The Norfolk County Asylum's centenary Annual Report noted that, although the institution was the oldest provincial public asylum in constant use, much of the physical fabric was new or had been renovated, ‘comparing favourably with the most modern of mental hospitals’. Like many other medical superintendents Thomson presented the institution as a community aiming for greater self-reliance and, increasingly, as ‘a hospital for the mind’. If less directly involved with individual patients, he sought to improve their physical environment and comfort and had improved nurse training and nursing standards. Correspondents for the Journal of Mental Science, visiting to mark the centenary, ‘could not desire a better illustration of the march of modern ideas as to the treatment of insanity than to walk through the wards of the Norfolk County Asylum’.

Attempts to continue in this progressive vein were disrupted by the Great War, which resulted in the evacuation of almost all the existing patients and the physical conversion of the asylum into a military hospital under War Office control. Key personnel associated with the asylum remained, providing some continuity, but most were faced with major and demanding challenges late in their professional lives and had little time remaining for peacetime reconversion.

Such work, as will be seen, involved fundamental changes. Existing accounts, based upon Thomson's own record, recognise the scale of the effort involved and present this in patriotic fashion but they are incomplete. Wartime changes also involved the partial reconstruction or different perceptions of mental illness and a significant proportion of the evacuated NCA patients had traumatic experiences, which for some ended tragically. A subordination of asylum facilities and staff to the war effort, along with subtleties in administrative and financial arrangements seeking to preserve the position of the asylum, are also noteworthy. The limited public recording of such features restricts a comprehensive view but it is possible to demonstrate the varying experiences of patients and staff and stark contrasts between public presentation and private realities. It is difficult to escape the conclusion that, for all the efforts and achievements surrounding the Norfolk War Hospital, consideration of the needs of asylum patients slipped disastrously in ‘meeting an unprecedented national want’.

The Norfolk War Hospital

As with much else in civilian life, the running of asylums was initially regarded as a matter of ‘business as usual’ after August 1914.