Tag Archives: Stanley Royd hospital

Notes on a scandal: infection control in the asylum

We’re fast-forwarding 100 years today, out of our usual 1880s comfort zone  and into 1984, to look at an event that suggests something of a failure of science in the asylum. This was the year when an outbreak of Salmonella at Stanley Royd Hospital in Wakefield (formerly the West Riding Asylum) led to widespread criticism and investigation of hospital hygiene, also feeding into contemporary debates about deinstitutionalisation.

Salmonella enterica. © Mark Jepson/Wellcome Images.

Salmonella enterica. © Mark Jepson/Wellcome Images.

It was the August Bank Holiday weekend of 1984 that marked the beginning of what would become a significant event. On Sunday morning, a few patients were found to be suffering from sickness and diarrhoea – not a particularly unusual occurrence in the hospital – but it became clear something serious was afoot when, by 9.15am, 36 patients across eight different wards were affected.

In When Food Kills, Hugh Pennington describes the course of events and illustrates the frightening rapidity of the outbreak: by Sunday’s close it  had claimed its first fatality. Being a Sunday – and a Bank Holiday – staffing levels were already low and medical care fell to a junior medical officer who had only been at Stanley Royd for three weeks. By Tuesday, when the Environmental Health Department was contacted, several staff were affected, along with a staggering 240 patients. That day, the agent was identified as Salmonella, but it was a development that did little to alter the outbreak’s toll. Within days, around half of the hospital’s 788 residents had been ill and 19 died. All 19 were elderly and less able to withstand the fluid loss of severe diarrhoea.

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub).

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub; you’ll need an institutional login).

Stanley Royd was propelled into the media spotlight: TV news documented the frantic attempt to clean the wards, as well as the somewhat defensive attitude of public health officials. Blame was placed on everyone from managers to kitchen staff. The patients themselves also became a key part of the explanation for why the outbreak had taken hold so quickly: the difficulty of ensuring that patients ate the food intended for them, of policing special diets, and of maintaining adequate standards of personal hygiene, were all cited as hindrances to ‘barrier nursing’ methods that might reduce the risk of infection.

Stanley Royd’s kitchen and food preparation procedures turned out to be the heart of the matter. The outbreak was traced to roast beef that had been cooked, cooled, and left in the open for 10 hours before being served to patients in salads. The details of the hospital’s catering arrangements were meticulously scrutinised, and the results were far from acceptable: cleaning schedules not kept, dirty cloths soaked and re-used, a lack of cold storage facilities. The very fabric of the hospital was problematic, the Victorian architecture (described as ‘Dickensian’) and repeated ‘building-on’ hindering modernisation. The kitchens, built in 1865, had such high ceilings that it was impossible to clean them properly.

Indeed, the hospital had struggled for many years with the spread of infection, as demonstrated by Claire Jones at our recent conference, ‘Science in the Asylum’. A 1913 report by West Riding pathologist Harold Gettings claimed the asylum had never been free of diarrhoea since it opened in 1818, and annual reports of the 19th century frequently showed a concern for the quality of the water supply.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS  C85/1111.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS C85/1111.

The inquiry that followed the Stanley Royd outbreak (also prompted by the discovery, in 1985, of Legionnaires’ disease at Stafford General Hospital) culminated in the 1988 ‘Acheson Report’ (Committee of Inquiry into the Future Development of the Public Health Function and Community Medicine). The Report pinpointed ‘a decline in available medical expertise’ in the control of communicable diseases, and a lack of forward planning in the event of an outbreak. The Salmonella outbreak had come at a time when food poisoning was increasingly on the agenda (Campylobacter, for example, had been isolated in human faecal specimens in the 1970s). Preventing the spread of food poisoning was a matter that concerned all levels of hospital staff; kN0029437 Scientist in a microbiology labitchen workers played a significant role, but the role of the microbiologist was repeatedly emphasised too. With medical training and knowledge of local epidemiology, consultant microbiologists began to play an increasing part in hospital infection control – an area that had previously relied on the cooperation of nurse/doctor/microbiologist for its success, and with few clear guidelines. Just as the asylum Superintendents of the late 19th century had stressed the uses of the laboratory in mental health care, the ‘behind the scenes’ scientific labour of the psychiatric hospital was once again brought to the fore.

