A Respectable Mad-Doctor? Dr Richard Hale, F.R.S. (1670-1728)

A Respectable Mad-Doctor? Dr Richard Hale, F.R.S. (1670-1728)Author(s): Jonathan AndrewsSource: Notes and Records of the Royal Society of London, Vol. 44, No. 2 (Jul., 1990), pp. 169-204Published by: The Royal SocietyStable URL: http://www.jstor.org/stable/531606 .

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Notes Rec. R. Soc. Lond. 44, 169-203 (1990)

A RESPECTABLE MAD-DOCTOR?

DR RICHARD HALE, F.R.S. (1670-1728)

by

JONATHAN ANDREWS

Queen Mary and Westfield Colleges, University of London

Medical historians have traditionally regarded Bethlehem Hospital as something of a nadir in the care of the mentally ill. Accordingly, therapeutics at the hospital have often been depicted as virtually non-existent; its administration as concerned rather with the distribution of alms than with cure. Its early practitioners (except for Edward Tyson) have commonly been portrayed (in the shadow of a stolid 'dynasty' of Monros) as arch-conservatives, content merely to repeat the array of evacuative, 'lowering' and irritant treatments, used by their predecessors (1). In support of this tradition, however, very little research has been done on the hospital, let alone on the record of its individual practitioners, or on their place within the contemporary medical world as a whole.

Recently, a revisionist view of Bethlem as an authentic, and even respectable, centre of cure, has quietly begun to take the fore (2). While I would not advocate an uncritical adoption of this stance (3), I will look more closely at Richard Hale, one Bethlem physician who has received little attention, and whose career tends to reinforce the call for a reassessment. In fact, little more than 'Little is known of Hale' has been said about the doctor since O'Donoghue devoted a page to him, in 1914 (4).

At a time when medical historians are arguing energetically over the chro- nology of the physician's emergence as a professional general practitioner, and over the social standing and homogeneity of physicians as a group, we are still remarkably ignorant of the careers of individual practitioners outside the mainstream core. The career of Richard Hale is a not untypical success story which might easily be incorporated into Geoffrey Holmes's notional period, between 1660 and 1740, dubbed 'The coming of the doctor' (5), wherein he locates the most profound changes in the training and standing of medical practitioners. Hale was educated and active at an apogee in the study of anatomy, during one of the most productive periods in the medical output of the Royal Society, at a time when the opportunities for medical students for

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study and contacts (at native hospitals, in Europe, and with an increasing influx of continental scholars) were rapidly expanding. He was also appointed to Bethlem at a juncture when benefactors were providing the hospital with a new

impetus of prosperity and growth, and when the 'mad-business' was extending itself into the profitable market places.

However, as we shall see, Hale's own education was basically traditional; he failed to capitalize on the enthusiasm for study abroad; and indeed criticized the poor standard of foreign scholarship, and bewailed the generally defective state of medical knowledge. As is only too familiar, Bethlem remained opposed to the admission of medical students throughout the eighteenth century. Moreover, ultimately, as Irvine Loudon demonstrates, the greatest transitions in the nature of medical practice and practitioners are to be discerned after 1740, and amongst the more humble surgeon-apothecaries, rather than in the ranks of the physicians (6).

THE MAKINGS OF A HOSPITAL PHYSICIAN

Richard Hale, eldest son of Richard Hale, of New Windsor, Berkshire, by his wife, Elizabeth Church, was born at Beckenham, Kent (site of the present Bethlehem Hospital), in 1670. Neither a 'younger son', nor a member of an established family of the country gentry, Hale's pedigree did not provide him with that archetypal platform envisioned for prospective members of the Royal College of Physicians by its conservative members (7). Hale's father and

grandfather bequeathed less than £1000 between them, or less than the estimated cost (according to Thomas Browne) (8), of a regular physician's education. However, Hale's father adopted the style of 'gentleman', and most of his and of his own father's wealth was invested in real estate, and must have arisen out of rents. Their wills give the impression of more than moderate

holdings, comprising (predominantly) leased farm houses and lands in East

Anglia, and a single farm in Cheshire. Yet Richard seems to have inherited little else from his father's will (owing partly to the longevity of his mother, who outlived him) beyond a grazing farm in Essex (9). The extent of a family's holdings and social status cannot be reconstructed merely from their wills. It does appear, however, that Hale was provided for, though not spectacularly, by a rather modest and recently established gentry family. Assuredly, like most of the established physicians of the period, the Bethlem physician's later prosperity and standing were far from simply self-made. Hale was subsequently to bolster his portion with his wife's jointure lands and a farm in Cheshire, apparently left him by his uncle John (10). (A family tree is given as an Appendix at the end of the paper.)

