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Clergy and the Care of the Insane in Eighteenth-Century Britain1

  • R. A. Houston (a1)

Extract

Writers on seventeenth- and eighteenth-century England have stressed the significance of doctors and clergy in the provision of residential care for the better-off mad person. “The private madhouse trade in fact started with the practice of doctors taking private patients into their homes.” So wrote Macalpine and Hunter. According to William Parry-Jones, English “lunatics from the more affluent classes were cared for individually, often in the custody of medical men or clergymen.” The two professions commonly overlapped, meaning that clerics could provide medical care. Andrew Mason has written enthusiastically that “towards the end of the seventeenth-century, so-called ‘clerical mad doctors’ abounded.” As educated men working in an occupation with few barriers to entry, English clergy could “readily take up medicine,” which was just one element of the burgeoning eighteenth-century market place. “Those entering the madbusiness were drawn from … clergymen, both orthodox and non-conformist, businessmen, widows, surgeons, speculators, and physicians.”

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2. Macalpine, I. and Hunter, R., George III and the Mad-business (London: Allen Lane, 1969), 323.

3. Parry-Jones, W. L., The Trade in Lunacy: a Study of Private Madhouses in England and Wales in the Eighteenth and Nineteenth Centuries (London: Routledge and Kegan Paul, 1972), 78; see also 74.

4. Mason, A., “The Reverend John Ashbourne (c.1611–61) and the Origins of the Private Madhouse System,” History of Psychiatry 5 (1994): 339.

5. Langford, P., A Polite and Commercial People. England, 1727–1783 (Oxford: Clarendon, 1989), 78.Holmes, G., Augustan England. Professions, State and Society, 1680–1730 (London: G. Allen and Unwin, 1982), 110, notes the reforging of links between the clergy and medicine during his period, notably through apprenticeships.

6. Andrews, J. and Scull, A., Undertaker of the Mind: John Monro and Mad-doctoring in Eighteenth-century England (London: University of California Press, 2001), 148.

7. Houston, R. A., “‘Not Simple Boarding’: Care of the Mentally Incapacitated in Scotland During the Long Eighteenth Century,” in Outside the Walls of the Asylum: the History of Care in the Community, 1750–2000, eds. Bartlett, P. and Wright, D. (London: Athlone, 1999), 1944.Houston, R. A., “Institutional Care for the Insane and Idiots in Scotland before 1820. Part 1,” History of Psychiatry 12:1 (2001): 331; part 2, 12:2 (2001): 177–97. Houston, R. A., “Professions and the Identification of Mental Incapacity in Eighteenthcentury Scotland,” Journal of Historical Sociology 14:4 (2002): 441–66. Allan Beveridge assumes that doctors were important for residential care in Scotland, though he cites only one example: that of James Boswell's brother Beveridge, John. A.: “James Hogg and Abnormal Psychology: Some Background Notes,” Studies in Hogg and His World 2 (1991): 91. In reality, however, Lieutenant John Boswell was sent to Newcastle for treatment. Ryskamp, C. and Pottle, F. A., eds., Boswell: the Ominous Years, 1774–76 (New York: McGraw-Hill, 1963), 4344, 49.

8. “As primarily charitable institutions the Scottish asylums were dominated by lay rather than medical influence and control.” Walsh, L., “‘The Property of the Whole Community.’ Charity and Insanity in Urban Scotland: the Dundee Royal Lunatic Asylum, 1805–1850,” in Insanity, Institutions and Society, 1800–1914. A Social History of Madness in Comparative Perspective, eds. Melling, J. and Forsythe, W. (London: Routledge, 1999), 184.

9. Parliamentary Papers (PP) 1816, VI, 370. See also 372. The equivalent figure for contemporary provincial England was at least a fifth of proprietors, with the metropolitan proportion much higher. Parry-Jones, , Trade in lunacy, 77, 82.

10. National Archives of Scotland (NAS) SC39/47/9, David Cross (1818). The Spence referred to was presumably Dr. Thomas Spens. Smith, C. J., Historic south Edinburgh (Edinburgh: C. Skilton, 1978), 195. “An act to regulate madhouses in Scotland” (55 Geo. III c. 59). This private asylum received high praise from the Sheriff's visitors.

