Medicine, Disease and Society in Britain, 1750 - 1950 ‘The Trade in Lunacy in the C18th and C19th’ Lecture 6
Lecture Themes and Outline Increased Institutionalisation – why? Confinement vs Care • The emerging ‘trade in lunacy’ in the eighteenth century • Treatment and care of the insane and the Lunacy Reform movement • The growth of public asylums - Scull’s ‘Museums of Madness’
William Hogarth (1697 - 1764) Bedlam. The word bedlam is derived from the name of the hospital and became a generic term for all asylums and used colloquially to mean random disorder or chaos. Bedlam was infamous for its ill treatment of the inmates, and this picture shows visitors, a man being shackled by the attendants and the overcrowding and squalor of the hospital during the mid 1700s.
John Howard, visitor to Bethlam 1780s ‘the patients communicate with one another from the top to the bottom of the house, so there is no separation of the calm and quiet from the noisy and turbulent, except those who are chained in their cells.’ (Lane, p. 99).
Bethlem Hospital, St George's Road, Borough, c. 1815: Bethlem Hospital was the largest of the philanthropic institutes that settled on St George's Field in the late 18th and early 19th centuries. The hospital for the mentally ill moved from its previous location in Moorfields in the City in 1815, and remained here until it moved to Beckenham in 1930. Print of a coloured engraving by J.Tingle from a drawing by T. Shepherd.
William Battie (1703-1776) William Battie In 1742, he was elected a governor of the Bethlem Hospital, and for the rest of his life he took an active part in effecting reforms at the hospital. In 1751, he was elected as the first physician to St Luke's Hospital for Lunaticks. In 1758, Battie published his best-known work, A Treatise on Madness. He was optimistic about the curability of madness.
W.L. Parry-Jones ‘The Trade in Lunacy’ ‘privately owned establishment for the reception and care of insane patients, conducted as a business proposition for the personal profit of the proprietor’. Mostly small-by 1800 only 7 provincial madhouses with 30+ patients.
Advertisement for Joseph Proud’s Madhouse, Aris’s Birmingham Gazette,1756 ‘A large and convenient house...in a retired and airy situation, with a garden walled round, for the safety and privacy of his patients, with a cold bath upon the premises, which in many cases is very necessary in that dreadful malady; the experience he has had by assisting his father, Samuel Proud, who, for upwards of fifty years, had kept a house for lunatics, and is well known in most parts of this kingdom, for the many and great cures he has perform’d in that disorder, has qualified him to treat that malady, in all its various appearances, with propriety and judgment: All persons who are committed to his care may depend upon being treated with the greatest humanity and care’. (Lane, Social History of Medicine,p.101).
State Regulation 1774: System of regulation and licensing London- Royal College of Physicians Provinces: Justices of the Peace Numbers of Private madhouses 1807 1844 Provinces 45 139 London 16 40 Numbers of recorded lunatics 1807 2,248 1828 12,547
Francis Willis (1718-1807). ‘The Madness of King George’ Francis Willis treated George III in 1789 ‘As death makes no distinction in his visits between the poor man’s hut and the prince’s palace, so insanity is equally impartial in her dealings with her subjects. For that reason, I made no distinction in my treatment of persons submitted to my charge. When therefore my gracious sovereign became violent, I felt it my duty to subject him to the same system of restraint as I should have adopted with one of his own gardeners at Kew. In plain words, I put a strait waist coat on him’. .
R.A. Houston, ‘Rights and wrongs in the confinement of the mentally incapable in eighteenth-century Scotland’ Continuity and Change 2003 (18), 373–394: • In England, 44 out of 68 provincial proprietors of licensed private madhouses in 1831 were doctors or surgeons. • Some 14 licensed private asylums existed at some stage during the first half of the nineteenth century in the East Riding of Yorkshire. • The proprietors were surgeons or apothecaries in nine cases and former asylum staff in three; the previous occupation of the other two is unknown. • Only one English madhouse keeper argued that it was improper to mix provision of medical care with accommodation. This was Benjamin Faulkner at his house in Little Chelsea, London, where he provided attendants and board and lodging, while patients were visited by their own physicians. • Faulkner’s ‘ free house’ was unusual in England, but close to the Scottish norm.
Causes of patients admitted to Bethlem: Misfortunes, Troubles, Disappointments • Grief 206 • Religion and Methodism 90 • Love 74 • Jealousy 9 • Pride 8 • Study 15 • Fright 31 • Drink and Intoxication 58 • Fevers 110 • Childbed 79 • Obstruction 10 • Family and Heredity 115 • Contusions and Fractures of the Skull 12 • Venereal 14 • Small Pox 7 • Ulcers and Scabs dried up 5 Lisa Appignanesi, Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present (London: Virago, 2008), p. 47.
A rotary machine based on Cox’s swing. A number of complicated variants on Cox’s original design were developed in the early nineteenth century. Joseph Mason Cox's swinging device was perhaps the most famous contrivance of all at the time. The idea for it had come from Erasmus Darwin, who in turn had derived it from classical suggestions about the value of swinging as a therapy. Cox was the first to develop a working model, and his book describing its construction and use rapidly went through three English editions, as well as appearing in an American and a German edition.
Immersion in cold water was an ancient nostrum for insanity. Aquatic shock treatment, otherwise euphemistically known as "hydrotherapy," here takes the form of the douche. From: Alexander Morison, Cases of Mental Disease (London: Longman and Highley, 1828).
Moral Management • York Retreat - founded by Samuel Tuke in 1796 after scandal at York Asylum: humanity kindness and reason • Spring Vale founded by Thomas Bakewell in 1808 Key factors: • Insanity believed to be curable • Emphasis on kindness and calm • Minimal use of restraint and medication • Domestic setting created in the asylum • Reinforced normal social routines e.g. meals, conversation, recreation, work • Rural setting to encourage walking and exercise • Emphasis on managing the mind of the patients • Promoting self-esteem, rationality and self-control
Legislation • 1808 – Permissive Legislation: right to raise finance for county asylums • 1828 - Metropolitan Commissioners in Lunacy (extended to provinces in 1842). Improved inspection of asylums. • 1834 - Poor Law Amendment Act- detention of dangerous lunatics in workhouses for a maximum of 14 days only • 1845 - Compulsory Legislation: all counties to provide county asylums for paupers. • 1873 - Lunacy Law Reform Association • Wrongful confinement, better standards, public rather than private provision.
Confinement, not cure Pauper patients % Curable 1844 County Asylums 4,244 15% Provincial Licensed houses 1,920 33% 1860 County Asylums 17,432 11% Provincial Licensed houses 2,356 15% 1870 County Asylums 27,890 8% Provincial Licensed houses 2,204 13%
Conclusion • Changing ideas over best methods to treat the insane • C17th Bethlem – large scale confinement, awful conditions, public spectacle • C18th Emergence of private trade in lunacy to meet demand, opportunity for both medical men and laymen (religious) • New approaches: ‘moral therapy,’ York Retreat and Springvale • C19th growth in asylums – confinement not cure • Late C20th abandonment of asylums – treatment community based