A CONCISE HISTORY OF ST. MARGARET'S HOSPITAL, GREAT BARR

Peter Allen
Pathology Department, St. Margaret's Hospital

[UPDATE: Please note that this document was written in 1987. Here are a few additional notes regarding the subsequent closure of the hospital.

St Margaret's Hospital was subsumed under Walsall AREA Health Authority (WAHA) when I first went to work there in 1974. It was renamed Walsall Health Authority (WHA) under reorganization in the early 1980s. Walsall Community Health Trust (WCHT) was formed in April 1993 and assumed overall responsibility for people with learning difficulties and mental health problems within the Borough. Many of its functions were taken over by the newly-formed Walsall Primary Care Trust in March 2002. West Midlands Regional Health Authority was largely responsible for estate administration and had no day-to-day jurisdiction over the hospital.

The national policy of "community care" brought about the wholesale closure of large-scale establishments for the mentally ill and the learning disabled from the mid-1980s onwards. The process began at St Margaret's in the late-1980s under WHA and was continued under WCHT - it was a slow and difficult process.

The male side of the hospital ("The Loop" close to Great Barr Hall) was entirely emptied by 1992 and services were concentrated on the female side ("The Horseshoe") in the final years. St Margaret's was formally closed in March 1997, although a small number of high-dependency residents remained on the estate until 2004.]

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In the last fifteen years there have been profound changes in the way the needs of the mentally handicapped are being met. The philosophy of 'community care', enthusiastically espoused by most professionals charged with the welfare of this group of special people, would have been anathema to workers in the field, legislators and most certainly the public at large, in the first half of this century. Accordingly, this essay attempts to show the development of St. Margaret's within a wide historical framework. It intentionally stops short at the late forties with the dawn of the National Health Service.

Earlier generations held their views with as much tenacity and conviction as we do our own. This brief history may convince some that today's philosophies, like those of the past, have to be viewed in their social context. They are current only as long as society wishes them to be so.

With the retirement of older employees, some with memories of the hospital spanning five decades, the chain of lore and tradition has been broken. This short history is therefore timely: a much more substantial document is in preparation.

INTRODUCTION

It is just a century since the first piece of legislation devoted exclusively to the mentally handicapped was enacted. The Idiots Act (1886), empowered local authorities to build institutions specifically for the 'care, education and training of idiots and imbeciles' [see Note 1], and guaranteed a capitation grant similar to that given for pauper lunatics. It was the first official recognition of the mentally handicapped as a distinct entity, with needs vastly different to those of the mentally ill, with whom they had been inextricably linked from time immemorial. The potential of the Act was never fully exploited: when superseded by the epochal Mental Deficiency Act twenty-five years later, only eight new institutions had been established in the whole of England and Wales.

Towards the close of the nineteenth century, a number of factors led to a growing interest in the affairs of the mentally handicapped. Compulsory education for all children was introduced by the Education Act (1870), and dull and backward children had become an inescapable educational problem. At the same time, new knowledge of heredity and the eugenic movement associated with Francis Galton gave rise to acute and, with hindsight, exaggerated fears of racial degeneration. Concern centered on the 'frightening fertility of the feeble-minded', a class of the mentally handicapped not so severely impaired as idiots and imbeciles, but numerically greater and requiring 'care, supervision, and control for their own protection or the protection of others'.

In the wake of this near hysteria, a Royal Commission on the Care and Control of the Feeble-Minded was appointed in 1904. They reviewed the evidence and carried out enquiries into the incidence of mental defect. The Royal Commission estimated there were nearly 150,000 mental defectives who had not been certified under the existing lunacy laws. Of these, just over a third were under Poor Law supervision in workhouses, cheek-by-jowl with the destitute but normal poor. Another third were receiving no care or supervision at all; and the remainder were either children at school or inmates in prisons, inebriate reformatories and similar institutions.

