Organisation of the Royal College of Physicians Commissioners for Madhouses 1774-1827
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Organisation of the Royal College of Physicians Commissioners for Madhouses 1774-1827

2.5.1 The Royal College of Physicians

2.5.2 The Physician Commissioners Commissioners' activities Selection of Commissioners

Table Commissioners elected 1774-1777

2.5.3 The officers:


2.6.1 Introduction

TA1 Officers of the Physician Commission
TA2 Table showing system of appointment
TA3 Table of individual commissioners with biographical notes

This table of individual commissioners is in chronological order of their first appointment. All commissioners are indexed alphabetically in the Directory of Lunacy Commissioners


Henry 8th, on the advice of his court physician (Dr Linacre), founded the Royal College of Physicians (London) in 1518 to control who practised as a physician in London and so protect the public from quacks.

At the time of the Physician Commission, Royal College of Physicians fellows were drawn, almost exclusively, from Oxford or Cambridge graduates, which secured that they were members of the established church, that they had received the social education of the collegiate life of Oxford or Cambridge: that they were "gentlemen".

The fellows formed the college and only they participated in its affairs. The Royal College of Physicians also licensed physicians who were not fellows (generally because they were not Oxford or Cambridge graduates) to practise. These licentiates took no part in Royal College of Physicians affairs (*a) and had no right to enter the college building (*b).

(*a) The provisions of the 1774 Madhouses Act for licentiates to serve as commissioners (section 3) were never acted upon. (See note 2 to Table of Commissioners)

(*b) Licentiates had no "privilege to enter the college". (1828 SCHL p.733 Evidence of C.D. Nevinson).

In 1800 there were only 47 fellows, but 115 licentiates. Medically a licentiate might be as well, or better, qualified than a fellow; socially they included physicians to the royal family and the aristocracy. Their exclusion from Royal College of Physicians affairs was, therefore, a source of friction.

Physicians (fellows and licentiates) were the elite of the London medical profession. Below them came surgeons, whose royal college was founded in 1800, apothecaries, whose London "company" was founded in 1815, and an infinite variety of practitioners who were `quacks' in the eyes of the three medical corporations.

I use the title Physician Commission for Royal College of Physicians's functions under the 1774 Madhouses Act (which were only partly performed by the commissioners), the term "Officers of the Commission" for the Royal College of Physicians President and Treasurer and the Secretary to the commissioners.

To investigate the commission's organisation I compared the Act's provisions with the practice revealed in Royal College of Physicians records and in evidence before Select Committees of Parliament.

The commissioners' minutes were kept in the Town Register (1774 Madhouse Act section 17). In 1828 the Royal College of Physicians passed the registers to the Metropolitan Commission and they have since been lost or destroyed.

The Treasurer's Account book remains in the possession of the Royal College of Physicians and the minutes (Annals) of the Royal College of Physicians meetings are very well preserved.

We can see from the 1774 Madhouse Act that the Royal College of Physicians' functions under it were only partly the responsibility of the commissioners. Finances were to be handled by the Treasurer, who was not responsible to them but to the President (section 20). Enforcement was the President's responsibility, again without reference to the commissioners (section 32). Given these provision one might expect that the third senior Royal College of Physicians officer, the "Registrar", to be made responsible for the registers, but instead the commissioners were to elect their own Secretary (section 7). His registers, however, were to be open to inspection by the President at any time (section 18).

The following organisational details in the Act suggest that the college as a whole, rather then the commissioners, was intended to organise the commission:

  • The continuous service restrictions (section 2) suggest it was considered undesirable for the commissioners to become a specialist organisation.

  • The commissioners and Secretary had to operate from the college: meetings were to be held (section 6) and registers kept (section 17) there and notices received (section 21) and sent (section 11) via the college Beadle.

  • It was the commissioner of longest standing in the college (not as commissioner) who was to chair meetings and have the casting vote (section 6).

