Remembrance

On a personal note, remembering the Armistice is important to me. I’m from a military family on both sides, after all. On a professional note, given that I’m devoting my thesis to exploring the untold stories of mentally disordered people – civilians and soldiers alike- from wartime through the interwar years, I felt a post today was fitting.

The lead up to days such as this are the main reason I’ve come to love twitter. I’ve seen some excellent articles on those forgotten soldiers who contributed to the war. Others have been memorialising memorials, celebrating the construction of the cenotaphs and other Armistice services.

Day of Remembrance Memorial at the Glasgow Cenotaph.

I could go on, but take to twitter today and have a look yourself.

And I just wanted to add to that a little today. In my last post you’ll have seen how soldiers were put before civilians; that the military was allowed to take what it needed from civilian mental healthcare. This wasn’t confined to the use of buildings either – but to those who worked the mental hospitals and kept the wards running day to day. Forgotten Lunatics is a great book, and Peter Barham had the right of it when he said that the war was

…luring away the choicest specimens to sate its appetite, and handing back its mutilated discards.

Mutilated discards. See, when a soldier had entered the public asylum, he’d been rejected from military care. At that moment in time, he was of no use to the war effort, and was taking too long to recover. And so to the civilian doctors he would go, whilst being discharged from the Army.

So were these men prioritised above the very civilians with whom they shared an asylum ward, as those under military care?

In Bangour, Edinburgh, sat the Edinburgh War Hospital (previously Edinburgh district asylum). As a hospital for military cases it received a lot of support. There was a War Hospital Supply Depot., of course, that helped with resources, but this was only the tip of the iceberg, so to speak. Both the British and American Red Cross Societies provided donations. But the largest supporter came from local communities…

The ladies of a community would treat the soldiers under treatment, inviting them to their homes or taking them on drives and afternoon trips into Edinburgh. Work parties, voluntary guilds, business firms, public works, churches, schools and private individuals gave whatever they could:

Food Entertainment Healthcare
eggs Books Wheeled chairs
venison Magazines Bath chairs
Fruits and vegetables newspapers Spinal carriages
poultry Writing pads and stationary A horse and 2 ponies
wine Playing cards Pony carriage and harness
game Games Motor ambulance
Cigarettes Billiard tables Socks
Tobacco and pipes Bagatelle boards bed-socks
Flowers Musical instruments slippers
Gramophones dressing-gowns
Musical boxes bed jackets
woollen comforters
sleeping suits
walking sticks
crutches
bandages
linen
swabs
face cloths
sphagnum moss
air cushions
water-beds
splints
surgical dressings and appliances.

And in the district asylum?

[I]n many Asylums there is little or no vacant accommodation, …the staffs of various Asylums have been depleted by the war, and…there is universal difficulty in obtaining the services of medical officers and suitable attendants.

Such was the acknowledgement of the General Board of Control for Scotland, yet they nevertheless demanded all asylum doctors to take on more and more patients throughout the war.

Reduce the floorspace allowed to patients across the country, they said. But you can’t make a profit from those patient removed from the new War Hospitals of Bangour, Dykebar and Murthly. We won’t be able to give all of you able-bodied patients to help with the work in your asylum, but the Pensions Issue Office with begin to provide money for former servicemen under your care from 1917…

This is obviously an over-simplification but you get the idea. Asylum doctors had to balance a rising patient population and decreasing resources. Local parishes and councils couldn’t offer more support, and any increases in their assessment contributions (the money the provided for the care of local asylum inpatients) into the interwar years was short-lived.

Financial stability was rare in the asylum and this affected all residents: staff, civilian and ex-serviceman.

And of the treatment they enjoyed?

Medicine and food were high commodities. In mental health care, there was little medicine could do. Hypnotics and sedatives were still the primary ‘treatments’ given to asylum patients.With more patients and no money to compensate, asylums were also struggling to buy in more food. They had farms to supplement, of course, with vegetables and grain. Livestock however was often sold, and not eaten. By 1917, food shortages had worsened enough for the normally very patriotic General Board to get critical. Scottish asylums, they said, had been treated unfairly in the rationing scheme. And when the Ministry of Food eventually increased the rations, did these extra allowances go to the servicemen atop the patient hierarchy?

No. It was the sick and infirm in the hospital wards – as they now counted as medical institutions – who benefited.

You see, not much is known of soldiers in public asylums, but being a soldier, or once being a soldier, actually meant very little in practice in these places. There may have been some distinctions erected between servicemen and civilians later in the war, but ultimately struggled through the asylum together. They may not have liked it. They could very well have resented each other. But their stories have to be told together.

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‘Move out!’ the acquisition of asylum war hospitals in Great War Scotland, c.1914-1917.

To read the article on this research in History Scotland, see here.

If you didn’t already know, I’m a funded PhD researcher on a studentship, which means that I came into the fray with a general research area all picked out for me. Twentieth century mental health in Scotland, possibly a closer focus on civilians in the war…

But when I discovered the use of public county/district asylums as war hospitals, that’s when my research really began to take shape. In this process the fundamental questions about the ‘value’ of men and women, of patients in institutions and the relationships different classes and cohorts could have with the ‘lunacy authorities’, doctors and government became very clear.

