The Fountain Mental Hospital as a Pioneer in its Relation to the Working of the Mental Deficiency Act, 19 1 3.” V
- Author:
James Nicoll, M.D., C.M.,Edin., D.P.H., Lond.
As a measure of national importance the passing of the Mental Deficiency Act was regarded as a red letter day by all those who had been working on behalf of the mentally backward or congenitally deficient. Arrangements were at once commenced by Local Authorities and others in order to obtain suitable institutions and homes, while various associations, voluntary and otherwise, busied themselves in rounding up patients who came within the meaning of the Act. This preliminary preparatory period was all too short when the outbreak of the world war commenced and with it the cessation of practically all work in this connection. From 1914- onwards until 1918, when the Armistice came, the Act to all intents and purposes was in abeyance. A few?a very few?Authorities had been able to establish places for housing these patients, confined almost entirely to the moderate or high grade types of the mentally deficient, so that it was left to the Metropolitan Asylums Board to provide accommodation for the lowest grade varieties described as “unimprovables.” As an Institution for the housing of this class therefore the Fountain Mental Hospital, Tooting Grove, may be regarded as unique, as no other place exists for the admission only of the lowest grade of the mentally deficient, and it is with reference to the nature of the work done at the Fountain Mental Hospital that this paper is specially intended to deal.
That such patients should be segregated is universally admitted, as even they are a menace to society, and it is a matter of considerable importance to the community that the propagation of such a species should be prevented, apart from the possible danger of disseminating venereal disease. Something more however is necessary to be done for these poor specimens of humanity than merely to house and keep them warm and to provide them with sufficient food. Few are found from experience to be so mentally deficient as to be unable to learn anything from training directly, or indirectly, and still fewer are so destitute of mental capacity as to be unable to recognise kindness when freely bestowed upon them. The kind of training appropriate to each varies within wide limits. On admission many are quite unable to obviate the most elementary dangers, while the great majority are never likely to be fit to compete in the outside world with their fellows of a similar age for the purposes of making a living. Nevertheless much can be and is being done, and such attention and care often proves to be economical?from the cost per individual point of view?in a manner causing surprise to those unacquainted with their management. It should be noted however than an institution intended only for “unimprovables” of whatever type including as they do idiots and imbeciles who may be subject to epilepsy, moral imbeciles and the feebleminded is scarcely likely to be a “show” institution or one in which eye service counts for much, but surely those, having the care of these poor creatures are worthy of the most liberal encouragement in what may be regarded as rather hopeless and dreary work, and one which requires a high measure of patience.
The nursing staff entirely consists of females, and in the selection of suitable candidates every endeavour is made to obtain persons who are especially desirous of nursing children. Preference is given to those who have had previous experience in a children’s hospital, or who have proved themselves as nursemaids well qualified to undertake such duties. They receive a three years’ course of training and are required to pass examinations necessary for the Medico-Psychological Nursing Certificate. Over these nurses are fully trained Sisters, who work in conjunction with the Matron and her Assistant, all of whom are specially qualified in the management and training of children. Here it should be mentioned that the hospital is much indebted in many ways to Miss Wilde, the Chairman, especially for advocating the trained nurse as a part of the personnel of the establishment.
Boys up to the age of nine years who are found suitable to be nursed by women, and girls up to the age of sixteen are admitted.
Before proceeding further it may not be out of place here to refer briefly to the character and structure of the building. Within a square shaped area of about 10 acres the Hospital consists of pavilions with airing courts and grass plots between each pair of wards. This arrangement permits of all the children, even the cripples who are not confined to bed, to spend most of their day in the open air, and while the weather is warm enough to take all their meals outside. The wards are arranged in pairs opposite each other, the main corridor, a covered way, dividing the bungalows.
