, Chief Male Nurse, who took over from Mr Thorne in 1910, remained in post until 1932 when Mr Tucker took over. Mr Kemp, the Clerk and Steward since 1884, was succeeded by his son in 1924. He died in 1939 and Mr Charles Mitchell (son of the former Chief Male Nurse) became Clerk and Steward and stayed in the hospital’s service until 1963. In 1929 the Visitors had appointed the previous year an Engineer, Mr Harry Merrin. He soon built up a most effective department and with slender funds undertook many building projects during the 1930s. He attracted to his staff many of the more vigorous personalities in the hospital and his ‘artisan gang’ of patients led by a group of sturdy epileptics became an elite group, with special privileges and an extra issue of tobacco.
Every year the Commissioners of the Board of Control brought the subject of Occupational Therapy up in their report. There was some response at Fulbourn. In 1931 an occupational therapist from the Maudsley Hospital in London spent six months in the hospital and in 1932 Miss Ross was appointed as full-time occupational therapist. In 1938 a new Occupational Therapy Department was built on the top of the chalk knoll behind the hospital; this was designed and erected by the staff and patients of the Engineering Department. It is said that a bottle under the foundation stone contains ribald comments on Fulbourn Hospital of that day – including a speculation as to whether patients would get as much good from using the building as they had from building it.
These years also saw the beginnings of organised social work. In 1923 Dr Reardon had started making visits to the homes of those patients about to be discharged. He was helped by the Secretary of the Cambridgeshire Voluntary Association for Mental Welfare. This body had been founded in 1908 by Lady Ida Darwin, Dame Ellen Pinsent and Mrs Florence Keynes to deal with the social problems of the mentally defective in Cambridgeshire which had been uncovered during their work for the Royal Commission on Mental Deficiency (1904–8). In the 1920s the Association began to help Fulbourn Hospital with the work for the adult mentally ill.
Dr Reardon had established an outpatient clinic at Addenbrooke’s Hospital in 1922 and for several years Dr Jones visited regularly and saw patients by request of the general practitioners. In 1932, however, a psychiatrist, Dr Ralph Noble, was appointed to the Honorary Staff of Addenbrooke’s Hospital and Dr Jones’ visits were stopped. This unfortunate rift caused difficulties for the next 16 years. No further outpatient clinics were opened despite the Commissioners’ suggestions.
Another point the Commissioners of the Board of Control regularly commented on was patients’ freedom. In 1924, 28 patients out of 595 had parole of the grounds; in 1939, 70 patients out of 883. However, all the wards remained firmly locked. Dr Jones’ reports are brief, and mostly concerned with the buildings erected and various social activities. It is only from occasional remarks of the Commissioners that any picture of medical treatment emerges. In 1928 they remark that malaria treatment for General Paralysis of the Insane is not feasible at Fulbourn and that such patients should be transferred elsewhere. In 1939 the Commissioners record that they ‘discussed modern methods of treatment’ and that 13 cases of depression (in twelve months) had been treated by convulsion therapy.
During these years the population of Fulbourn rose steadily, although the admission rate did not change greatly. The rise was probably due to increased survival of long-stay patients after the high death rate of the years of the First World War. Although tuberculosis continued to take its toll, and there were sporadic cases of Enteric fever, the general health of the hospital improved. There was some overcrowding; the traditional exchanging of patients between hospitals continued: from 1923 to 1929, 20 Cambridgeshire women were lodged in Powick Hospital,Worcester; from 1932 to 1939, Fulbourn took 25 patients from Napsbury Hospital, North London, and 15 patients from the Berkshire Hospital at Wallingford. It is an interesting comment on the attitudes of those times that no one thought it unreasonable to send asylum patients to live for long years many miles from their home counties or any relatives who might wish to visit them.
The outside world seldom broke in on the rural quiet of Fulbourn Hospital. In 1931 the staff ‘volunteered’ to accept a salary cut because of the Slump, but normal wages were restored in 1933. Later came the first foreshadowings of war. In 1937 the Territorial Army discussed the possibility of a Military Hospital at Fulbourn. In 1938 the Visitors formed an Air Raid Precautions Sub-Committee.
