A great deal has been written about the history of mental illness and its treatment but a brief summary of the situation leading to the foundation of Rauceby Hospital is essential to this record.
In the 1880s the problem of what to do with the mentally ill had been the subject for parliamentary discussion. By the very nature of their illness many of these people were housed either in prisons amongst the common criminals or in the workhouse. The county Asylum Act of 1808 had stated that every county should build an asylum for better care and maintenance of lunatics, be they pauper or criminal. In 1813 Sir George Paul, High sheriff of Gloucestershire wrote in The Philanthropist of his dismay at the continuing practice of magistrates committing lunatics to prison and the lack of adequate provision for pauper lunatics. The few asylums that did exist were staffed by people who had who had little or on idea of how to care for large numbers of disturbed people. There was no medication. Chains and contraptions for restraint were widely used.
The opening of Lincoln Asylum in 1820 heralded a new dawn in the enlightened care of the mentally sick. Robert Gardiner Hill who arrived there in 1835, was a pioneer with rare perception and humanity. Struck by the sheer misery and suffering caused by all forms of mechanical restraint, he took the unprecedented step of abolishing them altogether. After the initial outcry by skeptical contemporaries the non-restraint system became widespread throughout the county.
The general public quickly realized that they now had the opportunity to relieve themselves of the social inconvenience of having mentally disturbed relatives. The sudden increase in the number of patients necessitated the building of new wards to meet the ever increasing demand for beds.
One of the consequences of this massive influx was that patients were controlled instead of being treated. By 1890 the situation at Lincoln had become unmanageable. It had not been helped by restrictions on discharge imposed by the Lunacy Act 1890. The Lincoln Asylum board of Governors were forced to write to the commissioners in Lunacy in London stating that they could no longer accept further admissions from the county of Kesteven.
Acting on a directive from the Commissioners that an Asylum should be built as soon as possible by the Kesteven and Grantham Borough Councils.
A meeting was held on the 31st January 1894 at the Guildhall in Grantham at which a union was formed with the express purpose of building such an asylum.
Of the original sixteen sites to be considered, five were selected for the approval of the Commissioners. These were at Barrowby, Bourne, Bracebridge spa, Quarrington and the Quarrington Glebe adjoining Rauceby Station.
The choice of the Quarrington site had proved judicious, for the area selected was on high ground, ensuring excellent drainage and the water at the local Boiling Spring wells was both plentiful and pure. The railway line from Grantham to Sleaford would only be some hundred of yards away from the gates of the asylum as would be the main road. The building would be far enough away from Sleaford for the peace of mind of its population yet near enough for easy access.
While planning for the new asylum was in progress it was an urgent necessity to find temporary accommodation for the pauper lunatics of the county as it was quickly realized that it would be some time before the new building would be ready for occupation. The committee contacted the Great Northern Railway at Grantham with a view to renting the old workhouse which stood, awaiting demolition, on land designated for a goods yard at the station.
This hexagonal shaped building had been erected in the 1700’s but had stood empty for a number of years when a new workhouse had been built. A lease was signed in 1896 at a rent of £520 for three years. Alterations costing £1,500 were carried out by Rudd and Sons of Grantham and a further £500 was scheduled for furnishings.
The temporary asylum initially housed twenty three patients but a year later this had risen to a full capacity of one hundred and eleven, with sixty eight females and forty three males. A Large iron building was erected nearby to house a further influx of male patients.
Life in the temporary asylum was made as comfortable as possible taking into consideration the limitations of an old and somewhat derelict building.
Floors were of stone covered with coconut matting. Lighting was provided by oil lamps. Heating was supplied by coke stoves. Treatments were minimal for at this period there were virtually no medicines available to help the mentally ill. Alcohol, opium, ether, chloroform and nitrous oxide formed the basis of all medication for mental problems. The newly introduced bromide, prescribed as a sedative had the serious side effects of aggravating mental problems.
Chloral hydrate and Pareldehyde, two more sedatives, had similar effects.
