The Centenary of Mapperley Hospital
1880 – 1980
For a whole generation of British psychiatrists, mention of the name of Mapperley Hospital usually brought to mind immediately the name of its last Physician Superintendent, Dr Duncan Macmillan. The particular brand of “community psychiatry” that he developed is probably best epitomised by his unique additional appointment as Medical Officer of Mental Health to the City of Nottingham. There is no gainsaying the drive and abilities of this particular man and his impact upon Mapperley Hospital and upon Nottingham, but this history of Mapperley Hospital shows that it has always been an institution of interest. It has been characterised by events and features on more than local interest during its long development.
Duncan Macmillan retired in 1966 and died suddenly in 1969, so the great majority of the present staff at the hospital know him only through the memories of others. His name is also commemorated by the conversion of what was the Medical Superintendent’s house in the present postgraduate centre and records department.
Mapperley Hospital took on the new role in 1973 with the transfer of clinical headquarters of the Department of psychiatry of the new Nottingham Medical School to a so-
The implications of becoming an undergraduate teaching centre have been considerable but beneficial, particularly since the first requirement for good undergraduate experience is a high standard of postgraduate training and service work. Much effort from both academic and National Health Service senior staff since 1972 has gone into the building of the present postgraduate training scheme, which joins together the junior psychiatric staff of all the psychiatric units in the County (and for the senior registrars, also includes the two hospitals in Derby).
The last 10 years have also seen the birth and death of a unique administrative arrangement, the Trent Vale Hospital Management Committee. This brought together under one Administration all the psychiatric units and services of the County of Nottingham, wherever they were situated. Local feelings about this arrangement were clearly mixed, but the greater integration of psychiatric services that resulted had many advantages. Unfortunately, the Trent Vale Hospital Management Committee was dismantled in the reorganisation of the hospital side of the NHS in 1974, and there is no need to comment here upon the present administrative problems that face us all.
A note on the future is perhaps the best way to finish this introduction to a history. The psychiatric unit in the new University Hospital is now in an advanced state of construction, and could be in operation in between two and three years from now. Whatever this date turns out to be, the operational plans that are currently under discussion for the new unit will ensure that its opening will increase the connection between different sections of the psychiatric services, rather than produce a separation. The new unit will need support from both Mapperley and Saxondale Hospitals for the rehabilitation and long-
A Therapeutic Community
This is a term which gained currency in the 1950’s to describe a psychiatric ward or unit in which all concerned – doctors, nurses, ancillary staff and patients – meet, discuss, try to understand and work together in treatment. It is an appropriate description of the old-
In addition to medical and nursing care and food and shelter the hospital provided work, exercise, entertainment. It had gardens, a farm and a church, but no shops, no pub, no post office, no cemetery and no police station. A large degree of self-
Far from providing cheap labour – a jibe applied by unthinking critics in the recent past – the patients were being kept physically healthy and were helping themselves and their fellows by working together for the common good. Occupation and an ordered life – believed as far as possible of material stresses, were appropriate treatment in those days when psychiatric medicine had not yet developed.
Life in the hospital was not all work. Books and magazines were passed on from the town’s libraries and from the Mechanics Institute. There were fortnightly dances for the patients, and certain gentleman would only dance with certain ladies. The music was provided by the staff orchestra. In 1911 the Head Attendant was paid £5 per year for services as Bandmaster. Ability to play a musical instrument or prowess as a cricketer were recommendations for employment as an attendant. The cricket and football matches with teams from other hospitals were a regular entertainment.
In 1924 electricity was installed and by 1926 programs from a central wireless set were being relayed to all wards. In 1927 cinema equipment was purchased. Later, as the Majestic Cinema had been built just outside the hospital, the patients went there every week to a special matinee.
Regular church services were held. The choir was recruited from the staff and the annual choir outing was a popular event.
The other great annual event was the Anniversary Sports Day for the patients, commemorating in early August the opening of the hospital.