THE MOVE TO INSTITUTIONAL CARE

The Royal Commission seriously considered the social implications of mental deficiency- particularly with reference to drunkenness and illegitimacy. They came to the conclusion in their report (published 1908), that the provision of suitable institutions, especially for female mental defectives of child-bearing age, was an urgent necessity. The Royal Commission's main recommendations were accepted by the government of the day and embodied in the Mental Deficiency Act of 1913. In essence, the Act outlined the circumstances which rendered defectives 'subject to be dealt with' and prescribed a form of procedure for their committal to institutions. Local authorities were to provide these institutions and to appoint suitable officers whose duties were defined as 'supervision, protection and control'. They were also obliged to 'ascertain', certify and detain mental defectives in their area coming within the scope of the Act. Only 2163 defectives were in registered institutions under the Idiots Act when the new legislation came into being; by the zealous application of the considerable powers of the new Act, voluntary and official bodies had increased this figure to 17,642 by 1924.

When the Mental Deficiency Act was passed in 1913, it was confidently expected that local authorities would take up the duties laid upon them. It was anticipated there would be a gradual and steady provision of farm and industrial colonies and other homes suitable for the training and employment of mental defectives. Unfortunately, the spirit of the new legislation was partially thwarted by local authorities. Rather than face up to their new responsibilities, they made use of a clause in the Act which allowed application to the central body, the Board of Control, in order to gain approval for existing buildings or premises being used by local Poor Law Guardians. The Board were initially very reluctant for local authorities to delegate their responsibilities back to the Guardians in this retrograde manner, even though the legislation allowed it, but the outbreak of the First World War and the financial conditions arising therefrom made advance very slow and difficult and the Board were obliged to modify their views. Ten years after the Act came into being 169 local authorities had been allowed to delegate their responsibilities in this way, resulting in a third of all detained defectives remaining within the Poor Law system. The rest were cared for in a miscellaneous collection of institutions, hospitals and training colonies run by local authorities, philanthropic bodies, and the Board of Control itself.

Many joint ventures were entered into with the pooled resources of two or more proximate Poor Law Unions. But only three schemes were of sufficient size and sophistication to survive their Poor Law days: Prudhoe Hospital in Northumberland, nearby Monyhull Hospital and our own St. Margaret's Hospital.

POOR LAW ESTABLISHMENTS AND THE DISADVANTAGED

From Elizabethan times up until the passage of the Poor Law Amendment Act of 1834, provision for the poor was administered at parish level. Assistance was often meted out in a haphazard manner with considerable abuse both by relievers and relieved. The system had many critics. The new Act formed parishes into unions with their neighbours, abolished out-relief, and required those in need to surrender their liberty and enter purpose-built residential workhouses. Diet and conditions were standardized nationally by central government edict and rigidly applied at local level by elected Guardians of the Poor. It was envisaged that a Draconian regime would discourage the unemployed able-bodied, those mostly in receipt of relief, from pursuing a life of indolence on the local rates. By the early part of this century, very much against expectation, some 85% of persons receiving assistance were suffering from physical, mental or 'moral' disability. Poor Law institutions were increasingly becoming homes for the aged and infirm, abandoned and orphaned children, the mentally handicapped, the consumptive and other disadvantaged classes.

In 1905, a Royal Commission was appointed to enquire into the workings of the Poor Law system. Many far-reaching proposals were incorporated in their reports of 1909. In particular, the Royal Commission strongly favoured the removal of all children from workhouses. With the recommendations of the report in mind, Poor Law institutions throughout the land were inspired to seek ways of segregating the various classes according to individual needs.

THE GREAT BARR SCHEME

Around this time the West Bromwich Guardians were becoming increasingly concerned with the overcrowding in their infirmary, nursery and mental handicap departments. There was also a concomitant need for accommodation for consumptive patients in advanced stages of the disease. A committee was urgently set up under the Chairman, Mr A L Wells, to report on possible solutions to the Union's pressing problems.

The Great Barr Hall Estate came upon the market in 1909 on the death of Lady Bateman-Scott. Wells put forward a proposal that its purchase would enable the Guardians to fully carry out the suggestions embodied in the Royal Commission report. Approaches were made to the Scott Trustees to buy privately, but they refused to name a price. In October 1911, the major part of the Scott estates was advertised for sale by auction; a Lichfield estate agent acting for the Guardians was successful in buying the principal lot of 557 acres, comprising Great Barr Hall and Park (including Merrions Wood, all six lodges and Park Farm) for the sum of £28,000. Shortly after the purchase Park Farm, with its 110 acres of prime farming land, was sold to Wells for £3,700, a transaction which aroused much controversy. The land was converted to building use some forty years later and is now Park Farm Estate.

