A Mental Deficiency Institution in Wartime
- Author:
Edgar Benjacar, M.D.
Deputy Medical Superintendent, Royal Eastern Counties Institution, Colchester; Medical Superintendent, Turner Village, Colchester.
Situated as we are with only eighteen miles between us and the coast, and with the Central Institution and Turner Village and three other branches within a military town, it is not surprising that we should have had our first air raid warning within twenty-four hours of the declaration of War. Since then, we have experienced screaming bombs, witnessed aerial dog-fights, steered clear of unexploded bombs, feasted our eyes on wrecks of enemy ‘planes and treasured fragments of shells. Our boys and girls, in fact, pride themselves, not without some justification, on their Wartime experiences.
a.r.p. Fully conscious of their responsibilities, the Board of Directors made early and extensive preparations for the protection of the Institution community, and as the Commissioners of the Board of Control remarked in their last Report, ” A great deal ?f time, industry and money have been spent on equipping the place for A.R.P. Purposes.”
Most of us have discovered by now that the most arduous and difficult task of all was the digging of trenches. Having consulted veterans of the last war and questioned A.R.P. experts, we fondly imagined we were well-equipped to tackle this Problem in a resourceful way. Soon after the Munich episode, plans were drawn up, and the tiring and exhausting process of digging 70 feet long trenches in heavy clay s?il started. Both staff and boys expended a tremendous amount of energy. Tea ^as their only stimulant, and the way in which they toiled and exerted themselves most creditable. In record time, five open trenches, capable of holding between 80 and 90 boys each, were dug at Turner Village, well below ground level, and in an dually short space of time, much to our consternation and dismay, water welled UP from nowhere, the timber strutting gave way like match-sticks, and the sides c?llapsed.
Primed with this mortifying experience, the boys redoubled their efforts, and remodelled the trenches?this time in reinforced concrete. With an elaborate system of drainage, the trenches are now kept dry, and the concrete sides and roof ^ill stand anything, except a direct hit. At the moment, cabbages are sprouting ?Ver the top of the trenches, and the camouflage is most effective. Two water reservoirs, with a total capacity of over 24,000 cubic feet were also dug, concreted and > * I am indebted to Dr F. Douglas Turner, Medical Superintendent, Royal Eastern Counties nstitution, for permission to publish this article and for valuable criticism. covered in by the staff and boys, and a further reserve of water obtained by erecting a dam across the stream at Turner Village.
In other parts of the Institution, cellars were cleared, supported, and gas-proofed. Easy access and alternative exits were provided. Many thousands of sand-bags were piled outside windows and other ” vulnerable ” areas. Most of them, however, have rotted and collapsed, and have now been replaced by more substantial and durable brick walls, 14 inches thick.
To ensure a total black-out, with adequate ventilation, and without undue interference with daylight, was a problem which required much experiment. At Turner Village, the Villas alone have an area of 8,800 square feet of windows and glass doors. Various different devices were adapted to our immediate needs. For instance, by covering fanlights with thick brown paper and partially screening with ply-board painted matt black, it was possible to provide adequate cross-ventilation without attracting the attention of our vigilant A.R.P. wardens.
First Aid Units and Decontamination Centres were established in the three main departments of the Institution. At Turner Village, for example, the space under the stage in the Entertainment Hall was sub-divided into four sections, with shower- baths, eye douches, decontamination material, and First Aid equipment, each section being provided with an air-lock. Blood transfusion apparatus is kept sterilized ready for immediate use, and there is a record of the blood groups of both Staff and patients, so that no time need be wasted if transfusion is indicated. A record is also kept of the Wassermann reaction and Kahn Test of all probable blood donors.
By degrees, we have accumulated a liberal and varied stock of A.R.P. equipment, including oilskins, steel helmets, hoods, gloves, gum-boots, civilian duty respirators, hurricane lamps, chloride of lime, anti-gas ointment, stirrup pumps, Redhill con- tainers, pick-axes, crow-bars, and other demolition gear.
Iron rations and fairly large quantities of food are in safe storage in gas-proofed rooms in the various branches of the Institution. Perishable stores are renewed periodically. Dressings, drugs, sera, splints, plaster of Paris, and anaesthetic apparatus are set apart for emergency use only.
So far, our total A.R.P. expenditure is well over ?3,500.