What was suggested in the whole Stanley Royd scandal was a certain degree of apathy towards the psychiatric patient: it transpired that the kitchens had been described as ‘a culinary disaster area’ back in 1978, but that renovation proposals were steadily lost in local bureaucracy, the hospital not seen as a redevelopment priority. The public response to the episode, however, showed that people viewed it as far from a trivial issue. It was perhaps the final nail in the coffin for Stanley Royd: in the midst of moves towards deinstitutionalisation and community care, the Salmonella outbreak was a powerful argument for the inefficacy of the large, Victorian psychiatric hospital, and the hospital closed just over 10 years later. The far-reaching effects of the outbreak are reflected in its continued use as an example par excellence of how not to approach infection control – such as the title of Brian Keeble’s article ‘Sleep walking to another Stanley Royd?’ It was a rather sad and embarrassing end to an institution that was hailed in the late 19th century as a model of ‘scientific psychiatry’.

Further reading and viewing

Anon., ‘Stanley Royd: the epidemiological lesson’, BMJ (8 Mar. 1986).

H.S. Gettings, ‘Dysentry, Past and Present‘, Journal of Mental Science 59/60 (1913/1914).

Philip Johnston, ‘Defending 19 deaths from food poisoning’, BMJ (1 Feb. 1986).

Carol A. Joseph & Stephen R. Palmer, ‘Outbreaks of salmonella infection in hospitals in England and Wales 1978-87’, BMJ (29 Apr. 1989).

Mukesh Kapila & Roger Buttery, ‘Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?’, BMJ (2 Aug. 1986).

Brian Keeble, ‘Sleep walking to another Stanley Royd?’, BMJ (7 Sept. 2006).

T. Hugh Pennington, When Food Kills: BSE, E. coli, and disaster science (Oxford, OUP: 2003).

Debbie Weston, Infection Prevention and Control: Theory and Practice for Healthcare Professionals (Chichester: John Wiley & Sons, 2008).

Food Poisoning at Stanley Royd Hospital, ITN (7 Sept. 1984).

– Jennifer Wallis

A museum of mental health

Yesterday, Mike and I met with the lovely Jane Pightling at the Stephen Beaumont Museum of Mental Health in Wakefield. Secreted within the grounds of Fieldhead Hospital, walking into the museum is a little like walking into an Aladdin’s cave: it’s full of fascinating items that tell the story of the West Riding Pauper Lunatic Asylum (later, Stanley Royd Hospital), from its beginnings in 1818 to its closure in the 1990s.

Mortuary table

Walking into the museum, we were met with an imposing marble-topped mortuary table – an item that invites the visitor to consider both the long-term nature of many patients’ stays within the asylum, but also the importance of post-mortem and brain research in casting light upon the pathology of mental disease.

Just a few steps away is a padded cell; elsewhere are iron manacles and a straitjacket. These stock items of asylum history are, however, set alongside other objects that tell a much deeper story about the care of the asylum patient: a hydrotherapy bath, printing blocks, hand tools, and patient art.

Wooden printing blocks

In a corner stands a beautiful wooden lectern in the shape of an eagle, and on the opposite wall is a cleverly fashioned mirror frame – both made by patients. On one wall are photographs and programmes from theatrical productions put on by patients and staff, and sheet music and scripts testament to a staging of Gilbert and Sullivan’s ‘Trial by Jury’.

Sheet music and scripts from one of the asylum’s performances.

The museum contains many stories and voices – of patients, attendant and nursing staff, doctors, and local people. Its location  within the hospital grounds is, we discovered, ideal: Jane explained to us how school groups might arrive in the museum to learn about the history of electro-convulsive therapy, before going to look at the hospital’s modern ECT suite.

Under the umbrella of South West Yorkshire Partnership’s Change Lab project, the museum staff are currently looking at how to get even more out of their collections in order to raise awareness of the history of mental illness, and the experience of those with mental health problems.

Anaesthesia apparatus

Delegates at the Science in the Asylum conference on 19 October are warmly invited to visit the museum after the conference for a look at the exhibits, as well as some light refreshment, where Jane and her colleagues will be on hand to talk about the collections and future plans.

For those not attending the conference, the museum is free to visit and currently opens each Wednesday between 10am and 3.30pm. Visits outside these hours can also be arranged by contacting Jane or another member of the museum team on 01924 328654.

– Jennifer Wallis