  • The President was responsible for calling the first meeting. When commissioners called one, summonses were to be issued by the Beadle or someone else, belonging to the college, chosen by the President. (section 12)

  • Effective performance of the commissioners' and Secretary's functions was dependent on the President. Only he could ensure London houses did not continue to operate without licences, that when licensed they did not refuse admission, or neglect to send notices; because only the President could prosecute for these offenses (section 32).

  • Although not unambiguous, the financial provisions suggest close college supervision of the commissioners, in that their accounts were only to be "allowed" if the President and Elects found them "just and reasonable" (section 20). Presumably this qualifies the requirement on the Treasurer to pay a Secretary's salary determined by the commissioners (section 7). The payment per commissioner per visit was fixed (section 20), but, although empowered to visit as often as they thought necessary (section 14), the college could, arguably, have disallowed payment for visits not strictly required by the Act. The control of "expenses" was unambiguous: the Treasurer was only required to pay those that were "reasonable" (section 20).

An Act's provisions, however, although they may dictate a necessary form to be followed, do not give a prescription for organisation, and even when intended to, the prescription is not necessarily followed.

Without violating the letter of the law, the Royal College of Physicians could have delegated its responsibilities and powers to a sub-group of fellows elected regularly as commissioners:

    the continuous service restrictions did not preclude the same fellows being regularly elected. A group of seven of whom a different two each year were not commissioners easily satisfies the requirements.

    nothing prevented the President acting on the advice of such commissioners respecting prosecutions and they could have been considered as having their own budget (determined by the amount raised by licence fees) to spend as they wished.

But nothing like this happened. The "Commissioners for Madhouses" never formed an organisation distinct from the college, but were in fact more closely integrated with it than one can deduce from the Act.


As suggested in the preamble to section two of the Act, the commissioners' principal function was to make the statutory visits to licensed houses. None was to have an interest in a madhouse (section 10) and each swore not to reveal the time of visits to any keeper (section 5).

On the basis of the Act we can construct a calendar of their (*) activities during the year.

(*) The number of commissioners required for an activity and other specifications are as follows: Any commissioner could authorize a search, any two summons a meeting. For any other activity at least three of the five were required: all meetings (section 6), visits (section 14), signing licences (section 8) and visiting minutes (section 15).

They could visit with or without the Secretary. If without, a commissioner would have to make the minute (section 15). Similarly, if they met without the Secretary, a commissioner would have to minute the meeting (section 17).

September 31st or October 1st: ELECTION (section 2) and OATH (section 5) see October 15th:

FIRST MEETING Called by the President (section 11). This meeting appointed and fixed the salary of the Secretary, (section 7) and probably fixed the date of the licensing meeting. In practice Secretaries served for several years at a fixed salary (2.5.3) so the statutory business of this meeting was usually a formality. Except in 1774, 1797, 1808, 1814 and 1825, it only endorsed an established Secretary at his established salary.

Subsequent meetings called by commissioners Between 15th and 31st October:

Licensing meeting (section 8) The Secretary probably took his oath (section 7) and the commissioners signed licences. As they were obliged to grant all that were applied for, this must always have been a formality. Dr Macmichael told a SCHC:

"I am the junior commissioner ... the licences are signed by three commissioners: I have signed all the licences for this year." (1827 SCHC p.123)

A licensing meeting may just have meant three commissioners going to the college, hearing the Secretary take his oath, and signing licences he had made out for sixteen to thirty-eight houses. At the time of Macmichael's comment there were more licences than houses,because the commission issued more than one licence to larger houses (3.8.TA1)

After November 20th and before next September 31st:

ROUTINE VISITS A visit had to be made to all the houses licensed (section 14). At the same time, or within six days, the visiting commissioners signed any critical minutes (section 15).

In practice, one of the first two meetings may have been used to decide when visiting could be most conveniently and expeditiously performed.

