‘Unlocking the Asylum’ project- Patient Files

March 18, 2019

As Project Support Officer for the ‘Unlocking the Asylum’ project, a large part of my work involves the listing and repackaging of approximately 23,000 patient files. These files begin in 1948 (when the NHS was formed), up to the closure of the North Wales Hospital in 1995.

Repackaging

Before a patient file is repackaged, all metal fastenings (treasury tags, pins, staples, paper clips, rubber bands etc.) are removed, and replaced with brass paper clips and plastic treasury tags. Metal fastenings can cause irreversible damage to the files, their removal will prevent future damage. Each file is kept in its original order, however depending on the length of stay and treatment a patient received, a file can be as small as one piece of paper, to a file that can fill 2 boxes. Each individual file is repackaged in archival folders, tied and safely stored in archival boxes.

Listing

Information extracted from the files are listed on a database, detailing the patient number, patient name, date of birth, admission and discharge/death date. The diagnosis (if given) is also listed, along with any additional details such as treatment given, outpatient information, psychiatric social work notes, number of admissions, referral information, notes/poetry/sketches made by the patient and psychiatric reports for court proceedings.

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As the development of medicine progresses quickly during the mid-20th century, there is reference to a wide range of treatments within the files; for instance Insulin Coma treatment, Electro Convulsive Therapy, Leucotomy, Malarial treatment, Aversion therapy, Psychotherapy, and the use of early Anti-depressants such as Largactil and Tofranil are all well documented.

The first Annual Reports of the hospital (1850-1860), list only five ‘forms of disease in all cases admitted’- mania, epilepsy, dementia, melancholia and idiot. In comparison, the database (so far) has over 800 different diagnoses, ranging from acute alcoholism to Wernicke’s encephalopathy. Long term patients’ diagnosis’s also evolved, one example is of a patient admitted in 1949 with Manic depressive psychosis, who was discharged from the hospital 45 years later in 1994, with a diagnosis of Bipolar disorder.

Metal Fastenings removed from patient files during February 2019

Metal Fastenings removed from patient files during February 2019

The most common and most frequent treatment used during the 1950s to the 1970s, was ECT (Electroconvulsive therapy), however its reputation made many people consider it more of a punishment than a treatment. Despite this, it is evident from listing the patient files, that ECT was still used at the hospital up until its closure in 1995. ECT is in fact a therapy that is still used today, psychiatrists and patients still consider it to be a safe and effective treatment for severe depression and bipolar disorder. Current practice, known as modified ECT, uses muscle relaxants to avoid the physical dangers of a seizure and anaesthesia to avoid pain from the electricity.

As a result of the Abortion Act of 1968, there is a marked increase of patient files containing referral for psychiatric assessment in the late 60’s early 70’s. It was now possible to obtain an abortion under the NHS if a psychiatrist was prepared to sign a recommendation that proceeding with the pregnancy could damage the patient’s mental health.

In addition during this time, Psychiatrists were required to produce reports for the justice system, with needs to respond to probation officers and legal officers in providing evidence for court reports. However psychiatric reports were not only needed for criminal cases, but also for divorce proceedings, Court of Protection applications and claims for industrial injury and road collisions, as the compensation industry was established and was rapidly expanding.

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Of the 22,800 files listed 8,015 were outpatients or referred to outpatients upon their discharge from the hospital. The work of the outpatient clinics expanded rapidly in the immediate post war years, in 1947 the medical superintendent said he regarded the outpatient clinics as the most fundamental service provided by the hospital. By the end of the 1950’s the hospital ran outpatient sessions in Rhyl, Bangor, Wrexham and Dolgellau. Several of the files include notes by the psychiatric social worker, who supported the outpatient clinics by spending time investigating the home environment of patients. The social worker evidently had a valuable role to play in the after care of the patient, ensuring a smooth re-entrance into family, occupational and community life.

Very notably during the late 70’s into the early 80’s that there is a sharp spike in those admitted for drug addiction and alcoholism. The admission of a growing number of patients with drug related problems had implications on hospital management. The needs of these patients were very different, some of them, usually quite young, could be disruptive, particularly to the already established routines on the wards. By the late 80’s so high was the demand for rehabilitation, the hospital had its own drug and alcohol unit for treatment and recovery of patients diagnosed with addiction.

These files clearly contain a wealth of information, and there is so much more to be discovered in relation to medical advances and social trends in the mid to late 20th century. Please note that due to NHS regulations records of patients containing sensitive personal information are closed to the public for 100 years. These records may be available to researchers who belong to an academic institution upon request. If you are interested in using the North Wales Hospital collection for academic research please contact us.

Rhian Evans- Project Support Officer ‘Unlocking the Asylum’

In Memory Of Seven Children of H & G Evans, Cae Nant

February 26, 2019
Gravestone

Photo Copyright: C. M. Brennan (2018)

The photo above is of a gravestone in the churchyard of the old church at Llanbedr Dyffryn Clwyd. The inscription reads:

In Memory
Of
Seven Children of
H & G Evans. Cae Nant
Viz Jno. Eza. Ema. Ane. Gce. Eth. Ema.

Who were these children? Who were their parents? Did they all die at the same time?

The parish registers for Llanbedr DC were a great help in answering these questions. I found baptisms for seven children born to Hugh and Grace Evans who lived first at Pen y Ffrith and later at Cae Nant: Eliza, Emma, Margaret, Anne, Grace, Elizabeth and another Emma (it was common to reuse names of children who died in infancy). The children were baptised between 1814 and 1830. The records also record that Hugh Evans was the gamekeeper at Llanbedr Hall. Cae Nant, where they lived, was a cottage on the Llanbedr Hall estate located in the woods on the flanks of Moel Famau and an appropriate spot for a gamekeeper to live.

The initials on the gravestone mostly match up with the names on the baptism registers but the baptism records are missing “Jno” and the gravestone is missing an “M” for Margaret. The burial registers for Llanbedr show that “Jno” was Hugh and Grace’s first-born child, John, who died in March 1813 at the age of just one week. Four of the children (Elizabeth, Emma, Anne and Grace) died and were buried in the space of one week in the winter of 1827. They were aged between 2 and 11 years old. As the children died before civil registration of births, marriages and deaths began in 1837, we cannot know for certain what killed the children, but it seems most likely that they died of an infectious disease.

Hugh and Grace were left with just two children at this point, Eliza and Margaret, and they had one final child – the second Emma – in 1830. Further tragedy befell them, though, as Eliza, having reached the age of 18, died in 1835 and the second Emma died, aged 10, and was buried on Christmas Day, 1840.

Tragically, then, Hugh and Grace Evans had outlived seven of their eight children, only Margaret survived into adulthood. Even in an age of high infant mortality this was unusual.

Parish Register Entry

Extract from Llanbedr parish register held by Denbighshire Archives (PD/44/1/5)

In 1846, at the age of 27, Margaret married Joseph Williams, a wheelwright from Llanynys at the church in Llanbedr where her siblings were buried. They appear to have emigrated to Canada at some point during the 1850’s (possibly in pursuit of a healthier environment and more prosperous future for their children to grow up in).

Church

Photo Copyright: C. M. Brennan (2018)

 

Hugh Evans eventually died in Llanrhydd Almhouses in Ruthin in 1870 at the age of 81. The almshouses no longer exist but were located on Llanrhydd Road near what is now the entrance to the Ruthin Community hospital. Appropriately enough, the almshouses had been set up by Joseph Ablett, owner of Llanbedr Hall and Hugh’s employer for many years, for the benefit of “the poor equally of Llanbedr, Llanrhydd and Llanfair” in 1840.

Elisabeth Parfitt