ABSTRACT
If Bethlem Hospital stood for all that was traditional in attitudes towards the treatment of the insane - restraint, confinement, evacuative remedies and a dynasty of secretive physicians in the Monro family - St Luke's was founded with innovative intentions. One area of innovation was expertise. Among the 'Principal' ends for founding the hospital, as set out in the appeal for funds made in 1750 (which was written by Battie), were the need to attract the best minds to 'this Branch ofPhysick', and thus to stimulate improvements in the understanding and treatment of the mentally ill, and the necessity for training qualified attendants. As Hunter and Macalpine point out, 'The reference to "Servants peculiarly qualified" was perhaps the first printed statement that mental nursing requires special training.' Care for the patients' well-being was also to be particularly looked to: 'every Patient must have a separate Room, and Diet, most of them, equal to Persons in Health'. After a few years of operation, the hospital, unlike Bethlem, resolved to take in pupils, which was itself a remarkable opening up of the silent world of the confined mad, for it meant that future specialist physicians (including Sir George Baker) were trained through actual observation of patients, and
The Treatise on Madness was based, therefore, on an attitude towards madness that embraced both openness and a humane concern for the welfare of patients. Battie attacked, for example, the traditional remedies prescribed indiscriminately for all kinds of madness: 'e.g. bleeding, blisters, caustics, rough cathartics, the gumms and faetid anti-hysterics, opium, mineral waters, cold bathing, and vomits'. Bleeding, for Battie, was 'no more the adequate and constant cure of Madness, than it is of fever', while 'the lancet, when applied to a feeble and convulsed Lunatic' was no 'less destructive than a sword'. In fact, fundamental to his approach was the conviction that madness, which 'is frequently taken for one species of disorder, nevertheless, when thoroughly examined, . . . discovers as much variety with respect to its causes and circumstances as any distemper whatever'. 3 For this reason, 'all general methods' should be avoided in the treatment of mad patients, quite apart from the observed inutility of most of them. Indeed, not only does Battie recommend the laying aside of treatments when they are clearly achieving nothing, but he also goes so far as to recommend no treatment at all.
