Psychiatry in Liverpool: 20th Century

In 1906 2,700 patients, or one fifth of the total number under its control, were sent from Liverpool at a cost to the ratepayers of 8/2d. per patient per week.

The Town Clerk of Liverpool and the Treasurer suggested the building of a local hospital with accommodation for 60 males and 40 females for temporary care under detention orders and also provision for harmless chronic lunatics. It was anticipated that a new asylum would be needed every five years and that any measures to reduce pressure would be worthwhile.

This led to the erection of a special block at Smithdown Road Institution (later Sefton General Hospital) for 200 male and 100 female harmless, chronic, or temporarily affected patients who would otherwise be in the county asylums. The block was to serve as a Mental Hospital at an estimated cost of £70 per head and claimed be the cheapest ever built. It was opened on 31st August 1909 by the Chairman of the Guardians, a Mr Richards, who said that there were already inmates in the old buildings of Workhouse waiting to be transferred to the new quarters.

The same year Nathan Raw also stressed for temporary treatment to ease the strain on the Mental Hospitals and he gave some figures about Mill Road Infirmary, of which he was Medical Superintendent.

For example of 3934 admissions (D.T. and alcohol 1003. Other insanities 2931) 3925 were discharged as follows: -

• To county asylums - 1982.
• To non-county institutions - 92.
• Discharged Cured from Mill Road - 1505
• Deaths - 346

If all alcoholics are included in the 1505 as they may well have been, he was still able to discharge 500 patients suffering from "other insanities". or 12.5% of the total intake.

Nevertheless, there was a good deal of support from the Medical Officers of the Lancashire Mental Hospitals Board. as the following reports show. In 1910 the increase of cases insanity on 1st January 1911 compared with 1859 was 262% and with 1869 it was 150.4%. The corresponding increase in the population was 85% and 64%. Hypotheses to explain this apparent incrase at the time were (1) Earlier recognition of disease (2) Heredity (3) Alcohol (4) Stress.

In 1921 treatment was advocated at local mental clinics in every large centre (quote) "as many reaching asylums are past the curative stage".

The report of 1923 dealt with incipient lunacy and the difficulties of admission through existing legislature especially in cases of mania, puerperal illness and children, It was pointed out thtt out-patient departments were "very materially restricted without beds".

The advantages of the "Maudsley ideal' were presented and two points in it, in particular, were stressed (1) The high doctor patient ratio. (2) All nurses except probationers were state registered besides having mental experience and were almost all female.

In 1925 the Board "awaited the report into the reform of the Lunacy Laws with special reference to the crying need for treatment before the unhappy stage of certification is reached."

It referred to the suggestion by two commissioners to establish outpatient sections in Preston Royal Infirmary in conjunction with Whittingham, and commended the suggestion to the Liverpool Voluntary Hospitals owing to their proximity to two large mental hospitals.

In 1926 Dr. Reeve, the Medical Superintendent of Rainhill Hospital referred to Liverpool's place In the early treatment of Genera1 Paralysis of the Insane.This, he said, was the first effort ever made to secure early treatment before certification.

In 1927 he was commented that he thought that predisposition was the important factor in insanity and that alcohol was negligible.

It was again stressed that senile psychotics should be in Poor Law Institution.

With the Mental Treatment Act of 1930 it was hoped to provide treatment without the stigma of certification but there was no special accommodation for puerperal mania, mild or severe, and Section 5 of the Act could not be operated fully in its proper form.

The Management Committee of the Royal Southern Hospital offered to set aside one ward for patients suitable for Section 5 of the Mental Treatment Act (1930). The Board of Control accepted on condition it vics run under the direction of a Mental Hospital, so the offer was withdrawn.

In the same year, the Royal Infirmary opened the Department of Psychological Medicine for out-patients under Dr. Barton Hall. The earlier reports to the City Council must have borne fruit for in 1931 the Corporation established a Department of Psychiatry at Walton Hospital with 30 beds under the care of Dr. Rankin. This was probably one of the first of its kind in the country.

In 1932 outpatient clinics were opened at Bootle Hospital and in Liverpool at the offices of the West Lancashire Associationi for Mental Welfare at 14 Castle Street, They were run from Rainhill Hospital, as was the out-patient clinic at the Stanley Hospital, opened in 1933. That year sterilization for the insane was discussed in Council Proceedings and rejected. In 1934 two training and occupation centres for the mentally defective were opened, one in Princess Park, the other in Utting Avenue.

