warley hospital | the first one hundred years
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Warley Hospital




ACKNOWLEDGEMENTS

This history has been compiled from the various Minute Books, Annual Reports and the Medical Records of the Hospital.

Grateful acknowledgements are made to Mr. G. W. R. Bear for the loan of the photograph of his mother as a nurse in the late 1890s. A member of this family has always been represented on the staff since 1870.

The entire printing, with the exception of the preparation of the illustrations, has been carried out in the Male Occupational Therapy Department.




WARLEY HOSPITAL

BRENTWOOD

THE FIRST HUNDRED YEARS
1853-1953

"In a word, it (the direction of the Asylum) aims at making the Institution really and truly an Asylum, a place of refuge and retreat from pain and trouble and sorrow; an Hospital and a home." - Extract from the Medical Superintendent's Annual Report, 1874

WARLEY HOSPITAL
BRENTWOOD
1953
Second Edition
1969




LIST OF CHAIRMEN
COMMITTEE OF VISITORS
APPOINTED BY
THE JUSTICES
Capt. Charles du Cane1846-1850
C.G. Round, Esq.1850-1867
N.C. Barnardiston, Esq.1867-1872
J.W. Watlington, Esq.1872-1882
J. Round, Esq. M.P.1882-1885
Sir Thomas Lennard, Bt.1885-1889

COMMITTEE OF VISITORS
APPOINTED BY
THE ESSEX COUNTY COUNCIL & BOROUGH OF COLCHESTER
Sir Thomas Lennard, Bt.1889-1919
J. Tabor, Esq. C.B.E.1919-1930
A. Bradridge, Esq.1930-1946
C.E.S. Blackmore, Esq.1946-1948

HOSPITAL MANAGEMENT COMMITTEE
APPOINTED BY
THE N.E. METROPOLITAN REGIONAL HOSPTIAL BOARD
C.E.S. Blackmore, Esq.1948-1957
P.C. Ford, Esq. O.B.E., J.P.1957-1960*
K.E.B. Glenny, Esq. O.B.E., J.P.1960-
*Died in office

BRENTWOOD HOUSE COMMITTEE
The Rev. J.H. Lewis1851-1864
N.C. Barnardiston, Esq.1864-1871
J.G. Fry, Esq.1871-1872
The Rev. J. Pearson1872-1878
Sir Thomas Lennard, Bt.1878-1919
J. Tabor, Esq. C.B.E.1919-1930
Col. (later Sir) Gilbertson Smith1930-1934
W. Fortescue, Esq.1934-1936
C.W. Daines, Esq.1936-1946
C.E.S. Blackmore, Esq.1946-1948

LIST OF MEDICAL SUPERINTENDENTS
Dr. D. C. Campbell1853-1884*
Dr. G. Amsden1884-1911
Dr. J. Turner1911-1920
Dr. G. Evens1920*
Dr. W. Robinson1921-1925
Dr. W. G. Masefield, J.P., C.B.E.1925-1946
Dr. G. S. Nightingale (later Sir Geoffrey, Bt.)1946-1969
*Died in office




C. G. ROUND, ESQ.
Chairman, Committee of Visitors
1853.


C.E.S. BLACKMORE, Esq..
Chairman, Hospital Management Committee
1953.




INTRODUCTION

"The Essex Lunatic Asylum"


Any large self-contained institution inevitably becomes 'imperia in imperiam' and its story mirrors the customs and out-look of the times, more so perhaps 100 years or so ago than now, owing to the then relative isolation of a county district.

Built as a Pauper Lunatic Asylum (though many of its patients were pauperised merely on account of their being mentally ill, for we see tradesmen, an Army officer, a Police Superintendent and schoolmasters represented occasionally amongst its early admissions), its history clearly indicates the existence of Disraeli's "Two Nations", between whcih was a great gulf fixed; the well-established, often titled Hustices on the Committee on the one hand and the Pauper patients, dependent on the charity of the Parish, on the other.

Nowhere to is this reflection-in-miniature of the life of the community in general between seen than in the impact of the wards of the last 100 years had upon the hospital.

War being, until 1914, largely a private matter for the standing professional army and, in South Africa, for some "sporting gentlement", it might be expected that the wars of the 19th century would affect the hospital but little, as they did the community in general. That this was so, is seen by the fact that the Crimean War of 1854 passed unnoticed in any official records; one Reservist was called to the Colours for the Egyptian Campaign of 1882 and six for the South African War.

The Great War of 1914-1918 however, nearly paralysed the hospital, over 100 of the staff leaving to serve in the forces, whilst the rationing resulted in a phenomenal death rate among the patients.

Finally, the World War of 1939-1945 not only again decimated the staff but brought the hospital into the front line of air attack, though in fact, it bore a charmed life.

Any attempt to compress the history of 100 yeasr into the confines of a small booklet must of necessity mean that far more is omitted than is recorded; if therefore, undue prominence appears to have been given to the earlier years, the fact that this "potted history" has been compiled in the Centenary Year must be its excuse and explanation.




Chapter 1

Building


Before 1845, it had merely been optional for Counties to provide Asylums. The Lunatic Asylum Act of that year made it obligatory upon all Counties to make this provision and, in 1846, "Her Majesty's Justices of the Peace in Quarter Session assembled at Chelmsford", proceeded to execute the duty imposed upon them by the Act. "Being led to belive that it would occasion great inconvenience to the parishes comprised within the Boroughs of Colchester and Maldon if they were executed ...., they were invited to unite with the county. The Borough of Saffron Walden was also invited to join, though excluded by a technicality.