The six years of war (1939–45) was a period of striking developments in British psychiatry. Physical treatments were widely applied and new treatments were developed, such as narcoanalysis, abreaction and sleep therapy and were applied to the many psychiatric battle casualties. Army psychiatrists lived and worked among their general medical colleagues who learned to value their contribution. Psychiatrists and psychologists working in intake selection, officer selection, and reassignment of the many misfits, made a great contribution to the deployment of the thousands of men, and laid the foundations for social psychiatry. For rural mental hospitals, however, the Second World War meant another period of overcrowding, underfeeding, understaffing, shortages and an endless struggle to stop standards declining too far. Fulbourn experienced little of the fighting directly. The engineers made sandbag walls and revetments; water tanks were dug and filled and fire drills carried out; all windows were blacked out. But no bombs fell on Fulbourn; the nearest was a small raid on Cambridge early in the war.
At the start of the war, most of the London metropolitan asylums were emptied of psychiatric patients to clear beds for the expected casualties from bombing. Hill End Hospital was evacuated to Three Counties Hospital, Bedford and 147 Huntingdonshire patients were moved from there to Fulbourn on 28 August 1939. At the same time Fulbourn Hospital undertook to take in all fresh cases of mental illness occurring in Huntingdonshire. This raised the resident population from 747 to 894 – a rise of nearly 20 per cent – causing grave overcrowding. The men’s occupation centre and for a time the Recreation Hall were filled by beds. A certain number of long-stay patients were discharged in the next two years so that the resident population fell to about 820 by 1941, but the overcrowding and consequent lowered standard of hygiene persisted for many years.
War strains and shortages affected the hospital in many ways. In February 1942 the Board of Control Commissioners checked the weights of patients against those of January 1940. On average the men were lighter by 5lb and the women by 9lb. In 1944 the Commissioners had the diet sheets analysed and suggested some improvements. All possible land was brought into production, and in 1941 the cricket pitch was again ploughed up. The dairy herd was maintained and in 1944 the Visitors bought another farm to extend their farming activities.
The general physical health of the patients remained a matter of constant concern to the Commissioners and the medical staff. The Commissioners were also concerned about hygiene; in the summer of 1941 flies were so thick in the sick wards that they suggested ‘use of gauze in protecting the faces of feeble bedridden patients’. They also commented that some of the lavatories were so effectively blacked out that it was not possible to see if they were clean. Dysentery affected eleven patients on the male side in the summer of 1943, but otherwise there were no epidemics. Tuberculosis, however, did spread and a number of new cases were found. The annual deaths from tuberculosis in the hospital rose from four (in 1937–39) to eight (in 1941–43).
The gravest difficulty was the shortage of staff. At the beginning of the war all reservists were called to the colours; this removed many male nurses, who had been regular soldiers. Conscription took away other young men, and the war industries soon began to divert potential recruits. In 1939, 43 male nurses and 51 female nurses were considered sufficient for 294 male and 448 female patients. By 1944, 32 men and 37 women, many of them pensioners returned from retirement, were looking after 319 men and 495 women. This shortage was a matter of constant concern.
The Medical Staff, however, remained the same. They had permission to employ a fourth medical officer and a number of doctors worked for short periods during the war, but were soon called up or left. The last of them was a retired man so old as to be scarcely capable of carrying out his duties. His main contribution to the Fulbourn story was that he allowed his coal fire to ignite his living room in early 1945. The blaze involved some of the offices and the case papers of all patients admitted before 1903 were destroyed, a considerable historical loss.
One of the casualties of the war that is scarcely noticed in the reports was the social life of the patients. In 1940 the patients’ dances were stopped (the hall was a dormitory); in 1941 the cricket stopped (the pitch was ploughed up); in 1943 the Annual Fete was cancelled. The only entertainment maintained was the cinema. By 1945 the senior staff – and the whole hospital – were tired, weary, shabby and spent. There was little enthusiasm for the future which was seen to be full of difficulties and burdens. There was, however, talk of a National Health Service and a Welfare State and there seemed to be a possibility that things might change.
