A mysterious diagnosis in 1920…

By Dr Claire Hilton, Historian in Residence at the RCPsych.

As Historian in Residence at the RCPsych, I sometimes receive queries from script writers of dramas and documentaries which have forensic psychiatry themes. This aspect of psychiatry attracts public imagination and may make good drama, but it needs to be tackled sensitively and be historically accurate (as judged by medical knowledge of the era it is meant to portray). The tendency for too much sensationalism and drama risks mis-informing today’s audience and doing a dis-service to our patients.

In the 1920s, poisons, potions and strange states of mind caught public attention and inspired Agatha Christie to write her crime novels. One real-life scenario which inspired Agatha Christie was that of Herbert and Katherine Armstrong, a solicitor and his wife, in Hay-on-Wye in Wales. The whole story features in a recent Amazon Audible podcast Agatha Christie and the Dandelion Poisoner. This blog is a supplement to the podcast, and focusses on only a small part of the story: Katherine’s admission to a mental hospital. The hospital’s archives, including clinical records, are preserved at Gloucestershire Heritage Hub. I have drawn on them extensively for this blog, and I’m grateful to Barnwood Trust for permission to reproduce images from them.

Katherine Armstrong and her admission to Barnwood House Hospital, Gloucester,

Katherine had found the war stressful. Herbert was away from home, although he remained in England. She was in the “habit of worrying over trifles”, had been nervous and “excitable” for some months, and her general practitioner had treated her for “neuritis”. However, her physical and mental condition deteriorated suddenly in mid-August 1920. On 22 August, under the Lunacy Act 1890, she was certified as “a person of unsound mind, and a proper person to be taken charge of and detained under care and treatment”. The two medical recommendations for her admission suggested that she was psychotically depressed, suffering from delusions that “she was a disgrace to her family….has wrecked her husband’s life…had been a bad mother to her children.”

It was decided to admit her to Barnwood House Hospital, Gloucester, a reputable, recently built, private mental hospital. It charged 6 guineas (£6.30p) a week, a hefty fee, but within the means of a well-to-do solicitor, although a sum far out of reach for a working-class person at a time when, for comparison, a staff nurse at Barnwood House was paid around £40 a year.

Gloucestershire XXXIII.4 Ordnance Survey,25in, 1923. National Library of Scotland, Re-use: CC-BY-NC-SA

The journey from Hay-on-Wye to Gloucester took about three hours on country roads with a speed limit of 20mph. Sitting between her husband and her GP in the back of a hired car, Katherine vomited intermittently. She arrived at Barnwood exhausted.

On admission, the staff followed the strict protocol set out in the hospital’s General Regulations:

“Each patient shall be undressed and bathed immediately…,in the presence of the Head Nurse,…and the attention of the Medical Superintendent shall be at once drawn in writing to any mark, bruise, or other injury or peculiarity….This opportunity shall be taken to search the patient's clothing and luggage for dangerous or valuable articles,…a list of them shall be entered in the Head Nurse's report book, and they shall be handed for safe custody to the Medical Superintendent.”² Katherine’s signature below the list of the valuables she handed in was very shaky and smudged. It was more suggestive of someone very sick or very feeble than a literate middle-aged, middle-class woman.

D3725/Box 1/4 Patients' property book D3725/Box 1.4. (Courtesy of Barnwood Trust)

Herbert informed the doctors that Katherine had told him that “she would have to leave town because a warrant was out for her arrest”. Despite the content of her delusions, her mental state was not quite typical of severe depressive illness: if she had a depressive illness, she would probably have regarded her punishment as deserved, rather than wanting to escape it. A couple of days after admission, Medical Superintendent Dr Arthur Townsend, queried her diagnosis: “she is very confused and restless, talks to herself in a rambling way. Her replies to questions are disconnected and irrelevant…she is in poor bodily health….Her heart is feeble and she has albuminuria”. Likewise the junior doctor, Janet Smith, seemed mystified and wrote:

D3725/1/5/6 Case books, females (indexed); D3725/Box 123/2 vol 16, 1920-25 (Courtesy of Barnwood Trust)

“On admission she was found to be suffering from _________________”

The gap for the mysterious diagnosis, plus a note that her pulse was 120 and temperature 100^o, and the absence of psychotic features at that time, suggests that perhaps she was physically ill and had a fluctuating delirium.

Over the next couple of weeks, Katherine’s appetite began to improve, but she had some strange neurological symptoms, “loss of power in hands and feet with wasting of muscles. Fingers of both hands are hyper extended and flexion is difficult.” She had pain in her calves, her reflexes disappeared, and she was unable to walk. Her condition was attributed to “neuritis”, but her mood remained low, and she had episodes of agitation.

Barnwood had no laboratory facilities or X-ray equipment so diagnosis was entirely based on clinical observations and examinations. Tonics (which contained iron, arsenic and strychnine), sedatives (paraldehyde or a barbiturate), and cascara for constipation were given. Some neurological recovery in early November was attributed to “massage and passive movements having in part restored her wasted muscles.” By December she began to walk unaided and was regaining use of her hands. On 22 January 1921 she was discharged “upon the authority of her husband….very much better though still worrying about her past life.” For a private patient, the person paying the fees, in this case her husband, could authorise discharge.

A month later, at home, following a recurrence of her symptoms, she died.

Later that year, it became apparent that Herbert had an interest in using arsenic (not just to kill the dandelions in his garden) and her body was exhumed: it contained large quantities of arsenic, which could not be accounted for by small doses contained in medications, such as those used for fevers and as tonics. Herbert was hanged for her murder on 30 May 1922 at Gloucester Prison.

Was arsenic poisoning the cause of her initial clinical presentation, recurrence of symptoms and death?

Gloucester Prison, 2022