Lunacy, Law and Conscience, 1744-1845

The Social History of the Care of the Insane

Kathleen Jones

• Publisher: Taylor & Francis
• Year: 2013
• Print ISBN: 9780415868709
• eBook ISBN: 9781136278815
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

This is Volume II of seven in a collection on the Sociology of Mental Health. Originally published in 1955, this study presents the social history of the care of the insane from 1744 to 1845.

Chapter One Eighteenth-Century Theory

DOI: 10.4324/9781315008295-1

England in the early eighteenth century was a country of some five and a half million people who lived for the most part in small towns and villages. There were only two towns of appreciable size— London, with a population of little over half a million, and. Bristol, with about fifty thousand inhabitants. Elsewhere, people lived in semi-isolated communities, remote from each other and from any central stream of influence. Travel was slow and hazardous. There were few books, and no national newspapers. Many of the rich were cultured and sceptical; most of the poor were illiterate and superstitious; and some of the poor starved.

From an economic point of view, it was a society undergoing a slow process of disintegration, in the final stages of the decay of feudalism; from a social point of view, it was scarcely a society at all, for it lacked the homogeneity necessary to social action. The medieval conception of charity as a duty which each man owed to his neighbour was dying, and there was as yet nothing to take its place. The community recognized little corporate responsibility for the well-being of its citizens, and inevitably its weakest members—the very poor, the very old, the sick, and the insane—suffered.

There was no clear definition of what constituted insanity, and certainly no recognition of the insane as a separate social class requiring a distinct form of treatment. The problem was a submerged one. Only a small proportion of the total number were recognized as being insane, and the majority were treated as though they were fully responsible for their actions. If their mental condition reduced them to penury, they came within the purview of the Poor Law. If it led them to break the criminal code, they were judged by the penal law. If they wandered abroad from their legal place of settlement without means of support, they were involved in the rigours of the vagrancy laws.

The person who was recognized as insane—that is, the person whose actions were obviously a danger to himself or to others—had no protection in law. If he lived in or near London, he might be sent to Bethlem or ‘Bedlam’, the only institution of any public standing which dealt with the mentally abnormal. If he were wealthy, he might be sent by his relatives to one of the small private madhouses which combined high fees with a pledge of absolute secrecy, or confined alone with an attendant. If he were poor, he might be kept by his family in whatever conditions they chose, or sent to the workhouse or prison for greater security; but whether he lived in London, or in a small and remote village, whether he was rich or poor, he was almost certain to be confined, neglected, and intimidated, if not treated with open cruelty.

Since the lunatic or idiot was so dependent on those around him, our first task is to inquire what the eighteenth century thought about insanity, and what fundamental beliefs lay behind this treatment. The attitude of the labouring classes will be considered first, and then that of the medical practitioners, who were responsible for what little treatment of insanity there was; the clergy, who considered mind as a function of spirit, and all human misfortunes as falling within their province; and philosophers, who were at this time obsessed with that study of the rational faculties of man which later laid the foundations of the science of psychology.

i The Labouring Classes.

Society in its more primitive forms sees the manifestations of mental disorder as proof of divine powers, or evidence of divine disfavour. The Bible abounds in cases of reputed demoniac possession, and medieval Christendom, in its orgy of witch-hunting, persecuted thousands whose only crime was that they suffered from mental aberration. The so-called ‘Devir’s Claw’—a patch of insensitive skin on the body of the supposed witch into which pins and knives might be inserted without causing pain—is to-day widely recognized as a form of localized anæsthesia found in some cases of hysteria;¹ yet it was believed to be an infallible proof of witchcraft, for which the penalty was trial by ordeal, or death at the stake. The harmless lunatic was generally treated with respect in the Middle Ages, as being different from other people, and thus standing in a special relation to the Deity. Piers Plowman refers to the ‘lunatik lollers’²:

¹ B. Hart, Psychology of Insanity, p. 5; see also M. Murray, The Witch Cult in Western Europe, p. 86. ² ‘Lollers’ = vagabonds.

Moneyles thei walke

With a good wil, witlees, meny wyde contreys

Ryghte as Peter dude, and Paul, save that thei preche nat.

and the author continues:

Mattheu ous techeth

We sholde have hem to hous, and help hem when thei come.

The penal laws aǵainst witchcraft were removed in 1736, and belief in witchcraft had certainly been superseded by rationalism in the minds of the educated classes; but among the uneducated, this belief lingered on, and local trials for witchcraft were not uncommon in the mid-eighteenth century. A case is noted in the Percy Anecdotes—‘so recently as the year 1759’—in which an elderly woman named Susannah Hannokes was accused at Wingrove in Hertfordshire of bewitching her neighbour’s spindle, and was tried by the time-honoured method of weighing against the Church Bible. The Bible appears to have been a comparatively small one, for ‘to the no small astonishment and mortification of her accuser, she actually outweighed it, and was honourably acquitted of the charge’. Sir Frederick Eden, writing in 1797, found it ‘mortifying to a philosophic mind’ that a British jury could be persuaded that the crime of witchcraft existed, and that a woman could converse with the devil in the shape of a cat.¹ It is interesting to note in this connection that Mr. Montague Summers, that modern believer in witchcraft, relating the case of a female witch convicted and hanged in 1670, referred to her as ‘this miserable lunatic’,² apparently regarding mental abnormality as proof that the sufferer was allied to the powers of darkness.

³ F. Eden, State of the Poor, pp. 146–7. ⁴ M. Summers, History of Witchcraft and Demonology, 1926, p. 35.