Hale was educated at Trinity College, Oxford, proceeding; A.B. 19 May 1693;

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A respectable mad-doctor

FIGURE 1. Richard Hale. Oils on canvas by Jonathan Richardson. Printed by kind permission of the Harveian Library.

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A.M. 4 February 1695; M.B. 11 February 1697; and M.D. 23 June 1701 (11). Trinity served as something of a family tradition; Hale's brother Henry (1672- 1707), his cousin Sir John Shaw (d. 1739), and his two nephews, Christopher (1694-1771) and Thomas Tower (1698-1778), all graduated there (12). Hale was, more than likely, encouraged towards physic by the example of his uncle John, himself a physician. Nearing the end of his college studies, Hale was already enjoying the patronage of the famous anatomist, Edward Tyson F.R.S., his predecessor as physician to Bethlem (1684-1708), and precociously court- ing the recognition of the Royal Society. Membership of the Society, as A. Rupert Hall has shown, seems to have been an expectation for leading English physicians of the time, and Hale was not slow in acquiring the right credentials (13). His paper 'The humane allantois' (human foetal membrane) was communicated to the Society by Tyson, who also supervised its engraving, and was read at the Society meeting of 4 June 1701, weeks before Hale graduated (14). Tyson, and other Fellows of the Society, had long been fascinated by the mysteries of the foetus, but Hale's text, in which he respectfully cites 'the accurate Dr Tyson' (15), is perhaps more interesting in the clue it provides to Hale's successful application for the post of Bethlem physician, seven years later. This early association and shared anatomical interest of Hale and Tyson may well have proved decisive for Hale, in prevailing over his closest rival, Dr John Branthwait, in the election at Bethlem in 1708 (16). The other candidates for the Bethlem physicianship are not recorded in the Court of Governors Minutes, although 'the Profound Greshamite', John Woodward, seems to have been one of them. Woodward's failed candidacy incurred one of the customary jibes that were almost inevitably met with by physicians associated with Bethlem; namely, that 'they might as well elected him a patient, had he sense

enough to have been mad' (17). The obvious ambiguities in the prestige conveyed by a Bethlem physicianship were not serious enough, however, to dissuade physicians from keenly contesting the post.

In an age before psychiatry had emerged as an exclusive specialism, when doctors dabbled in multifarious fields, and when hospital posts were honorary and casual, rather than full-time positions, it should not surprise us to find doctors, like Hale and Tyson, appointed to Bethlem without evidence of any previous experience of treating the insane. Hospital appointments, as W.F. Bynum observes, were 'usually sought early in one's career or not at all', were 'a means to success, not a way of rewarding success' (18). In the seventeenth century, Drs Crooke, Meverall, and Allen all seem to have come to Bethlem via the anatomical studies encouraged at Oxbridge. That these physicians continued such anterior pursuits, even after appointed to the hospital, is something which separates Hale and his predecessors, as a more versatile, or less specialist, breed of mad-doctor, from the Monros. This is not to say, of

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course, that early-modern mad-doctors were (or ever had been) averse to claiming 'psychiatric' expertise. Yet they were also eager to be seen as all- rounders, and were more commonly portrayed as such by their colleagues, than the mad-doctors and asylum superintendents of the late eighteenth and nine- teenth centuries. While Harveian Orators praised Hale for his gifts in all branches of medicine, John Monro was merely deemed 'expert in that branch ... to which he devoted attention' (19).

When, in 1725, the post of physician to St Bartholomew's Hospital was being contested, Hale reciprocated the earlier support of Edward Tyson, by advocating the (ultimately successful) candidacy of Richard Tyson, the favourite nephew of both doctors (20). The bond between the two families had already been cemented by the marriage of Richard Tyson to Hale's niece, Elizabeth (21). Thomas Hearne tells how Dr Pierce Dod's candidacy failed because he was 'not great with Dr Mead, Dr Freind, Dr Hales [sic.], and some of the leading Men', and thus 'could not make any considerable Interest' (22). Dod was also disappointed, according to Hearne, because of his own political tergiversation at Oxford, which had lost him 'many ... Friends'. This account not only indicates the position of influence Hale was enjoying in the medical world by this time, and his close association with Mead and Freind (23), but presents a revealing picture of the patronage system by which hospital appointments were obtained (24).