The Royal Liverpool Children's Hospital and the Royal Southern Hospital started psychiatry departments. Dr. Hopkins was appointed Medical Psychologist for both and he also joined the staff of Smithdown Road Hospital. He was already associated with the Liverrpool Child Guidance Clinic. The Southern Hospital department had bed accommodation for four patients. Dr Vaillant was medical tutor about this time and also became his clinical assistant.

In 1936 an out-patient clinic was started at the Northern Hospital with Dr. Fitch in charge.

Despite all these developments the Poor Law Hospitals, first under the Board of Guardians and later under the Corporation, continued to provide the legal machinery for getting people into asylums. Such hospitals had an all pervading smell of paraldehyde.

The Guardians were empowered to move an inmate to any hospital under their control. Although Walton had a padded room in G Ward it was never used, certainly not after 1910, because lunatics were transferred to Mill Road. By 1930 Mill Road "Lowers" were closed and all mental patients sent to Smithdown Road. Belmont Road took female patients with senile dementia and Westminster House the male.

When a person who could not support himself through mental disorder or any other cause became a charge on the rates, he could be moved to his place of birth,, even as far away as India. This happened not infrequently, thus splitting families.

Apart from the Public Institutions there were several private houses for those who could pay but records of them are scanty. Theer was Tuebrook Villas in West Derby. It took patients into the 1930s.The managers were apparently very keen on prompt payment. Dr Rankin also had his own private nursing home. Theer was also Haydock Lodge, close to Haydock race course, which was a private institution for certified patients.

Though there were no psychiatrists to general hospitals in the early years, there were doctors there with a profound interest in mental disorders. The following is a list of papers given at the Medical Institution between 1867 and 1914.

In May 1924 the James Street clinic was re-opened officially as the New Psychoherapeutic Clinic, but it was more popularly known as the Liverpool Psychiatric Clinic, by Dr. Barton Hall with the help of a lay Committee and Betts Taplin. Group therapy was one et the forms of treatment used. It moved to St. Catherine's Hall in Vine Street, and later, owing to the kindness of the late Sir Sydney Jones, to No. 1. Abercromby Square. Until 1947 it was voluntary being supported by subscription and voluntary medical services. On the staff from 1934 till his death in 1956, was the late Dr. Lipman whose specialty was psychoanalysis. The clinic was transferred to the Liverpool Regional Hospital Board who secured for it premises in Croxteth Road, and it became the South Liverpool Psychiatric Day Hospital.

Dr Rankin was the first visiting psychiatrist to Walton Hospital. he had been Minister at Earle Rod Presbyterian Church for seventeen years before he quualified in medicine at Liverpool in 1925.

On Rankin's death it was stated: "Rankin' s keen adventurous spirit led him to the investigation of the new methods of vaccine and endocrine therapy in the treatment of those with a diseased mind. His previous work as a minister, his understanding of human nature, his readiness to help a colleague, his entire and simple faith all deepened his psychological insight".

He undoubtedly did very valuable work at Walton and wasa help to a very large number of people. He was interested in hypnosis and analysis and his adventurous spirit is shown by two innovations which were exceptional at the time. He started giving electroconvulsive treatment in Liverpool and he also had an electroencephalograph, obtained with difficulty from the United States. With the aid of his encephalograph he once created legal history when he caused a murder verdict to be reversed in a case of masked epilepsy. He died in 1945 at the age of 65.

The electroencephalogram was discovered in Liverpool in 1875 by the most distinguished Dr Richard Caton who was the f irst Liverpool doctor to become Lord Mayor.

Dr Fitch is important because in 1929 he started the Liverpool Child Guidance Clinic in Maryland Street. It was the second in the country, the first being Dr, Emmanuel Miller's in London. Fitch may have been a journalist, and was a Socialist.

In 1946 Dr Muriel Barton Hall took over the psychiatry department at the Children's Hospital. She was a distinguished psychiatrist, well known for her work in child psychiatry.

When the 'Appointed Day' was reached in 1948, and all hospital services became vested in the Minister of Health, psychiatric cliniocs were open in nearly every hospital in the city area.

In 1951 the Department of Psychoogical Medicine was founded by its Director, Dr Barton Hall.

Sources include:

Vaillant C M (1963) An Historical Sketch of the Emergence of Liverpool Psychiatry. The Journal of the Liverpool Psychiatric Club - Vol 1.