Francis Edward Pilkington, who was one of the most distinguished psychiatrists of his day, died at the age of 86. In 1968 he served as president of the Royal Medico-Psychological Association, the forerunner of the Royal College of Psychiatrists, of which he was elected a foundation fellow in 1971 and elevated to honorary fellowship in 1972. Further recognition of his contribution to psychiatry at an international level came with his appointment as an honorary member of the Société Royale de Médecine Mentale de Belgique.
Pilkington was born at Repton, Derbyshire, of Irish ancestry, a fact of which he was inordinately proud. His father, Frank, a well remembered housemaster at Repton School, was Irish and a graduate in mathematics from Trinity College, Dublin. Pilkington’s veneration of Ireland and all things Irish is seen in his acquisition in 1933 of the MRCP(Ireland) in addition to the London membership. He went so far, in fact, to write a short history of Ireland for the benefit of his children and grandchildren which, unfortunately, he did not see fit to publish. Further evidence of his enthusiasm, if such be needed, is seen in the unmistakable Celtic names bestowed on his three daughters -Cailin, Mairin and Ffiona.
Pilkington was educated at Clifton College and Emanuel College, Cambridge, where he read medicine. He completed his medical studies at King’s College Hospital, London. The next three to four years seem to have been spent acquiring a fistful of academic qualifications. In addition to the membership of Royal Colleges of Ireland and London, -being later elected a fellow of both - he took his Cambridge MB BChir and also obtained the DPM, (Eng).
Early on he decided on a career in psychiatry and to this end trained at the Maudsley Hospital, London, where he had the exceedingly good fortune to be taught by two giants of English psychiatry, Edward Mapother [Munk's Roll, Vol.V, p.266] and Sir Aubrey Lewis [Munk's Roll, Vol.VI, 284]. During the 1939-45 war he served as a psychiatric specialist in the RAMC, achieving the rank of lieutenant colonel. In the Army he came under the influence of J R Rees, the director of Army psychiatry, - another giant, albeit of a more gentle variety than his two previous mentors [Munk's Roll, Vol.VI, p.387].
After demobilization, Pilkington chose to exchange the cosseted comforts of academic psychiatry for the rigorous realities of mental hospital practice. After a period as deputy physician superintendent at the Central Hospital, Warwick, in 1946 he was appointed physician superintendent at Moorhaven Hospital, Devon, where his real life’s work began.
This important chapter of his life is well described in his presidential address to the Royal Medico-Psychological Association at its annual meeting in Plymouth on 10 July 1968. In lucid and, at times, lurid prose Pilkington illustrated how he was able to drag a backward and decrepit hospital out of the slough of despond into line with the most advanced mental hospitals of the postwar era; an era which has been termed ‘The Golden Age of the British mental hospital.’ He writes: ‘Although the hospital was a "modern" one compared to many, having opened m 1891, the state of the buildings - wards, departments, the lot -was disgraceful, even dangerous, and tangled masses of coarse grass and evil-smelling weeds grew within the boundary walls of what were still known as "airing courts".’ Nor is this pen-picture of decrepitude and stagnation confined to the physical aspects of the hospital: the same could be applied to the moral of the staff, medical and nursing; to the state of nurse training and to the therapeutic opportunities, such as they were. As a further example to the aura of mediaevalism that prevailed, Pilkington found - to his horror - that so absolute was his authority that no member of the nursing staff could marry without his express permission.
But the Golden Age was not to last. The last section of his address is headed ‘The Years of Decline’ in which he describes the disastrous effects of the virtual death sentence imposed on mental hospitals by the then Minister of Health, Enoch Powell. Ironically enough the decline began with the implementation of the Mental Health Act 1959, an Act which in intent was perhaps the most humane legislative instrument in the history of British psychiatry. The sense of bitter diappointment is well expressed in one of the last paragraphs of his address which, in the light of recent developments, has a prophetic tinge. He concludes: ‘Those who, like myself, have spent the major part of their careers in developing comprehensive community services based on their hospitals cannot avoid the feeling, when their elimination is advocated, that an assault is threatened on the whole fabric of the service.’
Despite his success in every department of life all who knew him, family and friends alike, pay tribute to his essential modesty. No better evidence of this endearing attribute could be found than in his reply to a questionnaire circulated to all fellows of the Royal College of Psychiatrists. One of the questions posed was ‘Major publications?’ to which Pilkington replied ‘Minor publications only.’ It needs to be pointed out that, inter alia, Pilkington was the author of a successful history Ashburton: the Dartmoor town, Exeter, Devon Books, 1989, second edition,
In recognition of his invaluable services to the Plymouth area, Pilkington - on his retirement from the NHS - was elected emeritus consultant to the south west regional hospital board.
In 1938 he had married Elisabeth, daughter of Edward von Westhoven, a soldier, and they had a son, Roland, and the three daughters. His wife predeceased him, dying in 1974, but his children all survived him. His interests, outside medicine and his family, were gardening, architecture and walking.
H R Rollin
[Brit.med.J.1992,304,1439; Brit.J.Psych., 1969,115,1-8]