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Customers and Patrons of the Mad-Trade

The Management of Lunacy in Eighteenth-Century London

Jonathan Andrews

Publication Year: 2003

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.

Published by: University of California Press

Series: Medicine and Society


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p. 1-1

Title Page, Copyright, Dedication

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pp. 2-7


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pp. vii-9

List of Illustrations

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pp. ix-11

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pp. xi-xiv

This is the second of two books we have devoted to the examination of John Monro, his patients, and the world of eighteenth-century madness and mad-doctoring. Once again, as with its predecessor (Undertaker of the Mind), Customers and Patrons of the Mad-Trade is the product of a...

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pp. xv-xvi

Naturally, we are especially grateful to the late Dr. F. J. G. Jefferiss; his widow, Phyllis Jefferiss; his son, Jeremy James Jefferiss; and his cousin, James Mackenzie, for agreeing to permit the publication of the case book that forms the basis of the analysis of the patrons and customers of...

PART I. Managing Lunacy in Eighteenth-Century London

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pp. 1-4

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1. Customers, Patrons, and Their Mad-Doctor

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pp. 5-11

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...

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2. A Rare Resource: John Monro’s Case Book

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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....

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3. Profiling Patients and Patterns of Practice

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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 mad-doctor, 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,...

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4. The Craft of Consultation: Managing Patients and Their Problems

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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...

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5. Diagnosing the Mad

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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...

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6. Religion, Madness, and the Case Book

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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....

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7. Treating Patients and Getting Paid

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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...

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8. Being Mad in Eighteenth-Century England: Patients’ Views of Their Own Illnesses

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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...

PART II. John Monro’s 1766 Case Book

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pp. C-1-C-124


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pp. 119-175


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pp. 177-201


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pp. 203-209

Production Notes

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pp. 210-351

E-ISBN-13: 9780520926080
Print-ISBN-13: 9780520226609

Page Count: 352
Publication Year: 2003

Series Title: Medicine and Society