Annual Reports of the 1920s: Children

As we have seen in previous blog posts, the three Staffordshire County asylums all created Annual Reports. In the twentieth century, these usually consisted of a Report by the Visiting Committee, a Report by the Medical Superintendent and a Report of the Commissioners. They provide a fascinating insight into the life of the hospitals, weaving together as they do descriptions of the events and developments over the previous twelve months, observations by the interested parties as to what had improved and what needed to be improved or bought for the hospital, and also a running commentary on medical research and how the hospitals were responding to changing medical theory and practices.

The reports highlight the issue of how children with learning difficulties were treated in this period. Asylums had long been catch-all institutions and had been receiving points for all types of patients who today would be regarded in very different ways and treated in very different settings. Children with learning difficulties had often ended up in asylums, some placed there when families could no longer cope, or when Poor Law institutions had no accommodation for them. As time went on in the early twentieth century, more specialised treatment of different asylum populations continued to develop, and children are a key example of this trend.

Mary Dendy Colony Hospital, Great Warford, Cheshire. Opened in 1902, before the 1913 Mental Deficiency Act (image courtesy of countyasylums.co.uk)

The legal status of children had already begun to change in the early 1900s, and the process of treating them as a separate entity from adults had begun. The Children Act (1908) was a major step towards seeing children as separate from adults, keeping them out of adult prisons, preventing their access to alcohol, and empowering local authorities to allow children poor relief outside of the workhouse.[i]

The 1913 Mental Deficiency Act set up a new ‘Board of Control’. Under this legislation ‘mental defectives’ were to be supervised in the community or placed in new ‘mental deficiency colonies.’ Some local authorities founded new colonies for this purpose, which acted as a halfway house between a small settlement and a hospital. Other areas which either lacked the money for new institutions, or didn’t wish to follow the new pattern, set up separate blocks and wards for children on existing asylum campuses.[ii]

The new legislation brought in a strict ‘grading’ system for people with learning disabilities, which was typical of much of the social science of the times. It placed people in categories, using language which is disturbing to us today.

‘Idiots’ were the ‘bottom grade’ (the profoundly disabled). The ‘middle grade’ were the ‘imbeciles’. The highest functioning disabled people were graded as ‘feeble minded’, with most of this group able to support and look after themselves to some extent. Alongside this group were the ‘moral defectives’ who were labelled as ‘(unable to) distinguish right from wrong and represent a grave danger to the community’.

The treatment of children graded under the new system continued in Staffordshire within the confines of the asylums, and Cheddleton asylum founded blocks for their accommodation and treatment. This was possible because at the end of the First World War, patients who had been transferred to Cheddleton from other asylums, which had served as War Hospitals, returned to their original asylums (mostly Rubery Hill in Birmingham). The departure of the ‘war boarders’ freed up 175 beds, which allowed a block on the female side of the hospital to be set aside for children.

The block initially accommodated 40 boys and 36 girls, described as ‘low grade imbeciles’. The 1922 Commissioners Report stated that the child patients were ‘receiving most excellent treatment under most kindly nurses. In the absence of a certified institution under the Mental Deficiency Act we regard this as a good temporary management’.[iii]

A lack of training or a specialist institution in Staffordshire meant that the county was reliant upon the expertise of other local authorities, and the childrens’ nurses employed at Cheddleton were sent to Meanwood Colony, opened by Leeds in 1919 as a ‘mental deficiency’ colony, for a whole month of training.

By the early 1920s, the children’s service was well established at Cheddleton. Medical Superintendent Menzies wrote in the 1923 annual report:

‘Two years ago I expressed the opinion that little could be done for the low grade child in our idiot wards. It is with pleasure that I am able to confess myself wrong’.

More details from his report, and from subsequent years, follow below.

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1923 Cheddleton

Resident MO and Superintendent: WF Menzies MD BSc (Edin) FRCP

Sen Asst MO: W D Wilkins MB ChB(Vict) MRCS LRCP DPM (Camb)

Jun Asst MO: F H Stewart MA BSc (St And) MD (Edin)

The special block (for idiots and low-grade imbeciles) has proved successful and a very elementary scheme of training is carried out, chiefly in the direction of teaching the most backwards to walk, talk, and take notice. 12 words a year is good progress in some cases, and an early necessity is to cultivate the rudimentary power of attention. The sisters in charge of the boys’ and girls’ wards were sent to the Meanwood Colony, maintained by the Leeds Mental Deficiency Committee, for one month’s intensive training, and returned full of enthusiasm for the methods used with the lowest-grade children…..The Newport Guardians are arranging to transfer one intelligent boy to the Derby Royal Institution for the Deaf and Dumb.

