This is an
excellent contribution to the Medicine and Society series published by the University of California
Press and a companion volume to Undertaker of the
Mind: John Monro and Mad-Doctoring in Eighteenth-Century England by the
same authors and in the same series. Jonathan Andrews is Senior Lecturer in the
School of Humanities at Oxford Brookes University . He has specialised in the
history and sociology of the treatment of mental illness and is well-known for
his book The History of Bethlem. Andrew Scull is Professor of Sociology
at the University of California , San
Diego . Over the past fifteen years or so he has
published several books on the history and social implications of the treatment
of people suffering from mental disorders as well as co-authoring with Jonathan
Andrews the two books about John Monro. He is also the editor of the Medicine
and Society series.

Several
generations of the Monro family served from 1728 to 1853 as either the sole or
joint physician for London ‘s
most famous, or infamous, place of confinement for the mentally ill. Bethlem,
often corrupted to Bedlam, was a mediaeval, monastic foundation which became a
madhouse in the early 1400s. John Monro was the second of his family to be
medically responsible for the inmates and held the post from 1751 to within a
few months of his death in 1791. Not only did he have the medical care of the
large numbers of mentally ill in Bethlem but he also became the proprietor of
other similar institutions and had an extensive private practice for the
reasonably well-off middle class and wealthy upper class members of society. He
seems to have kept annual case-books of his work with these private patients
but, not surprisingly, only one seems to have survived, that for the year 1766.

The 1766 case-book
forms the heart of Jonathan Andrews’ and Andrew Scull’s book. It has been
extremely carefully edited and reproduced, with each of its one hundred and
twenty four pages laid out one to a page in the reproduction. Crossings out and
mistakes are faithfully indicated so that it can be used as a scholarly
resource. The accounts of the various patients are often moving and we gain a
genuine insight into the suffering of these people and the unhappiness of their
families. What is perhaps most interesting, however, is what is, for the most
part, not there – Dr. Monro’s treatment. He seems to have had a very small
repertoire of remedies and these seem to be restricted almost entirely to what
the editors call "evacuative and antiphlogistic remedies – bleeding,
purging, and vomiting." (p.92)

The general reader
will find much that is fascinating both in the case-book itself and in what is
effectively a commentary on it. Two examples immediately come to mind. The
first is the way in which religion plays a part in the symptoms of mental
illness as interpreted by Monro. The good doctor himself seems to have been a
paragon of middle-of-the-road Anglicanism and was therefore very suspicious of
anything which might be classified as ‘enthusiastic’ in the religious line.
Indeed such symptoms might well help in a diagnosis of madness as was the case
with the famous Alexander ‘The Corrector’ Cruden. The eponymous author of the
famous concordance regarded his role of indexing every word in the bible as a
God-given task but Monro obviously viewed the whole affair as a sign of
madness. Cruden spent a good deal of time under Monro’s care at one madhouse or
another. Chapter six of the book, ‘Religion, Madness, and the Case Book’, is an
intriguing study of the relationship between religion and madness at this time.

The second obvious
area of interest for the general reader is the whole area of madness as a
business. These days, everything seems to have been commercialised but to find
that madness was such a lucrative proposition in the eighteenth century comes
as a shock. The poor and the extremely and violently deranged were dealt with
by institutional treatment at places such as Bethlem. The medical practitioners
like Monro were paid a modest retainer for their work with the patients. This
type of work gave the mad-doctors a professional base on which to develop a
reputation which they then used extremely profitably in private practice. Monro,
like many of his contemporaries, charged enormous fees when the families
concerned were wealthy and amassed a considerable fortune. Chapter seven, ‘Treating
Patients and Getting Paid’, gives a lot of interesting details about this
commercialisation aspect.

Other chapters
deal with the types of people who were thought to suffer from mental illness
and looks at the range from the poorest to a few examples of the aristocracy,
the art of consultation, how Monro went about the job of diagnosing dementia
and, finally, a chapter on how the patients viewed their own illnesses.

This is an
intriguing book which should be of interest to both the specialist and the general
reader.  The former will want to have the reproduction of Monro’s 1766
case-book on their shelves. The latter will learn a huge amount about human
nature in general and about the eighteenth century mad-trade in particular.

© 2003 Kevin Purday

Kevin Purday is Head
of the Cambridge International High
School and is currently a distance-learning student
on the Philosophy & Ethics of Mental Health course in the Philosophy Dept.
at the University of Warwick .

Categories: General, Philosophical