The impeccable records of uncles Tyson and Hale, did not, however, suffice to sway the Bethlem Governors to appoint Richard Tyson as physician, on Hale's death (25). Given Tyson's existing tenure at St Barts, it is striking that his candidature got as far as it did, and that he actually preferred the post at Bethlem to the one which he already held.

Hale's early interest in anatomy and propitious connections with Edward Tyson are further illuminated by the fact that, just before his debut with the Royal Society in 1701, he had been corresponding with another famous anatomist and Fellow, the surgeon, William Cowper, on the subject of 'the external Maxillar [maxilla, or jaw-bone] Glands' (Cowper was, himself, a friend of Tyson's, with whom he had studied the opossum and whom he had proposed F.R.S. in 1699) (26). This Hale related in his other contribution to the Philos- ophical Transactions, on the same subject, in 1721 (27). Thus, Hale reveals himself not only keeping good company early on in his career, but also interested in the study of glandular anatomy for at least 20 years thereafter.

English and Dutch medical scholars in this period, from Cowper to Godfried Biglow, concurred in embracing anatomy as the 'Mother of Art and Science' (28). The study of glandular anatomy had assumed increasing importance as new theories of disease (informed in particular by Archibald Pitcairn, at Edinburgh, and the iatromathematical school of medicine), began to achieve

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prominence, during the latter seventeenth and early eighteenth centuries (29). According to these 'mechanistic' theories, obstructions in the glands and other vessels of the body caused fevers by preventing natural excretions, and the method of cure should therefore rely heavily on evacuative means (30). Cowper had been especially interested in the lymphatic system, conceiving it the foundation of the animal economy. Moreover, lymphatics appeared to hold the key to the functioning of the human brain, and Hale must have found much of pertinence in Cowper's investigation of the pineal gland. Since Descartes, the pineal gland had often been seen as the seat of the soul; it was increasingly the focus of post-mortem operations on the insane, and had caused much debate at the Royal Society, particularly between Hale's predecessor, Edward Tyson, and George King (31).

Hale's own mechanistic stance is clear enough from his renowned Harveian Oration of 1724, in which he makes good use of his earlier research on glands, when expounding the significance of Harvey's circulatory discoveries (32). Hale's 1721 paper, like much of Tyson's work before him, was, however, regarded by the Society as interesting and scholarly, rather than seminal, being described in the Journal Books as 'curious and accurate'. Even so, it helped his proposal (by Edmond Halley) and acceptance as a Candidate, and two months later as a Fellow, of the Society (33). The week before, Halley had presented a paper to the Royal Society on the subject of the plague at Constantinople, by Emanuel Timoni, which had been communicated to him by Hale (34). Hale appears, by this time, to have gathered about him a number of eminent and influential friends, although he was never himself elected to the council, nor to any other office in the Society.

After graduating at Oxford, Hale set up in general practice there for several years, and, according to two sources, 'had good Business' and 'good success', and 'was reckon'd a good Physitian, and a Man of Parts' (35). However, Thomas Hearne, the historical antiquary and keeper of the Bodleian, goes on to tell how Hale was soon forced to 'retire' to London, in order to salvage this fine 'Reputation', which had begun 'to sink upon Account of his using opiats too much'.

Sedatives were a la mode during the eighteenth century. Yet contemporary medical opinion was divided in the extreme over the effects of opiates. While Thomas Willis and Archibald Pitcairn concurred in emphasizing the mortal dangers of opium against its limited virtues, others, like Richard Morton (Physician to James II, and Tyson's brother-in-law) and Richard Mead, Thomas Sydenham and John Jones, sang its praises with fewer reservations (36). Even Pitcairn and Willis disagreed over the seat of its operation (37). However, most physicians recognized that opiate remedies were not 'specifics', and might serve only as part of a combined course of treatment; that they gave only a transitory

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relief and were a slow form of poison; that they were inappropriate at the height of fevers; and that extreme caution was necessary in the timing and strength of their application; and Hale's excessive use of them should, perhaps, be attributed to inexperience (38). Throughout the century, many authorities, however, continued to play down the risks of opiates (39).

