History of Medicine

Devils in the Bed

08/05/201828/02/2018 by Northumberland Archives

Examination and Diagnosis

On the 30^th day of November, in the year 1860, two surgeons came to a home in Narrowgate, Alnwick to examine a Mr William Marshall for proof of “insanity.” The medical examination had been arranged by William’s family and facilitated by Hugh Lisle Esq, a local Justice of the Peace. William’s story, pulled from the Dickson, Archer and Thorp collection, allows us a unique insight into the lives of those diagnosed “insane,” and the families they often left behind, in nineteenth century Northumberland.

*Order for the Reception of the Patient William Marshall. REF: NRO 11343/B/DAT*

The surgeons examining William were a Henry Caudlish and a Thomas Feuder. In line with the requirements of their positions all three men completed detailed forms evaluating William’s mental well-being. The survival of these medical forms, used to certify William’s illness and record the thoughts of officials, make them rare and insightful pieces.

Henceforth are transcribed extracts from these forms, with the originals shown in pictures:

Facts indicating Insanity observed by myself:

Thomas: “He fancies that there are Devils in the bed, or parties going to do him some grievous bodily harm, he fancies that the bed clothes are moving. He is desponding.”

Henry: “He states that I have a desire to poison him, and that I have an interest in doing so and that I were among many conspirators. Fancies that there is poison in his bed – and in his food.”

Other facts (if any) indicating Insanity communicated to me by others:

Henry: “He persists that a great quantity of poison has been given to him, but not yet the fatal dose, and that if he dies a hundred persons will be living for him – communicated to me by his wife.”

Thomas: “He refuses his food and persists that what is presented to him contains poison – communicated to me by his wife.”

*Medical Certificate for Marshall Case Signed by Henry Caudlish. REF: NRO 11343/B/DAT*

*Medical Certificate for Marshall Case Signed by Thomas Fueder. REF: NRO 11343/B/DAT*

For William the visions of devils, paired with his belief that someone was secretly poisoning him, were vivid and terrifying. Yet the surgeons found a conspiracy unlikely, and they concluded William was indeed suffering from “insanity.” Upon the diagnosis Hugh Lisle arranged for William to be taken from his home to reside in the Northumberland County Pauper Lunatic Asylum, Morpeth. But why was William suffering with such terrifying visions? And what life awaited him in the county asylum?

Health and Visions

William was not the only patient sent to reside in the Morpeth asylum for having paranoid thoughts. The admission book for the asylum’s patients shows that many were diagnosed upon arrival as suffering from “delusional insanity.”

On the arrival of each new patient their symptoms, and the presumed cause, would be carefully recorded. These so-called causes often included hereditary problems and work place accidents. The surgeon’s involved in William’s case noted the cause to his problems stemmed from a mix of pre-existing medical issues, including chronic asthma and general ill health, with “straitened circumstances.”

Family Troubles and “Straitened Circumstances”

William Marshall was 50 years old when he suffered his first bout of psychological illness in the year 1860. He had lived in Alnwick his whole life, along with his wife Mary and their ever-growing brood.

Together the Marshall’s had eight children; Sarah, Isabella, William, John, Mary, Joseph, Thomas and Annie. The Marshall brood had a staggering age range, with the eldest being twenty years older than the youngest. But, sadly, not all the Marshall children reached adulthood, as Thomas died in 1856 aged just five.

William worked as a coach keeper to support his large family, and his sons followed him into coach and horse-keeping professions. In 1861, less than a year after William was removed from the family home due to his supposed “insanity,” his son John was working as a coach smith whilst Joseph was a hostler. By 1871 Joseph had progressed in the world, and is listed in the census as owning what appears to be 4 acres of land (although how he came to this settlement is a mystery.)

Following her husband’s illness Mary needed to find a way to financially support her young family. She subsequently became a cow keeper. Cow keepers often kept dairy animals, such as cows and goats, within their backyards and would use them to make and distribute dairy products amongst their neighbours. William’s daughters also took up professions to support the family, with Isabella becoming a dressmaker and Mary a domestic servant.

Working hard to feed and provide for his ever-growing family, yet still witnessing some of his children die, must have put strain on William’s own health and mental well-being. These demands, teamed with a potentially dubious financial situation, may explain the “straitened circumstances” referred to in his medical report. Thus, it is unsurprising that these pressures began to manifest in his psychological well-being.

The Northumberland County Asylum

Using the asylum’s minute book we know 80 male patients and 77 female patients were in residence when William arrived at the tail-end of November 1860. We also know, from notes made on the asylum’s weekly purchases, that William would have ate a diet of mutton, scotch oatmeal, split peas and livered meat during his first month.