A.R.P. Training
Much time and energy were devoted by the Staff to A.R.P. work. Two of our male Nurses specially trained at Falfield, were appointed Instructors and Examiners. Classes and Refresher Courses are held regularly throughout the year. Every member of the Staff is given an opportunity of tackling incendiary bombs, and other practical experience in fire-fighting. In an effort to reproduce a realistic effect, incendiary and smoke bombs are set alight in the actual buildings, including attics. Patients are lowered by means of a rope from the top floor of a villa, where it is assumed that both staircases are blocked by fire and falling masonry. With pardonable pride, we record that one of our Instructors has recently been appointed Staff Officer to the local A.R.P. Casualty Services.
The women staff display exemplary keenness. They are well skilled in fire- fighting, decontamination and other A.R.P. work, and they vie with the men in physical endurance and efficiency. At the Central Institution, women Staff volunteer to keep a look-out during raids for incendiary bombs from the top floors of the buildings, and to be on the spot with stirrup pumps, Redhill containers and fire-hose.
High grade defective boys and girls were enlisted in our A.R.P. scheme as stretcher-bearers and runners. Wearing steel helmets, gas masks and distinctive armlets, they feel they are being of real service to their community, and their zeal and aptitude are praiseworthy. It is interesting to note that after witnessing an air raid exercise at Turner Village, responsible A.R.P. authorities in East Anglia suggested that our best trained boys might be detailed to act as stretcher-bearers for civilian casualties outside the Institution. It was not possible to comply with this request.
Training Patients
Contrary to general belief, little difficulty was experienced in securing the co-operation of the patients in A.R.P. As a rule, defectives are suggestible, sub- missive and tractable. Once they are told and made to understand what is expected of them, they readily follow their appointed leaders, without the slightest suggestion of disorder or panic. Calm and efficient leadership however, is, absolutely essential. Diffident and faint-hearted nurses must be relieved of all A.R.P. duties, irrespective of any existing shortage of staff. Given the right kind of leadership, the demeanour of the average defective can be safely guaranteed.
Repeated and regular A.R.P. exercises are imperative. The value of these rehearsals, superfluous as they might appear, can only be fully appreciated in times of emergency when bombs are falling and the danger very real. The Commissioners of the Board of Control stated: ” When we first arrived at the Central Institution, an air raid exercise was in progress and we visited the extensive subterranean passages the population use as a refuge. There have evidently been many careful rehearsals and the complete absence of excitement showed the value of these practices.” The novelty of air raids has long worn off, at any rate in East Anglia. With an average of three or four siren warnings a day, it is neither expedient nor necessary to down tools and take cover every time we hear the ” appalling banshee howlings As siren warnings are now also a nightly occurrence, and, not infrequently, last till dawn, most of the ground floor rooms (well protected with sand-bags and extra brick walls), have been converted into temporary sleeping quarters, and top floor rooms are being used for recreation and meals. At night, the normal staff on duty are supplemented by A.R.P. personnel, including a Fire Fighting Squad. Patients are not sent down to the trenches if the sky is reasonably clear of ‘planes, and nothing is happening in the immediate neighbourhood. At Turner Village the order ” Proceed to trenches ” is given by telephone to all the Villas simultaneously from the switchboard in the Central Office. Boy runners on bicycles stand by in case the telephone is put out of order.
During actual air raids, a tour round the Institution by the Senior Medical Staff is encouraging and reassuring. Despite a lack of imagination, even the medium grade defective is vaguely aware of the potential dangers of an air raid, and the mere presence of a trusted person inspires confidence and is conducive to good demeanour. Rationing
The rationing measures now enforced in the British Isles have not caused us much concern. Odd complaints are, of course, inevitable when catering for a community of over 2,000, but with the co-operation of the Steward and the Cook, the dietary has so far been wholesome, varied and plentiful, and there is not the slightest suggestion of under-nourishment. Defectives, like most children, have healthy appetites, and they appreciate good helpings.
Conduct of Defectives
The effect of wartime stress and strain on defectives differs markedly according to the degree of intelligence and emotional stability. Those on the lowest level of the intelligence scale?the complete idiots?do not, of course, even realize that hostilities are in progress: such blissful ignorance is, however, not shared by the vast majority of medium and higher grade defectives. The latter take a moderately intelligent interest in the progress of the war. The phlegmatic type do not appear to be unduly affected by their disturbed environment, but the more demonstrative, fortunately few in number, are alternately electrified and petrified by rumour and the feverish sequence of events. Their influence on other less excitable defectives is unmistakable: they constitute a very real menacing factor to the orderly routine of an Institution, and it is wise to keep them discreetly under close supervision. During air raids, especially, tactful but firm control is indicated?a platitude of paramount significance to the experienced.