11. The 1857 Royal Commissioners remarked on the division, among private madhouse keepers, between “men of education, and well fitted, by professional training, to have the management of institutions for the insane,” and ignorant empirics such as a victual dealer, failed baker, gardener and public house keeper. Report of the Royal Commissioners on Lunatic Asylums and the Laws Relating to Them in Scotland … 1857 (Shannon: Irish University Press, 1969), 100. Facsimile edition: first published as Report by Her Majesty's Commissioners: Appointed to Inquire into the State of Lunatic Asylums in Scotland and the Existing Law in Reference to Lunatics and Lunatic Asylums in That Part of the United Kingdom (Edinburgh: T. Constable, 1857).

12. Report of the Royal Commissioners … 1857, 53; Appendix C, 104–32. It should be noted that private madhouses were less common in Scotland than England. Rice, F. J., “The Origins of an Organisation of Insanity in Scotland,” Scottish Economic and Social History 5 (1985): 4245, 4748.

13. Parry-Jones, , Trade in Lunacy, 78.

14. , J. A. R. and Bickford, M. E., The Private Lunatic Asylums of the East Riding (Beverley, U.K.: East Yorkshire Historical Society, 1976).

15. Andrews and Scull, Undertaker of the Mind, throughout.

16. Faulkner, B., Observations on the General and Improper Treatment of Insanity: with a Plan for the More Speedy and Effectual Recovery of Insane Persons (London: H. Reynell, 1789), 89, 1819.Porter, R., Mind-forg'd Manacles. A History of Madness in England from the Restoration to the Regency (Cambridge, Mass.: Harvard University Press, 1987), 144–45.Macalpine, and Hunter, , George III, 326–68.Andrews, J. and Scull, A., Customers and Patrons of the Mad-trade: the Management of Lunacy in Eighteenth-century London. With the Complete Text of John Monro's Case Book (Berkeley: University of California Press, 2003), 43, nevertheless note that “many physicians preferred to share in the wealth [of private madhouse keeping] as visiting consultants, rather than to traffic more directly in such an unpleasant and stigmatizing endeavor,” even if they then go on to suggest that the opposite was also true.

17. The Royal College of Physicians, chartered in 1518, administered supervision of this act in London, magistrates in the provinces.

18. Andrews, J., “They're in the Trade … of Lunacy. They ‘Cannot Interfere—They Say.” The Scottish Lunacy Commissioners and Lunacy Reform in Nineteenth-century Scotland. Wellcome Institute for the History of Medicine, Occasional Publications 8 (London: Wellcome Trust, 1998), 26.

19. See, for example, Monro's testimony in the case of David Hunter. NAS JC8/1, 12 March 1801. The limited deployment of medical terminology is doubly surprising since it is likely that patients (and their families and legal representatives) had access to quite sophisticated medical knowledge. Porter, R., “Laymen, Doctors and Medical Knowledge in the Eighteenth Century: the Evidence of the Gentleman's Magazine,” in Patients and practitioners. Lay Perceptions of Medicine in Pre-industrial Society, ed. Porter, R. (Cambridge: Cambridge University Press, 1985), 313.

20. Edinburgh Magazine, new series 6 (July 1795): 78.

21. Thomas, K., Religion and the decline of magic. Studies in Popular Beliefs in Sixteenth- and Seventeenth-century-England (Harmondsworth: Penguin, 1973), 16.

22. MacDonald, M., Mystical Bedlam. Madness, Anxiety, and Healing in Seventeenth-century England (Cambridge: Cambridge University Press, 1981), 8. A similar line is followed by Rack, H. D., “Doctors, Demons and Early Methodist Healing,” in The Church and Healing, ed. Sheils, W. J. (Oxford: Blackwell, 1982), 137–52, at 139.

23. MacDonald, M., “Religion, Social Change and Psychological Healing in England, 1600–1800,” in The Church and Healing, ed. Sheils, W. J. (Oxford: Blackwell, 1982), 103.

24. Quoted in Wear, A., Knowledge and Practice in English Medicine, 1550–1680 (Cambridge: Cambridge University Press, 2000), 33.

25. Puritans, for example, continued to advocate exorcism after the Church of England banned it in 1604. MacDonald, M., Witchcraft and Hysteria in Elizabethan London: Edward Jorden and the Mary Glover Case (London: Tavistock, 1991). More generally see Cook, H. J., The Decline of the Old Medical Regime in Stuart London (London: Cornell University Press, 1986), 32.