Of the original Committe of Visitors appointed at the 1846 Quarter Sessions, the Chairman, Captain CHARLES DU CANE died in 1850 before the opening. There remained in 1853:-

"CHARLES GRAY ROUND of Birch Hall, Esquire
THOMAS WILLIAM BRAMSTON of Skeens of Roxwell, Esquire, M.P.
JOHN DISNEY of The Hyde near Ingatestone, Esquire
WILLIAM WRIGHT LUARD of Witham Lodge, Esquire
PHILIP ZACHARIAH COX of Harwoods near Upminster, Esquire
JOHN GURDON REBOW of Wivenhoe Park, Esquire
THOMAS BIRCH WESTERN of Felix Hall, Esquire
The Reverend JOHN BRAMSTON of Witham Vicarage, Clerk
The Reverence JOHN HEATLEY LEWIS of Childerditch, Clerk
SAMUEL JAMES SKINNER of Springfield, Esquire
The Reverend HASTINGS ROBINSON of Great Warley, Cleark, Doctor of Divinity
Sir EDWARD NORTH BUXTON of Leytonstone House, Baronet, M.P.
JOHN GURNEY FRY of Hale End Woodford, Esquire
The Reverend JOHN PEARSON of East Horndon, Clerk
being fifteen Justices of the Peace for the County of Essex and :-

HENRY WOLTON of Colchester, Esquire
HENRY VINT of the same palce, Esquire
being two Justices of the Peace for the Borough of Colchester and :-
JOHN PAYNE of Maldon, Esquire

being a Justice of the Peace for the Borough of Maldon to whom were added :-
THOMAS SMITH of Saffron Walden, Esquire
ROBER DRIVER THURGOOD of the same place, Esquire
being two Justices of the Peace for the Borough of Saffron Walden; all of which said Justices constitute the Committee of Visitors of the Essex Lunatic Asylum."

In 1847, eighty-six acres of the Brentwood Hall Estate were selected, out of twelve sites surveyed, and were bought in February 1849 from Mr. William Kavanagh for 8,000. This site was choen primarily for reason of its water-supply fulfilling the not very exacting requirements of the times, but from almost every other point of view, it was ill-chosen, the gradients of the land making even the small original building costly and difficult to erect and causing greater complications when extensions became necessary in later years, while, as will be seen later, the presence of quick-sands in the sub-soil has always caused a great deal of trouble.

Advertisements were published for plans, prizes of 100 and 50 being offered for the second and third best. That of Messrs. Kendall & Pope of Brunswick Square, London was selected as the best and a tender of 57,920 by Mr. Myers of Lambeth accepted for the buildings, later increased to 66,000 during building.

Lord Maynard, the Lord Lieutenant of Essex, having "courteously refused" the invitation to do so, the Foundation Stone was laid by the Chairman of the Committee of Visitors on 2nd October, 1851 with suitable ceremony. Mr. Moul of the White Hart Inn in Brentwood provided a "dejeuner" on the ground at a charge of 10/- a head for gentlemen and 7/- a head for ladies; a tent was erected at a cost of 15, subscribed for by the members of the Committee at 1 each.

The buildings and gardens occupied an area of 8 acres and were designed at first for 300 patients, later increased to 400; before the opening, it was found that ward M.5 was so high off the ground that an extra ward could be inexpensively built underneath (M.7), so that the final accommodation figure was 450, then considered to be "a considerable excess beyond the requirements of the County of Essex" which at that time had a population of 370,000. That this was a gross under-estimate is seen by the fact that over-crowding became serious as early as 1860 and major building extensions were made in 1863, 1870, 1888, 1897 and 1936.

The style of the buildings, the present "Main Block" was, to quote the Architect .... ".... mediaeval, of the Tudor period .... being substantial, cheerful, English in character .... and not expensive."

The wards, often referred to as "Galleries", were of a uniform design with single rooms, dormitories and day space opening off the main "gallery", intended as recreational space in bad weather and not as part of the day space for which they were later used. Each gallery was a complete unit, and it was not until much later that certain galleries were set aside wholly as sleeping space. The galleries were connected one to another by covered ways, mostly open to the air at the sides. All the domestic offices, residences etc. were incorporated in the main block, only the wash house and brewery being separate, though within the boundary wall.

The unusual ceilings, still to be seen in all the wards of this block, were "arched and fire-proof", of hollow hexagonal bricks as executed at Colney Hatch Asylum, very novel and agreeable in effect", again to quote the Architect.

The heating of the wards was by horizontal flues under the floors and vertical flues in the walls; ".... nothing can be better than the system here carried out", said the Architect. Unfortunately however it appears never to have been a success as a heating system, but produced devastating draughts.

Fire-places were provided in the galleries and from time to time numerous expedients were tried to prevent them from smoking; that none was successful is vouched for the fact that they still smoke today in certain winds.

Quick-sands on the site caused a great deal of trouble during the building, arching having to be built under the kitchen block, the present Nurses' Lecture Rooms, and close wood-piling of "Swedish Dantzic wood", wrought iron tipped, placed under the water towers and Chapel tower; in parts of the building, men had to work "night and day, one party bailing while the other laid the foundations brick by brick". It was decided not to dig the well planned for the centre of the Main Courtyard lest the excavations brought the whole building down. A similar trouble arose 80 years later when the water tower of the Admission Unit was being erected.

In October 1851 the workmen struck because a concession that they be allowed to leave off work 2 hours early, at 4 p.m. on Saturdays, was withdrawn on account of late starting during the week. The masons were "out" for two weeks. Another strike of hodmen occurred in May 1852 for a rise of pay from 15/- to 18/- per week.

The grounds were deliberately not laid out before patients arrived so that the work would provide useful employment for them.

In January 1853, the first Medical Superintendent, Dr. D. C. Campbell, late of Glasgow and Aberdeen Asylums, was appointed out of eighty-four applicants and the hospital opened for patients on 23rd September, 1853, 180 patients being received.

Dr. Campbell wrote a full description of the design of the Asylum in the "Asylum Journal" Vol.1, No.11, p.166, dated 15th February, 1855, entitled "The New Pauper Lunatic Asylum for the County of Essex".

This Journal, the precursor of the "Journal of Mental Science" was published by the Association of Medical Officers of Asylums and Hospitals for the Insane, later the Medico-Psychological Association and now the Royal Medico-Psychological Association. The first volume was dated 15th November, 1853.




