Information from Dr Steven Cherry’s book about Norfolk Lunatic Asylum

NORFOLK COUNTY ASYLUM IN THE 1880s

Notes from Mental Health Care in Modern England: The Norfolk Lunatic Asylum, St Andrew’s Hospital, 1810-1998, by Steven Cherry, The Boydell Press, 2003

Dr Cherry’s book is a comprehensive history of the Norfolk Lunatic Asylum. These notes are from the chapter that covers the period of our Case Book patients, 1861 – 1887.

 

Background

An era of ‘therapeutic pessimism’. Ideas about evolution, inheritance, natural selection invaded medical thought, continuous nature/nurture debate. Sense that the Asylum was used to dump people who were ‘hopeless cases of dementia, imbecility and senility’ and undermined the asylum’s therapeutic role. Norfolk Lunatic Asylum was a pioneer in admission and discharge photography and weighing.

 

Asylum buildings and land

1862 Refurbishment including smaller ceramic baths, so each female could have a ‘fresh’ bath. Rooms painted or papers, blinds or shades fitted, wooden flooring laid.

1869 New wards completed, with furniture of polished birch.

1877 52 more acres were purchased for the Asylum farm. The farm provided food supplies and a modest cash surplus

Late 1870s the asylum became overcrowded again, and was reorganised.

1879 Auxiliary Annex was opened, to accommodate ‘chronic lunatics, imbeciles and idiots’. To manage and care, rather than cure. On the sit of a cricket field, to the north of the main buildings. 2-storey H shaped building with large male and female wards separated by an administrative block, kitchens and staff room. A go-between the Asylum and the Workhouse.

1887 the main buildings lacked brightness and interest, rooms in the mens side were shabby and dilapidated, the day rooms were dull and bare.

 

Wards

In 1884:

5 male wards with two attendants and 21-32 patients. At least 2 were working wards. Ward 6 had 14 patients and one attendant. Infirmary ward had 18 patients and one nurse.

9 female wards. Four wards and 2 working wards each had 23-30 patients and 2 nurses. Ward 9 had 56 patients and 4 nurses. Laundry ward had 29 patients, 3 staff, including 2 laundresses. Infirmary ward 18 patients and one nurse.

Suicidal and Epileptics were housed on special night wards, under constant supervision by an attendant.

 

Patient numbers and fees

By 1882 there were an average of 715 patients (from 390 in 1861). Around 50 were on probation, on weekly allowances of 3 – 4 shillings (saving up to 5 shillings on standard costs).

Norfolk unions were charged 8s 3d per patient per week. Outcounty patients were charged at 14s per week. Private patients paid 14 – 21s per week. Norfolk patients who were found to be non-paupers were charged the outcounty rate.

 

Management

Committee of visiting justices met monthly. Justices made up of landlowners, clergy and armed forces. Dr Hill reported to the committee, who discharged patients. Clerk to the Justices William Girling was responsible for inventories, purchases, upkeep and operations, including the farm and use of patient labour.

Annual inspection by the Lunatic Commission.

 

Staff and pay

Medical Superintendent

1861 William Hills appointed medical superintendent age 33 (till 1887). Member of the Royal College of Surgeons and Association of Asylum Medical Officers.

First proposals included dealing with hygiene and overcrowding, escape attempts and disease. Music to feature, including an attendants’ band.

William Hills was paid £500 in 1882, £600 in 1885.

Senior Assistant Medical Officer

From 1880 T Seymour was Head of the Auxiliary Hospital and Senior Assistant Medical Officer. T.J. Compton was Hill’s junior assistant in the main hospitals.

1882 Seymour resigned, Compton became Senior Assistnat Medical Officer and Head of the Auxiliary Hospital. He was paid £180 in 1885.

Junior Assistant Medical Officers

Junior Assistants were Drs McWilliam, Cocks, Creasy and Little (in succession) from 1882 to 1887.

Nurses and attendants

Head Female Attendant (in lieu of Matron), Bertha Waters. Head Male Attendant was James Ramsey. Deputy Head Attendants staffed the auxiliary hospital.

1880 there were 16 male attendants, i.e. 1:15 patients. 7 female attendants, i.e.1:15 patients.

The working week was round 84 hours, and pay for a senior attendant was around the same as for a Norwich navvy.