26. Herbert, G., A Priest to the Temple (London: T. R. for Benj. Tooke, 1671 edition).Booty, J. E., “The Anglican Tradition,” in Caring and Curing. Health and Medicine in the Western Religious Traditions, eds. Numbers, R. L. and Amundsen, D. W. (Baltimore, Md.: Johns Hopkins University Press, 1986), 250–51. The resemblances between medicine and religion were worked out in most treatises on practical divinity, such as Taylor, Thomas, The Principles of Christian Practice: Containing the Institution of a Christian man, in Twelve Heads of Doctrine (London: Robert Young and John Beale for I. Bartlet, 1635), 540607.

27. Harley, D., “The Good Physician and the Godly Doctor: the Exemplary Life of John Tylston of Chester (1663–99),” Seventeenth Century 9:1 (1994): 93117. Episcopal licensing of medical practitioners was tightened up after the Restoration.

28. Wear, A., “Puritan Perceptions of Illness in Seventeenth-century England,” in Patients and Practitioners, ed. Porter, R. (Cambridge: Cambridge University Press, 1985), 5599.

29. Harley, D., “James Hart of Northampton and the Calvinist Critique of Priest-physicians: an Unpublished Polemic of the Early 1620s,” Medical History 42:3 (1998): 362–86.

30. Cook, , Old Medical Regime, 32.

31. Some have argued that it was increasingly necessary for English clergy to curtail their “non-core” activities such as scientific investigation in order to perform pastoral duties. Feingold, M., “Science as a Calling? The Early Modern Dilemma,” Science in Context 15:1 (2002): 79119.

32. MacDonald, , Mystical Bedlam, 230.MacDonald, , “Religion, Social Change and Psychological Healing,” 106, 110–12, 118–19.MacDonald, M., “Lunatics and the State in Georgian England,” Social History of Medicine 2:3 (1989): 299313.

33. Houston, R. A., Madness and Society in Eighteenth-century Scotland (Oxford: Oxford University Press, 2000), 293330.

34. For two early-nineteenth-century examples, see Greater Glasgow Health Board HB13/ 7/184, Alexander Macfarlane, minister of Kilbrandon, and James Couper, vicar of Roath. Couper was cognosced in 1816. NAS SC36/74/13.

35. Bartlett, P., “Legal Madness in the Nineteenth Century,” Social History of Medicine 14 (2001): 107–31.

36. Report of the Royal Commissioners … 1857, 21.

37. An Introduction to Scottish Legal History. Stair Society 20 (Edinburgh: Stair Society, 1958), 170–73.Gouldesbrough, P., Formulary of Old Scots Legal Documents. Stair Society 36 (Edinburgh: Stair Society, 1985), 74.Bell, W., Dictionary and Digest of the Law of Scotland (Edinburgh: Bell and Bradfute [4th edition], 1838), 112–13. Walker, D. M., ed., The Institutions of the Law of Scotland … by James, Viscount of Stair … 1693 (Edinburgh: Stair Society, 1981), 702–11 (hereafter Stair's institutions).

38. For a full discussion of the procedure see Houston, , “Professions,” 441–66.

39. Davies, T. G., “Judging the Sanity of an Individual: Some South Wales Civil Legal Actions of Psychiatric Interest,” National Library of Wales Journal 29:4 (1996): 455.

40. NAS C22/68, 603.

41. Signet Library, Session Papers, vol. 29, case 98, “Memorials and answers for John Stark,” 1.

42. NAS SC54/2/36, Duncan Campbell (1726).

43. NAS SC36/74/13, James Couper (1816).

44. Signet Library, Session Papers, vol. 345, case 5, “The petition and complaint of the Rev. James Baine minister, and of Lieut. Michael Baine, of his Majesty's Regiment of Light Dragoons, November 18, 1768,” 4.

45. NAS C22/91, 193. CC9/7/79, 538.

46. NAS C22/112, 116.

47. NAS JC54/1, report for Forfar (1 May 1818). However, the Third Report of the Committee on Madhouses in England, etc. (June 1816), 377–78, had stated that there were no licensed private madhouses in Forfarshire.