What happened to the transferred asylum patients constitutes one of the hidden histories of the Great War…The profile of the mentally ill and concern for them was reduced and, within the asylums, those patients transferred from other institutions received even less priority.

Steven Cherry (2003).

Exploring two-hundred years of Norfolk country asylum, Cherry directly acknowledge a hidden history of British asylums in wartime: the history of forced patient migration, of the prioritisation of servicemen and the marginalisation of civilians and of civilian patient experience in wartime. Historians have neglected these questions in favour of nervous disorders, servicemen and, within Britain, experiences in England.

Slide3Initially, asylums were taken over, not specifically for the psychologically-injured, but to answer the desperate need for more beds. Bangour Village Hospital was receiving military patients by May 1915.

 

 

 

Slide4Yet the mental health of the troops was deteriorating at an alarming rate. News of this couldn’t be confined to the Front as men returned home, and public outcry encouraged the military authorities to act (Barham, 2004). This seemed a lesser problem in Scotland yet nevertheless, eight months after ‘Edinburgh War Hospital’ opened its doors, asylums in Scotland were being used specifically for the treatment of acute mental disorders in servicemen.

 

 

Despite the great need for effective treatment however, approving and codifying the use of asylums as hospitals, either medical or mental, was no smooth process. The stigma of entering the asylum at all, never mind as a ‘pauper

Slide6

lunatic’ brought honourable servicemen and their families ‘opprobrium’, conceded Harold Tennant. Accommodating these men alongside the ‘rank and file’ asylum resident and subjecting them to the same treatment would render them mad, insisted Laurence Ginnell. But it was Athelstan Rendall, like a dog with a bone and a thorn in the side of the Under-Secretary of State for War, who fought doggedly against any association between serving men and the asylum.

What then was to be done, but change the image of the asylum as far as possible?

Slide7

Lt. Col. DG Thompson was medical superintendent of Norfolk country asylum, and Major RD Hotchkiss, of Renfrew district asylum at Dykebar. To those like Thompson or John Keay at Bangour, who were to head medical rather than psychiatric hospitals, Sir Alfred Keogh was unequivocal. No trace of the asylum ‘character’ was to remain. Yet to Hotchkiss and co. caring for the mental health of servicemen, no such demands were made.

Yet did this mean that such asylums had an easier conversion from civil to military institutions? Not necessarily. Where Thompson was eager to please military authority and described his fellow superintendents as ‘patriotic spirits’, Hotchkiss and others were far more frank about their disagreements with the military approach, especially regarding the acquisition of nurses, attendants and other staff.

The time came for patients to be transferred out of the newly acquired war hospitals and into their temporary host institutions. At times the decision or where to transfer patients was simple. By January 1916 they couldn’t be sent to the district asylum at Stirling as sections were still under construction. Kirklands asylum had low staffing levels so there was no night supervision for any patients who would require it. And to get to Argyll and Bute asylum, patients had to be mentally and physically well enough to travel with a small cohort of nurses by boat. Yet sometimes consideration was given to motivations not so practical.

Slide13After appealing for beds for the civilian patients he had to displace, Hotchkiss was inundated by requests for ‘cherry-picking’: superintendents looking for able-bodied, non-troublesome patients who wold contribute, who wouldn’t become a burden.

 

 

 

Slide14He also actively tried to ease the burden upon others from the ‘Glasgow School’ of psychiatry. Fellow Glasgow graduate, JH MacDonald, like so many others, did not want the bed-ridden, chronic patients under his care. Neither however, did former Head Attendant George Pirie. The three seemed to come to a stalemate, with Hotchkiss trying to push Pirie into accepting more such patients than he claimed he could. It took the General Board of Control for Scotland to step in and decide in Pirie’s favour. Hotchkiss however was allowed to add the caveat that if the patients were unfit for travel, to Pirie they would go.

Former Matron and superintendent at East Lothian asylum Jean Sinclair didn’t engage in any such bartering. Yet all the same, despite the relatively easy distance between Glasgow and Edinburgh, Hotchkiss sent her only ten, quiet-tempered patients in comparison to the 88 he sent to Dr Kerr at Hartwood. The comparable sizes of East Lothian and Lanark district asylums undoubtedly played a role here, but equally as certain was Hotchkiss’ deference to ‘Miss’ Sinclair’s sex.

This led to another question however. Did superintendents like Hotchkiss give as much consideration to the patients themselves, as they did their colleagues?

Slide10

Being forced from the new war hospitals to other asylums was clearly a stressful business for all involved. Yet in Scotland, ‘moving day’ was reported with a far more positive spin than in Norfolk.

Slide11

Perhaps it was because the report in Scotland was published in the national media, and not a specialised, professional periodical. But patients were sent to new asylums at the opposite end of the country. Inverness district asylum was a popular port of call. Patients who were kept close to home were, first, those who had people to visit them. Hotchkiss did try to consider patient welfare. He refused to usher patients out the door before they were well enough. He petitioned the families of those he deemed suitable to return home to reclaim their relative. He refused requests for discharge if he felt a relapse was likely. But, realistically, he was strapped for time and had the military and national lunacy authorities waiting. There was only so much he could do to make these transfers as painless as possible, and it was inevitable that for some it was a uniquely traumatic event.