Each ward contains 40 or more cotS, and there are sixteen of these one storeyed huts altogether. They are built of corrugated iron with uralite linings painted without and within and are easily kept clean. They are quite suitable for administrative purposes and, as a noteworthy point in these days of economy, they are inexpensive to construct. The wards are well lighted by large windows on each long wall; easily heated by means of steam pipes, radiators and open fire places, and possess suitable arrangements for ventilation. At one end is an entrance door and at the other a fire escape door. The windows reach sufficiently near to the floor as to make it possible for patients to be transferred from the ward to the airing court should the contingency of an outbreak of fire occur. At the entrance portion of the ward are four rooms (1) a small kitchen, (2) bathroom, (3) store room, (4) a nurse’s bedroom. Near the middle of one of the long walls are off-shoots for lavatories and their special arrangements. About the middle of the institution is the administrative section, and also the kitchen and messrooms, the stores and an off-shoot from the main corridor leads to the laundry, the destructor and disinfector, with the needleroom (containing electrical motor power machines) close by. The buildings at the periphery house the nurses, or are used as schoolrooms, boardrooms, nurses’ home and other purposes, while another end is used as workshops for engineers, carpenter, painter?thus forming an artisan portion. Electric light is installed throughout the building.
These defective children are not only admitted from the Metropolitan area but also from the different Authorities in England and Wales by arrangement with the Metropolitan Ayslums Board who allot the beds at the Fountain Mental Hospital. The admissions being confined to the unimprovable class it is possible for any type to be received and as a matter of fact the inmates make up a heterogeneous collection of clinical entities as the most casual inspection of them would soon show. This has been recognised by those best able to judge, for daring the last two years classes have been instituted with the permission of the Metropolitan Asylums Board by the Central Association of the Mentally Defective as a post graduate course under the auspices of the University of London, with Miss Evelyn Fox the Hon. Secretary, as the guiding star. These classes have been well patronised by Medical Officers of Health, School Medical Officers and others representing various Authorities. The condition of the admissions only too frequently leaves much to be desired. Certain very essential preliminaries have to be carried out, for some days, perhaps for treatment of skin ailments or other reasons, as well as for classification purposes?the latter being referable more on the basis of their mental and physical condition than to their age. They are then distributed as far as possible to equalise the work in the wards, at the same time having in view the maximum amount of possible benefit to the type of patient. Photographic records of all admissions are taken as soon as found convenient after their first week’s residence is completed.
Generally speaking, the younger they are on their arrival the better are their prospects of deriving benefit, this fact being an important incentive for their early discovery. Some are not more than three years of age, but unfortunately the majority are over that age when they first come in. It is surprising how soon with training they are able to feed and dress themselves and in other ways become clean and even tidy and useful. So soon as they show themselves becoming accustomed to their new abode (a few days often sufficing), and that they are capable of taking an increasing interest in themselves and their surroundings they are encouraged to play and wherever possible are tried at school. The school-rooms, where there are at the present time between 150?200 attending, are in two sections, the junior, where a number are taught to play and amuse themselves for about 1J hours in the morning and afternoon: and the other for the more advanced, where they are taught the various Kindergarten exercises, musical drill and dancing, the dressing and making of dolls and mat-making under the care of a teacher nurse with other nurses to assist her. It is not to be inferred from the numbers above stated as attending school that these figures accurately represent the exact proportion of the total likely to receive educational benefit. There are infants who have not attained school age, and there are those who although they have reached school age are still infants from lack of mental and physical development.
Such children may be seven or eight years of age and yet be bottle fed. Many of these show surprising progress later. In reality there are only quite a small number, who, from paralysis or extreme mental deficiency, are regarded as apparently unteachable. Even with the lowest type every endeavour is made to inculcate a habit of cleanliness. Perhaps, this simple instruction may not appear to mean much, but in practice it is found to be economical in many ways, apart from the question of making their lives much brighter and happier. Periodically the Medical Officers test the progress of the children by means of the Binet-Simon and other tests, and they are graded accordingly. Whenever the progress has thus shown them to be sufficiently advanced, a consultation between the Medical Superintendents of Darenth Training Colonies and the Fountain Mental Hospital takes place, and suitable cases are selected for the more intensive training available at the former and to which Institution they are transferred. During 1921 nineteen such transfers took place.