48. Report of the Royal Commissioners … 1857, Appendix M, no. 6, p. 307.

49. Ibid., Appendix M, 298.

50. This includes newspapers. I have also benefited from discussion with Dr Helen Dingwall, who reports no such advertisements in her extensive study of medical advertising in eighteenth-century Edinburgh newspapers. Dingwall, H. M., “‘To Be Insert in the Mercury’: Medical Practitioners and the Press in Eighteenth-century Edinburgh,” Social History of Medicine 13:1 (2000): 2344. An example of a woman advertising her private madhouse can be found in Edinburgh Evening Courant, no. 10, 473, 2 March 1785.

51. Report of the Royal Commissioners … 1857, Appendix M, 188–89.

52. NAS C22/96, 346.

53. Address of Several Ministers of the Presbytery of Dundee to Their Parishioners (Dundee: n.p., n.d. [ca.1835]).

54. Sunnyside Royal Hospital (Montrose), SRI/1. Papers now housed in Dundee University Archives.

55. A portioner was an heir to a section of an estate.

56. The Miscellaneous and Posthumous Works of the Rev. Alexander Pirie, Minister of the Gospel, Newburgh, Fife, 6 vols. (Edinburgh: J. Pillans and Sons, 18051806). For an example of the opposition to Pirie's arguments, see A Narrative of the Process Against Mr Alexander Pirie, Minister at Abernethy, before the Associate Presbytery of Perth and Dunfermline (Edinburgh: n.p., 1768).de S. Cameron, N. M., ed., Dictionary of Scottish Church History and Theology (Edinburgh: T and T Clark, 1993), 660–61.

57. NAS SC49/57/4, George Henderson (1782).

58. These testimonies provide the principal source for Houston, Madness and society, and are discussed in detail in chapter 2 of that work.

59. NAS SC39/47/9, Francis Stuart (1816).

60. Houston, “Professions.”

61. Edinburgh City Archives (ECA) Merchant Company no. 264.

62. NAS SC67/42/1, William Adam (1723).

63. Signet Library, Session Papers, vol. 345, case 5, “Answers for Helen Hay … November 29, 1768,” 12.

64. Sibbes, Richard, The Sovles Conflict with It Selfe, and Victorie over It Selfe by Faith: a Treatise of the Inward Disquietments of Distressed Spirits, with Comfortable Remedies to Establish Them (London: M. Flesher for R. Dawlman, 1635).

65. NAS SC39/36/2, Margaret Crawford (1737). For a stimulating discussion of how mental problems were understood as a psychomachic struggle in the seventeenth century, see Yeoman, L., “Archie's Invisible Worlds Discovered—Spirituality, Madness and Johnston of Wariston's Family,” Records of the Scottish Church History Society 27 (1997): 156–86.

66. NAS SC39/47/3, Hugh Maxwell (1784).

67. NAS SC67/57/16, George Thomson (1818).

68. This finding runs counter to that of Heyd, M., “Medical Discourse in Religious Controversy: the Case of the Critique of ‘Enthusiasm’ on the Eve of the Enlightenment,” Science in Context 8:1 (1995): 133–57, who argues that ministers increasingly borrowed arguments from medicine in certain types of discourse. Houston, R. A. and Frith, U., Autism in History. The Case of Hugh Blair (Oxford: Blackwell, 2000), 4951, 8183.

69. NAS CC8/6/15, Blair v Blair (1748).

70. NAS SC39/47/3, Hugh Maxwell (1784). For an English comparison see Suzuki, A., “Lunacy in Seventeenth- and Eighteenth-century England: Analysis of Quarter Sessions Records, Part II,” History of Psychiatry 3 (1992): 3435.

71. Houston, R. A., “Courts, Doctors and Insanity Defences in 18th and Early 19th Century Scotland,” International Journal of Law and Psychiatry 26:4 (2003): 339–54.Houston, R. A., “Legal Protection of the Mentally Incapable in Early Modern Scotland,” Journal of Legal History 24:2 (08 2003): 165–86.

72. Andrews, J., “Case Notes, Case Histories, and the Patient's Experience of Insanity at Gartnavel Royal Asylum, Glasgow, in the Nineteenth Century,” Social History of Medicine 11:2 (1998): 262–63.Daunton, M., Progress and Poverty. An Economic and Social History of Britain, 1700–1850 (Oxford: Oxford University Press, 1995), 465–66.

