I recently visited the semi-derelict Horton Chapel, pictured here. Built in 1901 to serve Horton Asylum in Epsom, the chapel has been locked since the hospital closed in the 1990s, so this was a rare glimpse inside. A striking First World War memorial frames the altar, constructed to honour the dead and to mark Horton’s period as a first world war military hospital. As I read the names, I reflected on the poignancy of this memorial that nobody sees.
Horton Asylum’s original patients were moved in 1915 to accommodate the military hospital, and were among the many people with a mental illness who indirectly suffered the consequences of war. This post considers their experiences.
‘The wounded soldier’ said Sir Alfred Keough, Director General of the Army Medical Service, ‘has to have the best doctoring, the best nursing and the best treatment that exists in the country’. He was addressing Dr J.R. Lord, who listened closely. It was March 1915 and the army urgently needed facilities for wounded servicemen. Lord, the Medical Superintendent of Horton Asylum, was being given orders to transform his large institution, with its roots in Victorian notions of the treatment of ‘lunacy’, into a modern war hospital.
In his book about Horton War Hospital, published in 1920, Lord describes how he went on to command the military facility with impressive energy and efficiency. First, though, he had to move his existing patients; people drawn from the poorest parts of London and considered too ill – and in many cases too vulnerable – to live in society.
‘Patient removals’: leaving Horton
The asylum was emptied with astounding speed. Over two thousand patients were moved to other asylums between 12 March and 8 April 1915. Lord’s account suggests they were given little more consideration than their meagre luggage – the mass transfer of people, which must have caused some patients great distress, is even termed ‘removals’ as though they were so many pieces of furniture. They were provided with a change of clothes only ‘where possible’.
Reading this seems shocking to modern sensibilities, but Lord was presenting the realities of his time. Most of Horton’s inhabitants were very poor, with few possessions of their own, so as Ruth Valentine explains in her book about Horton, clothing was provided as needed by the asylum. Dr Henry R. Rollin, later Deputy Medical Superintendant of Horton, viewed this period as one of limited resources and inadequate conditions. As for his tone, Lord was writing for his medical contemporaries, who might have expected professional detachment to the point of indifference. As commander of a war hospital he reported to the War Office, so unsurprisingly the language of military logistics coloured his writing. There is, thankfully, a hint of empathy; the location of family and friends was considered when patients were moved, so perhaps there were other, everyday acts of kindness that Lord didn’t think were worth recording. For the most part, though, his account reflects the position of people with mental illness – at the bottom of society.
Where did the patients go?
Between 25 March and 7 April 1915, 120 female patients from Horton were admitted to the Manor Asylum, Epsom. It was a short stay. In mid-July 1916 the Manor itself was offered to the War Office as a military hospital, and by 11 August, more than a thousand patients had been ‘distributed’ between the other London County Council (LCC) asylums which ringed London, many of which were already overcrowded and struggling to retain staff. Nearby Long Grove Asylum received 120 patients from Horton, but records of the total number of extra patients admitted from other asylums are missing. National figures indicate there was 17% overcrowding in asylums, which makes the doubling of Long Grove’s death rate in 1917 and 1918 look disproportionately high.
‘The high death rate prevailing in those years’
Sadly the loss of life at Long Grove wasn’t unique. On 1 January 1915 the LCC asylums had a population of 21,539 pauper patients. By 1919 there were 17,226. With a bureaucratic shrug of the shoulders the Council’s official report laid the blame on ‘the high death rate prevailing during those years’. Nationally, asylum death rates rose sharply from 11% before 1914 to over 20% during the war years. As J.L. Crammer has shown, the combined effects of overcrowding, understaffing, poor food and tuberculosis (TB) were probably to blame. During the war patients in asylums were disproportionately affected by a reduced diet compared to the general population, and the unavoidably close proximity to others probably contributed to the spread of TB. At a time of national crisis it seems people suffering from mental illness weren’t anyone’s priority.
Under Lord’s management over 44,000 servicemen were treated at Horton War Hospital. He went on to enjoy an illustrious career, eventually becoming President of the Medico-Pychological Association. When Horton re-opened in 1920 it became Horton Mental Hospital, reflecting the aspirations of a more modern approach to the treatment of mental illness.
Dr Lord used the proceeds of his book to fund the memorial in the chapel to its ‘great and noble purpose’ as a war hospital, and to the staff who died in the war, so future generations would not forget. At the time the future of the mental hospital system must have looked as solid as the building itself. Less than a century on, the chapel has been abandoned and the memorial itself is rarely seen. A group of us, residents of Epsom and Ewell, are hoping to open the chapel to community use as an arts centre, with a permanent exhibition about the cluster. We plan to restore the chapel, and the war memorial, to its former glory; and we also need to tell the story of the Great War’s asylum patients and their forgotten sacrifice.
With thanks to staff at Surrey History Centre (SHC) and the London Metropolitan Archives (LMA), and to David Gulland for his photos of Horton Chapel.