Records of Fulbourn Hospital (formerly Fulbourn Asylum)

This collection contains the core records of Fulbourn Hospital from its inception in 1848 to the early NHS period of the 1950s. Governance, financial and patient records survive largely intact from the first one hundred years with the exception of early medical case notes lost in a fire in 1945. Records generated from the mid to late 1950s onwards are less comprehensive with many original records remaining with the Cambridgeshire and Peterborough NHS Foundation Trust. The physical format of the collection ranges from volumes and files to plans and photographs.

Fulbourn Hospital (originally called the County Pauper Lunatic Asylum for Cambridgeshire, the Isle of Ely and the Borough of Cambridge) opened in 1858 in an environment of optimism that mental distress could be cured with the right environment and treatment. The Lunacy Act and County Asylum Acts of 1845 between them defined those experiencing mental ill health as patients, established the Lunacy Commission, and made it mandatory for local authorities to establish Asylums for the mentally ill poor, who were increasingly incarcerated in work houses or prisons.

In 1848 there was agreement between the Justices of the County of Cambridge, Isle of Ely and Borough of Cambridge (who became known as the Three Bodies) to establish a pauper lunatic asylum. A committee was created composed of representatives of the Three Bodies, known as the Committee of Visitors. They acquired a site near the village of Fulbourn in 1850, but balked at the costs of construction, and spent some time searching for other solutions, including a merger with Bedford Asylum. This failed, and construction Fulbourn Asylum began in 1856. It would become an impressive building, its two wings containing two wards each, with men in the west and women in the east, as well as day rooms, and rooms for attendants in the attics. In the centre were the board rooms and the home of the Medical Superintendent. Behind this was the hospital chapel and a sixty-foot water tower. The legal requirement that the Committee of Visitors produce and publish an annual report, of which Cambridgeshire Archives has a complete record, gives us an insight into the Asylum since its beginning, particularly important as a fire in 1945 destroyed all the medical case papers of patients who were admitted before 1907.

When the Asylum opened in 1858, one hundred and six Cambridgeshire patients were admitted from other institutions, along with twelve new cases. The Medical Superintendent, Dr Bryan, noted improvement in the physical health of long term, chronically ill patients occurred within a few months of their arrival, and two such patients were discharged from the hospital entirely in the first year. The Commissioners' report for 1859 was positive, and noted "Non-restraint is the rule of the establishment." This was in keeping with the humanitarian ethos that had led to the establishment of the Asylums. The patients themselves constructed a bowling green and cultivated the land - Fulbourn would have a working farm for much of its history, providing work for the patients and produce for the Asylum. There was entertainment in the form of cricket matches, country dances, and walks both within and outside the grounds. In the evening there was access to books, games of cards and bagatelle, and music and dancing. Dr Bryan was succeeded as Medical Superintendent by Dr Lawrence who continued to create improvements, establishing a school for male patients to learn to read, and a library. A positive contemporary account was given in 1862 by Dr Lockhart Robertson in a lecture, and reported in the Journal of Mental Science:

"Neither belt, straight-jacket, manacle, strong chair or any other means whatever for restraining the patient, are to be found there. All appearance of a prison has also been removed. The windows have no bars, the doors no bolts, the entrance hall stands open."

Coercion and restraint had been rejected as appropriate means to treat those suffering mental ill health, but not long after this, conditions declined in the hospital. And already Asylums looked to ways to generate income. In the same year as Fulbourn opened, the Medical Act was passed, enforcing two years of human anatomy study for doctors before they could gain a licence for general practice. This drove the demand for human bodies for medical dissection, and previously the 1832 Anatomy Act had established that if the poor could not find the money to bury their loved ones in six weeks, the bodies could be used for dissection. Asylums became major sources of bodies for medical schools, and the Anatomy Department at Downing College established an agreement with the Board of Governors of Fulbourn to supply them with bodies. Asylums used this as income to defray costs. Fulbourn sold the bodies of the impoverished mentally ill up to six at a time. In 1861 James Merry and Sarah King, both thirty years old when they died at Fulbourn, were dissected before being buried together in a communal grave at Mill Road Cemetery in Cambridge. Dr Lawrence's own mental health declined. He suffered from Paralysis of the Insane, later known to be caused by syphilis. He was dismissed and replaced by Dr Bacon. Highly respected, he continued improvements, personally paying for the decoration of the recreation room at Fulbourn for Christmas in 1869.