Intention – To form a small schoolroom in the idiot’s block

Menzies Report:

‘Two years ago I expressed the opinion that little could be done for the low grade of child in our idiot wards. It is with pleasure that I am able to confess myself wrong. Nothing is more wonderful than the advance made. Two years ago a visitor to the ward met a howling mob, spiteful, mischievous, dirty in their habits. Now they are pleasant, quiet and smiling, very few but are clean in habits, none but the lowest who cannot respond to simple ideas. Nearly all can talk a little, many have learned to walk; they play games without squabbling and biting. This progress should be a source of satisfaction to Sisters Chaplin and Stanley, who returned from their course of intensive training at Meanwood Colony full of enthusiasm and have taken such infinite trouble with and interest in their charges. They have found a market for the small baskets and other articles made by the children, and with the profits have purchased further materials and instruction models, in addition to those provided by the Committee. I am making tentative enquiries as to the possibility of linking up our department with the newly established Leek Orthopaedic Centre, in order to get at the brains of the paralysed; for it is well known that if, by correction of congenital deformities, these children’s feet can be got to the ground, the nerve energy required for walking actually develops some of the latent areas in the brain, thus enlarging their experience of things outside themselves and leading to further intellectual progress…….what a saving of poor rate if they could earn even sufficient to pay for their maintenance, although they could never be expected to compete in the market outside. The public has only just begun to appreciate the economic advantages of orthopaedics in early life among the mentally normal, the possibility of improving the subnormal also is now beginning to be recognised by the medical profession.’

‘Nothing further has been done to make provision for the Mental Defectives in the county…..my advice…..is to acquire half a dozen of the numerous country houses which are at present available, and place in each of them 30 – 40 defectives, not mixing grades or sexes in any one building. No expensive staff would be required, as medical officers from the 3 hospitals would visit regularly; and in only one home for each sex, viz:- for that in which the highest grade resided, would workshops and artisan instructors be required. The Stoke-on-Trent villa is already adapted for high grade girls.’

1924 Cheddleton

Overcrowding by 32 male and 7 female – ‘it is specially unfortunate in regard to our Mental Defective wards. The boys cannot be unduly crowded or discipline suffers; they must have room to run about, be taught exercises and avoid jostling and fighting…..some of the less favourable cases have to be warded with adult men and the old undesirable regime again introduced.’

1925 Cheddleton

Considerable progress made in developing a system of education for the lowest grade of mentally defective children. Miss E Price, Travelling Organiser of the National Association for Mental Welfare spent a month working on a timetable suited to the mentality of the children, and returned for 10 days to note progress. It so happens that the girls in Ward XVI are of higher average grade than the boys in Ward XVII; so the former ward is popular with the nurses and the latter is not. Nurses can rarely see beyond their own nose, and do not recognise that there is more credit in teaching a low grade child cleanliness than in making a fairly intelligent one a scholar, for the former will save future expenses by helping to nurse himself, but as to the latter, the more he learns the nearer he will approach competition with normal workers. As he will never succeed in this contest he will remain expensive to keep.

Wants verandahs, to be able to hold outdoor classes, to benefit the children’s physical health.

‘the absence of sunlight most seriously handicaps progress’ in orthopaedic treatment, ‘many children will not stand the restraint of splinting and have to be prematurely released to save them from going downhill’ – trained masseuse and electrotherapist have started work on muscle re-education, observations on causes of muscle spasticity.

58 boys and 28 girls under treatment, plus 10 adolescent females, ‘infantile in type.’

‘Three boys have been given up as unmanageable and have been relegated to the male side; they were viciously sexual and violently malicious, attacking nurses and patients and destroying property.’

Children’s classroom is ready and all furniture delivered except the small special chairs not made in this country.

This is just a snapshot of the attitudes and approaches to child learning difficulties of the early interwar period. We can see in Menzies’ comments a mixture of very advanced medical thinking in providing therapy for the children, but also more regressive attitudes. His comments show that he believed that the aim of reducing expenditure should be a factor in offering therapy to a particular child, and that children with learning difficulties could never rival the abilities of ‘normal workers’ – teaching them too much was a waste of time as they would not gain independence and remain expensive to keep. In the next two posts, we will explore further the history of how childhood learning difficulties, psychiatric problems and psychological issues were imagined, explained and treated between the early 1800s and the twentieth century.