The proper organisation of Britain’s hospitals had been under discussion since the early years of the twentieth century. By the 1930s Britain had a mixture of ancient, wealthy voluntary hospitals, seedy poor law infirmaries, inefficient cottage hospitals and special institutions, such as lunatic asylums and colonies for mental defectives and epileptics. General Practice had been organised into a National Insurance Scheme by the great reforming Liberal Government in 1910, but the hospitals were all separate organisations.
After the First World War there had been frequent discussion on how the hospital service might be better organised and social reformers put hospital reorganisation high on their lists. However, nothing happened until the outbreak of the Second World War when the British Government brought all hospitals in Britain into an Emergency Medical Service to cope with the expected air raids. This worked so well that most people wanted it to continue after the war. The political parties all produced plans for a postwar National Health Service, but when the Labour Party won the Election in 1945 it was they, under Aneurin Bevan, who faced the actual task of creating the National Health Service – as part of the great revolution of welfare and health provision that they were bringing in. In this they had the support of most of the country who had been sickened by the unfair muddle and poverty of the Thirties and saw the ‘fair shares’ of the war years as a basis for a juster and healthier society in postwar Britain.
The National Health Service (NHS) as it was created in 1948, made a profound difference to British institutional psychiatry and to all hospitals for the mentally ill, including Fulbourn. All the hospitals in Britain were brought into the NHS and all were to be treated equally. No longer were there to be differences in treatment and care between the rich and the poor, between the nursing homes, the voluntary hospitals, the infirmaries and the asylums. Anyone who was sick would be able to get the treatment they needed and would be treated equally. It was a wonderful ideal, and for a decade or two it looked as if Britain might achieve it.
Finance was controlled centrally and the accounts of different hospitals openly compared. At once the shocking gulf between the levels of financing, of feeding, staffing and treatment provided in the former voluntary hospitals and in the former local authority infirmaries and asylums became glaringly manifest. Great efforts were made to even out these differences and in a first attempt to do this extra money was put into the deprived institutions.
In the Cambridge area all the local hospitals were taken into the NHS, and an attempt was made to link them in order to provide a better service for the sick in Cambridge. Many administrative and professional barriers between them were bridged. Finances were improved. Cooperation to provide better services became the new pattern.
The new East Anglian Regional Hospital Board (RHB) appointed as their Senior Medical Officer a rough-hewn, but outstanding Scot – Dr James Ewen, fresh from wartime work as Medical Officer of Health for Middlesex. He was appalled at the neglected state of the hospitals and asylums of East Anglia and set out to make improvements. He found the East Anglian mental hospitals dilapidated, overcrowded, squalid and ill staffed – and Fulbourn the worst of them.
Another important change brought in by the NHS was in the terms of service for doctors. Before the war, the best doctors made their living by private practice and gave free service in the voluntary hospitals. The doctors who took salaried posts in infirmaries and asylums were mostly those resigned to second-class professional status. Conventions and social barriers were created in the twenties to keep salaried doctors from access to private patients. The Fulbourn Hospital doctors were barred from seeing patients in Addenbrooke’s in the early 1930s.
Under the new NHS all doctors received substantial salaries. Though some private practice remained, it was not significant in the early postwar years. The doctors, their salaries secure, could work wherever the patients needed them. Cooperation between the psychiatrists at Fulbourn and Addenbrooke’s could flourish and soon did.
For the first time, junior doctors in hospitals were adequately paid. Before the war, house doctors in the great teaching hospitals received no pay; only those with well-off parents could afford to take the posts which were the sole route to the honorary posts and affluent private practice. Poor doctors, or those who wished to get married, had to go into general practice or to work in asylums and infirmaries. Now, under the new NHS all hospital doctors of every grade were paid a living wage and could even afford to marry.