But from 1870 the Asylum was full, and then became overcrowded, affecting the health of the patients and the running of the Asylum. Contagious disease spread, with patients and staff dying from conditions such as erysipelas, diarrhea and typhoid. In 1878 the Commissioners reported, "The high rate of mortality and recurrence of erysipelas and diarrhea point to a defective sanitary condition, which we think results from the present overcrowding of the Asylum." The Committee reported problems with the building, that it was "constructed in a very insubstantial manner which has been, and still continues to be, a source of great expense."

The deterioration in conditions came with a change in public attitude towards those experiencing mental ill health, who were increasingly seen as a financial burden on society. Commissioner's reports criticised the lack of staff, the low wages that made it difficult to attract good staff, the lack of recreational facilities, cheerless, drab rooms, and bed linen that was worn and unclean. When Fulbourn began doors were unlocked, but staff were able to ensure patients were not left alone. By 1908 the Cambridge Express reported: "it is, after all, a prison, and everybody and everything in it is under lock and key."

The First World War saw more staffing shortages as male staff were called up, and further overcrowding as patients were transferred from Norfolk Asylum to free it up to take in casualties from the war. The War Agricultural Committee demanded a newly created cricket ground be ploughed up, and rations were reduced. Patients lost weight and deaths from TB rose.

Between the Wars, the hospital's budget was curtailed by agricultural decline and the Great Depression. There was a lack of investment or change. World War Two again saw an increase in overcrowding and the patient population rose by 20%. Again patients lost weight and annual deaths from TB increased. Again staff shortages occurred as staff were called up to fight.

In 1948 Fulbourn became part of the new NHS. With this came new investment, ideas and administrative structure. The Hospital Management Committee replaced the Committee of Visitors, and was a sub-committee of the County Council made up of local politicians and figures associated with Cambridge University. Significant change in operational management came with the appointment of David Clark as Medical Superintendent in 1953. He introduced reforms based on ideas of social psychiatry, therapeutic communities, and open doors. His experiences as an Army doctor of internment, concentration and extermination camps left him opposed to locking people up, and witnessing brutal treatment in the back wards of other asylums made him committed to a programme of reform. He refused to tolerate violence by staff towards patients. In these reforms he was in tune with wider developments in British psychiatry - discussions of open, unlocked wards were appearing in medical journals such as the Lancet in the 1950s, and other asylums were unlocking their doors. In 1958, a hundred years after Fulbourn opened, all the wards were unlocked. While Clark was not unusual in setting up therapeutic communities within the hospital, with a flattening of the hierarchy, nurses out of uniform and known by their first names, and patients having a greater role in their own and each other's treatment, he was highly unusual in setting this up with the most severely ill patients, and allowing the continued use of physical therapies and compulsion in those communities

Treatment remained varied, and although Fulbourn became an internationally renowned leader of social therapy, continued use was made of physical therapies that were the norm in psychiatric treatment at the time. Deep insulin coma therapy was performed at Fulbourn from 1948 - it was not until 1957 that a randomized controlled trial showed the procedure, which carried significant risk for the patient, had no therapeutic effect. Electric convulsive therapy was performed in the hospital and the community throughout the period. Leucotomies were performed on Saturdays in the operating theatre by a neurosurgeon. Fulbourn was one of the first hospitals in the UK to routinely use Imipramine, one of the first anti-depressants, and used tranquilisers such as Chlorpromazine.

Asylum patient numbers peaked in the 1950s, a period that also saw a shift in government policy towards the closure of beds at asylums and treatment within the community. Fulbourn had already made moves in this direction - the first outpatient clinic opened in 1947. Clark enthusiastically engaged in a project to establish a half-way house for patients, called Winston house.

