ABSTRACT
I t was not until the mid-eighteenth century that medical men began to take an active interest in the institutional care of the insane, although the treatment of insanity had been included within their province by a few physicians in preceding centuries. The second half of the eighteenth century saw the emergence of professionalism and specialism in medicine in general; a process that was linked, closely, with the foundation of hospitals in London and the provinces. In the field of mental illness, the methods adopted at the small number of new lunatic hospitals, such as St Luke's Hospital, in London, and the Manchester Lunatic Hospital, played an important part in raising standards in the treatment of insanity. The assumption of medical responsibility for the insane, however, was a slow process, particularly in private madhouses, and the ‘mad-doctor’ had little social or professional status. Owing to these circumstances, the keepers of madhouses 2 in the eighteenth century formed an essentially heterogeneous group, not uncommonly including clergymen, and quack-doctors who specialized in treating the insane flourished, e.g. Irish, Fallowes and Thomas Warburton. The selection of the Reverend Dr Francis Willis to treat George III in 1788 was, therefore, an event of considerable importance in the history of medical madhouse proprietors and of ‘mad-doctors’ in general. It brought some professional respectability to the ‘trade in lunacy’ and demonstrated that the treatment of insanity required special skills and experience not necessarily possessed by the most eminent physicians of the day. Macalpine and Hunter (1969) emphasized that Willis ‘made his mark in medical history for propagating the notion that insanity was curable’, 1 removing, thereby, ‘the excuse for neglect which therapeutic pessimism had fostered for centuries’. 2