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[i] Steven J. Taylor, p.750

[ii] For more on these developments see https://historicengland.org.uk/research/inclusive-heritage/disability-history/1914-1945/mental-deficiency-between-the-wars/

[iii] For more on this Myers, pp.129-130

Further Reading:

Historic England, https://historicengland.org.uk/research/inclusive-heritage/disability-history/1914-1945/mental-deficiency-between-the-wars/

Edward D. Myers, A History of Psychiatry in North Staffordshire (Churnet Valley Books, Leek, 1997)

Steven J. Taylor,  ‘She was frightened while pregnant by a monkey at the zoo’: Constructing the Mentally-imperfect Child in Nineteenth-century England’, Social History of Medicine Vol. 30, No. 4 pp. 748–766

Asylum Annual Reports – A Snapshot of an Institution

The three Staffordshire County asylums all created Annual Reports. In the Twentieth Century, these usually consisted of a Report by the Visiting Committee, a Report by the Medical Superintendent and a Report of the Commissioners. They provide a fascinating insight into the life of the hospitals, weaving together as they do descriptions of the events and developments over the previous twelve months, observations by the interested parties as to what had improved and what needed to be improved or bought for the hospital, and also a running commentary on medical research and how the hospitals were responding to changing medical theory and practices. From looking closely at them, we can see that in many ways the asylums saw themselves as progressive and modern institutions, responding as best they could to medical developments and doing the best that they could for their patients. By today’s standards, many of the practices of the hospitals seem archaic, but in their time they were relatively progressive institutions. Cheddleton asylum in particular, under William Menzies, strove to be innovative, despite a constant lack of resources and also the calamitous events of the First World War. Lucy Smith, our PhD student based at Keele University, has been transcribing selections of the Annual Reports from the 1920s as part of her research, and here we share a section of the 1924 Report from Cheddleton:

1045 patients, 303 admitted

Much renovation work carried out – hope by 1927 ‘to overtake the accumulation of dilapidations left as a legacy of the war’

Several dismissals on the female side – some for infraction of discipline and some for want of interest in training or failure in examinations – acute shortage. On men’s side at least 10 applications for employment are declined weekly.

Overcrowding by 32 male and 7 female – ‘it is specially unfortunate in regard to our Mental Defective wards. The boys cannot be unduly crowded or discipline suffers; they must have room to run about, be taught exercises and avoid jostling and fighting…..some of the less favourable cases have to be warded with adult men and the old undesirable regime again introduced.’

There is a gradual increase in the alcoholic cases which has been in operation since the war, but the % has not yet reached pre-war dimensions, probably on account of the high price of intoxicants.

Many senile cases admitted.

Encephalitis Lethargica – since last year 1 discharged recovered, 2 much improved, the others are no better, 2 more admitted in 1924 one of whom is improving. The favourable cases are the ordinary type with diplopia, perverted sleep rhythm, and mental retardation, but even those with moral degradation (‘Apache type’) are not hopeless. The ‘Parkinsonion’ type is not common among children and we have had no cases in adults. This is of all types the most unfavourable.

Absence of gas for cooking is a bar to fried fish breakfasts – ‘I failed to find at Wembley any electrical method which would cook fish for 500 people in ½ an hour. It may ultimately be necessary to have the hot extra dish served at tea time, and all the breakfast additions cold, though this is less satisfactory’

If Leek UDC brought a gas main out to Cheddleton we could do all roasting and baking by gas which would also be welcome in staff houses.

Cost of fruit in England almost prohibitive, except at the flush season in the case of oranges.

Marmite is added to all soups after cooking, for B Vitamins.

For A Vitamins cheese is relied upon for the able bodied and cod liver oil in case of ill health. Many delicate children react well when massaged with cod liver oil.

Orthopaedics – Dr. Mitchell Smith to visit and supply a nurse of special orthopaedic training until his own work is finished and a nurse to instruct the Cheddleton nurses in muscle re-education.

Mental Defectives – the National Association for Mental Welfare will send one of their organisers in March to demonstrate instruction methods to the nurses.

Dysentery – previously patients with dysentery were gathered in one block, and not allowed to mix. After the war and compulsory notification, it was noticed that private patients on better diets were immune.

‘Five years of amino acids and vitamins have accomplished what no preventative medicine had previously done, and the disease is dying out among the insane’

Cold storage – large storeroom off the kitchen yard is being converted and a small electrically driven pump and refrigerator installed. Plan to bring a large van load of meat fortnightly from Liverpool Docks by road, saving one farthing per pound.

Laboratory – experienced highly trained lab assistant employed. The junior man trained here devotes himself to post-mortem work, section cutting and museum specimens, and a boy, the son of one of the attendants does the washing and cleaning of utensils; he will gradually be entrusted with more responsible work.

