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Customers and Patrons of the Mad-Trade

Customers and Patrons of the Mad-Trade: The Management of Lunacy in Eighteenth-Century London, With the Complete Text of John Monro’s 1766 Case Book

Jonathan Andrews
Andrew Scull
Copyright Date: 2003
Pages: 352
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  • Book Info
    Customers and Patrons of the Mad-Trade
    Book Description:

    This book is a lively commentary on the eighteenth-century mad-business, its practitioners, its patients (or "customers"), and its patrons, viewed through the unique lens of the private case book kept by the most famous mad-doctor in Augustan England, Dr. John Monro (1715-1791). Monro's case book, comprising the doctor's jottings on patients he saw in the course of his private practice--patients drawn from a great variety of social strata--offers an extraordinary window into the subterranean world of the mad-trade in eighteenth-century London. The volume concludes with a complete edition of the case book itself, transcribed in full with editorial annotations by the authors. In the fragmented stories Monro's case book provides, Andrews and Scull find a poignant underworld of human psychological distress, some of it strange and some quite familiar. They place these "cases" in a real world where John Monro and othersuccessful doctors were practicing, not to say inventing, the diagnosis and treatment of madness.

    eISBN: 978-0-520-92608-0
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations
    (pp. ix-x)
  4. Preface
    (pp. xi-xiv)
  5. Acknowledgments
    (pp. xv-xvi)
  6. PART I Managing Lunacy in Eighteenth-Century London

    • [PART I Introduction]
      (pp. 1-4)

      Goodwife Jackson, aged 39, of a burnt high-coloured sanguine Complexion, black Hair, 12 Years since fell mad, ran up and down the Streets, bare footed, Cloaths torn, Hair loose, was ready to lye down and pull up her Cloaths to every one, pretended Love to one Mr Holland her Master, then a Prisoner in the King’s Bench; at last she tore all things, and struck every one, and was raving mad; being poor, I have her a Glass of Antimony a Scruple in Beer, each other Morning for 14 Days . . . sometimes of Scamony in Beer or Ale...

    • CHAPTER 1 Customers, Patrons, and Their Mad-Doctor
      (pp. 5-12)

      The history of psychiatry, as David Ingleby wittily remarked some years ago, once resembled “the histories of colonial wars[: it told] us more about the relations between the imperial powers than about the ‘third world’ of the mental patients themselves.”¹ In recent years, his gibe has lost some of its sting, as historians belatedly have begun to make efforts to uncover the fates and the experiences of patients and their families.² Still, it is remarkable how much less we know of these customers and patrons of the mad-trade than we do of those who managed, cared for, and confined the...

    • CHAPTER 2 A Rare Resource: John Monro’s Case Book
      (pp. 13-27)

      In common with at least some other physicians of his generation, John Monro kept careful notes of the cases he treated—more particularly of those he encountered in his private practice. Like the records kept by his colleagues, most of his case notes have long since disappeared. Abandoned in obscure places and left to endure the gnawing criticism of mice, or effaced by the simple ravages of time and circumstance, they have vanished without trace, taking with them our chance to recover the intimate secrets of a deliberately obscured corner of the medical marketplace.

      Carefully preserved by one of his...

    • CHAPTER 3 Profiling Patients and Patterns of Practice
      (pp. 28-44)

      Possibly the most interesting details provided in Monro’s case book are those that give us clues about the identity of the customers of the maddoctor, an aspect of the mad-business that historians, thus far, barely have begun to investigate.¹ On the one hand, Monro’s case book reveals, as one might expect, that a significant number of his clients came from the “respectable,” moneyed classes, including merchants, lawyers, journalists, and established tradesmen. Monro was called to attend, for example, on prominent city politicians and tradesmen, including Alderman Richard Peers and the wife of Alderman Barlow Trecothick (both men were also prominent...

    • CHAPTER 4 The Craft of Consultation: Managing Patients and Their Problems
      (pp. 45-57)

      A significant proportion of Monro’s patients were plainly regarded as serious cases of madness. He refers to these cases with such terms as “violent,” “raving,” “furious,” “lunatic,” “mad,” and so forth. Many more among those Monro encountered, however, were observed to be merely “bewildered,” “nervous,” “hysterical,” “dull,” or “low/high in spirits,” or were fearful and anxious about being harmed themselves, rather than being inclined to hurt others. This suggests that although the special expertise of the mad-doctor was naturally thought to be necessary in cases of full-blown raving madness, Monro was more often summoned to deal with patients with milder...

    • CHAPTER 5 Diagnosing the Mad
      (pp. 58-81)

      Monro’s case book allows us, as one might hope, to obtain a relatively good idea of what both the mad-doctor and contemporary families considered to be the signs and symptoms of madness. The text reveals Monro to be someone who displayed considerable deliberation and a willingness to suspend judgment when diagnosing cases until more information had clarified matters. Generally, however, Monro’s diagnostic concern is directed to the mental processes that appear to be suggested by patients’ language and behavior, and it is notable that he attends very much to the form of their symptoms while not worrying very much about...

    • CHAPTER 6 Religion, Madness, and the Case Book
      (pp. 82-91)

      A Tory in his political sympathies and an Anglican in his religious observances, a man who in his youth had flirted with Jacobitism and who came from a family tainted by Jacobitism, John Monro was unlikely to have had much sympathy with “enthusiastic” forms of Protestant belief. And in his suspicion of the religiously transported and obsessed, he was at one with much of polite society in this period. As we shall suggest below, the Hanoverian elite was deeply mistrustful of unorthodox religious belief, whose potential for making mischief and subverting the social order marked it as a dangerous form...

    • CHAPTER 7 Treating Patients and Getting Paid
      (pp. 92-106)

      Monro devotes considerably more space in the case book to discussing patients’ symptoms and histories than he does to recording treatments. This adds further weight to the view generally taken of all the Monros: namely, that they had very little interest in therapeutics or experimentation and remained steadfastly conservative in their espousal of the standard evacuative and antiphlogistic remedies—bleeding, purging, and vomiting—that were the current orthodoxy.¹ When purging and vomiting are referred to in the case book, these are more frequently spontaneous, or disease-prompted, motions in the patient’s own body. Monro notes their existence for their diagnostic significance—...

    • CHAPTER 8 Being Mad in Eighteenth-Century England: Patients’ Views of Their Own Illnesses
      (pp. 107-116)

      When patients consulted physicians about all forms of illness in Monro’s time, the clinical encounter bore little relationship to its modern counterpart. Conversation was as a matter of routine quite central to the diagnostic process, for patients’ own accounts of the history of their disorders were considered of far more moment than anything that might be learned from the doctor’s direct examination of the body before him. Those bringing their complaints to the physician expected and were expected to not just talk at length of their pains and their suffering, but to offer up vital information concerning their habits and...

  7. PART TWO John Monro’s 1766 Case Book
    (pp. C-1-C-124)



    Flora an Indian girl, slave to MrsDenne, sent to MrMiles’s¹ from MrDudley’s Bloomsbury Square;² her mistress alledged she had been frighten’d by the ill usage of some servants in the house where she had been; however, as she had been guilty of several peices of extravagance, & had re: :fused both Physic³ & nourishmt, for fear of being poison’d; they not know: :ing how to manage her sent her to Mr Miles’s, but as the girl had also: lately some remains of fever upon her I think it better to await the event of that before I...

  8. Notes
    (pp. 119-176)
  9. Bibliography
    (pp. 177-202)
  10. Index
    (pp. 203-209)
  11. Back Matter
    (pp. 210-210)