Chapter 2

Early Years


When the asylum was opened in 1853, a year before the Crimean War, Brentwood was a very different place from what it is now; still a "hamlet" of South Weald, it had only begun to expand since the opening of the railway in 1840. Warley Barracks was already built and there were cottages and a number of beer houses, one at least used for other and less moral purposes, along Warley Woard; Crescent Road, from the station to Brentwood Hall was, as late as 1879, "scarcely passable". Otherwise, the asylum stood, enclosed except for its front entrance, in a brick wall surrounded by fields and woods sloping down to the south, west and north with a driveway on the east to the road. Across Warley Road was an open common.

It is possible, from the records, to make a very fair estimate of what the hospital itself was like in its early years.

Uncrowded until 1860, the wards were all self-contained units holding no more than their designated numbers. The galleries were curtainless and unfurnished, their walls whitewashed and the floors of many of them tiled. The unheated dormitories and single rooms, also whitewashed, contaiend only low wooden box-beds, with straw mattresses except in the Infirmaries. Water closets were not fitted to all wards and, although each ward had hot and cold water, washing facilities were scanty - one basin per ward.

After a few years, the straw mattresses were replaced by hair except for epileptics, the cold and damp tiled floros boarded and some furniture and pictures supplied for the galleries.

Only parts of the hospital were supplied by gas lighting, the single rooms having no lights until 1920. There was no gas even in the Entertainment Hall until 1865 and the attendants' rooms, all on the wards and only distinguisable from the single rooms by being 50% larger and having a fireplace, not until 1875.

The only water was a surface supply, continually contaminated by sewage from the cottages in Warley Road (and here let it be said that the asylum's sewage, in open ditches, often overflowed into adjacent properties lower down the hill). It is not surprising therefore that there were many out-breaks of intestinal infection; after an out-break diagnosed as "Asiatic Cholera" in 1854, a filter bed was built. In 1863, an offer from the South Essex Waterworks Company to supply piped water was rejected on the groudns that the surface supply was "adequate". In 1869 there was a severe typhoid epidemic in which two attendants died and after another in 1884, a deep well was dug.

The diet was ample but monotonous (see Diet Sheet of 1865), carved in the kitchen, with no means in the wards of keeping the food hot, probably roughly served and eaten with spoons, knives not being allowed for many years and then only with an inch of cutting blade.

It would appear that little water was drunk, the Asylum having its own brewery and beer was served to all patients at 11 a.m. and dinner, ½ pint a head. For the staff, a nicely graded allowance of beer was made daily according to status, the Medical Superintendent receiving a "sufficiency". In 1877, 40,000 gallons were brewed, the brewer being paid 40 a year plus 5 pints of beer daily. The relative costs of beverages in 1855 are an interesting commentary on the customs of the times :- Beer cost 498, Milk 157, Tea 160 and Coffee and Cocoa together 63.

In 1863, a patient unfortunately fell into the brewery copper and "died of lockjaw."

Gin and water was served at entertainments until 1892 when lemonade was substituted; the same year saw the beer at meals discontinued.

For the first few years, all patients wore uniform clothing, black dresses with bonnets for the women, corduroy suits and hobnailed boots for the men. Variety for women was introduced early but tweeds for men were not supplied for many years.


STAFF

Ward staffing, by modern standards, was scanty, on a basis of one attendant per ward, the wards holding 28 to 34 patients; one night attendent on each side patrolled the galleries. A second female nigh attendent was appointed in 1865, but the experiment of having a married couple as attendants, one on each side, ended in their being dismissed for fighting one another on duty. In 1856, the establishment was a Matron and Sub-Matron, 14 females attendants plus one at night, a Head Male Attendant, 8 attendants and one night attendant. No uniforms were provided for the staff till 1877 when the men had a suit of cloths, a cap being added in 1884; for the women, caps and aprons, to be worn with their own black dresses, came into use in 1889, a uniform dress being issued in 1899 (see photo).

It would appear that the attendants of the 50's and 60's were not always well selected and there are frequent references to intoxication on duty; on one famous occasion, a walking party of 9 male patients in charge of an attendant returned to the asylum all equally drunk.

Their pay was not, however, such as to attract the better types, a man being paid 28 a year and a woman 18, whilst discipline was severe and restrictive.


MEDICAL STAFF

For the first 27 years there were only two medical officers. Dr. Henry Maudesley, as a young man of 23, was Medical Assistant from October 1858 until his resignation in March 1859 on his appointment as Superintendent of Cheadle Asylum near Manchester.


TREATMENT

The early clinical records, though kept in great detail, contain no references to medicinal treatment of the mental disorders other than the use of opium, though the intercurrent physical illnesses were treated with the polypharmacy of the day, blisters, leeches and occasional bleeding. The then common practice of doctors purging and bleeding exited patients, and so quietening them by sheer exhaustion, prior to their admission to the asylum was strongly deprecated.

The hospital was designed for "seclusion" treatment rather than the earlier "restraint" treatment, one-third of the patients being in single rooms. There are constant references in the reports of the early years to the non-use of restraint and to the non-existence of "apparatus of restraint".

The advantages of recreational and diversional activities were well recognised and occupational therapy, not only of the strictly hospital-chores type, was undertaken, the proceeds of the sale of articles made going to the Benevolent Fund, started in 1857. In 1855, cricket equipment was provided for the male courts, one of which had a skittle shed. Bowls, quoits and lawn billiards were added a year or two later. Dances were held and regular entertainments given, the first in 1855 consisting of a musician and a ventriloquist. There was a library from 1857.

Walks were a regular feature both in the grounds and beyond. A picnic for 56 patients and 12 attendants to Purfleet was arranged in 1858, no inconsiderable undertaking. Similar outings later became regular and local landowners opened parts of their estates for the purpose.

For many years, the patients admitted were of the most unpromising clinical material, chronic with a very high proportion of epileptics and frequently moribund on admission. Of the 274 patients in the hospital at the end of 1853, 240 were regarded as incurable and would probably be so regarded today. This very unsatisfactory state of affairs was well recognised by the medical staff and frequent, but seemingly unavailing, representation were made to the Unions that cases should be sent in as early as possible when there was some hope of their recovery, instead of being left till they became unmanageable or completely demented.

