"Cure, Comfort and Safe Custody": Public Lunatic Asylums in Early Nineteenth-Century England (review)

Leonard D. Smith. "Cure, Comfort and Safe Custody": Public Lunatic Asylums in Early Nineteenth-Century England. London: Leicester University Press, 1999. ix + 310 pp. Ill. $80.00 (0-7185-0094-6).

Leonard Smith's new book is clearly a labor of love. Bereft of the security of paid academic employment, he has nonetheless spent many years burrowing into archives spanning the length and breadth of England to reexamine the history of public lunatic asylums in the first half of the nineteenth century. This was a period characterized by what he terms "a mixed economy of care" (p. 12). The County Asylums Act of 1808 was a piece of permissive legislation, allowing but not requiring local magistrates to spend tax moneys building pauper asylums. Most chose not to do so, and yet the movement to incarcerate growing numbers of the insane gathered force in these years. The profit-making private "trade in lunacy" continued to attract a burgeoning clientele, and more charity asylums (or public hospitals) for the mad were added to such eighteenth-century establishments as St. Luke's and the York Asylum, not to mention the ancient foundation of Bethlem or Bedlam.

Smith's focus is on the county asylums and the public hospitals, not the avowedly profit-making sector. Collectively, he terms the focus of his interest the "public lunatic asylums." Successive chapters examine the emergence of these establishments; the management techniques employed; what he calls "the waste stuff" that peopled the asylums; the lower-end staff, once dubbed "keepers," and now increasingly referred to as "attendants"; and a variety of aspects of life within these prototypical museums of madness, from the character of daily existence, through the details of treatment, care, and the employment of patients, to the resort to (and eventual "abolition" of) various forms of mechanical restraint.

Smith has been both persistent and diligent, and he has unearthed a mass of detail that serves to enrich and flesh out our knowledge of the nature and functioning of these pioneering institutions. Empirically, therefore, the book makes important contributions, and this by itself amply warrants its publication. Everyone with an interest in the context within which Lord Shaftesbury and the Lunacy Commissioners brought about the "reforms" of the second half of the nineteenth century will find Smith's study invaluable.

Historiographically, however, Smith's discussion is rather more problematic. Analytically, he claims to provide a useful corrective to what he sees as the excesses of an early generation of revisionist historians, with my own work most prominently on parade in this regard. In practice, there are, as I see it, two sets of problems with his discussions here: first, he misreads and oversimplifies what an earlier generation of scholars had to say about the issues in dispute; and second, he exaggerates the novelty of what he himself has to say by way of corrective. If those who wrote about lunacy reform two decades ago did not employ the fashionable term "mixed economy of care," they were nonetheless fully aware of the heterogeneous character of institutional provision in the early nineteenth century. If they were skeptical of the reformers' ability to create humane and curative asylums, they were most certainly aware (and stressed) that lunacy reform was launched amid a wave of utopian optimism about the likely impact of reform. If they stressed the importance of medical men as "moral entrepreneurs" helping to create and legitimize the new array of institutions, they most certainly did not fall into the trap of seeing these mad-doctors as all-powerful. On the contrary, the power of the purse and the parsimony of magistrates and poor-law authorities were central features of the revisionist accounts.

Smith emphasizes that asylums were obsessed with the production of order and regularity. In examining the empire of asylumdom, he again and again is driven to the recognition...