73. For an example where the Kirk Session spent much time and money on a madman, see the case of William Bran, maintained by the parish of Kinneff (Kincardineshire) and a local landowner from 1740–46. NAS CH2/218/2, pp. 331, 340, 342–43, 346–47, 357, 391.

74. Summary, Showing, According to the Returns from the Parochial Clergy in Scotland the Number of Lunatics in Each Presbytery (House of Commons, 9 July 1817). NAS SC9/21/1. Halliday, A., A General View of the Present State of Lunatics, and Lunatic Asylums, in Great Britain and Ireland, and in Some Other Kingdoms (London: Thomas and George Underwood, 1828).

75. NAS SCI/18/1, 10.

76. The Second Report of the Directors of the Dundee Asylum for Lunatics, 1821–2 (Dundee: Alex Colville, 1822), 18.

77. ECA Edinburgh Charity Workhouse, vol. 1, 24 July 1739. Regulations for the Charity Workhouse, or Hospital of Edinburgh (Edinburgh: T. W. and T. Ruddimans, 1743). See also ECA St. Cuthbert's Charity Workhouse minutes, vol. 1, 3 June 1766.

78. Smith, L. D., “Cure, Comfort and Safe Custody”: Public Lunatic Asylums in Early Nineteenth Century England (London: Leicester University Press, 1999), 5455.Bartlett, P., The Poor Law of Lunacy: the Administration of Pauper Lunatics in Mid-nineteenth-century England (London: Leicester University Press, 1999).

79. Hervey, N., “Advocacy or Folly: the Alleged Lunatics' Friend Society, 1845–63,” Medical History 30:3 (1986): 267.

80. Smith, , Public Lunatic Asylums, 54.

81. A Sermon Preached in St George's Church, on … 16th March 1815, in Behalf of the Edinburgh Lunatic Asylum, by Henry Grey … With an Appendix Containing a Report of the Managers Respecting the Asylum (Edinburgh: A. Balfour, 1815).

82. Edinburgh Charity Workhouse had a chaplain from its opening in the 1740s. Houston, R. A., “Fraud in the Scottish Linen Industry: Edinburgh's Charity Workhouse, 1745–58,” Archives 21:91 (1994): 4356.

83. Haley, D., “Religion and the Chaplaincy,” in “Let There Be Light Again.” A History of Gartnavel Royal Hospital from Its Beginnings to the Present Day, eds. Andrews, J. and Smith, I. (Glasgow: Greater Glasgow Health Board, 1993), 1821.

84. Report of the Royal Commissioners … 1857, 113; Appendix M, 399.

85. Haley, , “Religion and the Chaplaincy,” 19.Sueur, L., “The Psychological Treatment of Insanity in France in the First Part of the Nineteenth Century,” History of Psychiatry 8:1 (1997): 3753.

86. Ibid., 18–19.

87. Ibid., 21.

88. Ibid., 19, 21.

89. Hamilton, D., The Healers. A History of Medicine in Scotland (Edinburgh: Canongate, 1981), 99.

90. Brunton, D., “Smallpox Inoculation and Demographic Trends in Eighteenth-century Scotland,” Medical History 36 (1982): 407, 409, 412, 413.

91. Levitt, I. and Smout, C., The State of the Scottish Working-class in 1843 (Edinburgh: Scottish Academic Press, 1979), 219.

92. Houston, R. A., “‘Bustling Artisans.’ Patronage Disputes in South Leith During the 1740s and 1750s,” Albion 26:1 (1994): 5577.

93. See Barrie, V., “The Church of England in the Eighteenth Century,” Historical Research 75 (187) (2002): 6366 on pluralism and nonresidence, and 66–71 on the duties of English parish clergy.

94. It has become apparent in recent years that the level of church discipline, once thought to have fallen off after the Restoration, actually held up well during the eighteenth century. Jacob, W. M., Lay People and Religion in the Early Eighteenth Century (New York: Cambridge University Press, 1996).

95. Houston, R. A. and Knox, W. W. J., eds., The New Penguin History of Scotland (Harmondsworth, U.K.: Penguin, 2001), 234–63.