Apart from hereditary factors, the most frequent assigned cause of mental illness in those days was, in an almost wholly agricultural population, bad housing and low wages coupled with large families leading either to starvation or to alcoholism as an escape from the worries and overcrowding of home life. It was nothing unusual for a farm labourer, his wife and up to eleven children to try to exist on a wage of seven shillings a week.




Chapter 3

The Sixties and Seventies


By September 1860 the hospital was over-full, disproportionately so on the female side, the original plans having allowed an equal number of beds on the female galleries on the south side of the block and on the male on the north; this division into Male (M) and Female (F) wards being perpetuated to the present day in the number of the Main Female Block wards. To meet this problem, and pending the erection of new buildings, women were put into some of the male-side galleries and certain galleries were used purely as sleeping space and overcrowding allowed in the day space.

Rather than extend the main building, it was decided to erect "distinct houses with as much as possible the plain arrangement of a country home" and A, B and C Blocks were built for 65 patients with a common Kitchen and a rather fine dining hall, and opened in 1863.

Numbers continued to increase and reached 645 in 1870 by which time a further block, (D Block less the East Wing and Infirmary) had been built for 248 female patients, thus enabling a waiting list for admissions to be abandoned for the first time for some years.

This building was a great advance on the original block being arranged with the day space consisting of large rooms on the ground floor and the dormitories and single rooms above; all the walls were plastered and there was a pleasant central dining room, later converted into an extra ward (D.H.), and a separate kitchen. W.C.'s were, however, deficient in number.

In 1873, Brentwood Hall with 30 acres of land was purchased for 5,000. This property, demolished in 1936, occupied the site of the present Male Nurses' Home, and was used for 17 male patients working on the farm.

The next year saw serious consideration given to the ever increasing shortage of accommodation which was more than keeping pace with the new building; numbers had just exceeded 800 and vairous possibilities were discussed including a new wing on the Male side of the Main Block, a new wing to D Block or a fourth building to A, B, C Blocks. It was felt very strongly however that "no asylum should exceed 800 beds", an opinion with which the Commissioners of Lunacy agreed and the possibilities of a completely new asylum for 500 patients was mooted. This project proved impossible and a system of boarding out Essex patients in other counties' ayslums was started in addition to the acquisition on rent of country houses in various parts of the county. Brunswick House, near Harwich, was first opened for 44 chronic and harmless patients in 1876 to be followed by Lea Hall, Walthamstow in 1879, by which year there were 900 patients.

During these twenty years, improvements were gradually introduced into the older buildings; by 1872 every ward had a W.C., but the washing facilities were poor and the water supply inadequate, three patients having to use the same bath water until "new baths of a novel kind" of porcelain instead of painted iron were fitted in 1868. A maisn supply of water for fire and general purposes was installed in 1870 though the use of the surface water continued. In 1871 the sewage was piped onto the farm lands with noticeable improvement in the vegetable crop and a lessening of the pollution of the neighbouring streams and other properties' water supplies.

A new Recreation Hall was built on the site of the central Court in 1879. It can still be seen to have been an attractive and well-proportioned buliding, though now used as the General Stores. The open cloistures bordering this court were closed in, the one in the south being the present main corridor, hence the odd existence of the obvious "outside" windows to the Matron's offices, etc. opening into what is now an inside passage. The north cloistures are now incorporated into hte Stores and the west end closed off. The old Hall under the original Chapel, was converted into an Epileptic Dormitory which it remained until 1950 when it became the Staff Cafeteria.

In 1877, the main kitchen was converted from open range to gas cookers. This was not, of course, the preent kitchen, but occupied the rooms now used as the Nurses' Lecture Rooms, where three arched bays which housed the ranges can still be seen.

TREATMENT

1870 was the first mention of any specific medicinal treatment, other than opium, which was used freely for melancholia in does of one to three grains, for mental illness; the newly introudced chloral hydrate was tried as a sedative and ammonium bromide for epilepsy, to be supplanted by potassium bromide in 1875; other new drugs given a trial included Indian help (Cannabis indica), nux vomica, croton-chloral (Butyl-chloral hydrate) and amyl nitrate; in 1876, calabar bean (Physotigmine bean) was introduced for general paralysis of the insane, a then very common disorder.

The seventies saw too a change of views on the subject of restraint, previously regarded with pious horror, and its occasional use in the form of strait waistcoats and locked gloves were felt desirable in determinedly suicidal cases. It was still usual for cases to be brought to the hospital in chains, strait jackets or handcuffs whether necessary or not. A galvanic electric apparatus was ordered in 1872.

Chloroform was used for the first time, for the amputation of a stoker's finger, in 1868, a drachm being administered. Unfortunately he died immediately after the operation "from an epileptic fit", autospy showing "diseased matter known as Tubercle and fatty degeneration of the heart and liver."

A large scale vaccination was carried out of nearly all the 680 patients in 1871, Mr. Wallis, Surgeon of Brentwood "affording an ample supply of lympth from children." (Vaccination of children had been compulsory since 1855.)

The use of the word "hospital" for the institution first occurs in 1874.

A primitive form of questionaire for electing the patients' histories was introduced as early as 1862.

STAFF

A second Assistant Medical Officer was appointed from 1871 and in the same year a night nurse for the suidical ward. An inspector (Male Matron in charge of male Attendants) was appointed in 1870 when the establishment of Attendants was 26 male and 30 female; wages had been increased in 1872 "in consideration of the great expense of living, it being impossible to find accommodation in Brentwood at less than 5/- a wekk." A 2 per annum increase was made.

Trouble was still being experienced in attracting the right kind of person to be attendants and inefficiency, absence, cruelty and drunkenness were still problems, albeit rigorously dealt with when encountered. Discipline contined to be strict and the Minutes of September 1867 contain the rather cryptic entry :-

".... Nurse (sic), guitly of unbecoming conduct in receiving letters also of changing her dress on going to London, is allowed to resign, but to leave tomorrow." Also; ".... Nurse, having in like manner received letters" (presumably about a patient?) "and conversed with persons beyond the walls is allowed to resign."




