Extracts on madness

1758 "A Treatise on Madness By William Battie MD. Fellow of the Royal College of Physicians in London, And Physician to St Luke's Hospital"

"It was the saying of a very eminent practitioner in such cases that management did much more than medicine; and repeated experience has convinced me that confinement alone is oftentimes sufficient, but always so necessary, that without it every method hitherto devised for the cure of Madness would be ineffectual."
"Madness is frequently taken for one species of disorder, nevertheless, when thoroughly examined, it discovers as much variety with respect to its causes and circumstances as any distemper whatever: Madness, therefore, like most other morbid cases, rejects all general methods, e.g. bleeding, blisters, caustics, rough cathartics, the gumms and faetid anti-hysterics, opium, mineral waters, cold bathing and vomits."

1758 "Remarks on Dr Battie's Treatise on Madness By John Monro MD. Fellow of the College of Physicians in London; And Physician to Bethlem Hospital"

"Notwithstanding we are told in this treatise, that madness rejects all general methods, I will venture to say, that the most adequate and constant cure of it is by evacuation; which can alone be determined by the constitution of the patient and the judgment of the physician. The evacuation by vomiting is infinitely preferable to any other, if repeated experience is to be depended on...

I never saw or heard of the bad effect of vomits, in my practice; nor can I suppose any mischief to happen, but from their being injudiciously administered; or when they are given too strong, or the person who orders them is too much afraid of the lancet.

The prodigious quantity of phlegm, with which those abound who are troubled with the complaint, is not to be got the better of but by repeated vomits; and we very often find, that purges have not their right effect, or do not operate to so good purpose, until the phlegm is broken and attenuated by frequent emeticks.

Bleeding and purging are both requisite in the cure of madness... Issues between the shoulders, have been of great service in the removal of this distemper; cold bathing likewise has in general an excellent effect, but as it is sometimes apt to hurry the spirits, it is not to be prescribed indiscriminately to every one."

15.6.1830 Printing of 1829 Report of Metropolitan Commissioners

Later in 1830: background
Bethlem Hospital Minutes of Evidence taken by the Committee, appointed to enquire into the charges against Dr Wright, The Apothecary and Superintendent of Bethlem Hospital, and his answer pursuant to the direction of a special Court of Governors for the said hospital holden on Tuesday, the 28th Day of September, 1830, and directed to be printed for the use of the Governors, by a special court, holden on Friday the 15th day of October 1830. Reprinted for E. Wright, MD, President of the Phrenological Society of London, Member of the Royal Medical Society of Edinburgh, of the Medico-Chirurgical Society of London, and twelve years superintendent of the Royal Hospital of Bethlem, London. Printed by Mills, Jowett, and Mill, Bold Court, Fleet Street, 1830.

During the inquiry, Dr Wright examined Drs Monro and Tuthill, the joint physicians to Bethlem, who he had called in his defence. He examined Sir George Leman Tuthill respecting aspersions that had been cast on him (Wright) about his removal of heads from dead patients:

"In your opinion, as a medical man of many years standing, is it good and profitable to inspect the heads and bodies of the dead? Certainly it is

Did you, of your own knowledge, ever know that any inconvenience arose from that practice in Bethlem Hospital? Certainly not

Do you not believe that it is one of the grand means, by a sedulous prosecution of which we can, and can alone, expect to better our knowledge of insanity? I do

Did it ever come to your knowledge that I had made such dissections? Certainly"

December 1830 Haslam's Letter about the 1829 Report

A Letter to the Metropolitan Commissioners in Lunacy containing some strictures on the Act of Parliament and observations on their report. By J. Haslam MD of the Royal College of Physicians, London. 1830.


"In whatever asylum they may be placed, the means of cure ought to be furnished; the general health ought to be promoted by adequate exercise and wholesome diet; and when the recovery of the patient has been established and thoroughly ascertained, his liberation ought necessarily to follow. It must be evident that all these desiderata are to be accomplished by MEDICAL science and experience."

p.3 Haslam says that if insanity is a "morbid" condition:

"the incorporation of benevolent ignorance with medical science will be a serious impediment to the hopeful exertions of the accredited practitioner"

p.10: Haslam objects to the Commissioners' speaking of "imperfections of the present system" without saying what the imperfections are:

"... does this imperfection consist in an excess or deficiency of bleeding, vomiting or purging? in administering or withholding the tribe of narcotic poisons, belladonna, conium, hyoscyamus, opium and prussic acid? Does it arise from protracted confinement or severity of coercion, or is too much liberty permitted to the sallies of the madman's dangerous volition?"

p.11: Haslam objects to the Commissioners' statement that fewer persons recover from insanity than "a rational expectation justifies"

"It is generally understood that insane persons are restored to mental competency, by appropriate remedial agents, and by such occupation and rational direction of their intellects as may be suited to their several conditions. These later attempts have been termed moral management, a science at present very little understood, but to an intimate knowledge of which most persons, especially such as are least qualified, urge the strongest pretensions."

Haslam argues that it would be difficult for the commissioners to determine:

"what, under the circumstances of recent attack, and with the immediate assistance of the best medical aid, is the percentage of recoveries that a 'rational expectation justifies'"

The statistical implication of what he writes appears to be that the way to determine this would be by looking at a series of percentage recoveries over time. He has found it difficult to ascertain if there had been any diminution in "numbers formerly restored" and suggests that, if there has, the reason may be that people are less inclined to send their relatives for asylum treatment because of the intrusion into their privacy by the commissioners.


"The framers of the Bill, without any knowledge of the subject, and against all reasoning and experience, have set forth in the 38th clause that 'the hopes and consolations of religion may soothe and compose the minds of patients, and thereby tend to subdue the malady under which they are suffering'"


"During a period of nearly forty years, the treatment of insanity has been my constant and professional occupation, and it has uniformly occurred that when persons not medically educated have attempted to meddle with the regulation and care of lunatic patients their interference has always been detrimental"

John Haslam, 2 Hart Street, Bloomsbury, December 1830

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introducing the lunacy commission

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mental health
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Battie 1758

Monro 1758

Wright 1830

Tuthill on heads

Haslam 1830

Haslam on moral management

Hanwell 1834

Hanwell 1841

Mania 1844

Dementia 1844

Melancholia 1844

Monomania 1844

Moral Insanity 1844

Idiocy 1844

GPI 1844

Epilepsy 1844

Delirium Tremens 1844

Hanwell 1848

Progress of Psychological Medicine 1841-1881

Scotland 1881

Sanity and insanity 1890

Broadmoor 1903



Model answers 1928