Mental hospital modernisation: train waggons and a salutary story

By Dr Claire Hilton, Honorary Archivist at the RCPsych.

Mental health facilities in the NHS today could not do without their mains water, flush toilets, electricity via the national grid, and piped gas supplies. A century ago, not all mental hospitals had them. Prestwich Mental Hospital in Lancashire, with over 2,000 patients, was the last of the county mental hospitals to rely on ‘earth closets’, only replacing them with ‘water closet’ flush toilets in the 1920s.

Around the same time, some hospitals installed wiring for mains electricity. Electric lighting was a much-appreciated modernisation. Its benefits for inpatients included making evening activities, such as reading, much easier. For the nurses, it was a blessing, as they no longer had the time-consuming task of manually lighting and extinguishing each gaslight whenever it was used. Instead, they could light their ward by flicking a few switches. These improvements should not be under-estimated: they were enormous financial and logistical undertakings, especially in the larger and rurally situated hospitals.

Before mains supplies

Before mains supplies were available, mental hospitals had coal fires for heating, and they produced some gas and electricity in their own generating plants. A vast amount of coal was necessary, which was delivered, by lorry, train, or canal, or a combination of all three.

Napsbury Mental Hospital (NMH) in Hertfordshire, was one institution which received its coal deliveries by train. It had its own single-track railway, which linked the Midland Main Line directly into ‘Napsbury siding’ at the centre of the hospital. 

London North-West, one inch to the mile Ordnance Survey map 1958 available from National Library of Scotland (Creative Commons Attribution (CC-BY) licence)

The hospital also owned at least one waggon to deliver coal and other heavy supplies, such as building materials. ‘N.M.H.’ was painted on its side in large letters, and, in smaller letters, the words ‘NAPSBURY MENTAL HOSPITAL (MANAGEMENT COMMITTEE)’. It was also marked ‘Load 10 Tons’, and displayed the formula 6-0-0, meaning an empty weight of 6 tons, 0 hundredweight and 0 quarters of a hundredweight. That information meant that a loaded waggon, on arrival at its destination, could be rolled onto a weighbridge prior to unloading, to check that the coal merchant or coal mine had not overcharged the purchaser.

Much to my surprise, when I googled ‘Napsbury Hospital railway siding’, it took me to a replica, ‘OO’ gauge, 1:76 scale model. This month it is displayed in the Cabinet of Curiosities in the foyer of the RCPsych HQ. 

Seven-plank mineral waggon belonging to Napsbury Mental Hospital. Model manufactured by Oxford Diecast Ltd. Photograph by author.

Then and now and Dr Black’s salutary tale

The ‘deinstitutionalisation’ ideology from the 1960s onwards was associated with closure of the large mental hospitals. Many have been repurposed and often renamed. Surviving former Napsbury hospital buildings and much new-build has been restyled as ‘Napsbury Park’. A road called Siding Way has replaced the railway track.

We often hear of patients in the large institutions being ‘institutionalised’, but there were other hazards too. Fire was one, and at Napsbury, the siding was another. Dr Dora Black (1932-2021), a resident doctor there in the late-1950s, mentioned it at the RCPsych (2019) witness seminar about the mental hospitals. Dr Black said:

I want to tell you about just a few patients … The one that perhaps I remember the most, because it’s been on my conscience for the whole of my career, was a seventeen-year-old epileptic girl. I don’t know why she was in hospital; I think it was mainly her epilepsy as far as I know. And she asked for permission to be allowed to go out into the grounds and she’d been very stable and I didn’t see any reason why I shouldn’t give her permission and I did. But there was a railway that ran on the north border of Napsbury Hospital. It was a siding that brought goods into Napsbury, you know food and whatever, for the patients. And she was found dead on that railway track. She was seventeen years old. And nobody was sure whether she’d deliberately gone and killed herself or whether she’d had an epileptic fit perhaps when she was near the railway. And it was never really sorted out. I never really knew what happened. And I always wondered if I should have given her permission to go out. And you know I’ve remembered it for how many years? Seventy years, something like that, sixty years.

It is a salutary tale, with an important message: suicide is a tragedy for the individual and emotionally traumatic for the bereaved family and friends, and for the staff trying to help their patient. It is not something that one shakes off. As Dr Black said, the ‘what if I’d done something different?’ question can remain for a lifetime.

The Oxford University Centre for Suicide Research, has published a booklet: If a patient dies by suicide: A resource for mental health professionals (PDF). Do look at it, and the waggon.