An ample dietary is provided of which milk and milk foods constitute the predominant features. For these children it may be superfluous to add that both meat and fish require to pass through a mincing machine and that potato and vegetable food also require to be offered to them in a fine state of subdivision. In practice the latter are usually worked up with the meat, and beef tea is added to the mixture. In addition the older children have boiled suet pudding two or three times a week to which some form of sweetening agent?jam for instance ?is added. For breakfast and tea?cocoa or tea is served with bread, margarine and jam or treacle; while the helpless and small children have bread?margarine? milk?tea sop specially prepared beforehand. In addition porridge is also served with the morning meal. A sufficient quantity of fruit is given to each individual throughout the year. The strictest attention is given to the weights of the children which are monthly recorded in a book specially kept for the purpose.
All the clothing is of washable material, and care is always taken to see that they are warmly clad, with woollen garments next to the skin, especially in the cool or cold weather, cripples and mongolians being peculiarly susceptible to cold. From this, it will be evident that a large stock must always be available for each ward, especially of small articles. This implies suitable laundry machinery to deal with these, and in order to prevent sores occurring on such delicate skins, a great deal of calendering has to be undertaken.
Recreations and amusements are beneficial in many ways, and a dance twice weekly for an hour and a half, musical drill three times a week, and occasionally other entertainments are appreciated in a manner that even creates a feeling of enjoyment to the onlooker.
Nor are their religious requirements omitted, as the Church of England, Roman Catholic, and Non-Conformists have their respective ministerial representatives .
In conclusion it is important to sound a note of warning (to avoid cause for misunderstanding) to those whose duties are concerned in advising parents and other relatives to hand over their mental defectives for the purposes of certification and detention, or for them to be placed in an institution as a “place of safety” as the good working much depends upon the confidence placed in the Management. Friends ought not to be told that the children will be returned to them after any given time, or that the Mental Hospital is of the nature of a training college, or that they may have their children out for week-ends or for holiday times whenever they express the wish; or that special treatment may be accorded any particular individual; or that travelling expenses to friends living at a distance for visiting will be provided by the Institution Authorities, as such misstatements frequently create an atmosphere of discontent and distrust having ill effects both directly and indirectly. It should not be forgotten that mentally deficient children are frequently, if not generally, the offspring of those who have inherited nervous instability, the parents and relatives themselves oftentimes being observed to be not quite normal. Visiting Officers and others acting under the provisions of the mental Deficiency Act can and often do real good service by taking the fullest possible details of the family history and of the home conditions.
A special form in connection with the latter is now invariably issued, the contents of which have been found to be most useful in guiding the Official Visitors who periodically inspect for the purposes of extension or special certification, as well as to the Medical Superintendent in answering enquiries relating to questions of leave of absence or discharge.
It may have been inferred by some readers of this article that as a class the patients are repulsive both to look at and to manage, and they may be relieved to ltarn that on the contrary the nurses become very attached to their cares.
There are instances where a Millais might linger to find another ‘’Bubbles,” or a “Queenie” might arrest the attention of a Greuze, and although one cannot recall to mind at the moment one possessing the innocence of Reynolds’s ‘Samuel,” yet that deficiency is amply made up by numerous specimens leaning in the direction of Stanniland’s “Mischief” and “In Disgrace.”
The writer is fully aware that no attempt has been made to make this a scientific article, and some disappointment may be experienced that this opportunity has not been taken of indicating the lines upon which an ideal institution for mental defectives should be constructed; or that many more of the difficulties experienced in management and their solution have not been touched upon, but something will have been gained if the general principles of the daily routine of work at the Fountain Mental Hospital have been made clear.
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