Visiting was what they were paid for and it was their only substantial function. The practice was to visit all the houses in a week (1815 SCHC Evidence of Powell, cited Scull 1979 p.137).

SPECIAL VISITS on behalf of a court (section 29) were probably rare, but, at least in the later years of the commission, it was the practice to visit the large pauper houses twice in the year (1827 SCHC p.115, evidence of Bright).

Between visits and ceasing to be commissioners:

MINUTES MEETING The Secretary's record of visiting minutes was read to and signed by the commissioners (section 15)

At any time:



The list above gives the activities the commissioners had to do by law.

In practice, alone or with other fellows, commissioners also, sometimes, formed a committee to report on issues relating to the Madhouses Act.

  • In June 1811 they wrote that the Act "required revision".

    This initiative may have been a result of Arthur Daniel Stone being appointed a senior commissioner in October 1810. Stone became a fellow in 1795 and had served as a junior commissioner in 1799 and 1800. On 7.4.1800 he had brought before the Royal College of Physicians some regulations proposed by a Mr Harding for its better administration, including, apparently, reforms of the commission.

    In 1811 the commissioners with the Royal College of Physicians Officers and Elects (senior Fellows) were made a committee to consider revision of the Act. It reported eight defects, which were submitted to counsel (Mr Warren), who gave his opinion along with a general observation that the Royal College of Physicians might seek amendment by a private bill, but, that even without opposition before Parliament, this would cost £ 300 to £400. The Royal College of Physicians kept the committee in being, but apparently determined not to undertake the expense of private legislation. ( Clark, G. 1966 vol.2 pp 642-643).

  • In 1813, when George Rose MP first brought in a public bill (3.1.3) the Royal College of Physicians referred it to the commissioners (on 12.4.1813?), afterwards joining them with the Elects. This committee produced a draft bill, which the Royal College of Physicians approved (10.6.1816?). ( Clark, G. 1966 vol.2 p 658). SELECTION OF COMMISSIONERS

The general meeting that "elected" commissioners was the established annual meeting of fellows at which college officers were selected. The proportion who came was high. Fellows increased from 47 in 1800 to just under 100 in 1828 ( Abel-Smith, B. 1964 p.2; IC 1828). 31 attended the meeting "Comitus Majorbibus Ordinaris" on 1.10.1827 (Royal College of Physicians Annals).

The minutes of the meetings follow a regular pattern from year to year:

    The Treasurer read a statement of accounts (including the madhouse account),

    the outgoing President then withdrew with the Elects to elect the next year's President, who was declared to the meeting on their return.

    He proposed four fellows to the meeting to be censors (examiners of candidates) for the year, they were balloted for and, being elected, took an oath and gave their faith to the college.

    A Treasurer and a Registrar (usually the outgoing officers) were then proposed and balloted for,

    the college elected the "Commissioners for licensing Madhouses during the ensuing year",

    the President proposed four fellows to be curators of the museum (they were not balloted for) and finally

    he appointed four fellows to give the year's lectures

From the form of the minutes one suspects that all appointments were a pre- determined formality.

This is consistent with my analysis of the commissioners for madhouses "elected" (Royal College of Physicians Annals), from which it emerged that a system was developed of selection by rotation. My analysis of this system is set out in 2.6.1. Table 2, supported by the tables for officers and for all individual commissioners.

The system was not fully developed until 1797.

From 1774 to 1777 only two of the initial five commissioners were replaced each year and nearly all commissioners were fellows of several years standing, including Royal College of Physicians officers and ex-officers. In the first four years only Robert Thomlinson had been FRCP for less than ten years. From 1775 the President was almost invariably a commissioner unless debarred by the three year rule.

In 1778 four completely new commissioners were appointed with the President. Two (George Baker and Richard Tyson) had been fellows for 21 and 17 years respectively, but the other two (Isaac Schomberg and Henry Reynolds) only for seven and four years each.

