GUEST BLOG DR FRANK CROMPTON - THE BUILDING OF LUNATIC ASYLUMS (LITTLE HAS CHANGED)

Little has changed in the 179 years since Earl Grey’s Whig Administration determined that they would compel County and County Borough Councils to establish pauper lunatic asylums to house insane paupers from their areas. The Lunacy Act of 1845 (8 & 9 Vict. c. 100) and the County Asylums Act of the same year (8 & 9 Vict. c. 126) reformed the Mental Health Law in England and Wales from 1845 to 1890. However, both Worcestershire County Council, and the Worcester City Council were reticent to implement this new law. It took both over 5 years to even begin to respond to the demands of the new act. 

In part this reticence was because both administrations were fortunate as William Ricketts had already created a private lunatic asylum in Droitwich in 1791 which accepted insane pauper lunatics from both the county and city of Worcester. This institution was extremely humane, in comparison with most lunatic asylums (or ‘Madhouses’ as these institutions were often called). The lunatic asylum scandals that afflicted much of England and Wales were unknown in the county and city of Worcester and when William Ricketts died in 1817 his son Martin took over the Droitwich Private Lunatic Asylum that continued to accept patients from Worcestershire Poor Law Unions until the Pauper Lunatic Asylum at Powick opened in August 1852. 

In 1835 surgeon Thomas Lewis opened Duddeston Hall. Situated north of Birmingham and licensed to accept 30 private patients and 60 paupers, this institution was housed in a large mansion. It too was favourably regarded and, like the Droitwich asylum, was used by some Worcestershire Poor Law Unions. In 1822 the Fairford Retreat was created by Alexander Iles, another surgeon. It also accepted some pauper patients from the County and City of Worcester and was regarded with approval for the humanity of its treatment. 

The County Asylums Act of 1808 (48 Geo. 3. c. 96) determined the Mental Health Law in England and Wales between 1808 and 1845. This Act determined that Public Mental Asylums in England and Wales could now be administered by County and County Borough Administrations. It permitted but did not compel councils to provide establishments for the care of pauper lunatics, which meant that they could be removed from workhouses and prisons. This Act was also known as Mr. Wynn's Act, because Charles Watkin Williams-Wynn, the Welsh MP for Montgomeryshire, was the original promoter.

However, the Act was unsuccessful in promoting the creation of many new County or County Borough Lunatic Asylums, and the failure led to the introduction of the County Asylums Act of 1828 (9 Geo. 4. C. 40), another attempt to address concerns about the slow creation of asylums in England and Wales. This legislation required Magistrates to send annual records of admissions, discharges, and deaths of insane paupers in a County or County Borough, to the Home Office annually.

Similarly, this minimal Legislation failed to encourage the creation of new Lunatic Asylums, so, in 1845 were passed both the Lunacy Act 1845 (8 & 9 Vict. c. 100) and the County Asylums Act (8 & 9 Vict. c. 126). Together these created Mental Health Law in England and Wales between 1845 to 1890 which obliged County and County Borough Authorities to provide Asylum for the pauper lunatics in their area. This law was based on the work of John Connolly and Lord Shaftsbury which also led to the use of ‘Moral Treatment’ of pauper lunatics in County and County Borough asylums. This treatment was pioneered by William Tuke at the York Retreat and led to a change in status of pauper lunatics being treated as patients, not prisoners. Following this legislation, and until 1890, over 60 asylums were built and opened. However, they were soon overcrowded, meaning a further 40 were opened soon after.  

Even though councils were now obliged to build new lunatic asylums, there was an almost 7-year delay before the opening of the new City and County Pauper Lunatic Asylum at Powick on 12 August 1852. Instead, the local authorities attempted to persuade neighbouring county authorities to build joint lunatic asylums that Worcester’s patients could share. Hereford, in many ways a logical partner to Worcester, had already agreed with several Welsh counties to set up a new pauper lunatic asylum at Abergavenny. Gloucestershire, Shropshire and Warwickshire were also approached, but refused to build shared asylums, claiming that their asylums were already too large to contemplate taking additional patients from Worcestershire.

So in 1849, almost 5 years after the 1845 acts demanded that Worcester County and City build a new pauper lunatic asylum, an asylum was planned. The City of Worcester demanded that the new institution be sighted close to the city, and Powick, less than two miles from the centre, was chosen. (1)

The writer believes that little has changed since 1845. Today legislation is often delayed due to the reticence of local authorities to accept decisions made by Central Government that are at variance from the opinions of local authorities.