Work includes:

Blood counts

Malarial parasite blood smears

Sputa

Throat swabs

Urines, bacteriological, chemical and microscopical

Blood sugars

Wassermann reactions

Colloidal benzoin and cytological CSF

Complement fixation tests

Agglutination tests

Precipitin tests

Autogenous vaccines

Formaldehyde estimations

Work by Dr. Stewart – bacteriology of the intestine. The results so far point to there being some connection between the mental attack and the presence of a specific bacillus, but whether it is causative, concomitant or resultant remains for future work to determine.

St. Edward’s Hospital, around the time of its closure in the 1990s.

Parole and Open Door Wards – ‘in the old days the best class of chronic patients were almost better off, except as regards food, than at present. The wards were small and homelike, there were few official rules; the staff suffered very long hours, were few in number, but they were personal friends of the patients, giving up their life to their work and constituting a truly devoted body of men and women. Freedom for patients was not officially recognised, but in practice they were given keys and did pretty well what they liked. But the excited and turbulent had rather a bad time. The wards were mostly unheated, the food was poor and extras few, low diet, purgative draughts, shower baths and surprise cold plunge baths were part of treatment, and no risks were taken with the convalescents, all efforts being concentrated upon the prevention of suicide and escape. Now such risks are considered a part of the medical officer’s duty, for it has been found that for one suicide by the removal of supervision a hundred patients recover many weeks earlier than formerly.

We have here 6 out of 24 wards without keys so that over 300 of our patients may go in or out day or night if they feel inclined, yet escapes have not multiplied chiefly because people feel they are trusted and a sense of honour prevails. 60 or more patients walk all over the country at weekends and rarely abuse the privilege, many are taken out by their friends for daily walks or for statutory 4 days holiday. When voluntary admission to, and early uncertified treatment in, rate-aided mental hospitals are legalised further and larger step will have been taken to assimilate the treatment of mental to that of physical disorders.

Music and mental disorders – mentions letters of ‘nonsense’ to The Times – ‘had the authors of the correspondence been better informed they would have recognised that the curative influence of music in mental diseases as distinguished from normal life comes to exactly nothing at all’

‘The place filled by music in a mental hospital is therefore not specially curative, but rather becomes a very necessary entertainment and relaxation in lives otherwise pitifully divorced from the world outside.’

Nursing – Departmental Report on the Nursing Service – fails to say how the service could be made more popular.. ‘…we have the higher rate of wages [than the general hospitals] here and are still worse off than they. We limit our selection by 2 factors not usually insisted upon in mental hospitals – a minimum age of 21 and some secondary education. We seem thus to secure more stability and a higher sense of responsibility although we are correspondingly shorter in numbers. History shows that if a vocation is fashionable remuneration is immaterial. Nursing used to be thus favoured; it is not now.’

But no problem recruiting men – many applicants turned away weekly

‘If the ultimate remuneration of our nurses were adequate to secure certainty of tenure, with reasonable comfort, we would get them for little or nothing during their training. In this direction lies the chief hope of improvement in the status of the profession.’

Report of Commissioner of Board of Control (R.W. Branthwaite)

Favourable condition of hospital.

‘Close attention appears to be paid to the classification of patients according to their mental and physical state, conduct and probability of recovery, with very good results. I agree with Dr. Menzies …that …a separate small garden should in some way be provided for the exercise of recoverable convalescents apart from the chronic irrecoverable.’

Suggests a ‘commodious shelter’ in the centre of the large new garden on the female side for hot sun/light rain.

Great improvement in the children’s wards and in the efforts made to teach these young patients hand work. Suggests a classroom for 3Rs. Charge Nurse has evidently benefited much from her visit to Meanwood – suggests further training at the Royal Eastern Counties Institution in Colchester.

Recommends appointment of a 3rd medical officer to further develop lab work alongside Dr. Menzies, Dr. Wilkins and Dr. Stewart.

Cheddleton Water Tower

The construction of Cheddleton asylum involved many impressive engineering feats. Perhaps the greatest of these was the construction of a self-contained water supply. However, this was not a one-off endeavour, and was part of an established method of making asylums as self-contained as possible. The sight which most came to symbolise the British asylum over the years was the water tower, many of which became landmarks across the countryside. Many Victorian-built asylums sank their own wells, and were effectively self-sufficient in water, and the water tower was an essential component for the storage and distribution of the supply. Some asylums had water towers and chimneys combined in the same structure. Staffordshire had constructed a water tower at Burntwood asylum, which was the county’s first attempt at a properly self-sustaining asylum ‘campus’.

The water tower also gave architects an additional opportunity to decorate their buildings. Whilst several fine water towers still exist, including the ornate Italianate ‘Rundbogenstil’ tower at Parkside, Macclesfield, which was integrated into the building, one of the largest and finest towers still standing is the one at Cheddleton.