Thereafter one, two or three commissioners each year were normally quite recent fellows (Junior Commissioners) and in the 1780s and 1790s ex-Junior commissioners began to be appointed for another year of office (Senior commissioners).

From 1783 the juniors were clearly selected in the sequence of their admission to fellowship

By 1797 the selection of commissioners was so systematic as to be quite simply tabulated. Each year the President (except in the fourth year), two senior commissioners and two junior commissioners were appointed. The next year, both seniors were replaced, but the juniors served a second year before being replaced by more recent fellows. Some years later, the ex- juniors would serve as seniors for a year.. and so on.

The concept of an "election" does not seem appropriate in these circumstances. Fellows served pre-determined turns. There would have been no rival candidates and so no discussion of dispute about who should serve. Presumably the system itself was discussed and determined at some meeting/s. I did not come across any relevant minute, but, as I did not know the system, I was not looking for one.

Most fellows active in Royal College of Physicians affairs performed the role of commissioner at some time and so it did not confer on them a knowledge that set them apart as experts:

    At the general meeting on 30.9.1824, seventeen fellows were present apart from the five appointed commissioners. Of these, nine had already served (five as seniors, four only as juniors). The remaining eight had all become fellows after that year's juniors.

    On 1.10.1827 twenty six were present who were not appointed commissioners. At least two were ineligible as they had an incompatible professional interest (*) and eleven had not been fellows long enough to serve. Of the remaining thirteen, eleven had previously served (seven as seniors, four only as juniors).

In the 1820s a new FRCP had to wait about ten years before his turn as a junior commissioner, but this was because the admission of new fellows had, for many years, exceeded the one new junior commissionership available. (In the 1780s new fellows served as juniors in the year of their fellowship or soon after). In earlier years, therefore, the proportion of active fellows with experience as commissioners would have been far greater.

(*) Edward Thomas Monro (born about 1790, died 1856) and Sir George Leman Tuthill (born 1772, died 1835)) who were joint physicians to Bethlem from July 1816 (Hunter and MacAlpine pp 633 + 758). Monro was also the proprietor of Brooke House, Clapton ( Parry-Jones, W.L. 1972 1972 p.18). (See Prohibition of Interest) TA Madhouse Commissioners elected 1774, 1775, 1776 and 1777
Indicating their status in the Royal College of Physicians
Clicking on names will take you to fuller details of their service
YEARS COMMISSIONER Office, or number of years a fellow on election
1774-1775- 1776 William Pitcairn President 1775-1785
1774-1775 Henry Hinckley Treasurer 1762-1779
1774-1775 Robert Thomlinson 5 years FRCP. Treasurer in 1780
1774 Sir John Pringle (1) 11 years FRCP.
1774 Thomas Reeve President 1754-1763
1775-1776 Richard Brocklesby (2) 19 years FRCP.
1775-1776- 1777 Thomas Gisborne 15 years FRCP. President in 1791
1776-1777 Thomas Lawrence (2) President 1767-1774
1776-1777 William Cadogan 18 years FRCP.
1777 John L. Petit 10 years FRCP.
1777 Richard Warren 16 years FRCP.
(1) John Pringle was not particularly active in Royal College of Physicians affairs. He was appointed censor in 1770, but declined to act, choosing instead to pay the fine required by the by-laws. His election as one of the first commissioners may have been as an honour to a distinguished fellow. He was President of the Royal Society from 1772 to 1778, Physician to the Duke of Cumberland since 1749, to the Queen since 1761, and that year (1774) had been Gazetted physician in ordinary to the King. (Munk)

(2) Richard Brocklesby (Commissioner 1775 to 1776 and on five later occasions) was the author (1749) of a book on the application of music to the cure of diseases, including insanity. He and Thomas Lawrence were both physicians to the melancholic Samuel Johnson. (Royal College of Physicians Annals, Hunter, R.A. and Macalpine, I. 1963 pp 376-8, DNB under Lawrence.)