Nursing basically consisted of caring for patients with kindness, a firm hand and occasionally a strong arm! There is no record of mechanical restraint ever having been used at either the temporary or the new asylum. The few recorded cases of cruelty or unkindness to patients by members of staff were promptly dealt with and were proven, the offender was summarily dismissed.
Kesteven County Asylum
The building of the new asylum went ahead rapidly. In October 1901, a lengthy report appeared in the Sleaford Gazette eulogizing the almost completed asylum and giving a detailed description of the building materials used, the excellence of the layout and the facilities provided. It went on to say that the workmanship and materials throughout were of the best.
On 20th June 1902, Kesteven County Asylum opened its doors to its first patients. They were transported from Grantham by train and waggonette.
One can only imagine how the staff and patients must have reveled in the comparative luxury in which they found themselves, with large airy wards, heating and the miracle of electric lighting. Life in the new asylum followed much the same pattern as in the old one. All aspects of daily life were controlled by rules and regulations which were established in the general rule book published in 1904. There was strict segregation of the sexes, with the building being divided into two halves by locked doors leading from the inner entrance hall. There was another door halfway along the corridor adjoining the ballroom which itself had two separate entrances. Patients were not allowed private visits and could only have visitors once a fortnight. (this was mainly because it was felt it was too unsettling for the patient to have too frequent visits)
Workmen entering the female ward had to be accompanied at all times by a female member of staff. Each ward employed at least two attendants for every twenty patients who were tranquil or convalescent and one for every ten who were ‘dirty or dangerous’.
Patients and Wards
The ground floors opened onto large, secure areas know as airing courts which were little more than grassed areas surrounded by a concrete path bordered by iron railings. All patients not actively employed elsewhere expected, unless ill, to exercise in these courts at regular prescribed times regardless of weather conditions. Patients were not allowed to leave the grounds of the asylum without the express permission of the medical Superintendent. On admission, all patients were examined by the Medical Superintendent or his assistant, to detect injuries, bruises or peculiarities, after which the patient was bathed in the presence of either the Head Attendant or the Matron, according to their sex.
Administration and medical sections
The administrative and medical sections of the asylum were minimally staffed. The medical Superintendent was assisted by an Assistant Medical Officer with a head Attendant in charge of the male sections and the matron in charge of the female section. The clerk performed the duties of storekeeper and there was one engineer. The asylum was not connected to the public telephone system until 1928 although an internal system operated. The GPO provided a speedy and efficient telegraph system which was noted to be ‘adequate’.
The staff ate and slept on the wards for there were was little separate accommodation. The nurses and attendants received their uniforms after an initial trial period of three months. Staff were on duty from 6am to 8pm with one half day off each week.
Security throughout the asylum was strict. Wards were locked at all times. After each meal the cutlery was counted and locked away. The windows throughout the building were fixed so that they opened just enough to allow some air to circulate.
First Medical Breakthrough – 1913
1913 saw the first medical breakthrough in the treatment of mental disorder with the introduction of phenobarbitone. This drug became the standard treatment for epilepsy and is still in use today. In adults the sedative effect could be troublesome and when used the children, who needed a higher dose, could cause hyperactivity. Apart from these drawbacks it still represented a major breakthrough in the control of a distressing disorder.
Causation of Mental Disease
In his 17th annual report Dr Ewan wrote:-
‘the causation of mental disease remains an unsolved problem and there is still much controversy as to the part the heredity plays in its production, although of all the assigned factors heredity predisposition stands first and is more prominent in rural than urban districts. The inter-marriage of the tainted or degenerate is much deplored and the principals of eugenics might be taught with much benefit to future race. The high pressure which is much evident in the larger cities is not without its effects on rural populations and migrations to towns and emigrations to the colonies have in resent years removed many of the stronger leaving behind a population of the unfit who keep swelling the number of insane’.
Kestenven Mental Hospital
In 1923 Dr Iain McPhail took over as Medical Superintendent, Mr. A Pykett as Head Attendant and Miss R Sutherland as Matron.