Strategic management change came in 1974, with the end of hospital management teams in favour of district management teams. Fulbourn came under the Cambridge Area Health Authority. Operational management was through the Fulbourn and Ida Darwin Management Committee. Further change occurred with the appointment of Professor Sir Martin Roth as the first professor of psychiatry at Cambridge in 1976. He advocated a biological model of psychiatry, often called the medical model. Again this reflected wider trends in British psychiatry, as the biological, medical model became widely accepted. This gradually saw an end to much of the social psychiatry practices established by Clark, although there was some continuation via nursing staff who often had the most contact with patients.

The 1980s saw the replacement of consensus management in the NHS with general management, and the end of the role of Medical Superintendent. Dr Clark retired in 1983. For five years, from 1985 to 1990, Fulbourn and Addenbrookes management were linked. This ended with the shift to NHS Trusts brought about by the NHS and Community Care Act of 1990. The 1990s also saw the sectorisation of mental health services. In 1995 a medium secure locked unit was constructed at Fulbourn, ending the period of open doors throughout the hospital.

But Fulbourn hospital did not close as most of the former county asylums did. Today it provides specialist inpatient psychiatric treatment in a number of wards, and saw a major refurbishment in 2013. It stands on a new site, and is under the Cambridgeshire and Peterborough NHS Foundation Trust.

This collection is arranged as follows:

• KHF/1 - Hospital management
• KHF/1/1 - Meeting minutes
• KHF/1/1/1 - Visitors' meeting minutes
• KHF/1/1/2 - Fulbourn and Ida Darwin Hospital Management Committee meeting minutes
• KHF/1/1/3 - Finance and Auditing Sub-Committee (and predecessors) meeting minutes
• KHF/1/1/4 - Farm Committee meeting minutes
• KHF/1/1/5 - Meeting minutes relating to staff and buildings
• KHF/1/1/6 - Meeting minutes of medical committees
• KHF/1/1/7 - Meeting minutes of committees reporting to the Fulbourn and Ida Darwin Hospital Management Committee
• KHF/1/1/8 - Meeting minutes of the Winston House Management Committee and the S.O.S. Society
• KHF/1/1/9 - Meeting minutes of regional NHS committees
• KHF/1/1/10 - Meeting minutes of external organisations

• KHF/1/2 - Annual reports
• KHF/1/3 - Medical Superintendent's records
• KHF/1/4 - Policy and governance records
• KHF/1/5 - Studies, statistical reports and correspondence

• KHF/2 - Financial records
• KHF/2/1 - Annual financial statements
• KHF/2/2 - Abstracts of accounts
• KHF/2/3 - Salary and wage books
• KHF/2/4 - Patient financial accounts
• KHF/2/5 - Farm and garden produce accounts
• KHF/2/6 - Precept books
• KHF/2/7 - Cash account maintenance books
• KHF/2/8 - Clerk's cash maintenance books
• KHF/2/9 - Building and repairs accounts

• KHF/3 - Operational records
• KHF/3/1 - Patient registers and records
• KHF/3/1/1 - Admission registers
• KHF/3/1/2 - Registers of sectioned patients
• KHF/3/1/3 - Continuation certificate ledgers
• KHF/3/1/4 - Medical registers
• KHF/3/1/5 - Visitor registers
• KHF/3/1/6 - Discharge, death, transfer and burial records
• KHF/3/1/7 - Case files
• KHF/3/1/8 - Lunatic reception orders
• KHF/3/2 - Reports on operational matters
• KHF/3/2/1 - Matron's weekly reports
• KHF/3/2/2 - Matron's daily reports
• KHF/3/2/3 - Chief Male Nurse reports
• KHF/3/2/4 - Chief Male Nurse day and night reports books
• KHF/3/2/5 - Male ward night reports
• KHF/3/2/6 - Principal Nursing Officer's daily report book - female patients
• KHF/3/2/7 - Daily patient statistics
• KHF/3/3 - Religious records
• KHF/3/4 - Other operational records

• KHF/4 - Staff records
• KHF/4/1 - Obligation books
• KHF/4/2 - Nurses' record books
• KHF/4/3 - Other staff records

• KHF/5 - Property records

• KHF/6 - Photographs, publications and reference material

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This collection includes records containing sensitive personal information as defined by the Data Protection Act 1998 that are restricted from general access - specifically admission registers. For permission to view these records please contact CAS or telephone 01223 699399.

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