96. Bruce, S. and Wright, C., “Law, Social Change, and Religious Toleration,” Journal of Church and State 37:1 (1995): 103–20.

97. McIntosh, J. R., Church and Theology in Enlightenment Scotland: the Popular Party, 1740–1800 (East Linton, Scotland: Tuckwell, 1998).

98. See Birken, W., “The Dissenting Tradition in English Medicine of the Seventeenth and Eighteenth Centuries,” Medical History 39 (1995): 197218, for discussion of “medicine as a practical option for a lost career, or to supplement and subsidize uncertain careers,” 197.

99. Mitchison, R. and Leneman, L., Sexuality and Social Control. Scotland, 1660–1780 (Oxford: Blackwell, 1989), 99133.

100. Mason, , “Private Madhouse System,” 343. Mason persistently and erroneously refers to the foundation of a “Private Madhouse System” (caps, in original; emphasis added) in England. Ibid., 341–43.

101. A third of English livings were worth less than £50 in 1710–11. Barrie, , “Church of England in the Eighteenth Century,” 48.

102. Holmes, , Augustan England, 8387, 9497, 103–6.Langford, , Polite, 7778, 261, 453–54.

103. Holmes, , Augustan England, 95.Evans, E. J., “The Anglican Clergy of Northern England,” in Britain in the First Age of Party, ed. Jones, C. (London: Hambledon, 1987), 221–40. Not all curates were poor. Virgin, P., The Church in an Age of Negligence: Ecclesiastical Structure and Problems of Church Reform, 1700–1840 (Cambridge: James Clarke, 1989).Clark, G. Kitson, Churchmen and the Condition of England (London: Methuen, 1973).

104. Holmes, , Augustan England, 172–76.Mason, , “Private Madhouse System,” 338–39.Thomas, , Religion, 1114, 308. Universities too had licensing powers. In its origins, ecclesiastical licensing may have been an extension of the notion that mad people were possessed by the devil and that a cleric was “physician of the soul,” but there was also ecclesiastical licensing of doctors generally and of teachers.

105. Guy, J. R., “The Episcopal Licensing of Physicians, Surgeons, and Midwives,” Bulletin of the History of Medicine 56:4 (1982): 528–42.Willis, A. J., “Bishops' Licenses to Laymen in the Eighteenth and Nineteenth Centuries,” Amateur Historian 5:1 (1961): 26.Evenden, D. A., “Gender Differences in the Licensing and Practice of Female and Male Surgeons in Early Modern England,” Medical History 42:2 (1998): 194216.

106. MacDonald, , Mystical bedlam, 1923. For other examples, see Cook, , Old Medical Regime, 32.

107. Holmes, , Augustan England, 176–77.

108. Parry-Jones, , Trade in Lunacy, 75.Macalpine, and Hunter, , George III, 269–74.Porter, , Mind-forg'd Manacles, 174.

109. Ibid., 143–44. Mason's diary for this period is in Bristol University Library.

110. Durkan, J. and Kirk, J., The University of Glasgow, 1451–1577 (Glasgow: University of Glasgow Press, 1977), 329.

111. Geyer-Kordesch, J. and Macdonald, F., Physicians and Surgeons in Glasgow. The History of the Royal College of Physicians and Surgeons of Glasgow, 1599–1858 (London: Hambledon, 1999).Craig, W. S., History of the Royal College of Physicians of Edinburgh (Oxford: Blackwell, 1976).Dingwall, H. M., Physicians, Surgeons and Apothecaries. Medicine in Seventeenth-century Edinburgh (East Linton, Scotland: Tuckwell, 1995).Houston, R. A., Social Change in the Age of Enlightenment. Edinburgh, 1660–1760 (Oxford: Clarendon, 1994). The surgeons of Edinburgh were able to expand their jurisdiction in the later eighteenth century. Watson, W. N. Boog, “Four Monopolies and the Surgeons of London and Edinburgh,” Journal of the History of Medicine and the Allied Sciences 25:3 (1970): 311–22.

112. Houston, and Frith, , Autism in History, 36.

113. Rosner, L., Medical Education in the Age of Improvement. Edinburgh Students and Apprentices, 1760–1826 (Edinburgh: Edinburgh University Press, 1991), 2, 24.