Chapter 4

The Eighties and Nineties


The next twenty years were notable for the large building programme. After the proposed second asylum at Wickham Bishops near Whitham, proposed at the 1876 Quarter Sessions, had been abandoned owing to the failure of borings to 1,100 feet to find water, various alternatives were discussed for the enlargement of the Asylum by another 450 beds. Three possible sites were considered; between the Main Buildings and the road (where the cricket field now is), on the site of the laundry drying ground and south of it (the sites of the present medical staff houses), and that finally chosen betwen the Main Block and Brentwood Hall.

It is a little difficult to conceive why this site was chosen, as it is singularly ill-adapted for building with its 40 feet drop of level in the 780 feet length of the block, necessitating endless steps and resulting in an unsatisfactory lay-out.

The building was delayed owing to the usual difficulty over water, the Waterworks Company charging "a very high price". A tender was finally accepted for 64,000 in 1886 and the block opened for Male patients, F Block, in 1888.

It was decided not to install electric light in the new block on account of the expenses; to provide the 185 lights of 8 candle-power and 547 of 16 c.p., two steam engines developing 110 indicated h.p. would have been needed at a cost of 4,000 and an annual upkeep of 733. The Committee was also advised that (shades of the 1950's!) "they could not depend on the light going out unexpectedly." Gas was therefore installed and the proposal to build a gas works in the estate was only abandoned when the Gas Company, force majeure, reduced its prices.

The plan of the wards tended to return to the older style of the original block with long galleries, though somewhat wider, with the associated dormitories and single rooms opening off them, rather than the more modern and pleasing style of D Block built 18 years previously. Despite criticisms by the Commissioners in Lunacy over many years about the unplastered walls of the old block, except in the new Infirmary (Ward 14), the same mistake was perpetuated and, save for some single rooms, cost has prevented complete plastering to the present day.

The building, despite its comparatively short life of 65 years, has proved to be an engineer's nightmare in maintenance due to damp and rot. This block contained a new Recreational Hall; that in use today.

The wards were, and still are, somewhat dingy and were deliberately plainly furnished and decorated "being more acceptable to persons of the labouring classes"; a nice piece of Victorian class-consciousness.

Due to the greatly increased number of patients, the old Chapel had long been too small and, owing to its situation, very difficult and costly to enlarge. A new Chapel was proposed at a cost of 4,375 and completed in 1889 and was dedicated to the Bishop of St. Albans. The old Chapel was, two years later, converted to its present use as a dormitory, having in the meanwhile been used as a library.

On the opening of F Block, all the male patients were moved there and the Main Building given over wholly to females. Admissions were once more unrestricted and the 250 patients boarded out in other asylums bought back. Indeed, the asylum's income was for the first time augmented by taking patients from other counties. By 1895 the position was again reversed and Essex patients boarded out again. In the same year, following a series of epidemics, the Isolation Hospital was built.

Brunswick House continued to be used as an Annexe, but the lease of Lea Hall having run out, it was decided to look elsewhere for a house, Lea Hall needing to have so much spent on repairs. The choice fell upon Harold Court, Harold Wood then only 20 years old; this was bought for 3,100 in 1891 and connected to the asylum by telephone along the Great Eastern Railway Company's wires. Improvements continued in the older buildings; D block having insufficient lavatories, small sanitary wings were added north of East and West Wings in 1889 and 2 complete new wings, East East Wing and Infirmary Wing, added in 1897 for 100 patients.

In the old block, two new padded rooms were built at a cost of 43 each, the W.C.'s in all wards which still never had more than two "seats" per ward, were cut off from the ward with glass screeens and a system of air ducts installed to improve the ventilation. The old and rat-damaged brick sewers that ran under the main building wards were replaced by iron pipes from 1885.

In the wards, a great many of the original wooden box-beds were still in use, but were gradually replaced by iron beds.

PATIENTS

The number of patients rose from 904 in 1880 to 1999 in 1899 of whom 173 were in the Annexes and 61 boarded out. There were still a very large number of General Paralytics, 32 being admitted in 1889; in 1896 it was commented that 38% of the admissions were metnally defective and the need was felt of a separate "Asylum for Idiots". Children were commonly and quite indiscriminately mixed with adults in the wards.

Difficulties were encountered in getting the workhouses to accept senile patients no longer needing asylum treatment so that the wards were unncessarily full, a problem that still exists. Where the workhouses did not accept them, there were more often than not sent back to the asylum after a short time.

This period was also characteristed by a number of severe epidemics; typhoid broke out in 1884 and 1889 and was attributed to sewer gas leaking from the old drains; the Senior Assistant Medical Officer himself became infected, thought to be due to his having performed an autospy. In 1894 there were 37 cases of Smallpox amonst the patients, of whom 13 died, and 5 amongst the staff, all of whom recovered. The next year saw a large outbreak of Diphtheria, 33 "true" cases being confirmed by bacteriological methods and 80 suspect sore throats. The outbreak was treated with antitoxin serum and sulphurous acid to the throat. As the Isolation Hospital had not then been completed, two "Iron (Corrugated) Buildings" were erected as temporary isolation wards. There were small epidemics of Influenza and Diphtheria in 1897 and 1898.

An operation for a strangulated hernia was performed in 1884, but the patient died five days later due to peritonitis.

Experiments were carried out with the use of coloured glass in the windows of certain single rooms, violet coloured for excited cases and rose coloured for melancholics.

Beer as an article of diet was gradually given up on the grounds that it was too weak to be a stimulent and that, as so many of the mental illnesses were considered due to alcohol (a very large number came in with delirium tremens), if the patients learned that it was possible to live without it in hospital, they might do so on leaving.

The withdrawl was gradual; from 1882, only working patients of both sexes were given ½ pint at 11 a.m. and 4 p.m; in 1892, it was withdrawn altogether "will no ill effects". There was in fact a report that more work was done by the patients who had previously tended to blackmail the staff on the basis of "more beer or no more work" but, to quote Dr. Amsden the Superintendent "no one seems to ask for more tea". The staff were given a monetary allowance in lieu and were reported to be "greatly contented". Reading between the lines, one senses that this withdrawal was carried out with some trepidation as to whether it might have provoked a riot, and there is a sense of relife to be read into the reports of its success.