On the 4^th March 1861, roughly three months after William had arrived, the asylum received a visit from its Board of Guardians. What they observed was recorded in the institution’s minute book and can be used to give us a deeper insight into William’s experience of the Northumberland County Pauper Lunatic Asylum. During the visit the gentlemen noted that patients had “good bodily health” and were “without exception quiet and orderly.” They recommended enlarging the chapel, and adding blinds to the patient’s dormitories, to encourage godliness and increase patient privacy. Overall the board members were pleased with the asylum, and noted how they had enjoyed a “good laugh” with some of its residents.

To understand more about the Northumberland County Pauper Lunatic Asylum please see one of the archives’ previous blogs on the subject.

The Devil Put To Bed

It is unlikely William ever left the asylum following his 1861 entry. In the 1871 census Mary Marshall listed herself as being a widow, with William’s death having probably occurred less than a year before in 1870. One can only hope William was no longer troubled by devils in his bed.

The travels of TB patients – other sanatoria from the Stannington patient files

23/01/201718/01/2017 by Northumberland Archives

As shown in our previous blog home visits were not possible for all Tuberculosis patients in the community, and the medical officer therefore looked to sanatoria as a means to both help sufferers and prevent its spread. Sanatoria began as open air resorts for wealthy patients in late nineteenth century Europe, usually located in mountains or spa areas. The idea spread and many were created for different types of clientele, religious groups, companies and even trade unions. However they were run, sanatoria were usually in the countryside, and the presence of pine trees was thought to bring benefit. Covered verandas protected patients from the elements when outdoors, or French windows allowed patients to enjoy fresh air inside. Firm adherence to rules, hygiene, feeding-up, and an increase in movement and work were thought to both improve the patient and prepare their return to health.

The Stannington files have revealed that children were admitted from or to a range of 58 hospitals and sanatoria, as far away as Great Ormond Street. The files show Stannington in the context of the wider tuberculosis movement in the UK and even abroad, as during WWII there were Stannington patients who were refugees and evacuees, who had attended sanatoria and hospitals much further afield. Here we will examine Stannington’s connection with some of the local sanatoria.

A map showing the location of the sanatoria mentioned in the patient files in relation to Stannington Sanatorium.

Barrasford, Northumberland.

Situated on the moors north of Hexham, Barrasford shared much of its history with Stannington. It was funded by the raising of a public subscription, helped by a large donation from an individual, in this case William Watson-Armstrong (later Baron

Killer in the community – the County Council’s approach to Tuberculosis

06/01/2017 by Northumberland Archives

When the PCHA created Stannington Sanatorium in a bid to combat Tuberculosis (TB) they were not alone in the fight against the disease. In 1906, the year before Stannington Sanatorium opened, the National Association for the Prevention of Consumption highlighted to local authorities that deaths from the disease of 60,000 people each year in England and Wales were preventable if they acted.

Northumberland County Council acted by urging district councils to notify them of cases of disease, punish spitting, appoint health visitors for sufferers and their families, and place strict controls on dairies. However they put great emphasis on the district councils to improve the major problem of sub-standard housing. As one County Medical Officer put it ‘Tuberculosis is a housing disease’.

A pamphlet from 1849 titled Report to the General Board of Health on a Preliminary Inquiry into the sewerage, drainage [etc…] of the borough of Morpeth and the village of Bedlington by Robert Rawlinson (NRO 2164) shows just how bad this could be. Rawlinson described the collier’s cottages of the area, where a flagstoned 14ft square room served as living room and bedroom for a large family, with a small bedroom in the roof space ‘open to the slates’. Other houses like the above in Morpeth, had a 16ft by 15ft bedroom in which 8 people slept. Worse however were the overcrowded lodging houses. He quotes the Town Clerk’s account of them, where beds were occupied by ‘as many as can possibly lie upon them’. When these were full others would sleep on the floor in rows. The Town Clerk added ‘nothing but an actual visit can convey anything like a just impression of the state of the atmosphere… what then must it be like for those who sleep there for hours?’ This description shows an atmosphere in which TB could easily spread, where the occupants of the lodging houses (often labourers moving between work) could then spread it at the next lodging house they came to.