Once again the problem of overcrowding became a matter for quick action. The Isolation Hospital in the nearby Willoughby Lane had never been used as such, so it was decided to convert it into accommodation for patients who worked on the farm. The building was renamed ‘Ash Villa’. Concern was expressed about the high number of elderly and senile patients being admitted (the same concern to be expressed some fifty years later)
As there an increasing number of consumptive patients two verandas were added to each wing of the hospital. These provided the fresh air which was an essential part of the treatment and helped isolate the disease. The statistical tables for 1929 show an entry under the heading ‘cause of death’. It reads – death from General Paralysis of the Insane’.
The Commissioners report for that year includes a reference to the suggested treatment of this paralysis but it is apparent from the hospital records that it had not been used at this hospital – no reason is given. This form of treatment was eventually superseded by penicillin.
On the 1st March 1930 there were 445 pauper lunatics and 19 private patients in residence. Of these 243 were from Kesteven, the remainder came from the soke of Peterborough, Grantham and West Ham
The hundreds of popular trees lining the driveway were chopped down s they had become dangerously tall. They were replaced with elm trees.
The report for 1929 is the last in which the patients were referred to as pauper lunatics. In accordance with the requirements of the 1930 Mental Treatment Act all patients were reclassified – ‘low grade defectives’ and patients with ‘objectionable habits’ were segregated from more resent, recoverable and ‘better type’ patients.
Rise in Admissions
Admissions in 1939 reached an all time high. Dr Henderson Unfortunately make no comment in his reports on this increase so it is left to us to reflect that the country had gone through a particularly traumatic period with high unemployment and industrial unrest. It had been a time of considerable privation and deprivation particularly for those in rural area and the horror of the 1914 – 1918 war had left indelible impression on the minds of the older population. The threat of another armed confrontation must have given rise to much stress and anxiety.
Second World War 1939 – 1945
No 4 RAF Hospital – Rauceby
As war clouds gathered over Europe in 1939 it was obvious that air warfare was going to play a strategic part in the struggle ahead. Lincolnshire with its vast tracts of open land and its central position was destined to site of many airfields.
In 1939 the RAF station at Cranwell included a small well equipped hospital but it was quickly realized that this would be inadequate for the treatment of the sick and wounded on any large scale. With this in mind the War Office set wheels in motion for the take-over of Kesteven Mental Hospital. The admissions Hospital in the grounds was cleared and left empty in readiness for RAF occupancy until 11th April 1940. On this day, with just a few hours of notice, seventy five patients from RAF Cranwell took up residence. Many of the staff during these early days were members of the local Red Cross Society under the supervision of Nursing sisters from Princess Mary’s Nursing Service.
Rauceby had been envisaged from its inception as one of the principal RAF hospitals. It was within easy reach of the many bomber and maintenance stations in the area and was well served with road and rail facilities. Its spacious grounds were ideal for convalescent patients. From 1940 onwards the number of service personnel served by the hospital increased rapidly.
The very nature of air warfare meant that many of the aircrew were not only physically injured but were also badly burnt before they could be rescued. Rauceby often became the first stop on the long, painful road to recovery either in the excellent hands of Squadron Leader Fenton Braithwaite, the resident plastic surgeon, or, on transfer, to the pioneering specialist Mr. Archibold McIndoe at the now famous burns unit at East Grinstead.
The main building of the hospital was used for general purposes and the Admissions Hospital now accommodated the Burns and Orthopedic Units. With such an influx of personnel from the United Kingdom and many other countries, there was a significant rise in the number of tubercular patients. Once again the verandas were called into use as isolation and treatment bays. As the war progressed RAF Rauceby played a central role in the care of service personnel. At the height of the war there were a thousand beds in use with another thousand in store ready for an invasion or bombardment.
The hospital would have become a receiving and clearing station for both civilian and service personnel.
