Excerpts from Nova Scotia Hospital: 125 Anniversary, 1868-1983

Treatment Philosophy

In 1875, a congregation of medical professionals met at the hospital and were entertained at dinner. Representatives came from all Provinces and parts of the USA. Even in the early days, the hospital was viewed by the medical profession as a progressive facility for the mentally ill, and thus it became one of the first accredited psychiatric facilities in Canada, and still is today.

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In 1919, the first occupational therapy began at the hospital. Community volunteers assisted with this endeavour. Today the Volunteer Service of the hospital has grown proportionally- but there is always room for more interested persons. Patients today are no different from years ago. They may need companionship, assistance with locating living accommodations, stimulation through activities, or just someone to be there and to say “You’re an okay person”. Returning to the community is a hurdle that remains to be encountered, even after the illness is over. Volunteers make the community a more welcoming atmosphere to return to, and can ease the pain of transition.

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Through the years there have been sleigh rides for patients, horse and buggy rides and bus rides. The present mode of transportation for recreation for patients is via hospital bus, purchased through public donations.

The Treatment Segment

Before starting this segment of the History of the Nova Scotia Hospital on Patient Treatment, it is only fitting to give credit and thanks to our former Director of Nursing, Miss E.C. Purdy, R.N., for her fine contribution to the hospital by being the author of the “Nova Scotia Hospital History”. She has made it possible to retrieve information on patient treatment (s) very easily. Much of the following information will be direct quotes from her work.

Time and space will not allow to go into patient treatments in depth for a period of 125 years; therefore, only the highlights will be explained and written at this time.

The first mention of any form of “treatment” was prior to December, 1858. Both occupation and recreation were recognized as agents of remedial importance. It was also mentioned that early admission to the hospital was a factor in the patient’s recovery.

It appeared at this time the community plated a large part in hospital activities. They donated a very large selection of books, money, a music stool, fruit and delicacies, magazines, took the patients on afternoon excursions on the harbour in the steamer “Neptune”. The patients were also taken on carriage drives from time to time. In 1859 the male patients were occupied with farm work and gardening, and for the females, sewing, knitting and general household work. They were encouraged by small gratuities.

Being gainfully occupied was considered to be very beneficial for their treatment. From 1859 until 1878 it appeared that manual labour, walking about the grounds, and general amusement was the form of treatment used.

In 1878 Dr. DeWolfe recommended that there be special facilities for the care of the chronically insane, that there be some system of follow-up whereby convalescent patients can be kept under some supervision near their home and that the whole problem of supervision of jails, poor houses, asylums, etc., should be under Government supervision to insure that good conditions exist in these institutions. He recommended the “Cottage System” in which the patients would be maintained in small groups in home-like situations. Also recommended was that the Counties single or with two or more associated, should erect cottages, or small asylums to accommodate from 50 to 100 inmates, not less that one to three miles from the village or town, with not less than an acre of good farming land to each of the estimated population. This apparently was the beginning of the County Home System in Nova Scotia.

In the year of 1885 was the first mention of drugs which were used for the treatment of mental illness. It was noted that it would not be expected that staff depend wholly on drugs to accomplish the effect which assisted in bringing about recovery. They were ever mindful of the paramount importance of fresh air exercise, food and employment. Drugs were used as an adjunct only -regular administration of such medicines as bring about curative results by an indirect or constitutional action. The prescribed tonics used were Iron, Quinine, Strychnine and simple Bitters.

The year 1892 saw the beginning of the first Laboratory. This included a Thermostat, Hot Air Sterilizer, Steam Sterilizer, and other Bacteria Culture apparatus. The air on the wards did not indicate encouraging results. Crowded conditions led to the impurity of the air and something had to be done. It was found that a number of the patients had Tuberculosis, and this was causing concern, as there was not proper way of isolation these patients.

In 1893 the use of mechanical restraints as means of controlling violent and destructive patients had been practically abolished. It was felt that by extra attention on the part of the nurses, and interesting the patients in some other kind of work, would attain the end of what was considered unnecessary restraint.

Quoted under the “Changes” for 1893, “I have long thought that the systematic use of mechanical apparatus was injurious to the moral of the hospital. It changed the relationship which should exist between patient and nurse, and it tended to foster a feeling with the latter that there were other means that tact, skill and attention available to counteract faults on the part of the former, and so led to the neglect of the cultivation of those qualities which constitute the special training of a nurse. I am not a bigot on the subject, and when an occasion arises in which I think the camisole of cuff a mode of treatment necessary, or better than intelligent watching, I shall use it.” Also in this year, plans for a Nurses Training School were established.