The brewery was converted into a laboratory and mortuary.

STAFF

Dr. Campbell, the Medical Superintendent from 1853, died in office in August 1888 and was succeeded by the Senior Assistant, Dr. Amsden.

A third assistant was appointed in 1887 and the next year a Dispenser-Secretary was appointed, the second Assistant Medical Officer having previously acted as dispenser.

In 1890, some form of training for the attendants was felt to be desirable and a skeleton was hired for lectures "from time to time".

By 1889 there were 84 male and 116 female attendants and two Head Attendants on each side in addition to the Matron, Sub-Matron and Inspector. Their hours of duty were long, 14 hours a day with one day off every 23 days. Following complaints in the local press, it was found possible to gie one day off every 14 days and, it was reported after an inquiry, that the "pay and conditions compared well with other asylums". There was no Annual Leave.




Chapter 5

1900 to 1919


The next twenty-year period saw only minor building extensions at the asylum itself, but, what was far more important, relief from some of the overcrowding in the opening of two completely new asylums, that of Goodmayes by the recently formed (1889) Borough of West Ham to which 680 patients were transferred in 1901, and Severalls at Colchester, the site for which had been bought in 1903 but which was not opened till 1913, and planned to be increased by stages eventually to house 2000 patients.

The relief afforded by the opening of Goodmayes was largely off-set by the return of all the Essex patients "boarded out" in other counties' asylums.

By the time Severalls was ready to receive patients, the patients boarded out had again reached several hundreds, and these were the first admissions to the new hospital.

One of the difficulties of the boarding-out system was that the receiving hospitals not only charged up to double the actual maintenance rate but also laid down strict criteria as to the type of patient they were willing to accept, so that the crowded hospital, forced so to dispose of its surplus patients, was inevitably left with the worst ones.

At Brentwood, 1900 saw the erection of the new "Nurses' Buildings", the first nurses' accommodation off the wards.

Screens were erected part-way along the galleries of some of the wards to make temporary dormitories in 1901 to relieve overcrowding; they are still to be seen in F.5, F.6 and F.7 wards. Other measures were the erection of further corrugated iron structures to a total of four, which remained in use until 1914, when they were dismantled and re-erected on the Home Farm as workshops. They were destroyed by enemy action in 1940. At one time space was so short that the Laundry Workers, who slept in an Iron Building, had no day space and lived in the Laundry, taking their meals off the ironing tables.

A new mortuary was built in 1905 and in the same year, electric light was installed in the workshops. The rest of the hospital was still gas-lit, one Commissioners' Report stating it was so inadequate that it was difficult to see patients in one F Block ward from half the length of the gallery. Incandescent fittings were supplied from 1907.

A big advance came in 1910 with the completion of the new Central Kitchens to replace the uneconomical system of each block separately cooking its own meals.

In 1911 the old kitchen built in 1853 became a needleroom and gas ovens were introduced into the wards, for the first time enabling food to be kept hot. The same year saw D Block's needleroom converted to a General Bathroom.

In 1911 too, the hospital was connected to the National Telephone System, soon to be taken over by the G.P.O.

Brunswick House became redundant in 1912 and in 1919 the use of Harold Court and the Chestnuts was given up.

The verandahs of F.1 in the main building, Ward 14 in F Block and the Infirmary in D Block were added for open-air treatment in 1913-14.

A Cinema was installed in 1919.

PATIENTS

No great advances or innovations in treatment took place in these years, though the use of mechanical restraint became, after the turn of the century, a rarity.

Epileptics and General Paralytics still accounted for a considerable percentage of the admissions. From 1902 the children (mental defectives) were housed in separate wards from the adults with some exceptions. Later, a Children's Court with swings and see-saws was provided.

Pathological work, in the investigation of possible organic structural abnormalities as a cause of insanity, incrased enormously from 1910 and a great deal of research was carried out.

There were two more typhoid epidemics resulting in two deaths in 1900 and a very much more serious one in 1917, when 82 patients were affected, of whom 21 died, and 55 staff of whom 9 died. The resulting strain on the nurses when over 100 of the staff were already serving in the Forces can be imagined. The entire unaffected staff and patients were given anti-typhoid innoculations.

A fete for 800 patients were given in 1911 in celebration of the Coronation of their Majesties King George V and Queen Mary.

STAFF

Dr. Amsden, the second Superintendent, retired in 1910 after a total of 41 years' service in the asylum. Dr. Turner was appointed in his place.

In 1900, a fourth Assistant Medical Officer was added to the staff, none too many with 2,000 odd patients at the asylum itself and Harold Court.

From 1903, nurses were encouraged to sit for the examinations of the St. John's Ambulance Brigade and the Medico-Psychological Assoication, a bonus being given for the latter examination.

In 1912 the East Anglian Division of the British Medical Association and the (now Royal) Medico-Psychological Association held meetings at the hospital at which Dr. Turner and Dr. G. Clarke (later Superintendent of Bexley) read papers.




Chapter 6

The 1914-1918 War


In August 1914, 1,000 officers and men of the Essex Regiment were billeted in the hospital for a week prior to their emabrkation for France, the new kitchens doing all the additional cooking.

By the end of 1914, 39 male attendants, one medical officer and 10 other staff were in the forces, a figure that rose to 102 by 1918 when 7 lost their lives, including one of hte Medical Officers. There is a Memorial in the Chapel.

Norfolk and Napsbury Asylums having been evacuated for conversion to Military Hospitals, a considerable number of patients were received from them resulting in greater overcrowding.

Rationing for patients was more severe than that for the general public and, with the overcrowding and other factors, resulted in an enormous death rate during the latter years of the war. In 1917, 525 patients died, only 10 less than the number of admissions for the year. By 1919, deaths fell to 346.

Peace celebrations were held in July 1919 with sports, an open air concert and a dance for the staff.




Chapter 7

The Twenties And Thirties

"Brentwood Mental Hospital"


Although not legally abandoned until the Mental Treatment Act of 1930, the name "Asylum" was dropped from 1920 onwards and the term "Mental Hospital" used with its indication of a more hopeful outlook in the care and treatment of the insane.