Figures provided by the Air Historical Branch of the RAF show that in 1943 alone there were:-
1398 Major operations 2926 Minor operations
1452 Orthopaedic patients 1233 Medical patients
163 Burns patients 48 Orthodontic patients
1791 Psychiatric out-patients 141 Psychiatric in-patients
(Including 47 aircrew)
Admissions totaled 5337 with 18650 outpatients
Burns and Orthopaedic Departments
Aircrew involved in crashes and emergency landings were often seriously burnt or had suffered injuries to their hands and faces. Their flying gloves were extremely clumsy and cumbersome and despite constant reprimands they were notorious for not wearing them. Lack of heating in the aircraft meant that flying at high altitudes often resulted in severe cases of frostbite. The surgeons had the daunting task of repairing these young men so that they could retake their place in society feeling and looking as normal as possible. Many, in fact, returned to normal flying duties.
Badly burnt patients were photographed on arrival by the Clinical Photographer Bill Howlett. As treatment progressed more photographs were taken so that both the surgeons and the patient could see the progress and transformation that was occurring.*The albums bear silent witness to the skill of the surgeon and the fortitude and courage of his patients.
An ex-theatre nurse said that patient’s wounds would often still be sizzling with phosphorus on their arrival and this had to be cleaned out before treatment could begin. In the burns unit there was a bathroom containing three large deep baths. Badly burnt patients were submerged in them soaking in saline solution. Nurses knelt on the stone floor, sometimes for hours, gently easing away the burnt flesh. The pain must have been almost intolerable but most patients managed to grit their teeth and swear their way through it. The nurses would often develop severe blistering on their own hands and arms from the continual immersion in the saline solution.
RAF Rauceby operated for the comparatively short period of seven years. Much of the work carried out was of routine nature but a fair proportion had been, by the very nature of the injuries treated, both experimental and life saving.
*The albums have been handed to the medical Branch of the RAF and they are to be used in the training of RAF surgeons
The Great Fire of Rauceby
A dance was held in the ballroom on Whit Monday in 1945 which finished shortly after midnight. By 3am the whole room was engulfed as the pine paneling and highly polished floor were greedily consumed by the flames.
The stained glass windows and arched ceiling were destroyed and despite the efforts of the resident firefighters and the Sleaford Fire Brigade the room was completely gutted. Fortunately the wind blew the flames away from the surrounding building, had they not done so they might well have been lost.
It was believed that the fire started under the stage where a number of items of furniture had been stored. It is thought that someone had used the area for an assignation and had left a cigarette smoldering on one of the seats.
The Rauceby Club 1947 – 1980
Such was the feeling of comradeship among the medical staff at Rauceby that in 1947 Wing Commander Eric Jewesbury instigated the formation of the Rauceby Club. The membership list bears the names of many who rose to become eminent in their chosen speciality, several being knighted for their work. As age caught up with the members attendance gradually dwindled until in 1980 it was decided to disband the club.
A New Beginning
Although the war in Europe ended in 1945 the hospital remained in the hands of the RAF until April 1947. Apart from the work connected with structural alterations and damage resulting from the RAF occupancy, there were considerable engineering and building items needed including additional housing for staff. By 1949 the only outstanding work to be completed was the refurbishment of the burnt out ballroom.
By the end of 1949 there were thirty three male and seventy five female patients in residence attended by twelve male and four female staff. Numbers only rose in 1950 when the hospital was ready to resume its normal role.
Development of the National Health Service
Before the war, provision for the care of the mentally ill and mentally handicapped had rested with local government with central responsibility divided between the ministry of Health and the board of control. In 1941 it was announced by the government that a National Health Service would be created at the end of the war. The Brown Plan of 1943 did not cover the inclusion of the mental health service in plans for this service, a decision soundly condemned by the British Medical Association.
The war years had the effect of improving the public’s attitude to both physical and mental illness. The field of battle had produced Psychiatrists experienced in the treatment of battle neuroses and the development of new drugs for the treatment of mental illness meant that changes could be made.
