Jonathan Andrews, Andrew Scull. Undertaker of the Mind: John Monro and Mad-Doctoring in Eighteenth-Century England. Berkeley: University of California Press, 2001. xx + 363 pp. $35.00 (cloth), ISBN 978-0-520-23151-1.

Reviewed by John S. Haller (Department of History, Southern Illinois University Carbondale)
Published on H-Disability (April, 2002)

This panoramic view of eighteenth-century medicine and culture is part of a twelve-book Medicine and Society series, edited by Andrew Scull, which examines medical knowledge and psychiatric practice in an historical and sociological context. The book was constructed from case books, diaries, family papers, and correspondence of physician and mad-doctor John Monro (1715-1791), visiting physician to Bethlem (Bethlehem) Hospital at Moorfields. Using these sources, the authors provide a fascinating account of society and culture surrounding Britain's first public institution for the insane. The book is ambitious in its intent and includes chapters on Monro and his family; Monro's rival mad-doctors; a remarkable account of the relationship between Methodism, madness, and religious enthusiasm; several case studies of madness among the classes; and issues of madness and false confinement. The authors also use portraits, satires, poetry, ballads, broadsheets, caricatures, paintings, maps, and engravings to bring both depth and breadth to the topic. What they achieve appeals to a broad audience of readers as well as breaks new ground in the interpretation of eighteenth-century madness. The authors chose the title, "Undertaker of the Mind," to convey the close association between madness and death; as one of Monro's patients explained, the mad-house became for him a "premature coffin of the mind" (xvi).

John Monro came from a family of divines and physicians. His father James was the first of the family to be appointed chief medical officer to Bethlem, which opened in 1675. Both father and son were educated at Oxford, and made their tour of the continent and its medical schools before settling into practice. The Monro connection at Bethlem (James, John and son Thomas) lasted 125 years and gave them virtual monopoly of the mad-doctoring work at the hospital, including control of admissions and treatment. Their appointments, which were regarded as a part-time activity, also served to connect them to the daily care of private patients in numerous mad-houses (some of which they held part ownership), serve as confidants to the British elite, and act as expert witnesses in civil and criminal trials.

As the authors explain, John Monro broke few new paths in mad-doctoring. To some extent he was an absentee-physician at Bethlem, who failed to attend staff meetings. He seemed largely insensitive to the vulgar amusements that the hospital's patients seemed to provide to the public and took little role in post-mortem investigations. Monro stayed well within the mainstream of rational therapeutics characterized by evacuations (purges, vomiting, bleedings), tonics, and low diet. Although he was responsible in part for the medicalization of mad-doctoring and the increased use of mechanical restraints and seclusion, these changes could not be attributed to him alone.

In the history of psychiatry, Monro is often linked with William Battie (1704-1776), physician at the rival St. Luke's Hospital for Lunatics in Upper Moorfields which opened in 1751. Their theoretical and practical differences in managing the world of madness became the basis for considerable historiographical analysis but, as the authors explain, the genuine differences between the two doctors was often exaggerated in order to portray Monro as a reactionary and to demonstrate a progressive development of eighteenth-century psychiatry. While the authors accurately characterize Mono as resolutely opposed to the intellectual currents of the Enlightenment, he was nevertheless clearheaded enough to attack the prevailing belief that the insane were insensible to bodily disease and temperature extremes, a belief that carried into the nineteenth century. According to the authors, the prevailing verdict of twentieth-century historians (except for Akihito Suzuki) to praise Battie at Monro's expense is ill-founded and based on an overly simplified teleology.

The authors' chapter on religion and madness is particularly interesting and provides an enormously important perspective on understanding post-Restoration England when the Newtonian and Cartesian underpinnings of the Scientific Revolution brought heightened skepticism to bear on the spiritual transports and evangelism of the Methodists. With religious enthusiasm identified increasingly with fanaticism, England's mad-doctors became part of a campaign to police religious sectarians who were seen as a threat to the body politic. Methodists such as George Whitefield and John Wesley were refused access to Bethlem's numerous Methodist patients and other Protestant evangelicals who had been declared insane. As the authors explain, Methodism became "inextricably linked with madness, and their Anglican and other opponents...jump[ed] at the opportunity to associate them with popery, superstition, and unreason" (85). Almost ten percent of Bethlem's patients in the 1780s were confined because of their religious enthusiasm, an eccentric condition reputedly improved by appropriate purging and bloodletting.

Mad-doctors like Monro and Battie derived lucrative consultation fees from the discreet advice and treatment they gave to Britain's more affluent families, treating patients in the privacy of their own homes, in confinement at a private madhouse, or at more public hospitals such as Bethlem or St. Luke's. These cases required frequent attendance and offered good remuneration for months and even years. Over time, the more successful mad-doctors employed retinues of servants to manage houses and serve the needs of families that could afford private care. In this manner, families avoided social embarrassment as well as financial disarray. In this manner, too, mad-doctors richly profited. Battie, Monro's rival, died in 1776 with a worth estimated at L 200,000, mostly attributable to his mad-house profits.

Cases of false confinement, particularly of women locked away to wrest control of property, figured largely in the press and printed word. However, the authors argue that these instances were more a product of fiction than of reality. The Enlightenment had left English society with a sense of libertarianism that served it well in matters of false confinement and, as a rule, physicians went to extra lengths to substantiate cases involving confinement of the insane. Nevertheless, the authors admitted that the madhouse "lived up to and exceeded the darkest imaginings of its critics" (153).

Finally, the authors address several notorious cases of insanity, including Earl Ferrers' murder of a long-time family steward. Although the Earl, in his defense, attempted to use Monro as an authority to justify his claim of madness, he was brought to justice and hanged for his crime. Other cases included the attempted regicide Margaret Nicholson, for whom Monro was brought in to give expert opinion; and his opinion on the likelihood of mental recovery by George III.

Overall, this is an excellent book, enriching the life of Monro by casting it against the color and character of the times. Monro may have been the high priest of the mad-trade, but for purposes of this book, he was more a backdrop to the authors' synoptic view of madness in eighteenth century society and culture. The book is amply illustrated and superbly well written, and represents a convincing interpretation of the age.

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Citation: John S. Haller. Review of Andrews, Jonathan; Scull, Andrew, Undertaker of the Mind: John Monro and Mad-Doctoring in Eighteenth-Century England. H-Disability, H-Net Reviews. April, 2002.
URL: http://www.h-net.org/reviews/showrev.php?id=6195

Copyright © 2002 by H-Net, all rights reserved. H-Net permits the redistribution and reprinting of this work for nonprofit, educational purposes, with full and accurate attribution to the author, web location, date of publication, originating list, and H-Net: Humanities & Social Sciences Online. For any other proposed use, contact the Reviews editorial staff at hbooks@mail.h-net.org.