ABSTRACT
W Hilst there is little information regarding the precise treatment of the insane in medieval times, there is evidence that the mentally afflicted were accommodated at times alongside the physically diseased in the infirmaries of the period. 2 In addition, monastic houses often gave shelter to lunatics in company with vagabonds and vagrants. The priory of St Mary of Bethlehem, London, founded in 1247, was one such establishment, and by the beginning of the fifteenth century it was functioning as a receptacle for lunatics. In 1547, it was given by Henry VIII to the city of London as a hospital for poor lunatics and, until the early eighteenth century, Bethlem Hospital was the only public institution for the insane, although the numbers admitted were small. From a legal viewpoint, a distinction was drawn, at an early period, between lunatics and idiots, and legislative provision for the protection of their estate was made in the Statute de Prerogativa Regis, of uncertain date, but usually printed as a statute of 17 Edward II, c. 9 & 10, 1324. Until the beginning of the nineteenth century, the emphasis was placed on the protection of the estate rather than on the treatment of the insane person concerned. The Poor Law Act of 1601,43 Eliz., c. 2, served to focus attention on the poor and unemployed, but no separate provisions for the insane were made and harmless lunatics and idiots continued to be left at liberty as long as they were not considered to be dangerous and caused no social disturbance. However, a change in social attitudes towards lunatics in the community was to take place in the seventeenth century. 1 This marked the beginning throughout Europe of the period of ‘The Great Confinement’ 2 of the insane in company with criminals, vagrants and the unemployed, a process that was reflected in England in the increasing use for this purpose of houses of correction and, later, the workhouses. The Act of 1714, 12 Anne, c. 23, distinguished, for the first time, between impoverished lunatics and ‘Rogues, Vagabonds, Sturdy Beggars and Vagrants’. It was enacted that two or more justices of the peace could authorize the apprehension of lunatics who were ‘furiously mad, and dangerous’, by the town or parish officials, and order their confinement, ‘safely locked up, in such secure place … as such justices shall … direct and appoint’, where, if necessary, the lunatic could be chained. Apart from such restraint, which was to be applied only during the period of madness, no treatment was provided for, although the lunatic was exempted from whipping. The cost of detention, in the case of pauper lunatics, had to be paid out of the funds of the lunatic's parish of legal settlement. The charge for ‘curing’ such persons was added to these expenses by the Vagrant Act of 1744, 17 Geo. II, c. 5, which was essentially a re-statement of the Act of 1714. It is likely that the provisions of the latter reflected the prevailing practice during the late seventeenth century. One of the methods which had become adopted by the parishes for the disposal of lunatics placed in their charge was to board them out, at the expense of the parish, in private dwelling houses, which gradually acquired the description of ‘mad’ houses. For example, it is known that such an establishment existed in the parish of Horningsham, Wiltshire, in 1770, the lease of which was taken over by the parish officers in that year. 3 Boarding-out remained an important mode of management of lunatics and idiots until the mid-nineteenth century and, as has been observed by Fessler (1956), it constituted one of the roots of origin of the private-madhouse system. 4