The Superintendents Journal
This was a diary in which the medical superintendent had to record matters of importance – admissions, discharges, cause of death patients, engagements and dismissals of staff and any unusual happenings. It was put before the Visiting Committee every month. From it we get glimpses of what was of moment in the hospital and of events in the world outside. There are references to storm damage, to mishaps to farm animals, to the replacement of earthenware chamber pots by pulp ones after a fracas, etc.
There are applications for increases of staff wages and salaries, mentions of acquisitions of equipment, warnings of overcrowding, reports of meetings to plan new sewers or nurses’ homes.
In 1900 the maximum wages of the nurses was increased from £28 to £30 per annum.
In 1919 the wage rate of attendance was £60 × £5 to £90 per annum.
The visit of the Public Vaccinator vindicates an outbreak of smallpox in the city. During the 1914-
National events have their echo in the hospital. In June 1893 the patients had a dinner of mutton and fruit pie to celebrate a Royal Wedding. It was that of the Duke of York and Princess Mary of Teck, who became King George V and Queen Mary. In 1902 there was an entertainment for the Coronation of King Edward VII. The roast mutton and fruit pie appeared again for the Coronation of King George V in 1911 and that the Armistice in 1918 and the Peace Celebrations in 1919. At the latter the staff received 5 shillings each and an extra day’s leave. For the patients there were in addition oranges for the women, tobacco for the men, jam for tea, and entertainment in the evening followed by coffee and cakes. The men who could appreciate it had half a pint of beer with their dinner.
Cooperation of Hospital and Community
In order to ensure the best conditions for its patients the hospital has worked to enlist the sympathy and goodwill of the population which it has served. What were the then revolutionary ideas of open doors and easy access to treatment had to be explained to the public, for without their understanding and acceptance the hospital’s aims could not be achieved. To this end Dr Macmillan and his staff went out into the community and in lectures to professional and technical gatherings and talks to local associations, church groups, schools and contacts with councillors, magistrates and others, explained the purpose and the results of the changes being made. Visits from interested parties were welcomed and in the 1950’s Open Days and Open Weeks showed hundreds of visitors that the hospital was no longer hidden behind high walls and that the conditions were matters of pride rather than of shame.
The annual show of the Mapperley Horticultural Society was energetically directed by Mr A. E. Spalding, Group Treasurer and later Group Secretary, and attracted many who would otherwise never have visited a mental hospital. The Hospital Pantomime, revised and produced by Mr H. Collins, the Deputy Chief Male Nurse, was another attractive event at that time and in recent years has proved to be so again.
The Hospital in a Comprehensive Mental Health Service
The papers written by Dr Duncan Macmillan who was Physician Superintendent from 1941 until 1966 and who is the subject of a separate memoir, are essential reading for this part of the history. On his advice the Visiting Committee altered its designation in 1945 to Mental Health Committee and in 1946 he was appointed to be Medical Officer of Mental Health to the City of Nottingham
“The duties of this post included the medical superintendency of Mapperley Hospital, supervision of the outpatients clinic at the other hospitals in the city, and responsibility for the mental health of the city generally, including social psychiatry with all measures for the prophylaxis of mental illness and education of the public in such matters. The concept underlying the creation of this new organisation was that it should be responsible for the prevention, care and treatment of mental illness, in the same way as a department of the medical officer of health was at the time responsible for the prevention and treatment of physical illness. The medical establishment of the hospital was expanded to enable it to deal with its new responsibilities.”