Frank Crompton

Endnotes

(1) Powick was over 30 miles from Dudley and Shipston-on-Stour, then parts of the County of Worcester and patients from distant places could be transported by train to Worcester (there were reports that patients climbed out through windows on to the roofs of carriages). The new County Asylum Authorities refused to have a station next to the asylum, but the Worcester to Hereford Railway, built in the 1860s, was rerouted a couple of miles from the asylum.

 

Join us in welcoming Dan to the George Marshall Medical Museum!

We’re so lucky to have accepted a volunteer offer from Dan, who joins us as a District Training Lead for St John Ambulance, amateur Nurse Historian and a former nurse, to boot! He’ll be helping us to engage our visitors and online audiences with nursing history (he loves badges!), and with a focus on First Aid and St John Ambulance. Watch this space for activities and displays. Thanks Dan!

"As a long-standing lover of all things medical, I recently visited the GMMM and I was smitten! Coming from a former nursing background, I hope to support Louise with expanding our nursing history archive and hopefully increasing the reach and spread of this topic of history."

"TRAGIC MISTAKE OR NEGLIGENCE AT POWICK HOSPITAL" GUEST BLOG BY CATHY BROAD

In 1921, a strange incident occurred at Powick Mental Hospital…

Nine male patients were poisoned by ingesting belladonna. Three of them died, and an inquest into these deaths found the doctor who prescribed the medicine not guilty of any misdeed. Eight days later a fourth patient died, and a second inquest into his death reached the same verdict.

During the first inquest, which was reported in both Berwick’s Worcester Journal and the Worcester Herald, both published on Saturday 17 September 1921, Dr Henry Fenton, the medical superintendent at the asylum, testified that on the morning of 14 September, his attention was called to the nine patients. He called the doctor who had been in charge the previous night, Dr Alexander O’Flaherty, and together they examined the patients. Dr Fenton diagnosed them as suffering from belladonna poisoning. Two of them, George Newman and Herbert Peasley, were comatose. A third, John Jones, was not as badly affected. These were the three who died.

Berrow’s Worcester Journal, Saturday 17 September, 1921

Dr Fenton testified that he knew the patients had been prescribed purgative draughts the night before, and asked to see the bottles used. He concluded that they had been given a mixture of glycerine and belladonna, and immediately ordered that the patients be given emetics and antidotes.

To his credit, Dr O’Flaherty admitted his responsibility, but claimed that he had made an honest mistake. He had intended to give the patients a purgative of glycerine and cascara, but told Dr Fenton that he must have given them glycerine and belladonna instead. He testified that he saw the abbreviation ‘Glyc’ on a bottle and assumed that it was the glycerine and cascara mixture. He claimed not to have noticed that the bottle was labelled ‘Poison’ as it contained glycerine and belladonna.

The Coroner asked why he didn’t look closely at the bottle to ascertain its contents. The doctor replied that he did not expect that glycerine and belladonna would be used. The Coroner asked to examine the bottles, and the report mentions that apart from the labels and the level of the contents, the bottles were identical. The Coroner suggested that if the glycerine and belladonna had been in a ribbed bottle, it would have been immediately obvious that it contained poison and would not have been used. Dr Fenton agreed with this statement.

In his instructions to the jury, the Coroner said that they must decide whether Dr O’Flaherty had taken due caution in making up the purgatives, in which case the deaths were due to misadventure, or whether he was guilty of gross negligence, in which case he would be guilty of manslaughter. The jury took only a few minutes to bring in a verdict of Death by Misadventure.

 On 21 September the fourth patient, George Frederick Bokenham, died. An inquest into his death was reported in both Berwick’s Worcester Journal and the Worcester Herald, both published on Saturday 1 October 1921. The Coroner went through the incident that had been the subject of the first inquest, and questioned the doctor who had performed an autopsy on the deceased. It was revealed that death was caused by pneumonia, which the doctor said was probably accelerated by the belladonna poisoning.

The jury went to inspect the dispensary, and closely questioned the assistant medical director, Dr Romer, who was unofficially in charge of the dispensary.  Dr Romer had criticised the arrangement of the dispensary, but as he was not officially responsible, he did not feel able to insist on better security. The jury again brought in a verdict of Death by Misadventure, but added that there should be better supervision of the dispensary.

Note from the inquest held about George Frederick Bokenham’s death. Image taken from the patient’s mental hospital notes

At the time it was not mandatory to keep poisons in ribbed bottles for easy identification. There had been a Bill for Prevention of Accidental Poisoning in 1863, but it had failed to pass into law, although many institutions did take the precaution of using ribbed bottles. One cannot judge history by today’s standards, but one cannot help wishing that those in charge at Powick Asylum had taken similar precautions.

With thanks to Cathy Broad for researching and writing this article.