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Reviewed by:
  • Lunatic Hospitals in Georgian England, 1750–1830
  • Jonathan Andrews
Leonard Smith . Lunatic Hospitals in Georgian England, 1750–1830. Routledge Studies in the Social History of Medicine. London: Routledge, 2007. xvii + 288 pp. Ill. $135.00 (ISBN-10: 0-415-37516-9, ISBN-13: 978-0-415-37516-0).

In the two decades since the publication of Roy Porter's Mind-Forg'd Manacles (1987), Leonard Smith has deservedly emerged as one of the leading and most productive researchers on the history of English psychiatry. His surveys of nineteenth-century asylumdom, mad-doctoring, and the private mad-business have been particularly useful and well referenced, produced—somewhat miraculously—while sustaining a full-time professional career in the mental health services. His latest work sees his research chronology extended as far back as the mid-eighteenth century and provides us with a superb complementary companion [End Page 791] to his earlier Cure, Comfort and Safe Custody (1999). This study is hugely welcome, constituting, remarkably, the first to offer separate in-depth analysis of the voluntary and subscription generation of lunatic hospitals that emerged in England starting in 1751, from St. Luke's, Newcastle, Manchester, York, and Liverpool to Leicester, Exeter, Lincoln, and Oxford.

Smith's main aims in this book are twofold: to accord these hospitals a more significant, "rightful" (p. 4) place in the evolution of care and treatment for the mentally disordered and to emphasize the importance of what he terms "the medical model" and the key "leadership" role of physicians (p. 5) in these institutions' management and delivery of services. In pursuit of both objectives, Smith delivers cogent, well-substantiated arguments. He offers persuasive evidence of the significant translation of the core ethos and orientations that had originated in the voluntary lunatic hospital sector to the county asylum movement that followed. His wide-ranging coverage of the identities, interests, and conflicts of the key emerging specialists in mad-doctoring associated with this new generation of lunatic hospitals (from William Battie, Thomas Arnold, and John Ferriar to Samuel Foart Simmons) is combined with instructive portrayals of some of the less familiar lunatic hospital practitioners (including James Vaughan and John Hall). Significantly, his attention to the praxis-oriented concerns of medical men is admirably textured by attention to their broader economic, sociocultural, political, and career-promotion activities. The meticulous research that has distinguished Smith's many other notable contributions to the field is constantly and reassuringly on view here. This reviewer would contest the extent to which doctors are privileged as actors in Smith's account above lay governors, subscribers, benefactors, and managers (by contrast, e.g., with Michael Brown's studies of York asylum).1 One might also challenge the odd passing assertion, such as the claim that private madhouses did not cater to paupers until "later in the eighteenth century" (p. 3). Yet Smith's survey is almost invariably highly authoritative, reliable, and informative in its navigation of the empirical and historiographical terrain.

Smith's approach (already significantly rehearsed in his 1999 study) is characterized by regular reference to the "custody versus cure" "paradox" (e.g., p. 5). Thus, he skirts the middle ground between emphasizing the harsher, more "custodial," extirpatory dimensions of Georgian provision for the insane, while substantiating its significant therapeutically oriented and "philanthropic" features, stressing the higher "aspirations" of managers and reformers. Smith also highlights the multiplicity of concerns these institutions reflected, whether they had to do with "altruism," "civic pride," or political influence/patronage, and the philosophical and policy emphases and shifts over the period. The structure of the book, which opens with a section on St. Luke's, followed by chapters on "provincial lunatic hospitals," "management and staffing," "the physician's domain," patient admissions and backgrounds (under "proper objects"), with a penultimate section [End Page 792] on the dissonance/decline "from [the] aspirations" of Georgian lunacy provision "to [the] actuality," especially in the first decades of the nineteenth century, is relatively conventional but is eminently coherent and serviceable in fulfilling the author's brief. Although one might wish for more attention to patients' own views of their confinement and to the wider familial and local parochial authorities' concerns and expectations, which were...

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