Two years later the National Health Service Act interrupted development on these lines by splitting community care from hospital treatment. The difficulty was overcome by a joint user arrangement whereby the medical staff at the hospital acted as the medical staff of the Mental Health Department of the local authority and the Medical Officer of Mental Health acted as advertiser to the Medical Officer of Health of the City. To these arrangements Nottingham No.3 Hospital Management Committee under the chairmanship of Miss Glenn-
In 1947 the hospital appointed its first social worker, later expanding the complement to four. These social workers were stationed at the Mental Health Department. Mr J. Westmoreland, the Mental Health Officer had seven Duly Authorised Officers who also acted as social workers. A request for him for pre-
Another function of the joint user arrangement was joint domiciliary visitation. (Domiciliary consultations between consultant and general practitioner started in 1954.) The visit by consultant and local authority social workers to the patient’s home was made when an old person was referred to the Mental Health Department. It enabled the social and medical factors to be evaluated and assessment of the need – post-
Nuffield House and Day Care
In 1953 the Nuffield Provisional Hospitals Trust appointed Dr Macmillan and offered to finance a scheme in the mental health field which could not be launched for lack of funds. After discussions it was agreed that the Trust would bear the capital cost of a day centre for the elderly and contribute largely to the running costs in the first three years. The project was accented by the local authority who were responsible for community care and Nuffield House, administered by the local authority, was opened in 1955. It provided, and continues to provide, a service which prevents psychiatric breakdown in the elderly and release some of the burden of caring relatives, thereby preventing their possible breakdown. The principle of day care patients was extended to younger patients who live in the community if they were supported by nursing supervision and simple occupation.
Park House, opened as a pre-
Not all the patients fit for discharge from hospitals had homes to go to. For these system of hostels in the form of sheltered lodgings was devised. The original lodgings wearing houses run by former theatrical landladies, whose clientele had disappeared with the demise of the variety theatres. To give the landladies advice and support in looking after the discharge patients, some of whom had been many years in hospital, one of two experienced psychiatric nurses visited regularly. These visiting nurses were the nucleus of the Community Nurse Department, whose members not only continue to visit the lodgings, but also visit other patients in their homes, counselling the relatives and supplying maintenance medication and other nursing care. They report back regularly to the medical staff and arrange outpatient appointments for their charges.
A further step in coping with the growing problem of psychogeriatric patients was taken in 1966 when one of the wards at St Francis Hospital was opened as and assessment unit. Here the psychiatrist, the geriatric physician and the local authority social worker could admit problem cases for investigation. When the work of assessment had been completed it was then possible at a joint conference to make the appropriate decision for the patients continued care – discharge to home, day care or local authority home, medical ward or long stay psychogeriatric ward.
In child psychiatry there was also integration of the hospital and local authority services. From 1950 to the consultant in charge of the child psychiatry unit at St Ann’s Hospital attended for one session per week at the Child Guidance Clinic. Other consultants provided special clinics for after-
Case records are not only important for the continued treatment of individual patients but from collected record statistics can be extracted which give information on trends in mental illness and the influences of treatment and hospital and community organisation. In 1959 the Ministry of Health agreed to fund a system which recorded all contacts patients in the community with the mental health service. The Nottingham Case Register still provided data which have been used to monitor the effectiveness of the service and on which the Department of Health can base its projections and advice.
When patients needing hostel care had been determined others were discovered who were considered to be fit to live out of hospital supporting one another in a small group. The first of these lived in a flat offered by a local tradesmen. They were supervised and advised by the hospital social workers.
In 1975 the Guideposts Trust bought a house near the hospital and a group of patients moved in. They were visited by a voluntary worker who collected the rent, and by a community nurse. The failure of this group showed that careful preparation was necessary. Now, before a group home is established, potential members are assessed carefully and then given domestic and social training as a group in a training flat in the hospital run by the Occupational Therapy Department. At the time of writing MIND have undertaken the management of three homes and the Guideposts Trust two and the University Students Union one. The Rotary Clubs have generously helped furnish these homes.
A comprehensive mental health service is not a static organisation. Further developments are planned. These include day hospitals for the outpatient treatment of young and elderly patients, improvement of the accommodation for patients who have grown old and infirm in hospital, modernisation of the medical record system, and a sheltered workshop.
Although psychiatric wards will be opened in the University Hospital and at the City Hospital in the near future no general hospital has a space to provide the full range of services for long-