The original plan for Cheddleton’s water supply was to draw it from the Ladderedge reservoirs. However, during the planning stages of the asylum, exploratory drilling was carried out, and the on-site water was found to be of a very high standard. Bore holes were drilled through 100 feet of almost solid rock, and these became the basis of the hospital’s water supply, which was pumped up the water tower to a reservoir holding 40,000 gallons of water. Gravity was then used to distribute it to the asylum.

The newly completed water tower dominates the construction site (image courtesy of NSRC (1978) Ltd)

The building of the 135-foot tower was a substantial and costly undertaking, but the saving in water bills from self-sufficiency, estimated at about £400 per year, was worth the investment. Two pumps were placed in the well to pump a maximum of 4,000 gallons an hour, and they cost around £690. During construction work, two men were injured when they fell to the ground from the cage used by the workmen. Fatalities were avoided, however, and construction continued apace, with the octagonal shape of the tower taking form as it grew.

The rooms at the tower’s base, from which the tower itself emerged, were not completely disconnected from the rest of the asylum buildings, and covered walkways connected them to the north corridor and the kitchen scullery. The ground floor of the tower building housed the butcher’s room, which was always kept locked due to the number of knives and implements stored there. A series of stairs lead up to each successive floor.

At the top of the tower was the water tank, containing 156 tons of water. To stop the tank forcing out the sides of the tower an elaborate steel structure was constructed around it. This had to be done on site, as the structure was so massive and unwieldy. Access to the top of the water tank was through a tunnel with a ladder attached, at the top of which the workmen emerged on a platform above the open water surface of the tank.

The water tower after the hospital’s closure (image courtesy of countyasylums.co.uk)

As with the rest of the asylum buildings, use of the water tower was rethought during the Second World War, as space was at a premium. The tower was used to store ARP equipment, and this use of part of the building as a storeroom for civil defence material continued after 1945. The tower had not yet outlived its main function, however, and continued in use as the main water supply for the hospital. Competition for water from surrounding businesses, such as Wardle’s dye works, did lead to water shortages from the asylum’s long-standing well. Over time the hospital’s water supply had to diversify, and other wells were dug which fed an underground reservoir. The importance, and increasing rarity, of asylum water towers was recognised when Cheddleton’s tower was listed at Grade II in 1986. After decommissioning, it was lucky to be bought and turned into a private house, and still stands today, dominating the skyline above the railway lines and canals surrounding Leek and Cheddleton.

The Life of an Asylum Attendant

From the 1927 Stafford Mental Hospital Handbook –

‘The male and female attendants are not allowed to associate together while on duty in the Mental Hospital. They are to conform, in every way, to the orders of the Superintendent and Head Attendants. They are to rise at 6 o’clock in the morning, are to go to bed at 10 o’clock at night, and are never to absent themselves without the permission of the Superintendent. They are expected to be clean and neat in their dress, quiet, respectful, and attentive in their conduct and manners’.

‘Their whole time is to be devoted to the patients, and they are to be constantly with them. They are not to sit in their own rooms, except at mealtimes, and when off duty; and are expected to amuse and employ the patients in every way in their power.’

1927 Staff Handbook, Stafford Mental Hospital (later St. George’s) (staffspasttrack.org.uk)

Each staff member was given this rulebook, and it is clear from reading it that the life of an attendant in an asylum was no less strictly regulated than that of a patient. The role of attendant was more than just a job – attendants were expected to devote their lives to the institution and were expected to play a full part in the life of the hospital. Despite the demanding nature of the work, for a young man or woman between the late Victorian and interwar periods, it had relatively good pay and conditions. Female attendants were especially easy to recruit, as in many places going into service was their main employment alternative. In 1859, a female attendant could earn around £17 p.a. in an asylum, with their board, lodging and food included. Wage rates for female servants could be as low as £10.

Providing most of the face to face contact with patients, the job of an attendant was not an easy one. It was physically and mentally demanding, and needed continual vigilance and quick thinking. The medical officers and nurses relied on the attendants to manage the patients, and as such getting the right staff and keeping them over the years was an important factor in day to day management. Most of the attendant staff lived in the asylum grounds, including some married couples. Food and lodging was included on top of wages.

After a period of training, learning about the different wards and mental conditions and how to deal with them, attendants were allocated to their own wards and roles. Tasks would be allocated by the head male attendant, who oversaw male staff, and the matron who supervised female staff.

Duties for the daytime shift began at 6am and continued into the evening when the patients were put to bed. The attendant’s primary role was supervision of patients during meal times, leisure time and work activities, but the daily life of an attendant contained far more varied demands upon their time and energies. Keeping the patients occupied, and their minds busy, was a key part of the whole asylum regime’s approach to mental recovery, which the attendants were expected to lead.