In the years of 1900-1902 the Superintendent became quite concerned over the lack of treatment facilities which were being offered, and he questioned why it was any wonder that 55% of the patients coming to the hospital had remained insane, and it was not rather a marvel that so many had recovered under conditions so unfavourable. He stressed the need for a small admission building, planned very differently from the present hospital building into which a new patient could be received without being at the very outset compelled to associate with others in various stages of mental degradation, and without being made to feel that he is but one of a vast community in which the share of attention he can receive is very much smaller than that which he feels his case demands.

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Not one of us can truly visualize, in any great detail, the kind of life lived 125 years ago by the staff and patients of this hospital. Mount Hope, as it was then known, must have been quite isolated, at least by modern day standards. Travel to and from the hospital, even to local areas such as Halifax, would be long and arduous, particularly during the seasonal inclement weather. It is known that the staff generally lived within the hospital precincts or relatively nearby, of necessity, probably in the old sugar refinery houses. Because of these factors, the staff and patients were in close contact with each other at all times. Might this not be considered as a forerunner of the “Therapeutic Community Concept” expressed by the renowned Dr. Maxwell Jones almost a century later?

Given that food and shelter then, as now, were the basic requirements of life and one’s expectations are only relative to the general conditions of the period in which we exist, did the patients in those early days really suffer undue hardship? Patient accommodations were certainly somewhat cramped but the method of heating, by forced hot air duct, is still extensively used nowadays in our homes. Incidentally, some of the equipment used for heating is still in place in the basement area of the original building (now the North Unit). Meals were augmented by fresh additive-free produce, including dairy products, meat and vegetables, raised and grown on the hospital farm. Perhaps it may have been somewhat lacking in variety but nevertheless was nutritious.

The treatment programs for patient were, of course, far less sophisticated and efficacious that those of the past three decades or so, consisting primarily of custodial care for extremely lengthy periods or life. In the absence of advanced chemotherapy or other modes of treatment, which were not developed until comparatively recently, physical restraint had to be used more often that at present. However, I cannot believe that iron shackles or chains, as so often depicted, were used extensively, except perhaps for violent patients on transportation to the hospital. Patients were more likely to be placed in seclusion cells during episodes but, contrary to what was public conception, there were not placed in “dungeons” in the basement. These “dungeons” were storage rooms or maintenance tunnels and, as far as I can ascertain, have always been used for similar purposes.

We would be remiss if we did not take this opportunity to pay tribute to our predecessors in the mental health field, particularly those employed at this hospital in the first century of its existence. They carried out their duties with dedication, under what must have been adverse working conditions, with such limited resources at their disposal.

During the past 25 years great strides forward have taken place in the field of psychiatric care, in general, and at this hospital in particular. Many new buildings have been provided, both for patient, staff and student accommodations, new modes of treatment have been developed, patients are allowed much more freedom of movement, male and female patients are no longer segregated, nursing units are no longer locked and the meal service provided is of a very high standard. However, the main asset of this hospital is still a truly dedicated staff, without which such progress would not have been possible. Hopefully, our successors in the years to come will show the same dedication and accept future challenges with the same spirit of cooperation as that displayed by our present staff. This cooperation is evidenced by psychiatric facilities in Canada to be awarded top Accreditation status by the Canadian Council of Hospital Accreditation and, to the great credit of our staff, has attained this high standard in every survey since.

V.F. Simpson

Administrator

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Medical and Psychiatric Service

Many advances have occurred in the care and treatment of the mentally ill during the 125 years that the Nova Scotia Hospital has been in existence.

Prior to 1858, there were no psychiatric hospitals in this Province. The mentally ill were cared for at home by their families, resided in Poor Homes or were left to wander at large. At that time, a movement was underway to build asylums in North America in order to provide the mentally ill with a place of refuge where, through compassionate care, persons so affected could recover from mental illness. This asylum principal, well known at that time, has endured as an important adjunct to treatment today.

In this Province, the efforts of Dorothea Dix, and American philanthropist, and Dr. Hugh Bell, who was the Mayor of Halifax, convinced the government to erect the first building of this kind. It was built in a rural setting on a knoll of land across the harbour from Halifax and was named Mount Hope Asylum. The building was of brick and two stories high. The first floor was for male patients, and the second for females, and there were a few rooms included for the staff to reside. From these modest beginnings, the Nova Scotia Hospital developed.

Records show that a number of patients improved in this atmosphere of care, rest and the judicious use of work therapy on the hospital farm. It is further recorded that interested citizens and organized groups from the nearby community of Dartmouth would visit patients and accompany them on regular outings such as sleigh rides and walks. Over the years, the hospital grew with the addition of more buildings, but the treatment methods saw few changes until the 1940’s when the use of electrotherapy became recognized as an effective treatment for depression and some types of schizophrenia. A significant number of recoveries occurred and a greater number of patients were discharged to their homes.

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H.P. Poulos, M.D., C.M.

Medical Director