114. Heller, R., “‘Priest-doctors’ as a Rural Health Service in the Age of Enlightenment,Medical History 20 (1976): 361–83.

115. Goldstein, J., Console and Classify. The French Psychiatric Profession in the Nineteenth Century (Cambridge: Cambridge University Press, 1987), 197201.

116. Ibid., 211–25, 301–21. See also Brockliss, L. and Jones, C., The Medical World of Early Modern France (Oxford: Clarendon, 1997), 748–50.Sueur, L., “La place de la religion catholique dans les asiles d'aliénés au XIXe siècle,” Revue Historique 289:1 (1993): 141–48. For nineteenth-century Ireland, see Prior, P. and Griffiths, D., “The Chaplaincy Question: the Lord Lieutenant of Ireland Versus the Belfast Lunatic Asylum,” Éire-Ireland 32: 2–3 (1997): 137–53. Erik Midelfort has informed me that none of the patients in his study of part of sixteenth-century Germany had been cared for by clerics before entering “hospitals.” Monasteries too offered medical help.

117. Heyd, “Medical Discourse,” 145, argues that the growing currency of Cartesian mindbody dualism from the mid seventeenth century created a distinction between medical and clerical professions: “by giving a medical interpretation to the phenomenon of enthusiasm, the ministers not only became reliant on a body of knowledge alien to their theological training but also relegated the treatment of the so-called enthusiasts to the medical profession.” Indeed, there seems to be no Scottish parallel with the English literature that used the label of madness to attack religious rivals by linking dissent with “enthusiasm” and Anglicanism with reason. See, for example, Lavington, George, The Enthusiasm of Methodists and Papists Compared (London: J. and P. Knapton, 1749).

118. Schmidt, L. E., Holy Fairs. Scottish Communions and American Revivals in the Early Modern Period (Princeton, N.J.: Princeton University Press, 1989). This contrasts with England where we are told that alternatives to medicine “had been discredited by their association with religious fanaticism.” MacDonald, “Religion, Social Change and Psychological Healing,” 123. This may be an overstatement. Barry, J., “Piety and the Patient: Medicine in Eighteenth Century Bristol,” in Patients and Practitioners. Lay Perceptions of Medicine in Pre-industrial Society, ed. Porter, R. (Cambridge: Cambridge University Press, 1985), 144–75.

119. MacDonald, , “Religion, Social Change and Psychological Healing,” 106, 110–12, 118–19.Booty, , “The Anglican Tradition,” 250–53.

120. Andrews, and Scull, , Undertaker of the Mind, 148. This in no sense detracts from the important contribution of old and new dissenters to the care of both individuals and groups, the latter through the founding of asylums like the Quaker York Retreat. Digby, A., Madness, Morality and Medicine: a Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985). Among many others writing on John Wesley and healing, see Rack, , “Doctors, Demons and Early Methodist Healing,” 139–40.Ferngren, G. B., “The Evangelical-fundamentalist Tradition,” in Caring and Curing, eds. Numbers and Amundsen, 498. On Edinburgh University, dissent, and the medical profession see Booth, C. C., “Medical Radicals in the Age of Enlightenment,” Journal of Medical Biography 8:4 (2000): 228–40. On variations in attitudes towards mental ailments within the reformed faith, see Vaux, K. L., Health and Medicine in the Rreformed Tradition: Promise, Providence, and Care (New York: Crossroad, 1984), 5765.

121. Harley, D., “‘Bred up in the Study of that Faculty’: Licensed Physicians in North-west England, 1660–1760,” Medical History 38:4 (1994): 398420. Birken, “Dissenting Tradition,” 199. Hardly any women received Episcopal licenses to practice in England. This may begin to explain why fewer females kept private madhouses in England than in Scotland. Evenden, “Gender Differences,” 195–96.

1 I am grateful to the following for commenting on earlier drafts of this article: Jay Brown, Jane Dawson, Helen Dingwall, Bruce Gordon, Jeremy Gregory, Stephen King, Deryck Lovegrove, Morrice McCrae, Eric Midelfort, Ed Miller, Bill Naphy, Peter Marshall, Hamish Scott, Keith Snell, David Stevenson, Steve Sturdy, Stephen Taylor, Lorraine Walsh, and Nigel Yates.

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