When burning witches became prohibited by law, and witchcraft became a doubtful hypothesis which only the totally uneducated took seriously, the poorer classes turned to other methods of driving the devil out of the lunatic. D. H. Tuke, in his Chapters in the History of the Insane in the British Isles, mentions the existence of several wells in the remoter parts of the British Isles where superstitious rites connected with insanity were practised even in the nineteenth century. The usual procedure was a combination of repeated duckings and religious rites—a system which differed little in practice from the ‘ordeal by water’ formerly used in witchcraft trials, and which had more than a little in common with the ‘cold bath’ and the ‘bath of surprise’ which were favourite remedies for insanity among the medical profession. At St. Nun’s Pool in Cornwall, the sufferer was made to stand with his back to the pool, and was then thrown suddenly into it. After being repeatedly ducked until halfdrowned and thoroughly exhausted, he was taken to the church, and certain masses were sung over him. If there was no marked improvement in his condition, the process was repeated as long as life remained. At a well in Scotland, the lunatic was stripped of his clothes, bound hand and foot, immersed in the sacred pool, and then left all night in the chapel. If he managed to free himself of his bonds during the night, there was a good hope of recovery. ‘It sometimes happens,’ added Tuke’s informant, ‘that death relieves him during his confinement of the troubles of life.’¹

⁵ D. H. Tuke, op. cit., Chapter 1, passim.

If the insane were no longer judicially executed, they were certainly regarded with superstitious fear by the lower classes, who clung to the belief that harsh treatment would drive out the devil. Thus there was no hope of pressure for the amelioration of conditions from this quarter.

ii The Medical Profession.

Medical qualifications were at this time unstandardized, and the title of ‘doctor’ bore no settled meaning. A Master of Arts of the Universities of Oxford or Cambridge could still acquire an M.D. degree by expounding a book of Galen in three written or six spoken lectures,² the Royal College of Physicians and the Company of Barber-Surgeons held their own examinations, but the examining boards were completely irresponsible, and the standard required was low.³ The Society of Apothecaries licensed its own men, but anyone who had served a nominal apprenticeship as a druggist might set up in his own right and call himself an apothecary. No legal action against the unqualified practitioner was possible, and none of the licensing bodies had any real authority outside the metropolitan area. One witness before a Select Committee which examined this problem in 1834 spoke of a man who had set up as a ‘chemist, druggist, surgeon, apothecary and man-midwife’ without qualifications of any description.⁴

⁶ A. Chaplin, Medicine in the Reign of George III, pp. 18–19. ⁷ A Statement by the Society of Apothecaries, 1844, p. 20. (Evidence of Sir David Barry and Mr. R. D. Grainger before Select Committee, 1834.) ⁸ A Statement by the Society of Apothecaries, p. 35.

Since professional standards were so low, the average medical practitioner contented himself with a rough-and-ready knowledge of the ailments of the body, and had little or no apprehension of the complexities of the mind-body relationship. There were no facilities for research, and few ways of disseminating information. Medical knowledge was still dominated by the belief in the four ‘humours’ of blood, choler, phlegm and bile, and the theory that all human ailments were due to an excess of one or more of these substances. The means employed in driving out the excess humours were in some ways akin to those used in driving out the devil, since they consisted in systematically weakening the patient, and sometimes in a calculated terrorism.

The Anatomy of Melancholy, published in 1676, gives a detailed analysis of the beliefs which were commonly held by medical men up to the end of the eighteenth century and beyond. Burton’s treatise derived partly from Hippocrates, with a superstructure of religious and superstitious ideology. The original cause of madness was the Fall of Man. “We are . . . bad by nature, bad by kind, but far worse by art, every man the greatest enemy unto himself.” Mental and moral defect were synonymous.

Although he attributed the basic causes of insanity to sin and the activities of the devil, Burton also believed that the ‘six non-natural things’ were contributory causes. These were bad air, the retention of bodily excretions, bad diet, lack of sleep—‘which causeth dizziness of the brain, frenzie, dotage, and makes the body lean, dry, hard and ugly to behold’, too much or too little exercise, and emotional disturbances.

Burton’s outline of physiology was almost entirely derived from Hippocrates. The body consisted of parts contained and containing, the most important of the former being the four humours. The treatment of mental disturbance was a matter of removing the excess of these substances by means of evacuation.

The most readily accessible means of evacuation were ‘simples’, or purges and vomits. Burton recommended laurel, white hellebore, antimony and tobacco—‘divine, rare, super-excellent tobacco ... a sovereign remedy to all diseases. A good vomit, I confess, if it be well qualified, opportunely taken, and medicinally used; but as it is commonly abused by most men . ...

Table of contents

• Cover Page
• Half Title Page
• Series
• Title Page
• Copyright Page
• Contents
• Preface
• Introduction
• Chapter One Eighteenth-Century Theory
• Chapter Two Eighteenth-Century Practice
• Chapter Three The Growth of Public Concern
• Chapter Four Experiments in Treatment
• Chapter Five The Foundation of County Asylums
• Chapter Six The Select Committees of 1815–161
• Chapter Seven The Reform Movement, 1815–27
• Chapter Eight The Metropolitan Commissioners
• Chapter Nine Local and Departmental Developments, 1832–42
• Chapter Ten Ashley and the Achievement of Reform
• Epilogue
• Appendix One Criminal Lunatics
• Appendix Two Chancery Lunatics
• Appendix Three The Incidence of Insanity
• Bibliography
• Index