Nursing pay also changed. The main nursing work force of the pre-war ‘voluntary hospitals’ had been the ‘probationers’, often the daughters of middle-class parents, who received little or no pay, had to live in firmly controlled nurses’ homes and work appallingly long hours. Only the asylums and infirmaries paid a living wage – so their nurses were scorned by the affluent teaching hospitals. With the NHS, all nurses received an adequate salary, similar in all hospitals.
In the Cambridge area, Addenbrooke’s was declared a Teaching Hospital and placed under a Board of Governors. The local authority hospitals in the City – the Mill Road Infirmary and the old Workhouse at Chesterton – were also put under the Addenbrooke’s Governors. Fulbourn Hospital was made the responsibility of the Regional Hospital Board and under them of the No.1 Hospital Management Committee, which was also responsible for Newmarket General Hospital.
As well as the changes brought about by organisational rearrangements under the new NHS, other factors were causing ferment in the English psychiatric hospitals in the early 1950s. These included the new treatments which doctors were applying to psychiatric patients. After the war came news of another new treatment: brain surgery for mental disorder – prefrontal leucotomy. This operation had been developed in Portugal in the 1940s and taken up enthusiastically in the USA. As with every new form of treatment there were enthusiastic reports from the innovators describing striking recoveries.
The new treatments dominated the admission wards of Fulbourn in postwar years. Most patients received some form of physical treatment. Electroplexy (Electro Consulsive Therapy – ECT) given with an anaesthetic and a muscle relaxant, was prescribed for all depressed patients and for many others. Insulin Coma Therapy, carried out in the male Admission Villa, was prescribed for most schizophrenics. Patients were referred for leucotomy to Norwich or London because there was no one in Cambridge able to do the operation. Patients who were not receiving some form of physical treatment even complained of feeling neglected, or even cheated, when they witnessed the almost miraculous transformation seen in some people receiving electroplexy – from weeping misery and melancholic ruminations to cheerful good humour in a few days.
In the immediate postwar years, until the mid-fifties there was not much change in patterns of medication in psychiatry. Effective hypnotics – drugs to promote sleep – were needed as most psychiatric patients complained of difficulty in sleeping. The traditional sedative in the asylums had been paraldehyde, a cheap, safe, but foul-smelling draught which gave peaceful sleep and often calmed the furious. Paraldehyde and chloral hydrate had been available for nearly a century. The barbiturates which had been available for half a century were also widely used. Odourless and easy to swallow, they were preferred in outpatient and private work. They were, however, dangerous as it was easy to take an overdose. There was not much interest in drugs amongst the keen young psychiatrists in the early fifties as all hopes were pinned on the physical treatments. There were many studies published on how to increase the effectiveness of such treatments – ‘swinging’ the insulin dosage, ‘clustering’ the ECT treatments, daily ECT ‘to promote regression’, varying the site of operation in brain surgery – but little was published on the use of drugs in treatment of the mentally ill.
The question of whether the new forms of treatment could or should be applied to long-term patients was a matter of discussion. Some treatments had been strikingly successful; prefrontal leucotomies for very violent long-term patients had produced some amazing, almost miraculous, cures. People had left hospital greatly improved after many years on disturbed wards and were able to live outside hospital once again. Electroplexy had relieved some chronic melancholics with persistent suicidal tendencies. However, some doctors still thought that the ‘old asylum chronics’ were best left in peace.
It is difficult in the 1990s to convey an impression of the asylum world of the 1940s for that world has now, thankfully, largely disappeared. In those days the hundred or so mental hospitals in England, containing nearly 250,000 people, were accepted as the centre of English psychiatry. These large, ancient institutions – most of them built in the 1850s – stood outside cities and big towns. From a distance one would see the great barracks-like buildings and a water tower rising above the treetops. There was often an imposing gateway with a gatekeeper’s house. The grounds were always impressive and sometimes strikingly beautiful. A broad drive would sweep through woodland, past cricket grounds and shrubberies up to an imposing entrance. Inside were shining floors and spotless corridors with a few uniformed people moving about. It was only as you penetrated further, into the back corridors, the airing courts and the wards that the vast mass of human hopelessness became apparent.