Throughout the day, attendants manned the wards in pairs, and no attendant was left to manage a room on their own. Monitoring patients for potential problems and noticing things such as open windows and other suicide risks were part of the duties on a ward. Attendants also supervised and encouraged the leisure activities of patients, and accompanied them in the airing courts, guarding against potential escape.

Female attendants supervised and cared for the patients throughout the day, and also kept the asylum, and the wards in particular, clean and tidy. Theirs was the role of nurse and domestic combined. Alongside their ward duties, male attendants tended to supervise patients’ outdoor work, gardening, farming and other activities. Male attendants who came from an artisan background would divide their time between supervising the wards, working in the asylum workshops, and perhaps supervising practical leisure activities and crafts. The working day thus encompassed supervision, monitoring, domestic duties and physical or artisanal labour.

Staff members who were not attendants carried out the more specialised tasks, be they domestic or artisan in nature. A whole range of additional staff were employed to keep the asylum complex running, almost as a self-contained village, including seamstresses, laundresses, tailors, cooks, maintenance men and farm staff.

Advertisement placed by Burntwood Asylum in the early 1900s, limiting the applicants for the role of attendant to cornet players (Staffordshire Record Office)

Day to day tasks were not the only responsibility of an attendant. They were often expected to have skills which could be used to provide entertainments for the patients, and to contribute to the social life of the asylum. Staffordshire’s asylums often advertised for attendants who could play sports or musical instruments. Once the working day was done, they were often expected to take part in concerts, rehearse as part of the asylum band or join various sports teams, or even use their foreign language skills to provide classes for patients during the day. Footballers and cricketers were given overtime pay for home matches if they were off duty, as these were seen as part of the entertainment provided for patients. The sports teams and bands had a full calendar of fixtures and concerts outside the asylum, and were often seen in Staffordshire’s concert halls and attending charity events.

The general leisure time for an attendant was often restricted by the location of their asylum, and so social activities for the staff developed within the asylum grounds. Early in the life of asylums a beer ration was provided for the staff, which later became a weekly allowance of cash. Burntwood asylum advertised in 1901 for a male attendant – £30 p.a. with board, lodging and washing, with £3 10s allowance for beer. Alcohol was strictly regulated within the asylum, however, and Cheddleton established a canteen for the male staff where attendants could buy beer in the evening. Bringing alcohol onto the premises was strictly forbidden.

As time went on, the role of the attendant became more professionalised. Early in asylum history physically strong and tall men were favoured as attendants, a policy which eventually gave way to individuals who were more knowledgeable or qualified, or quick to learn. In 1891 the training scheme of the Medico-Psychological Association began, and many asylums took up this scheme enthusiastically. Gaining a certificate from the MPA in caring for the mentally ill eventually became a requirement for new attendants at Staffordshire’s asylums.

The MPA certificate began to be offered in 1891, and was a standard feature in recruiting and training new staff at Burntwood asylum by the mid-1890s

Not all asylums paid more if attendants had this qualification, but Staffordshire’s asylums appear to have done so from early on. New staff would be enrolled on the course if they had not yet gained the certificate. In 1900 Burntwood asylum advertised a wage supplement of £2 for any new male staff member who held the certificate. Getting staff through the training programme became a priority for Medical Superintendents such as Cheddleton’s W.F. Menzies, and the first nurse at Cheddleton to be awarded the certificate was Alice Campbell Denman, three years after the hospital opened.

In April 1900, the newly opened Cheddleton asylum had a staff of 43 attendants and nurses, which worked out at a ratio of 1 to 7.5 patients. By December 1900 the numbers had risen to 60 for day duty, and only 4 men and 5 women for the night shift. This was deemed the lower end of staffing in terms of safety, which was a policy followed by Menzies. By December 1912, there were 1033 patients in the hospital, with 96 day staff and 17 night staff – 1 staff member to every 10.8 patients.

The role of attendant remained the key frontline position in the asylum well into the twentieth century, and the attendants nursed, supervised and socialised with the patients every day. Their job was not easy, but at a time of limited opportunities, it provided secure, relatively well-paid employment, and a part in the life of an ever-eventful community, alongside the daily struggles and tragedies of asylum life.

Daily Routine of a Patient, Part Two

The day of a late Victorian asylum patient continued as a working day until lunchtime, which was the main interruption for most patients, and was served around 12-1 o’clock. It was the main meal of the day, and usually consisted of bread, potatoes, meat and vegetables. A fairly bland diet was considered suitable for patients, who may become overexcited by rich foodstuffs. Cheddleton asylum often used basic ingredients such as mutton, potatoes and haricot beans to make stews. However, an asylum diet was often better than many working-class people could afford, with regular fish or meat and vegetables, and cheese, beer, cocoa and tea. William Menzies argued with his superiors for a better diet in his own institution, because the diet of asylum patients should be ‘more liberal’ than that of workhouse inmates. He believed that as asylum patients were ill and were effectively held against their will that they should be well fed, whereas the inmate of a workhouse ‘may leave if dissatisfied’.