Cruelty and neglected of patients was punished by fines and dismissals. In 1880 a patient under special observation died during an epileptic seizure and another was scaleded in an untested bath: responsible staff were dismissed.

1880 – 1885 the Lunacy Commission remarked that staff levels were inadequate in larger wards. By 1887 poor working conditions led to 11 nurses resigning, nine going to private nursing and 2 to other asylums.

Women attendants were not allowed to marry (or had to resign if they did). There was insufficient family accommodation so asylum work did not suit married men.

 

Asylum life

Work therapy

By 1880 45-50% of male patients were working, farming, gardening, and building, cleaning kitchen, ward helpers. At least 55% of women patients worked indoors by 1885, as cleaners, helpers on wards, in the kitchen or laundry, and doing needlework.

Entertainment

An annual frolic, shows with slides, ventriloquists, the fortnightly asylum ball, asylum band, boat trips, outings for elderly patients, trips, recreation.

Exercise

Three times a week walking beyond the asylum walls, otherwise in the airing courts. Cricket field where men played and women watched. When it was built on for the auxiliary asylum another was swiftly prepared.

Religion

3/4s of patients were expected to attend services on Sunday. In 1881 a nave was added to the church to accommodate growing numbers while maintaining sexual segregation.

Diet

Beer was stopped for all except outdoor male working patients in 1879. Women had bread for breakfast and supper, men had oatmeal with broth two evenings a week. From 188) dinner was “Australian meat’ cold, on Sundays. Otherwise meat and vegetables, with soup and bread two days a week. In 1882 and 1885 the Lunacy Commission criticised the lack of fresh fruit and vegetables in the diet.

 

Admission, diagnosis

Admission had a moral or physical cause. Moral could be poverty, adverse domestic circumstances, death of a relative, religious fervour, disappointment in love, immorality. Physical included debility, epilepsy, senile decay, hereditary factors, intemperance, puerperal features. Hereditory or congenital defects were noted. General paralysis of the insane, a cause of death, was tertiary syphilis.

 

Treatment

Work therapy, music, entertainment, exercise, diet (as above).

Other treatments

Extra diet and porter, for cases where food was refused.

Padded room, seclusion room

Packing in tight sheets, packing in wet sheets

Blistering

Shower bath

Long sleeved dress to prevent serious self injury

Leather locked gloves, to prevent self injury

Faradisation, galvanisms in dementia

Force feeding

Suicidal patients were heavily sedated.

Drugs

Dispensary costs increased by 1885, but were still just over a penny per patient, compared with 1.5 pence for wines and spirits.

Croton oil, a powerful purgative, to calm excited patients, followed by a warm bath.

Veratine (veratrum viride) given for mania, to lower temperature and pulse.

Curare administered as a muscle relaxant in paralysis.

Chloral hydrate for nervous insomnia, or hysteria. Sometimes combined with Valerian, a sedative for ‘neurotic conditions.

Henbane derivatives for violent or unmanageable patients, to lower the heart rate.

Hyoscyamine for temporary pain relief

Digitalis, a heart tonic. Also for treatment of diseases of the nervous system such as general paralysis, deliriu trements and epilepsy.

Bromide potassium was prescribed for treatment of epilepsy, to reduce the influence of the sexual organs.

Bromides of ammonium or sodium were used as analgesia, and to improve patients’ temper and demeanour.

Opium was regarded as risky, with dangers of addiction ad loss of appetite. It was given for temporary relief of pain and excitement. Sedation

Chloral nitrate shared the risks of opium.

Cannabis tincture was given to women who suffered bouts of mania during menstruation. Also for headaches, to reduce shock of bereavement, for stomach ulcers.

Bismuth was used to treat stomach ulcers and ulcerative colitis.

Zinc ointment was used for skin conditions including erysipelas.

Chloroform as a sedative.

Spirits were regarded as tonics. Expenditure on them dwarfed other drug costs.

 

Recovery and morbidity

1880 – 1889 42.3% of those admitted recovered, 9.9% died. NLA recovery rates were comparatively high. During the 1870s, 22% of admissions were readmissions.

1877 12 deaths from phythisis. Around 1/5th of all deaths were from tuberculosis.

1879 outbreak of erysipelas

1880 typhoid epidemic, ascribed to sewer gas and inadequate trpping of old drains during building of the Auziliary Asylum

1883 influenza/pneumonia outbreak killed 8 patients, several dogs and a cat