2.5.3 THE OFFICERS (See 2.6 Table 1)

The commissioners' principal function only occupied a week a year ( Routine Visits) and (after 1780) only the President was commissioner for more than two successive years. In contrast the officers served continuously. The Secretary's tasks were performed throughout the year and the President and Treasurer were involved whenever questions of litigation or finance arose. These were key roles in the commission whose holders were generally in a position to have more knowledge of its affairs than other fellows. Whilst the President was usually a commissioner, the Treasurer was only occasionally so. He served the normal turns in the system. The role of Secretary was never combined with that of commissioner.


The first commissioners chose a Mr Wall as Secretary and fixed the salary at £50 a year. I suspect he was an attorney specially retained for the purpose (*). He was first named in the Treasurer's accounts in 1775 and served for over twenty years.

(*) I inspected the Royal College of Physicians's general accounts in case he was an employee in some other respect, but could not find his name.

In 1797 John Mayo, a fellow who had already been a junior commissioner, was appointed Secretary. Succeeding Secretaries were also fellows. Mayo served eleven years and was replaced by Dr Richard Powell in September 1808. On 27.10.1814 the salary was increased from £50 to £105 a year, at which it remained until the commission was closed down. The last Secretary, John Bright, replaced Powell sometime in 1825 (RCP Commission Account; 1815 SCHC p. 871: evidence of Powell). Bright and the Treasurer, Thomas Turner became medical commissioners on the Metropolitan Commission in 1828.

The Act was specific about some of the Secretary's duties, but others are only suggested by the phrasing. He:

A Probably took meeting minutes and entered them in the registers (see my note to secton 17)

B Presumably (as he was paid a fee per licence made out the licences. He was required to collect the licence fees and pay them to the Treasurer. (section 8)

C Could be taken on visits (section 14) and make the minute. Was required to enter these in the register within a week (Critical ones being signed by three visiting commissioners. All being read to the commissioners at their next meeting and signed) (section 15)

D Had custody of the key to the box in which the registers and accounts were kept, and was required to keep it locked. (section 17)

E Was required to enter such county minutes as he received in the County Register (section 24)

F. Received admission notices via the Beadle. Was required to file and preserve London notices and enter a copy or extract in the Town Register within two days of receipt, and, in practice, entered county notices in the Country Register. (sections 21 and 27)

G. Was required to carry out searches on a commissioner's authority and provide an enquirer with specific details (section 19)

The registers were highly sensitive documents. They should, if the law had been fully complied with, have recorded the confinement of ever non-pauper in every licensed house in England and Wales, including those related to the richest, noblest and most influential of the country's citizens. Each patient's name, the house confined in, the names and addresses of those confining and the doctor signing the certificate, the date of confinement, the comments of the official visitors on the condition of the house, and any made on the patient's case, should all have been entered and carefully indexed for quick reference.

The Secretary's responsibilities with respect to the registers were statutory. With respect to them his only necessary reference to the commissioners was for their signatures to authenticate London visiting minutes (Point C above). Commissioners had statutory responsibility for meeting minutes (section 17), but the Secretary had statutory responsibility for entering visiting minutes and filing, preserving and entering details of admissions (Points C, E and F above). He was custodian of the commission's confidentiality. sworn to keep the information of his office secret (section 7), he had custody of the key, was required to keep the registers locked (Point D above) and had to be present if the President chose to inspect them (section 18). I would infer a general responsibility to ensure only those stated in the Act had access to the registers, and only under the circumstances stated (see my note a* relating to access and section 17) 2S.2.7.A).

Those executing the Act could be summonsed and examined by the Westminster courts (section 29) and were liable to civil actions (see section 33 and counsel's opinion on making critical minutes public). Presumably an action against the commission would name the Secretary if it involved any of his statutory responsibilities. To gain the Act's protection he had to show he had acted in pursuance of it and with its authority (section 33). He had, it appears, personal responsibility for the confidentiality of the commissioners' records, a responsibility he was reminded of annually by his oath. Whilst the commissioners had to ensure he was "a proper person" to execute such trusts (section 7), he was personally responsible for executing them in accordance with the law.



