[from "The Birth of a Service", 2008]

CHAPTER 8

The Mental Hospital had started life as a Victorian institution, the main building being erected in 1868, and therefore needing a considerable amount of continuous maintenance, and looking back from 60 years, memories give the impression that in 1948 there had not been many changes in the accommodation and treatment of the patients. There were 345 beds, usually fully occupied, with all classes of mental disabilities crowded into large wards and dormitories, with no privacy. Even readers familiar with the Hospital in later years might not be aware that in those days there was a second-floor ward in full use in Centre Block, making it a three-tier operation, some wards having up to 70 patients. All the doors were locked, so that each member of the staff, except the very senior members who had master-keys, carried a very large bunch of keys, needed to traverse quite small distances. As to the patients, it is generally conceded that their number was greater in proportion to the Island's population than would have been expected to be the case in England, for whatever reason. The cases varied from the violent to some who should, by our standards, never have been there at all, either because their condition, however slight, was thought to be an embarrassment in society as it then was, or because they had been deemed to be "moral defectives" who would bring shame on their families, and were put away "for their own good". Many were simply senile, and had nobody to care for them. Some had been admitted at an early age, and had become institutionalised to the point that they simply could not have coped with release into the outside world. There were few discharges, and in these cases the Island can only consider that its shame is shared with similar institutions all over the United Kingdom.

The drugs, so effective now, had not then made their appearance, and control over patients diagnosed as being a possible danger to themselves or others, not least the staff, was exercised by the liberal administration of the well-named Paraldehyde, a preparation most unpleasant to both smell and taste, not unnaturally having to be administered by force in some cases, although some became inured to it, or even addicted. Electroconvulsive Therapy, or ECT, was given to some patients, and could yield good results (it is still used, but currently administered at Noble's, under anaesthetic). There was a fully equipped operating theatre, where there were some operations for leucotomy, also known as frontal lobotomy, but this fell into some disrepute, and the practice had ceased altogether by the 1960's. In the very exceptional circumstance that it might be recommended, the patient would be transferred to one of the three centres in England still equipped to carry out the procedure.

As was the common concept, the Hospital was intended to be as self-supporting as possible, with its farm and market gardens. The men most capable worked as assistants to the artisan staff, those less so on the farm, actually what had been originally four farms and was therefore a considerable operation, or the gardens. The women were employed, if competent, on sewing, in the kitchen or the laundry, or other domestic work, so that domestic staffing from outside was virtually non-existent except for cooks, and servers and waitresses in the staff dining room.

Not everybody was confined to the Hospital, however; some men had outside day employment, and some women had employment, for example during the visiting season in boarding houses in Douglas.

There was, of course, the annexe, Ard Aalin, for voluntary patients, where conditions were obviously much better, even, at one time, having its own croquet lawn, but even there patients had their duties to perform.

It would be a mistake to think that the atmosphere was entirely Dickensian. Every effort was made to provide entertainment for those for whom it was suitable. The Hospital had its own projection equipment for showing films, held dances, and there were regular visits by bands, choirs, and concert parties. Christmas was of course the really big occasion, with a dinner in the main hall, the visit by Father Christmas with presents, and a party with a band and dancing. There were also games and sports. With the increase in funding by the NHS rather than the rates, it was possible to increase the accommodation by the erection, by the Hospital tradesmen, of another ward, Druidale, for senile female patients.

There was no satisfactory segregation of children, although there were not many, being placed in the female wards, and some of them were in fact largely looked after by the patients. Male children, when they showed signs of approaching maturity, were of course then transferred to the adult male wards. Urgent attention was needed, and this was taken by building the Children's Villa, to accommodate, originally, 30 patients, at a cost of 62,150. Some reservations had been expressed by Government Office as to the site chosen, its comparative isolation from the main buildings, but it was explained that this was intentional, to be away from the adult quarters. The size and cost were also queried, the explanation being that the cost was occasioned by the design, which would allow for expansion as required. As it happened, the latter objection turned out to be justified, as the children never occupied all the space available, half eventually being taken for senile females.

The other early improvement instituted was the provision of a canteen, where the patients could purchase refreshments and small items with any earnings they might have, or their allowance of pocket money.

In October, 1949, the Board and the Hospital Committee agreed that the use of the name, Mental Hospital, was to modern thinking inappropriate, and should be changed. The first suggestion, Ard Aalin, was discounted as being already in use for the annexe, and thereby could be a cause of confusion, and Ballamona was settled on, from the name of the farm and land, and has been used ever since, although it is not entirely clear by what legal process the change was made, if at all, or whether some rule of customary usage would apply.

Having served as the Ramsey Isolation Hospital from 1896, and taken over by the Local Government Board in 1930, Cronk Ruagh Sanatorium was not purpose-built, and over the years extensions and alterations had been made piecemeal, which, while meeting the needs seen at the time, now produced problems in its efficient working. In deciding on its future, the Board faced a problem on two fronts. One of the aims of the Service had been the eradication of disease, and tuberculosis was very much in the forefront of this thinking. There were 28 beds, and the Board had been advised that an extension of 22 beds would materially assist in this aim. On the other hand, there had been tremendous strides in the efficacy of drugs, and treatments and surgical procedures, which seemed to indicate that the expense of an extension might not be justified in the long term. A compromise was reached, careful planning and rearrangement of facilities producing space for a further six beds should the need arise, while adopting a wait-and-see policy. Meanwhile, the X-ray room was updated, and 1952 saw the completion of a Nurses' Home.

Because of the lack of preparation for the introduction of the Service, the Board were unable immediately to take over the administration of White Hoe Isolation Hospital, but were able to rely on the cooperation of Douglas Corporation, who continued to run it until 1st. March, 1949. It was already an old building, completed in 1888, and the Board carried out only the repairs and improvements seen as necessary, as there had been no serious outbreaks of infectious diseases in the past few years, and they were aware that during that time there had been fresh thinking on the methods of dealing with them, which left the question of the unit's future use open. They did, however, play safe by bringing the smallpox block up to date. The chief worry in this connection was that the relative freedom from outbreaks had been due to previous programmes of vaccination or immunisation against smallpox and diphtheria, and their concern that this appeared to have lulled the public's awareness of the need to take advantage of these measures.

In 1954 there were a number of cases of para-typhoid fever, which, although not a serious outbreak, gave rise to unexpected expenditure of 1,056, and a reflection of the minimum funding upon which the unit was run is the fact that this represented an overspending of 17% of White Hoe's annual budget.

The other matter upon which the Board took action was in combating poliomyelitis (usually nowadays referred to as "polio", but then more often known as "infantile paralysis"), by bringing up-to-date the stock of mechanical respirators, "iron lungs", and moving the isolation accommodation to the former nurses' quarters in Noble's, for better access to resources.


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