Occupational Therapy
The varied activities of the Institution had to be curtailed in some directions, and intensified in others. Owing to the shortage of timber, and as additional acreage was put under the plough, carpentry boys were transferred to the farm. Lower grade defectives normally employed in the mat shop, are occupied in making wattle hurdles in response to an appeal from the Local Authority. Boys in the brush shop are still fully occupied, and basket workers find it difficult to cope with the orders for hampers. Owing to wartime economy, more attention is being given to repair work in the tailoring and boot-making departments.
Medium and high grade girls were sent out daily during the fruit-picking season. It is noteworthy that these girls earned ?30 in currant-picking alone, and the sum of ?28 was credited to the Local Authorities concerned. The balance was given out as pocket-money. Countless sand-bags and black-out curtains were made in record time by needlework girls. The weaving and fancy work departments have continued as in peacetime.
Defectives resent a sudden change of employment just as much as normal people do, but soon adapt themselves to new conditions and rise to the occasion. That there is no lack of patriotism is shown by the fact that many of the high grade boys, undismayed by the ” Rightfulness ” of the enemy, expressed their desire to join the Colours. As even high grade defectives are exempted from the provisions of the National Service (Armed Forces) Act, 1939, and debarred from voluntary enlistment, a small band of our lads ran away and somehow succeeded in joining the Armed Forces.
Military Service
Up to the present, 52 members of our Staff have been called up for service with the Forces. Over 50 per cent, of the staff at Turner Village rallied instantly to Mr. Eden’s call to enlist in the Home Guard. Following an intimation from the ^ar Office, that it was ” not desirable for specific defence to be provided for M.D. Institutions “, the Turner Village Guard had to be disbanded.
Overcrowding and Licence
On the outbreak of the War, over 120 evacuation cases from various areas, chiefly Walthamstow, Ilford, Dagenham and Kedington, were admitted at very short notice, and early this summer 68 patients from our Clacton Branch, situated on the sea-front, had to be evacuated. This entailed considerable overcrowding, which is gradually being offset by licence.
The constant stream of re-socialized defectives leaving the Institution on licence has swelled very noticeably since the outbreak of the War, in response to appeals from parents and prospective employers. The increased probability of securing a Job outside and the higher wages paid, have no doubt acted as an added stimulus for the good behaviour essential before a boy or girl is considered for licence. Since September, 1939, 46 jobs have been secured for our boys and girls, and 36 medium grade stable defectives have been boarded out to the care of foster-parents and to their own homes. Many of our boys are now engaged on work of national impor- tance, and a considerable number are earning over ?3 a week.
Owing to evacuation measures, 15 girls out in domestic service in Clacton lost their jobs and had to return to the Institution. Eight have already been placed out again. The demand for service girls is increasing month by month.
Recreation
So far we have not found it necessary to make any very drastic change in our recreational activities. All through this last year, we have had talking pictures every week, and the usual number of concerts, whist drives and dances. We propose to Carry on this next winter in much the same way. Diversion and recreation are essential in these days of uncertainty and suspense.
Half-day parole has been allowed as in peacetime. Boys and girls leaving the Institution are given a card with their name, address and identity number, and &as mask. An average of 80 boys are allowed parole every Saturday afternoon.
If caught out in an air raid, they take shelter wherever they happen to be, and return to the Institution when it is all over.
Most of our Scouts and Guides missed their annual camp owing to wartime restrictions and the danger of air raids. East Hill House Troop, however, camped out during Whitsun week-end, and Halstead Guides resorted to a farm house for a fortnight.
The lack of outside teams necessarily curtailed our football and cricket pro- grammes. A number of friendly games were played, but these somehow lacked the incentive and the excitement of a trophy or two at the end of the season. The War certainly did not mar our Yuletide celebrations. Presents were perhaps not quite as plentiful and expensive as in former years, but the rejoicing and the merrymaking were continuous and unabated. Father Christmas, impersonated as usual by Dr Turner, was heralded and ushered in to the loud strains of the Turner Village Band, and cheered as lustily as ever. The dancing and singing went on till the small hours of the morning. War, with all its horror and tragedy, was very distant on that Christmas day.
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