Visitors were taken round by a staff member with a key, who unlocked doors and locked them again behind one – the crashing of the keys in the locks was a constant feature of asylum life. You would be shown into big bare rooms, crowded with people, with scrubbed floors, bare wooden tables, benches screwed to the floor. There was a smell in the air of urine, sweat, paraldehyde, floor polish, boiled cabbage and carbolic soap – the asylum smell. Some wards were full of tousled, apathetic people just sitting – 20 in a row. Other wards were noisy, especially the ‘disturbed wards’. On some, there was an air of tension. The visitor felt frightened the whole time, and watched his back; he knew there was a very real chance that somebody would try to hit him. Outside were the airing courts – big, grey courts, paved with tarmac, surrounded by a high wall with scores of people milling around; a few of them walking, some running, others standing on one leg, posturing, with urine running out of their trouser leg, some sitting in a corner masturbating. Bored young nurses would be standing on ‘point duty’, looking at the patients, ready to check anybody who got out of line, but otherwise not doing anything.
The asylum day had its pattern. The patients were turned out to the airing court, counted out, then counted in for meals. They were sat down at tables, spoons and forks were handed out and the food put on the table; the charge nurse said grace and they were allowed to eat. Then the spoons and forks were all taken in and washed by the staff and counted. Nobody was allowed to leave the table until all the cutlery was accounted for.
To relieve the tedium there were weekly film shows – only of course for the better patients, and there was Church on Sunday. This was the one occasion when patients had the chance of seeing the opposite sex! There were walking parties going around the grounds – 20 patients, one nurse at the front, one at the back, two at the sides, to make sure that nobody escaped; afterwards everyone was counted in again. Few patients had any property, and none on the disturbed or ‘wet and dirty’ (or incontinent) wards. On many wards, the patients’ clothes were rolled up at night and taken and put in a cupboard, and issued again the following morning. No patient was allowed to have money; that was contraband and they were punished if found with it.
The job of the nurses was to watch the patients to see that they did not escape or harm one another. The job of the doctors was to watch the nurses to see they did not steal the patients’ food or abuse them. One of the main tasks of a doctor was to examine bruised people, to be told a story of how the bruises had occurred and then to decide whether the injury was so flagrant that there had to be an inquiry. Deliberate violence by the staff to patients varied a great deal; there were those amongst the staff who said it was their duty to ‘show them who the boss is’. The doctor’s job was to hold the balance, to see that staff violence did not get too far out of hand.
A special part of the English asylum was the padded room (‘the pads’). These were small side rooms that had been specially equipped for violent patients. The walls were lined with padding – usually rubber – and there was nothing in them that could cut or injure. Any windows or lights were protected by unbreakable glass and bars. The door, also padded, was massive and fastened by double locks and heavy bolts. ‘Pads’ were to be found on all disturbed wards, and many admission wards. A persistently suicidal person would be stripped naked and put in the pads. Often the pads were the centre of the system of ward punishment. Any patient who showed signs of becoming violent was threatened with the pads; anyone who struck a nurse was automatically put in. It was part of a doctor’s duty to visit anyone who was in the pads, to check their injuries, to listen to their story and to make a decision whether they should stay in. A wise junior doctor soon learned to endorse the charge nurse’s ‘suggestion’ as to whether a person could be ‘Let out now, Sir’ or whether it would be ‘Better for him to stay in a bit longer, Sir’.
In a disturbed women’s ward the women would be in ‘strong clothes’, shapeless garments made of reinforced cotton that could not be torn. Their hair was chopped off short giving them identical wiry grey mops. They would rush up to any visitor and crowd round him. Hands would go into his pockets grabbing, pulling, clamouring for release, for food, for anything, until they were pushed back by the sturdy nurses, who shouted at them to sit down and shut up. At the back of the ward were the padded cells, in which might be a naked woman smeared with faeces, shouting obscenities at anybody who came near.