Cheddleton kitchens c.1900-1920 (staffspasttrack.org.uk)

The daily routine for many asylum patients was effectively a working day, but patients who were unfit to work or did not want to had to be encouraged to spend their time productively. Many of these patients were allowed to spend more of the day in ‘recreations’ rather than work. Attendants would encourage most patients to get out of the day rooms and wards for at least a part of the day – partly to take fresh air, and also to make sure that they did not become idle. During the early 19^th century, asylum wards were usually locked and security was paramount. As time went on this regime became more liberal. Although usually confined to the asylum ‘village’, late Victorian patients had far more freedom of movement than their earlier counterparts, as long as they did not enter wards of the opposite sex, or areas forbidden to patients. Despite this more liberal approach, attendants still had to supervise patients, and would be held accountable if any of them escaped from the hospital.

Cheddleton airing court shelter (By permission countyasylums.co.uk )

The airing courts outside would be available to most patients, as would walks beyond these courts – again, mostly supervised by staff. Recreation time would also encompass sports and games, depending on the weather and time of year. Most asylums had cricket and football pitches, and these would provide recreation for the staff and patients, with fully organised teams of staff playing in local leagues. In the case of Cheddleton asylum, it appears that the cricket loving Superintendent William Menzies often selected potential male staff on the strength of their batting averages. Patients who were not working would also be encouraged to read, and reading materials were provided for all patients, with newspapers, bibles and suitable fiction being available at all times. Most asylums established their own small libraries or book collections. In some asylums, the chaplain would oversee the book collection to ensure its moral character. Patients were also allowed to use spare time in the day to write to their relatives, although the contents of these letters was heavily censored.

On rare occasions the day might include a visit from relatives. This was strictly limited however. As late as 1921, Cheddleton asylum only allowed one visit by relatives every month, and none at all in first month after their loved one had been admitted. Visiting times were firmly enforced, with Wednesdays between 10-12 and 2-4 being the only times permitted by Menzies. Most weeks would pass with patients going about their routine without a visit. Limiting visits was seen as essential to allow the recuperation of the patient, and any relative wanting news of their loved one outside of visiting hours had to send a letter and a stamped addressed envelope for reply to the Superintendent.

A final mealtime at around 6o’clock marked the end of the working day, and it usually consisted of bread and butter and tea, with perhaps some extras. Any evening entertainments happened in the hour or so after, but on most evenings the patients were allowed a short time in the day room before being returned to their wards. Music was often considered therapeutic by the asylum medics, and many asylums developed their own bands and concert groups, which would play at evening events and balls. Worcester asylum employed Edward Elgar as its musical director in the late 1870s, and Cheddleton asylum developed a very strong asylum orchestra, which not only entertained patients but also regularly toured North Staffordshire.

St. Edward’s Hospital orchestra, Cheddleton, 1936. Conducted by Superintendent Dr. W.F. Menzies (staffspasttrack.org.uk)

Most evenings were less eventful, however. Any patients due a bath on a particular night would be bathed, and by mid-evening (around 8-8.30), patients would be settled, and lights would go out. Some patients were monitored throughout the night by the night shift, whilst other dormitories were less closely monitored, depending on the likelihood of disruption by the patients.

This was the shape of the day for many asylum patients in the late 19^th and early 20^th centuries, and it remained largely unchanged right through to the interwar period.

We hope in further posts to more fully explore food, clothing and entertainment in the asylum, and the jobs done by patients and staff within the asylum ‘village’.

Daily Routine of a Patient, Part One

The experience of patients in an asylum differed from individual to individual. Daily routine, however, was essential to keep the asylum running and for patients to know what was expected of them. Different groups of patients had different routines, usually determined by their mental and physical condition and their age and sex. By the late 1800s, a predictable daily routine was common to most working people, and also to those unlucky enough to find themselves in institutions like the workhouse. The asylum routine was thus a new version of a familiar way of life and may have helped the patient to adjust to their new surroundings. For others, it was far from comforting and may have made them even more aware of their current predicament.

In the late Victorian asylum, the day generally started at 6am, when patients would be awakened and made to go through their washing routine. In general dormitories a table with flannels and soap was wheeled in, and able-bodied individuals were left to wash themselves. Patients who needed help would be assisted by the attendants. Toothbrushes were provided, and patients were then allowed to dress themselves – or, again, were assisted to do so.