The President was required to administer the commissioner's oath (section 5) and call their first meeting (section 11). The current President was a commissioner for 42 of the 54 years of the commission. There were only three occasions (1774, 1784 and 1819) when the Royal College of Physicians could have appointed him, but did not do so. (All three occassions are at the end of a Presdient's period of office).

Often, but by no means always, he was the commissioner of longest Royal College of Physicians standing, who chaired commissioner's meetings and had the casting vote. He was entitled to inspect the registers at any time and, with the Elects, audited the Accounts. Any legal action to enforce the Act in the London area had to be taken by the President in the name of the Treasurer. (For references see 2.5.1).

Royal College of Physicians funds were risked in legal actions, its reputation if it failed to enforce the Act. This may have been the reason that the President was made a commissioner whenever legally possible: prudence dictating that the senior college officer should also be the senior commissioner (See Bright's use of the term in 2.6.1d). In the years he did not serve, the vacant place was filed by a Fellow of long standing: in 1777, 1788, 1819 and 1823 by ex Presidents and in 1816 by an ex Treasurer.

The Royal College of Physicians sought legal advice on the (enforcement clause) soon after the 1774 Madhouse Act was passed, and again in 1782: this time from Lord Chief Justice Kenyon, the Attorney General. Someone had applied for a licence outside the legally specified period (see section 8) and, the commissioners therefore refusing, had started his madhouse without. Another party (unnamed) threatened him with prosecution and applied to the President for leave to use his name, or the colleges's, as petitioner in the prosecution. The Royal College of Physicians asked Kenyon if the President had:

"a discretionary power ... to prosecute or not on an application of any person ... . Or can any person make use of the name of the Treasurer without the President's consent, and in the case of a verdict for the defendant how can the Treasurer ... recover the costs he will be obliged to pay?"

Kenyon said he could not "give a receipt to provide for the inaccuracies of an ill-penned law." If an action was brought and lost he could see no way in which the Treasurer could be indemnified against costs, but "The President of the College is not as I conceive compellable to bring the action against his own judgement, nor can anybody else make use of the name of the Treasurer."

As the madhouse proprietor "had done all in his power to comply with the injunctions of the Act", a general meeting of fellows requested the President not to give leave to use his name or that of the Treasurer as plaintiff, and the President agreed. (Royal College of Physicians Annals 12.6.1782 pp 18-20, 25.6.1782 pp 17-21).

The Royal College of Physicians Annals have already shown us the activity relating to the physician commission in the years following 1811. In 1813 the college successfully prosecuted an unlicensed house in Hoxton:

"Budd v. Foulkes, A Mrs Foulkes, of Ivy Lane, Hoxton, was summoned by the Treasurer of the Royal College of Physicians (Dr Budd), for keeping in her house more than one lunatic, she not having a licence from the Commissioners by 14 Geo.3,Cap.49. Mr Roberts, solicitor to the College, on March 2nd 1813, called at her house and asked her how she came to keep such a house without a licence. She was much confused, and said she could not afford to pay for a licence, which was £10. He asked if Mr Dunston, Master of St. Luke's Hospital, kept the house; she said he did not, but he was the landlord and recommended patients, but had nothing to do with the management or profits of the House; she said no medical gentleman attended the house; her patients were not ill enough to request medical assistance. There were four lunatics at that time in the house of defendant, some of them had straight-waistcoats, one was double waistcoated, had a lock which crossed the wrists; and at night she had a lock on her legs. By the evidence it seems Mr Dunston was the owner of the house"

The jury found Mrs Foulkes guilty and she was fined £500

© Andrew Roberts 1981-

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