However if you think this only happened in the mid-nineteenth century, think again. Dr Allison, who worked for many years at Stannington, described the inside of a house he had visited in 1905:

Dr. Allison’s story from the Yorkshire Post, 14th September 1905

In the five years leading up to 1914 it was calculated 92 people for every 100,000 in the county died of consumption. This was more than Scarlet fever, Diphtheria, Enteric fever, Measles, and Whooping cough combined, as these diseases together killed 70 people in every 100,000 (NRO 3897/4, 1914, p.26). Notification of cases became compulsory, and the County Medical Officer was under a lot of pressure when asked to assist TB sufferers, and so a full time post was created for a Tuberculosis officer from January 1914. Tuberculosis dispensaries with the TB officer and nurse were established in densely populated areas (NRO 3897/4, 1914, p.25). During the 1920s one in every ten deaths in Northumberland was caused by TB, and the County Council used around 75% of their health expenditure to tackle the disease.

Tables from NRO 3897 showing the condition in 1922 of adults and children treated in 1914 for different stages of TB.

The Council felt provision of sanatoria was vital, providing uninsured patients with 10 beds at the private Barrasford Sanatorium, 9 at Stannington Sanatorium, and housed insured patients at other sanatoria as well. However many patients shortened their stay and returned to work to keep a wage. Likewise many tried to avoid going to see doctors in the early stages of TB as they feared taking time off work. The Medical Officer’s report for 1922 noted that many were coming to see the Tuberculosis Officer at the dispensary in the late stages of the disease. Above are tables showing what condition patients who applied for treatment for TB in 1914 were by 1922, and many had worsened or relapsed.

The Medical Officer also feared that once the patients had left the sanatorium, without further help the disease would return. The Stannington Sanatorium patient files echo this reluctance to return their patients to poor living accommodation. The majority of files give us some idea of the living arrangements in each child’s home, who the family members were and whether they had had TB. Below is part of a letter written in 1953 between Dr Miller and the Whickham Chest Clinic, in which he describes a patient’s home conditions:

The patient was kept at Stannington longer than medically necessary because of this. Another patient was only discharged when their family moved into a council house. Though the longer treatment received by the children at Stannington Sanatorium gave patients a much better recovery rate, improved home conditions were seen as essential to their long term improvement.

In 1944 the TB After-care Sub-committee was formed from the Public Health and Housing Committee. The central committee met quarterly, and worked with local sub-committees and an almoner to look after patients discharged from the sanatoria and new patients in the community. The county was divided up into 12 of these sub-comittees based on the then existing dispensary areas: Wallsend; Gosforth and Longbenton; Whitley and Monkseaton; Seaton Valley; Blyth; Ashington; Morpeth; Bedlington; Newburn; Hexham; Alnwick; and Berwick (CC/CMS/PROPTBA/1). Cases were referred to sub-committees by the Tuberculosis officer through the dispensary or local health visitor. Patients’ needs were assessed after a visit by the committee members, who would provide additional medical treatment such as nursing, free milk, extra food, training for employment, and financial assistance such as with rent. They also helped families move to better accommodation, provided travel expenses for patients and their families, clothing, shoes, and importantly, bedding ‘to enable patients and contacts to sleep apart and thus prevent the spread of infection’ (CC/CMS/PROPTBA/1). They provided equipment, from beds to back supports and bedpans, sputum mugs and even deckchairs. Gifts of drinking chocolate, tinned fruit, and magazines also went through the sub-committees. As at Stannington occupational therapy was important (see our previous blog post) with after-care patients crafting everything from embroidery to fishing flies, leatherwork, and even cabinets.

An important function was to refer patients for help with different organisations too, such as the British Legion, Ministry of labour, and the Poor Children’s Holiday Association. A patient assisted by the committee to become a shorthand typist was provided with holiday travel expenses by the ‘BBC Children’s fund for Cripples’, likely describing a forerunner of BBC Children in Need. The County Council paid the PCHA to board out children from homes with a Tuberculosis case, and many of these children likely went to Stannington.

There are several references to individual cases, including one lady:

During the Second World War mobile mass radiography became a huge boon to diagnosing the disease, with factories and workplaces often used as bases, and later mobile vans with their own generator operated in the community. They were used across the world and even reached Alaska by dog-sled. The County Council paid a shilling to the Newcastle local authority for each Northumberland case x-rayed with their machine. The County Council knew they would require an adaptable and economic mobile unit, but first used Newcastle Corporation’s unit at Ashington Colliery, where radiographs were taken from the 30^th April 1947 (CC/CMS/PROPTB/2). By September that year 3,642 had attended in Ashington, with 23 referred to the Dispensary, and 1,780 attended the unit at Blyth, with 25 referred for treatment. Though the disease is by no means eradicated, improved housing conditions, the TB Vaccination, and early diagnosis with mass radiography made such a dramatic impact on the disease that sanatoria like Stannington were converted to other uses.

References:

Bynum, H., (2012) Spitting Blood: a history of Tuberculosis. Oxford: OUP

Taylor, J., (1988) England’s border county: a history of Northumberland county Council.