Considerable efforts were made in early years to sell off the Merrion's Wood portion of the Park, but no buyer was forthcoming. In the late 1940s, stewardship of the wood and associated land was placed in the hands of trustees to be administered as a public amenity.

It was noted by the West Bromwich Guardians that their colleagues in Walsall were also considering extra provisions for the poor. Lengthy discussions took place and some months after the acquisition of the estate, Walsall Guardians agreed to join the scheme and share capital costs. They later became the senior partner through changes in rateable value.

Months were spent repairing and redecorating Great Barr Hall, which had been sadly neglected during the final years of the Scott family's tenure. The formal order setting up a Joint Committee was issued by the Local Government Board in October 1912, in time for the official opening of the Hall for the reception of its first pauper residents.

The utmost priority was given to the removal of children from the nurseries in the two workhouses and the Hall quickly filled up its accommodation for 100 children and 20 mothers.

By this stage, plans for the estate were well advanced. It was envisaged that the Great Barr scheme would make provisions for certain priority classes, viz;
I 'Normal' children under the age of five years, 'and so long as advisable', their mothers also.
2 Consumptive patients, principally in the advanced stages.
3 'Mental defectives, imbeciles and epileptics'.
The intention was to build inexpensive small homes 'in such positions as to allow for each class being dealt with in an area distinct and separate from the others'.

The first purpose-built structure, completed in April 1914, was old Darby Home, a wooden fabrication on the French Garden site behind the Hall. It was carefully designed to incorporate the old summerhouse, which, because of its important associations with Great Barr Hall, was allowed to survive the recent demolition of the old ward. Facing south, and in an elevated and isolated position, it was ideally suited for its intended use as accommodation for refractory tuberculosis patients from the workhouse infirmaries of the constituent Unions. Sunshine and lots of fresh air was then the only treatment for this killer of the masses. Shortly afterwards, provisions for the consumptive poor were made the sole responsibility of local councils, and the building was converted for use as an annexe to the children's home at the Hall. It later served as staff accommodation and more recently as administrative offices.

Plans for constructing a self-contained six-villa children's home near the Chapel Lane entrance to the estate occupied the minds of the Guardians in the early 1920s, but the scheme, although well advanced, came to nothing. Sanders Home (now demolished), offering accommodation for children under the age of five years, was opened in April 1926, and appears to have been the only fruit of their considerable labours. The small children's unit, run on hospital lines, remained until 1932, when public concern over the co-existence of normal children within an ever-growing colony of 'mental defectives', brought about its closure.

THE EVOLUTION OF THE COLONY

Provisions for the mentally handicapped, adumbrated in the Guardian's early plans, outstripped other considerations. In 1932, shortly after the Poor Law system was disbanded, the whole of the estate had been taken over exclusively as a 'training colony' for the mentally handicapped.

The accommodation for 'mental defectives, imbeciles and epileptics' grew up on the site which now principally houses the female residents of the hospital. A Birmingham architect, Gerald McMichael, was instructed to prepare plans for the accommodation of 300 patients and the necessary administrative buildings. The Local Government Board initially approved four homes for 225 patients (45 men, 40 women, 70 boys, 70 girls), and work commenced in 1913. Before details of the remainder of the scheme could be settled, the First World War broke out. National energies were diverted elsewhere and the first two homes, for men and boys (Prince Edward Home and Wells Home), were not ready to receive their first residents until the first week in 1918. Lavender and James Home, for women and girls, remained unfinished until well into 1921. [Note that Lavender Home and Edward Home swapped names a few years ago].

The considerable cost of the scheme was partially eased by entering into formal agreements with local authorities and Poor Law Unions without adequate facilities of their own. The Joint Committee administering Great Barr Colony contracted to take a number of defectives, on agreed terms, for a fixed period of 21 years. Birmingham City Council was the first to negotiate such an agreement, and from August 1920 they had the facility for the reception and maintenance of up to 100 defectives, as and when the need arose. The pursuit of such a policy leaves its mark to this day. The current emphasis on community care has led to the repatriation of many long-stay residents to home towns with which they no longer have any affiliation.

