1. ‘The Trade in Lunacy in the C18th and C19th ’ Lecture 6 Medicine, Disease and Society in Britain, 1750 - 1950

2. 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’

3. 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.

4. 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).

5. 1774 Madhouses Act Set limits on the number of patients admitted to madhouses. Madhouse proprietors had to obtain a licence and be inspected on a regular basis. London – 5 Commissioners appointed by the Royal College of Physicians; responsible for inspection. In the provinces, Justices of the Peace responsible for inspection and licensing. Introduced the necessity of certification on admission – only for private not pauper patients.

6. 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’..

7. Moral treatment York Retreat - founded by Samuel Tuke in 1796 after scandal at York Asylum: humanity kindness and reason Key elements: 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

10. 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.

11. Bethlem Hospital, St George's Road, Borough, c. 1815: Print of a coloured engraving by J.Tingle from a drawing by T. Shepherd. 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.

12. 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.

13. Legislation 1808 County Asylums Act – Permissive Legislation: counties could erect an asylum (not mandatory) and given the right to raise finance. 1828 Madhouses Act – established the Metropolitan Commissioners in Lunacy (extended to provinces in 1842). Improved inspection and regulation. Medical attendant had to regularly visit private madhouses. 1845 Lunatics Act- established a permanent regulatory body, the Lunacy Commission – responsible for the annual inspection of all types of asylum in England and Wales. 1845 Lunatic Asylums Act – made the erection of county and borough asylums mandatory.

14. Confinement, not cure Pauper patients % Curable 1844 County Asylums 4,24415% Provincial Licensed houses1,92033% 1860 County Asylums 17,43211% Provincial Licensed houses2,35615% 1870 County Asylums 27,8908% Provincial Licensed houses2,20413%

15. Devon County Asylum, opened in July 1845.

16. Conclusion Small scale, private madhouses encapsulate the idea that an institution is the proper place to care for the insane – offered first separate institutional provision. Private madhouses also embody a faith in expertise and eventually confirmed the role of medical men in treating the insane. Madhouses were closely linked to C18th consumerism – financial enterprises. Private madhouses subject to disparagement; mid- C19th standing had been enhanced.