The dining hall was then opened for breakfast, and patients were expected to queue to gain admittance. The meal usually started at around 7am, and was most often bread and butter and tea. In later years, in the ‘high-tech’ set-up at Cheddleton asylum, huge urns were available to serve the tea. Breakfast was strictly controlled, and patients would be expected to finish and leave within a certain time.

Asylum cutlery from Cheddleton asylum (Staffordshire County Museum Collection)

Cutlery, if needed for a meal time, was dispensed to patients in a strictly controlled way. It was specially made for the asylum, with knives having a very small cutting edge to prevent the danger of self-harm. Forks had very short prongs, likewise to stop anyone stabbing themselves or any other patient. The cutlery was counted out, and then counted back at the end of the meal, and patients are not allowed to leave until all cutlery had been accounted for.

A non-compulsory chapel service would be held after breakfast. It is hard to know how many patients attended, but it is not likely to have been a majority. Any Catholic patients may have had to use a set-aside room, as asylum chapels were Church of England, although as time went on Nonconformist services were also allowed in them. By the late 1800s most asylums had constructed their own chapels separate from the main asylum buildings, allowing patients to feel they were ‘going to Church’ outside of their everyday surroundings.

St. Edward’s chapel, Cheddleton asylum (Reproduced by permission of countyasylums.co.uk)

The working day would start for patients after the morning routine. Some patients were keen to work and saw it as a useful means of helping their condition. Others were less keen and saw work as an imposition. Although encouraged to take up an occupation within the asylum, their status as patients meant that they could not be compelled to work, and whether they did or did not depended on their physical and mental state, and their inclination. The importance of work to the asylum regime was primarily a question of moral therapy, the recuperative power of labour and the occupation of the mind on things other than mental distress.

Finding the right work for the right patient was vital to the asylum doctors and Superintendent, in order to maximise the therapeutic effect. Cheddleton Superintendent William Menzies was particularly keen on finding the right men to work in the (for 1900) technologically advanced boiler rooms. Work was rewarded either with extra rations, or later with hospital tokens. These could be used to buy items or experiences while being treated at the hospital, in lieu of money. The system helped to reintroduce patients to dealing with money and budgeting for themselves before their release.

Cheddleton asylum tokens (Staffordshire County Museum Collection)

Work tended to be manual and aimed at making the day to day working of the asylum go more smoothly. Utilising the skills of patients from their outside occupations meant that all the jobs which needed to be done in the asylum and its grounds could generally be filled. Men were often used to run and maintain the parts of the asylum which needed mechanical skills and basic brawn. Male patients were also employed as maintenance gangs, repainting and whitewashing walls and carrying out the standard repair work which was within their capabilities. People with skills developed in their professions in the outside world might join the group of artisans providing services to the hospital, such as shoemaking and carpentry.

Patients might be banded into teams to complete cleaning rosters, and female patients might work in the laundry or complete associated tasks. State of the art washing machinery, which cost about £3000 was installed at Cheddleton asylum when it opened in 1899. It had no overhead gears, which meant that the patients could be allowed to work in there as the likelihood of accidents was much reduced. Guards and railings also helped to create a better culture of safety by the 1900s, as asylums took advantage of technological improvements. Working in the laundry, even after the introduction of advanced machinery, was still hard work, and took some physical strength in dealing with wet washing.

In the case of Cheddleton, to qualify to join a labour gang made up of patients you had to be adjudged ‘robust in bodily health and sufficiently reasonable’. Superintendent Dr. Menzies believed that the best laundry workers were ‘turbulent ,chronic maniacs’ and that the attendants deserved great credit for maintaining control of them. In 1901 78% of male patients and 73% of females were employed in the asylum and its grounds.

Making rugs and other objects to improve the asylum was regarded as women’s work, and formed an ongoing program of manufacture and repair. Outdoor work, in the gardens and farms, was a standard occupation for suitable male patients. The gardens of the asylums were also kept by teams of patients, and Cheddleton asylum even had its own stone crushing machine to make gravel for the pathways. Growing plants for the kitchen in a cottage garden was a common occupation. Most asylums had farms, and this provided work for those who could be trusted with agricultural tools. Asylums with farms often needed more helpers during the harvest, and so teams of capable and trustworthy patients would often help at peak times.

Some of the female patients worked in the kitchens, although this would be very closely supervised. As time went on this became a more professional operation, and when Cheddleton opened in 1899 their kitchens took on apprentices from the local community and even offered catering qualifications which could be gained through a course of practical instruction. Sewing rooms were also common, and experienced seamstresses might be allowed to staff them, if they were sufficiently capable and trustworthy.

Part Two follows shortly