It was a rule of the colony that defectives of substantially the same mental capacity should be kept by themselves and not inter-mixed with others of a lower or higher grade. Admission was strictly limited to trainable cases: potential admissions were carefully vetted. Indeed, each agreement contained a clause specifically excluding 'dangerous criminals or defectives who were bed-ridden or whose infirmities rendered them incapable of being employed or trained at an industrial colony.' Contracting bodies were asked to remove any defectives who became a burden through physical or mental incapacity.

THE PHILOSOPHY OF MENTAL DEFICIENCY COLONIES

The day-to-day workings of a training colony for mental defectives are nowadays much of a mystery. One of the few in-depth statements of the philosophy behind such institutions can be found in a contemporary article by the Resident Medical Superintendent of nearby Monyhull Colony. This joint Poor Law scheme was established a decade before the Great Barr Scheme came into being [see Note 2].

As far as Monyhull's supremo was concerned, the objects of treating mental defectives in closed institutions were:
'(1) To correct their anti-social conduct.
(2) To develop their self-respect and ensure their happiness.
(3) To teach them various kinds of work for which they are best fitted by reason of their mental and physical condition, and to recover from them some contribution, however small, towards the cost of their maintenance. To lead up to discharge if possible.
(4) To prevent the procreation of children, and so to stop the handing on of the blight to successive generations'.

It was the considered opinion of Dr McCutcheon that the objects were best achieved by:
'...segregation in institutions, preferably of the colony type, whereas sterilization, which is advocated by some, solves only one of the objects, namely, that of preventing procreation of children. It certainly does not tackle the conduct aspect, nor the work aspect, and it is surprising the number of defectives that one finds trying to carry on jobs with very indifferent success. These are the people who drift about from place to place, unable to hold a position for any length of time, and this surely constitutes a distinct menace to our industrial position in the world'.

There is every reason to believe his forthright views would have met with the approbation of counterparts in similar establishments throughout the land.

EXTENSIONS TO THE COLONY

The rigorous implementation of the Mental Deficiency Act led to the certification of large numbers of defectives, who thereby became the responsibility of local authorities. In January 1924, the Mental Deficiency Committee of Walsall Town Council asked the Joint Committee to take low-grade as well as high-grade defectives, in order to relieve the overload.

To accede to the request would require the erection of additional buildings. A conference of interested parties was duly convened later in the year to discuss the matter. It was agreed that further accommodation was urgently needed and that the Joint Committee should at once take the necessary steps for 'extending the colony buildings. McMichael was again consulted and plans were furnished for an additional 342 beds together with ancillary buildings. The new construction, ranged around the original four villas in a pleasing horse-shoe shape, provided matched accommodation for males and females.

The new enterprise was promptly commissioned and up and running by September 1929. So many urgent requests for admissions to the colony were received, that a clause was inserted in the building contract allowing new homes to be handed over as and when completed. In deference to the Joint Committee, made up of Walsall and West Bromwich Guardians, each of the new buildings was named after a member.

The carefully structured regime of the inter-war years required colonists who had previously been largely maintained by the public, without any economic return, to make a material contribution to their own upkeep. Men were employed on the land (derelict farm buildings close to Sutton's Drive bridge are a legacy from this period), in shoemaking, tailoring, carpentry, engineering and painting. The women were engaged on domestic work, sewing, laundry work, etc. Workshops were erected by the colonists and the greater part of the furniture, clothing and bed linen for the new buildings was manufactured on site.

Following enactment of the Local Government Act (1929), which brought the Poor Law system to an end, the colony was vested by the Minister of Health in the Councils of the County Boroughs of Walsall and West Bromwich. As from I April 1930, a Joint Board managed the colony until brought within the National Health Service in July 1948. Shortly afterwards it was renamed St. Margaret's Hospital.

In response to a continuing need for more beds, a further eleven homes, in a 'dignified phase of Georgian architecture', were erected on a site which is now the male side of the hospital. The extensions also comprised new workshops for men, and additions to the Hailey Nurses' Home and colony school. The new buildings, formally opened in May 1938 by the Earl of Harrowby, increased accommodation to 1355 beds. At this point it became the largest such establishment in central England.