The introduction of chlorpromazine made it easier to control disturbed behavior so that a new air of freedom was breathed through the hospital as wards were gradually unlocked and in some cases patients discharged. It became more and more necessary to rehabilitate many of those patients who had become seriously institutionalized. In 1948 the catchment area of the hospital was enlarged to cater for the mentally ill of all Kesteven (apart from North Kesteven), the county of Holland and the soke of Peterborough. The total population of this area was approximately 3, 000, 00 for which only 609 beds were available. Since the opening of the hospital at the turn of the century the work of catering for the mentally ill had increased yearly and by 1952 could offer a service for all types of patients (excluding children who were treated at special clinics in local authority premises). Out-patients clinics were held regularly at Sleaford, Boston, Spalding and Grantham.
The period between 1950 – 1960 saw many changes not only in management but also the refurbishment of the building. Wards were upgraded with new furnishings, decoration and improved heating. At the end of 1950 Dr Henderson retired, His place was taken by Dr Cole.
‘There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower and chimney, rising unmistakable and daunting out of the countryside’.
Enoch Powell. MIND Annual Conference 1961
The desirability of the closure of mental hospitals was first mooted by the Government in 1961 and was an idea that met with little opposition. The introduction of the long acting psychotic drugs which successfully controlled the severe symptoms for many people suffering from schizophrenia theoretically enabled them to live outside the hospital. It was also recognized that long periods in institutions took away peoples ability to cope with independent living. The watchword through the 1960’s and 70’s became rehabilitation. Rauceby Hospital, in line with similar institutions, made rehabilitation a matter for priority. It became possible to discharge many more patients who then attended out-patients clinics where their progress was monitored. The former ‘Parole Villa’ was converted to a Day Centre and renamed ‘Verbena Ward’. Government policy by the mid 1960’s was for the closure by the end of the century of all mental health institutions and the gradual transition to care in the community and the development of the Community Mental Health Nursing Service.
Post war years saw the development of numerous specialized departments within the hospital. In the early days a physiotherapist from RAF Cranwell visited the hospital on a part time basis but in the late 1950’s Rauceby boasted its own Physiotherapist. A radiography department was opened in 1963.
In 1953 Orchard House, which opened in 1939 as an admissions Unit, was in fact a separate hospital. In contrast to the custodial approach of the main hospital it was run as an open hospital. The patients were primarily referred from out patient clinics and were classified as voluntary patients. They wore their own cloths, went home at weekends and were encouraged to organize their own entertainment. Doors were not locked except at night. Male and female patients mixed freely as far as the old fashioned layout of the wards would allow. Physical treatments such as ECT, modified insulin therapy and deep insulin coma therapy were practiced. The main emphasis, however, was on the treatment of depressions, neurosis, sexual problems, alcoholism and drug independence. To this end techniques such as abreacttive therapy using intravenous and general anesthetics, individual and group psychotherapy, psycho-drama and hypno-analysis were used. With the introduction of new drug treatment the distinction between the clientele of the main hospital and Orchard House became less noticeable. Patients suffering from acute schizophrenic and manic-depressive illnesses rapidly responded to the new drugs available (e.g. phenothiazenes and lithium carbonate)
The policy of closure of the mental hospitals and the emphasis on Community Care meant that as Rauceby Hospital followed the schedule laid down for its own closure Orchard House became surplus to requirements. Subsequently in 1987 it was handed over to the Area Health Authority to provide a centre for clerical and community use thus ending fifty years of service to the mentally sick.
Into the next century..
During the period 1974 – 1986 the NHS was subject to changes in management style and organization. The introduction of general Management saw the appointment of Mr. John Somers as Rauceby Hospital’s first General Manager in the summer of 1985.
In 1986 Rauceby Hospital was the base for the District Psychiatric Service and contained all in-patients beds as follows:
1. Acute admission beds
2. long stay beds for general psychiatry
3. Continuing-care beds
4. Assessment beds
5. Mother and baby facilities
6. Adolescent beds
7. Day Hospital with 35 places for Adult General Psychiatry