Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

The resort to pillars of churches is illustrated by what an Augustine Canon of Scone says, in a work on the rule of his foundation (Paris, 1508), for he protests against the desecration of churches, with the exception of curing lunatics in the way I have just described, as being bound to the church pillars.

Nearly a hundred years after Dr. Borde wrote, that remarkable work was published, "The Anatomy of Melancholy," by Burton. Some quaint lines and a rough engraving on the title-page illustrate but too well the treatment of the insane familiar to him, although not a physician; it seems worse, instead of better, than that of the doctor of St. Giles.

"But see the madman rage downright
With furious looks, a ghastly sight!
Naked in chains bound doth he lie
And roars amain, he knows not why."

The first edition of Burton's work was published in 1621, five years after the death of Shakespeare, who speaks, in "As You Like It" (Act iii. sc. 2), of madmen deserving "a dark house and a whip," and in "Twelfth Night" makes Sir Toby say of Malvolio (Act iii. scene 4), "Come, we'll have him in a dark room and bound." The medical treatment of melancholia contained in Burton consists mainly of herbs, as borage, supposed to affect the heart, poppies to act on the head, eupatory (teazel) on the liver, wormwood on the stomach, and endive to purify the blood. Vomits of white hellebore or antimony, and purges of black hellebore or aloes, are prescribed.

The famous "Herbal" of Gerarde, published in 1597, gives various remedies for madness, but they are, unfortunately, copied for the most part from Dioscorides, Galen, and other ancient writers. They are so far of interest that they show what was accepted as the best-known drug practice at the time in England in mental disorders. Under "A Medicine against Madnesse" we have rhubarb and wild thyme, the latter being "a right singular remedie to cure them that have had a long phrensie or lethargie." He is here only following Aetius, and when he says, "Besides its singular effects in splenetical matters, it helpeth any disease of melancholy," he appears to follow Galen. Feverfew is said to be "good for such as be melancholike, sad, pensive, and without speech." Syrup made of flowers of borage "comforteth the heart, purgeth the melancholy, and quieteth the phrenticke or lunaticke person." Hellebore, of course, has its virtues recognized. Black hellebore, or the Christmas rose, "purgeth all melancholy humors, yet not without trouble and difficultie, therefore it is not to be given but to robustious and strong bodies as Mesues teacheth. It is good for mad and furious men, for melancholy, dull, and heavy persons, for those that are troubled with the falling sickness (epilepsy)," and "briefely for all those that are troubled with blacke choler, and molested with melancholy."[43]

Gerarde strongly commends "that noble and famous confection Alkermes, made by the Arabians," containing the grains of the scarlet oak (Ilex coccigera). "It is good against melancholy deseases, vaine imaginations, sighings, griefe and sorrow without manifest cause, for that it purgeth away melancholy humors" (p. 1343). Poultices applied to the head, of mustard and figs, are recommended for epilepsy and lethargy. Gerarde adopts from Apuleius the virtues of double yellow and white batchelor's buttons, hung "in a linnen cloath about the necke of him that is lunaticke, in the waine of the moone, when the signe shall be in the first degree of Taurus or Scorpio."

Such are the principal remedies for insanity given by Gerarde, original and second hand.

Returning to Burton, it should be said that among the causes of the disease he distinctly recognizes the same uncanny influence that his contemporaries Coke and Hale regarded as a legal fact—I mean witchcraft. After saying that "many deny witches altogether, or, if there be any, assert that they can do no harm," of which opinion, he adds, "is our countryman (Reginald) Scot (of Kent),[44] but of the contrary opinion are most lawyers, physicians, and philosophers," he proceeds, "They can cause tempests, etc., which is familiarly practised by witches in Norway, as I have proved, and, last of all, cure and cause most diseases to such as they hate, as this of Melancholy among the rest."[45]

It may be asked, What was the medical knowledge or practice at the time of Coke and Hale, to which they would turn for direction when insanity came before them in the courts of law? and I think a correct reply would be best obtained by taking this wonderful book of Burton's, the works of Sir Thomas Browne, who gave evidence before Hale, and what may be called the case-book of the celebrated Court physician, Sir Theodore de Mayerne. A Genevese, he settled in England in 1606, and was regarded as the highest authority in mental and nervous affections. A medical work of his was translated into Latin by Bonet. Mayerne's treatment was certainly of a somewhat cumbrous character, and his patients must have had an unusual and commendable amount of perseverance if they pursued it thoroughly. The drugs probably cured in part, at least, from the duty entailed upon the patients of collecting the numerous herbs which were ordered for the composition of the mixture, and Sir Theodore truly and naïvely remarks to one of his patients, "It will take some time before you have mixed your medicine." It is clear that he was under the influence of the old belief in the connection between the liver and insanity, and the paramount importance of getting rid of the black bile. Of one case he asserts that the root of all the griefs wherewith the patient has been afflicted is a melancholy humour, generated in the liver and wrought upon in the spleen. This humour is stated to be mixed in the veins, and so extended to the brain, which this offensive enemy of nature doth assault as an organical part. Hence, he says, it happens that the principal functions of the soul do act erroneously. His treatment consisted of emetics, purges, opening the veins under the tongue, blisters, issues, and shaving the head, followed by a cataplasm upon it, the backbone anointed with a very choice balsam of earthworms or bats. One prescription for melancholia contains no less than twenty-seven ingredients, to be made into a decoction, to which is to be added that sine quâ non, the ever precious hellebore. Other remedies were prescribed; in some cases the "bezoartick pastills," composed of an immense number of ingredients, including the skull of a stag and of a healthy man who had been executed. The commentary triumphantly made by this lover of polypharmacy in the case in which this medicine was administered, runs thus:—"These things being exactly performed, this noble gentleman was cured." With certain modifications, the general treatment here indicated was that in fashion at the period to which I refer, and was based on a strong conviction of the presence of certain peccant humours in the body, affecting the brain, which required elimination.

Mayerne, of whom there is a portrait in the College of Physicians, was physician to more crowned heads than has fallen to the lot of probably any other doctor, namely, Henry IV. of France, James I. of England, his queen, Anne of Denmark, Charles I., and Charles II. He introduced calomel into practice. Dying in 1654/5, he was buried in the church of St. Martin's-in-the-Fields, where a monument was erected to his memory.[46]