4.7.3
McNaughton, the Lancet and the Development of
Psychiatry
The broader influence of McNaughton can be seen from examination of
The Lancet.
Soon after
its
foundation on 5.10.1823,
Thomas Wakley's
journal took the
stand that insanity is a medical subject, and gave generous space to
relevant issues when opportunity arose. It was one of the pioneers of what
became known as
psychiatry.
The content of early issues of The Lancet was heavily based on reports of
hospital cases - reports of the cases of eminent doctors that they would
normally have charged students a fat fee to have looked in on! The cases
reported included some that we would now call mental. These included
"Somnambulism ... A remarkable instance of this affection of the nerves"
(Lancet
12.10.1823 p.65),
and a Middlesex Hospital case of
"Affection of
the Nervous System" ... treated by electricity "which from analogy may be
presumed to be useful in this affection" (This case ran and ran!
Lancet
23.11.1823 pp 278-279 and 312-113; 1.2.1824 p.160 and 14.2.1824 p.379)
The argument that people's actions are determined by external causes rather
their conscious choices emerged early. An two page article from a
correspondent tried to show that one John Thurtle "was a murderer only
after he had been a gamester, and only as it appears, because he had been a
gamester" and concluded that "wickedness is not the effect of nature, but
of external circumstances"
(Lancet 9.11.1823 pp
214-216)
In 1824 considerable space was given to Phrenology, concurrent with the
publication of George Combe's Elements of Phrenology and the
pioneering lectures of Dr Willis. These lectures were only attended by
seven people. When Combe lectured in April 1824 his audience of only 36
included Wakley "who expressed his determination to support the science"
(Gibbon, C.
1878 pp 170-171)
The columns of
The Lancet
and even Hansard testify to Wakley's
continuing commitment to phrenology (See
Hansard 20.4.1842 col 88).
Phrenology provided him, as it did many asylum doctors, with the
theoretical basis to link human behaviour with the brain, and assert the
medical nature of mental disorder.
In April 1827 three early
psychiatric
texts were reviewed in twenty five
columns running through two issues of the Lancet (In the second adjacent to
reports of the Phrenological Society). The books were Observations on
the Deranged Manifestations of the Mind, Or Insanity by the
phrenologist J.G. Spurzheim; Observations on ... Derangement of the
Mind by Paul Slade Knight the surgeon superintendent of Lancaster
County Asylum from 1816-1824 and Outlines of Lectures on Mental
Diseases by Alexander Morrison. (There are extracts from Knight in
Hunter and MacAlpine 1963 pp 774-776 and from Morrison in Hunter and
MacAlpine 1963 pp 769-773)
By 1840-1842
The Lancet
was reviewing the Annual Reports of county asylums,
publishing editorials and copious correspondence on non-restraint, berating
the Metropolitan commissioners
(See
3.11.2
+
3.14), denouncing
Conolly's
opponents, giving heated support to efforts to reform Bethlem,
campaigning against the Licensed Lunatic Asylums Bill
(See 4.2)
and exposing
the treatment of lunatics in Wales (see
Prichard's
biography)
The effects of 1840s criminal lunacy trials on The Lancet
In response to the controversy surrounding criminal lunacy trails in the
1840s
The Lancet's emphasis
moved from militant assertion of the medical
achievement in treating lunacy to asserting a need for a sounder scientific
basis for the medical study of insanity. Subsequently it devoted more space
to the actual content of the science. In 1845 it devoted a substantial
proportion of its columns every week to publishing two courses of lectures
by M. Baillarger (physician, Salpetriere, Paris) and John Conolly so that
"the results of the researches, the theories and the modes of treatment" of
two
prominent physicians in the world's "two first countries" on Diseases of
the Brain and Insanity would be placed "almost at one view" before the
British medical profession and "the philosophical portion of society".
(Lancet
18.1.1845
p###)
This trend in
The Lancet
to focus on establishing
psychiatry
as a science
can be traced back to that momentous occasion when it suspended judgement
on McNaughton for a week. On 18.3.1843 an editorial dealt with the issues
arising directly from the trial. The scientific spin-off began the next
week when "Some further considerations on insanity, in its relation to
jurisprudence" induced a seven column lead editorial on the "study of mind"
as "part of the science of medicine". The editorial called for more
empirical rigour in phrenological investigations, accurate classification
of mental phenomena, and precise and logical definitions
(Lancet
25.3.1843
pp 936-939). In June 1843 an article citing McNaughton as its cause
examined the theory behind moral management and argued for "obtaining a
correct knowledge of the principles of psychology in daily medical practice
(Lancet
3.6.1843 pp 349-350)
In stimulating such an interest in the status of the medical theories of
Lunacy and its treatment McNaughton's case prepared the way for a more
informed reception of the 1844 Report of the Metropolitan Commissioners.
© Andrew Roberts 1981-
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