This period saw a tremendous amount of new building, unfortunately terminated by the outbreak of war in 1939; it was also notable for the passing of the Mental Treatment Act in 1930 which permitted the admission of patients for the first time without a Justice's Order as Voluntary and Temporary patients, thereby both avoiding the "stigma" of certification and allowing early and non-certifiable cases the benefits of the rapidly increasing therapeutic armamentarum available, and also permitted preventative psychiatry in the establishment of out-patient clinics.

In 1920, clinical rooms were made for the first time in the wards, at first in the admission wards only and later extended to the more chronic wards. Two years later, gas lighting was fitted to the single rooms and street lights placed in the roadways. Electric lighting was installed in the Recreation Hall and on hte stage, battery-fed, in 1922 but the hospital was not generally electrically lighted until 1930.

New buildings erected included verandahs in F Block Ward 11 and D Block, a new laboratory, operating theatre and General Bathrooms in the main building in 1925; the removal of part of the original circumferential wall in F.5 garden, improved ward heating by Wilmer Fire system, each open fire heating two or three radiators in F Block, later extended to the other blocks. It is still in use. The new Nurses' Home was opened in 1930 and was increased in size by having another story added two years later.

A new laundry and boiler house were built in 1931, freeing the old laundry in the south-east corner of the old block for conversion into workshops, needleroom, occupational centre and canteen. Later, the upper floor was opened as an extra dormitory F.3, a more unsuitable situation, though partly still in use.

A male convalescent villa, Garden Villa was erected as a "temporary" structure for 40 patients at a cost of 2,204 in 1933; (compare the cost of the 12 bedded Staff Stick Quarters erected in 1951 for nearly 10,000!); a similar, but slightly larger villa, Rose Villa, was put up the next year for women. These "temporary" buildings are still as good as ever in 1953, twenty years later.

The separate Admission Unit, projected as long before as 1921, was finally opened in June 1936 by Sir Laurence Brock, C.B., Chairman of the Board of Control. Woodside Villa, the male convalescent unit was opened in 1937 but its female counterpart was deferred indefinitely by the war and has never been built.

Brentwood Hall, regarded as unsafe and emptied of paitents in 1934, was demolished in 1936 and a new structure, which has carried on the old name, built the next year as a male occupational therapy department on the ground floor with male nurses' rooms above.

Other smaller improvements in the 20-year period were the levelling of the cricket field in 1922, the installation of the first X-ray plant in 1923 (a modern one was incorporated in the new Admission Block), a sound-film projector and wireless in the wards in 1932, (a central wireless receiver was bought in 1936), bathrooms and a sanitary annexe in A, B, C Blocks and a sterilizing room for the operating theatre in 1938.

In 1933, 400 acres of the Margaretting Hall estate at Ingatestone had been bought as the site for a new Mental Hospital, but the war stopped building, and the project has never been seriously reconsidered, the land being farmed by the Brentwood Committee on a definitely non-profit-making basis.

Other building schemes shelved owing to the war and post-war financial difficulties, have been a new kitchen-canteen-ballroom unit planned for the space between Rose Villa and the Laundry and the female convalescent villa.

The opening of Runwell Hospital, Wickford in 1936 by the combined boroughs of East Ham and Southend further relived the pressure of admissions on Brentwood.

PATIENTS AND TREATMENT

Until 1921, there was no segregation of tuberculous patients; treatments remained much as in 1900 until 1926 saw the introduction of Malarial treatment of G.P.I., Sulphosin in 1930 and Tryparsamide in 1932. Hydrotherapy became a vogue in 1926 that lasted until the war; prolonged narcosis and chemical convulsant therapy with Cardiazol and allied preparations were used from 1937.

The parole system was greatly extended from 1926 and certain wards "opened".

A Consulting Surgeon was first appointed in 1926, operations having previously been performed at the local hospitals.

Out-patient clincs were established in 1931, at first once a week at Oldchurch Hospital, Romford and later fortnightly at a house in Woodford and at Orsett Lodge Hospital. A part-time Social Worker supplied by the Mental After-Care Association assisted from 1932 until the appointment of a Psychiatric Social Worker in 1944.

In 1920, 180 patients housed during the 1914-1918 war were returned to Norfolk and Napsbury Asylums.

STAFF

In 1920, there were 80 male and 114 female nurses, in 1939, 163 male and 195 female. A Dental Surgeon visited weekly from 1921.

Dr. G. Evans was appointed Superintendent on Dr. Turner's retirement in 1920, but he died in December the same year and Dr. W. Robinson succeeded him. Dr. Robinson resigned in 1925 and Dr. W. G. Masefield, later to become for many years the General Secretary of the Royal Medico-Pyschological Association and, after his retirement, its President, was appointed.

A Staff Social Club was formed in 1934.

A fifth Assistant Medical Officer was appointed in 1931, a sixth in 1935.

One cannot conclude this section of the hospital's history without recording a delightful piece of, presumably unconscious, humour in the Committee Minutes of 1921; a certain member of the House Committee, having visited parts of the hospital made this entry in the "Visitor's Book" :-

"Visited the following: Workshops fair condition. Mortuary, no complaints.




Chapter 8

The War Years, 1939-1945


Early in 1939, the possibilities of war has been anticipated and 825 spent on advance air raid precautions. On the outbreak of the war, the Admission Unit and Woodside Villa were evacuated at 48 hours' notice and part of the London Hospital, Whitechapel, move in complete with staff and special equipment. Members of their nursing staff were accommodated in Woodside Villa, the Nurses' Home and the Staff quarters at the Admission Block, whilst the resident Medical Staff and a number of Medical Students were billeted in the Residents' houses. 230 general medical and surgical beds were acccommodated and an operating theatre fitted up in the Hydrotherapy Room (now the male Occupational Therapy centre).

The ground floor of the new Brentwood Hall was fitted as a First Aid Post, shelters were dug and the buildings sand-bagged, and black-out screens hastily prepared.