In an asylum there might be pleasant admission wards with flowers and pictures, kind nurses and cooperative patients. But behind these were always the ‘back wards’, filled with people for whom hope had been abandoned – the ‘chronics’, the ‘back ward patients’, the incurables and the intractables.
Anyone who came to work in a mental hospital – nurse, doctor or orderly – had in due course to come to terms with the back wards. They learned to tolerate the squalor, smell and brutality and hopelessness – or, if they could not, left the asylum service.
Fulbourn Hospital in the postwar period was much like any other somnolent county asylum. It had 950 patients – a middling size – not 2–3,000 patients like some city asylums, nor small and cozy like some hospitals with 2–300 patients. Although undamaged by the war, its aged buildings had been inadequately maintained for years.
Seen from the high road, Fulbourn Hospital still looked much as it had in 1858. The range of buildings still stretched along the ridge, dominated by the central water tower and the former Superintendent’s house, now the main administrative block. Over the century the grounds had taken shape. The main drive was flanked by tall lime trees and beech hedges, and there were beech and elm trees along the borders of the estate and scattered through the grounds. The front of the building was hidden behind massive yew hedges, 20 feet high, grown to conceal the airing courts.
The newer wards were mostly behind the original front; still much the same design, massive two-storey blocks with day rooms below and dormitories above. To the west, however, were some quite different buildings – low one-storey buildings with gardens and verandahs. These were the Admission Villas, built during the 1920s.
Apart from the handsome drive, the rest of the hospital land was farmed intensively. In front of the hospital were fields of cabbage, potatoes and grain. There was a large orchard. The Visitors kept a substantial herd of cows (whose milk yields won prizes) and a large pig herd (fed on hospital scraps). The Visitors leased surrounding fields for their crops and owned a farm on the Fen behind the hospital.
In 1953 Fulbourn Hospital housed 570 women and 380 men. Apart from 80 people in the two Admission Villas, all others were crowded into the main building. In the main building the men’s wards were to the west – Male Ward 1 (M1), M3, M4 (the infirmary ward) and M5 (the ‘disturbed’ ward). The women’s wards containing 530 women, were to the east, F1 and F3 in the 1858 block, F4 (the infirmary ward), F7 and F5 (the women’s ‘disturbed’ ward) in the 1890 blocks at the back of the hospital site (M2 and F2 had disappeared in rearrangements in the 1920s). Apart from the two small infirmary wards containing people in need of physical nursing care, the other wards were all large and overcrowded – up to 100 people in each. All were locked. They were as I have described elsewhere – bare empty places, with big day rooms, crowded dining rooms and bare dormitories upstairs. Outside most of the wards were airing courts – into which most of the patients were turned if the weather was fine. Scattered round the grounds were a few houses for senior hospital officers. In 1950, the Group Secretary, the hospital Engineer and the Chief Male Nurse had houses. The Matron and Deputy Matron lived in flats in the centre of the hospital, as did several of the doctors. Male nurses lived in rooms off the wards, female nurses in a Nurses’ Home at the back of the site.
The first task at Fulbourn after the war ended was to repair the damage from years of overcrowding, understaffing and lack of maintenance. Dr Jones was unwell from October 1944; he retired in March 1945 (and died two years later) and Dr Thomas was then appointed Medical Superintendent. Gradually staff began to reappear from war service. Male nurses returned and some ex-service nursing orderlies came to train as psychiatric nurses. However, very few of the women staff returned and consequently the women’s side was very understaffed. The clerical, maintenance and other staff returned and Mr Merrin, the Engineer, began work on overdue maintenance, lamenting the shortage of reliable skilled workmen.