A considerable amount of work was done by the colonists themselves under the direction of the Clerk of Works. This included the making of thousands of concrete blocks, the very extensive rough excavations entailed in the construction of new roads, underground ducts, levelling of ground and formation of terraces, and the garden lay-out for all the homes.

Because of its facilities and the enlightened approach of the staff, the colony was recognised at this time as one of the finest in the country.

THE WAR YEARS

Life at Great Barr Colony was severely disrupted by the outbreak of the Second World War. Many of the staff were drafted into the Forces and those remaining were further burdened by the additional responsibility of providing an Emergency Medical Scheme hospital of 350 beds from existing facilities. During the early years of the war the EMS hospital, centred on Williams Home and surrounding buildings, required 54 staff to deal with the many civilian evacuees, air-raid victims and military casualties. Many of the services were provided by the colony personnel who relished the opportunity to contribute towards the war effort. During the six years of its existence, 3130 civilian and military patients received treatment at the hospital for a wide variety of surgical and medical conditions.

The colony experienced air-raids at first hand on at least two occasions. In March 1941, a high explosive bomb was dropped in the top part of High Wood close to the male homes. There was slight blast damage but no serious casualties. The worst raid was on the night of 30th July, 1942, when large numbers of incendiary and explosive bombs rained down on the colony, particularly around the Woodward and Radcliffe Homes. One inmate died and four others received shrapnel wounds.

Despite severe privation, the recreation, education and employment of colonists was carried on 'comparatively well' during wartime, with regular dances, fortnightly cinema shows, the traditional annual sports day and Christmas & New Year festivities.

In response to the national call to 'Dig for Victory' a total of 112 acres were turned over to agriculture. It was a successful venture and the colony was nearly self-sufficient in many commodities. Farming activities were carried on into peace-time: in 1947, the Medical Superintendent could report that 18,442 lb of pork, 1077 lb of offal and 1576 lb of lamb and mutton had been produced for colony use. Enough potatoes had been grown for the whole year, and there had been a sizeable crop of wheat, oats and barley. There were still sheep, poultry, goats and 137 pigs in January 1950.

RECENT DEVELOPMENTS

No further major building construction took place on the estate until the late 1970s. Recent additions, all on the female side of the Hospital, include a well appointed activity centre and four imaginatively designed Mental Handicap Units (MHU's) offering a system of small group living in a 'home' environment. Long-term plans are to reduce the number of residents considerably, and to develop a base-hospital offering specialist services to the community.

It is worthy of comment that all developments on the hospital site have taken careful account of the historical importance of the area. As a result unnecessary sprawl has been avoided and large areas of the original Scott family estate remain much as they were centuries ago.

The unspoilt nature of the lakes and their environs has been widely recognized. This area is now managed by Staffordshire Nature Conservation Trust who preserve and enhance this outstanding natural history asset.

NOTES
1 The history of mental handicap is littered with changes in nomenclature. The terms used in this brief history are those in common use until the passage of the Mental Health Act of 1959, which superseded the old Mental Deficiency Act, Unhappily, many of the terms are now used wholly in a pejorative sense.
2 McCutcheon-A.M, Institutional Treatment of Mental Defectives, with Special Reference to Occupation, J. Mental Science, Vol 71 (Oct 1925), 694-70.

SOURCES
1 Parliamentary Reports, particularly Board of Control Annual Reports.
2 A large deposit of 340 items relating to Great Barr Colony is housed at the Local History Centre in Walsall. It comprises nearly 160 minute books of the early committees, covering the whole period from 1912 until 1948. There are also a considerable number of files, medical superintendent's reports, insurance policies, contracts, agreements, etc. The Centre also possesses a bound collection of Annual Reports and Abstracts of Accounts covering the years 1937-45. Walsall and West Bromwich newspapers are another very rich source of information.
3 The author has an extensive collection of photographs, post-cards, maps, souvenir pamphlets and ephemera, which complements the above archive deposit.

© Peter Allen, 1987 [Last revision October 1987]