Many voluntary patients went home, but the vacating of the top floors produced serious overcrowding. Female patients were accommodated in the Female Occupational Therapy Hut, known as the Studio Ward.

In 1940 the hospital sustained its only serious air raid damage, in the destruction of some farm stores buildings, although minor damage occurred in subsequent years.

Many of the staff were once again called up into the forces and four of the Medical Officers were away from 1940 to 1945/46. Temporary, but psychiatrically inexperienced, Medical Officers helped to carry on, though active treatment had to be confined practically to the recent admission who were, perforce, treated in the old admission wards.

The out-patient clinic building at Woodford was damaged and the clinic closed.

In 1941, entertainments practically ceased as the Recreation Hall in F Block was used as a dormitory.

The patients suffered little in comparison with the previous war; there was no heavy death rate, though some of the chronic patients lost weight on the rations. Curiously enough, most recently admitted cases gained weight, presumably due to the relatively plentiful milk supply from the hospital farm.

In 1942, 40 patients were received from Severalls which had been bombed.

The extingencies of war did not stop progress in new treatments, and electro-convulsive therapy was introduced in 1941 and the antibiotic drugs used successfully on dysentric cases.

June 1945 saw the return of the Admission Unit to the hospital for its own use and the end of the First Aid Post, in which Brentwood was singularly fortunate, as some other mental hospitals had general hospital wards in part of their accommodation for several years after the war.




Chapter 9

The Post War Years, 1946-1953

"Warley Hospital"


Many factors have contributed to make this eight-year period one of relatively considerable advance; physical methods of treatment had made great strides during and just after the war, the full medical staff returned from service in the army and the advent of the National Health Service, which lessened the "catchment area" of the hospital and, at the same time, allowed an increase in the number of doctors on the establishment, permitted of their being put into operation.

Insulin Coma therapy was started in the wards in 1946, a special insulin unit, contrived out of a staff kitchen at the Admission Block, being opened in 1950 and extended into a combined male and female centre in 1953.

A neuro-Surgeon was appointed in 1946 and 200 pre-frontal leucotomies have been performed since (up to 1953).

It can now be said that all modern forms of psychotherapy and physical treatments are available, with the exception of Electronarcosis.

Although the medical staff has been increased to a total of 13, the nursing staff has shown a steady decrease, first noticeable on the female side where the problem has been partly solved by the employment of part-time nurses who now out-number the full-time, and the recent recruitment of French Student Nurses.

From 1951, the same problem began to show itself on the male side, with no such easy solution.

This nursing shortage and the difficulty of getting new buildigns has led to a considerable degree of improvisation and compromise in the use of existing accommodation.

Partly to ease the nursing situation in the wards, the Isolation Hospital has been used as a patient-administered unit for 14 mild chronic patients; occupational therapy accommodation has been much increased, the females having taken over Rose Villa which will accommodate up to 270 patients at a time; recently Garden Villa has been converted into a male centre, the dispossessed patients being rehoused by a complicated rearrangement of space, including the coversion of Dormitory 16 in F Block to a ward unit, and the old O.T. department, previously the "Head Attendants' Office", to a dormitory.

On the female side, the old O.T. centre has been used as premises for the Social Therapy Department which organises the patients' Social Club Groups.

Some new building has been possible, and a Staff Sick Quarters of 12 beds was erected in 1951 behind the centre building of the Admission Unit. Three modern sanitary annexes, similar to the one erected just before the war, have been added to the Main Building. Three verandahs, previously open, have been modernised and glazed in for the treatment of tuberculosis. One wing on the M Side of the main building has been centrally heated with an efficiency that only shows up its lack elsewhere. A new ward unit using the old name E.D. (Epileptic Dormitory) but without its significance was made from staff quarters near the stores in 1952 as an open convalescent female centre.

A new 300 m.a. X-ray was installed in 1952 enabling, inter alia, air encephalographies to be carried out.

A central dining room has been re-introduced into F Block in 1953. Public demand has increased the out-patient work enormously and 16 doctor-sessions are serviced by the medical staff each week at Oldchurch Hospital, Romford, and Whipps Cross Hospital, Leytonstone (the logical successor to the old Woodford Clinic), at St. George's Hospital, Hornchurch and at Warley itself, the latter including special clinics for children and for out-patient electrical treatment.

In July 1951, a 20-bedded Neurosis Unit was set up at St. George's Hospital, Hornchurch (Romford Hospital Group) in accommodation used before the war as an Observation Ward.

In July 1948 the hospital severed its 95 year-old association with the County of Essex and the Borough of Colchester and came under the aegis of the North East Metropolitan Regional Hospital Board. Continuity was, fortunately, preserved by the many members of the old Committee of Visitors who remained on the new Hospital Management Committee, including the Chairman, with the leavening of Members from and representing other interests.

In conformity with modern custom, the name "Brentwood Mental Hospital" was changed to "Warley Hospital" in 1953. It was not possible, owing to inevitable confusion with other hospitals in the district merely to drop the word "Mental" and the name of some geographical significance was considered desirable rather than the common, but somewhat confusing, "Saint" name.

Despite all progress, the essential problems remain; old buildings designed for a totally different outlook on the care of the mentally ill, too costly to demolish and rebuild, costly too to maintain in even reasonable repair and decoration and, at their best, a compromise for modern usage.

Looking back over the 100 years, one is struck, not so much by the change for the better and the progress made in the care and treatment of patients, great though they have been, nor by the tremendous change of public outlook on the mentally ill, but by the similarities of the problems of today with those of the fifties and sixties of the last century.

Chronic overcrowding was and still is a problem; waiting lists have always, from time to time, been necessary; senile but harmless patients still cannot be discharged to chronic hospitals where they would be more suitably cared for; even the same chimneys smoke as they did in 1854.

Many of those forms of activity that we tend to think of as most modern we find anticipated in the very early years, though often allowed to lapse; the motor-coach outings of today and their counterpart in the waggonette picnics of the sixties; occupational thearpy and recreational activities are no new thing; even the "new" idea of letting the better patients, especially females, choose their own clothes dates back to the seventies.

"Plus ca change ..."



BRENTWOOD
March 1953
G.S.N.




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