The reports of the Visitors, the Superintendent and the Board of Control in 1945 and 1946 register these activities, but the next years are mainly filled with the hopes and fears relating to the approaching National Health Service that was to take over the hospital in 1948. The new NHS settled the areas for which hospitals should be responsible. Fulbourn was to serve Cambridge, Cambridgeshire and the Isle of Ely, as before. It was to continue to serve Huntingdonshire (as it had done since 1939) and also provide for the Saffron Walden district of Essex. This gave Fulbourn Hospital an enlarged catchment population of about 300,000. Its catchment area now stretched from Stansted in the south to Wisbech in the north, nearly 60 miles, and from Kimbolton in the east to Kentford in the west, some 40 miles. This was still a predominantly rural area, with farms, small holdings (in the Fens) and small market towns, such as Huntingdon, Wisbech, Ely and March. The largest town – soon to be called a City – was Cambridge, with a population of 100,000.
It became clear that the hospital would no longer belong to or be paid for by the Three Bodies which had financed and controlled it for 90 years. Though the parent bodies were probably relieved, the members who made up the Visitors Committee were filled with doubts and regrets – especially when it emerged that Fulbourn hospital was to be linked with Newmarket (General) Hospital and run by a Joint Management Committee. The Committee feared that the special needs of the psychiatric patients would be overlooked and the next few years showed that they were right.
Although the immediate postwar years were mostly spent making good the damage and deficiencies of the war years, there were some new developments. Young staff returning from the war were keen to try out new ideas. Dr Dewi Jones, who joined the staff in 1945, started an Insulin Coma Therapy Unit in 1946 which the most energetic and bright staff competed to join.
Dr Thomas had always been keen to improve the physical medical services within the hospital. He and Mr Merrin planned an operating theatre in the cellars of the central building; they designed and built it with the hospital workmen, and opened it with great pride in 1947. When in 1948 the Regional Board asked for his first postwar priority, Dr Thomas pointed to the infectious patients – those with chronic open tuberculosis and the carriers of typhoid. A special infectious diseases annexe was planned and built as an extension to the women’s sick ward. It was opened in 1954.
Another postwar initiative was Outpatient Clinics. The first was started at County Hall, March, in 1947. After 1948 it became easier to work with the general hospitals, and clinics were opened at Huntingdon County Hospital in 1949, at Saffron Walden Hospital in 1950 and at the North Cambridgeshire Hospital in Wisbech in 1952. Outpatients were also seen regularly at Fulbourn Hospital. After 1948 cooperation improved with Addenbrooke’s Hospital and many outpatients were seen there.
However, other things did not go so well. The Joint Management Committee was taken up with the development of Newmarket Hospital, especially when it became a Regional Poliomyelitis Centre. The Board of Control became increasingly worried about the neglect of the psychiatric patients’ needs and wrote a very critical report. This was picked up by various interested people in Cambridge who were impatient to see a good modern psychiatric service develop. As a result of the pressure the Regional Board changed their policy. A new Hospital Management Committee (No.13) was created in 1951 and Mrs Hester Adrian, the wife of the Master of Trinity College, was appointed Chairman.
Joint appointments between the two hospitals – Fulbourn and Addenbrooke’s – started to be made. One of the first, in 1949, was Dr Edward Beresford Davies who joined with Dr Derek Russell Davis, the University Reader in Psychopathology, to press for change and reform in the psychiatric services in Fulbourn and in Addenbrooke’s. As a result of their pressure, two wards (one male, one female) for the hospital elite workers were declared ‘open’ in 1951.
All these pressures for change bore heavily on Dr Thomas. His once magnificent physique, swollen by years of overeating to a gargantuan 22 stones, was at last letting him down. He was short of breath and constantly anxious. He often expressed concern about new developments and distaste for all the postwar bustle and innovation. The new developments worried him, as did the hustling of the bright young men. He was severely ill with pneumonia and heart failure in 1951 but stayed on until his full pension was due in 1953, when he retired.
The new Management Committee faced a major task in choosing a new Superintendent. They wanted someone to change things – but few young psychiatrists wanted to be superintendents in 1952. The pay for the job was no more than for other consultants, carried far more responsibility, and was restrictive since superintendents had to live within the hospital grounds and were barred from private practice. The Committee could not find anyone satisfactory the first time, so they readvertised. It was then that I applied for the post.