PUBLIC PRACTICE

It was thus with somewhat mixed credentials, and indeed before he had even been admitted as a Candidate of the Royal College of Physicians, that Hale was appointed physician to Bethlem on 10 September 1708 (40). Hale's record at Bethlem is by no means well documented, and must be pieced together from minutes that record decisions, and rarely the processes by which decisions were made. He receives little mention in the Court of Governors Minutes, but his term of office coincided with the erection of the new wards for 'incurable' patients at the hospital, the first of which was finished, and the first patients admitted into it, the month before his death. How intimately Hale was involved with this initiative at Bethlem is impossible to substantiate. His presence or influence is not recorded in the (surviving) reports of 'The Committee for the New building for Incurables', but few were actually transcribed. However, Hale had been concerned since his appointment with the certification of patients as incurable, periodically presenting lists of such patients to the Sub-Committee recommending their discharge (41). In collaboration with this Committee, Hale provides us with the first explicit definition of incurability at Bethlem, when Richard Walton and Henry Golding (the first patients admitted to the new wards) are described in 1723 as 'still very [or 'raving'] Mad', despite 'the Utmost Endeavours ... for ... Recovery'; whose 'Enlargement would be Dangerous'; and who have 'no friends ... able to bear the Expences ... of Confinement' (42). Hale was one of those accorded special thanks by the Court (with the Treasurer and Marmaduke Alington, Esq.), for their pains in obtaining a licence from the Crown to alter the footway in Moorfields so that the incurable hospital could be built (43). He probably advised the Committee which in 1728 drew up the 'Rules for Governm[en]t of ye Patients' (44), and may have inspired the enlightened fourth rule which allowed the physician to administer to incurables any medication he thought 'proper', if any of them should exhibit a 'Change...in their Madness as might give hopes of Recovery'. While the exigencies now recognized in providing for incurables were primarily those of security and economics, or, moreover, of the public defects of charity (for excluding the incurable), Hale and the governors did acknowledge both an 'opportunity' for curing incurables, and their responsibility to 'improve' that opportunity. Hale's will, by which he left £500 to the incurables of Bethlem, suggests his personal

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concern for their plight (45). While there is even less evidence concerning Hale's relations with the

Bethlem staff, all of it points towards amicability. Hale's solidarity with the other medical officers of Bethlem is suggested by two entries in the minutes for 1718. Hale not only backed up William Elderton, Apothecary from 1715 to 1751, when challenged by the governors over the price of his bills, averring that they were 'reasonable', but also supported the petition of John Wheeler, Surgeon from 1714 to 1741, for a gratuity, by certifying that he 'hath given constant attendance' and performed more 'Chirurgicall operations & cured more patients ... on extraordinary accidents of Mortifications Ulcers & other Sores than formerly has been done' (46). Despite the proverbial aloofness of the eighteenth century physician and obvious social disparities between Hale and the lesser officers of Bethlem, Thomas Yates, Steward of Bethlem from 1690 to 1713, showed no qualms in bequeathing gold rings to Hale and to others of the superior officers and governors of the hospital (a symbolic gift more commonly reserved to friends and relatives) (47).

That Hale himself attended Bethlem at least once a week (as, indeed, he was required to do) is clearly substantiated by the minutes of the Bethlem Sub- Committee (extant from 1709), which record his presence. Hale received annually a salary of just £26 13s. 4d for his attendance at Bethlem and an additional gratuity (conditional upon efficient performance of his duties) of no more than £50 (48). Like his predecessors and successors at Bethlem, he amassed most of his fortune by way of the private custom which his office brought him. Absenteeism has long been a charge levelled by historians at Bethlem physicians, but it must be emphasized that their role in this period was never intended to be anything more than a visiting, consultative one. The physician of Bethlem was typical of 'most physicians', who 'saw private practice rather than hospital work as the primary pre-occupation of their careers' (49); and little wonder when the contracts of hospital practitioners required no more than a part-time attendance.

For the most part, the Sub-Committee Minutes reveal little more about Hale than the performance of ordinary duties and the certification of patients as fit or unfit for admission or discharge, in his advisory role as physician. The physician normally undertook a role on these committees subordinate to that of the treasurer, and three or four other governors. However, for diagnostic purposes, the Committee generally deferred to the doctor's expertise, and occasionally, we find Hale presiding alone, dispensing Tyson's Gift for the relief of recovered and indigent patients on their discharge, or ordering a truss at the hospital's expense for the rupture of 'an Out patient' (50). Moreover, the criteria for admission and discharge seem to have become tighter and more sophisticated under Hale's guidance. The number of patients being rejected by

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Hale and the Sub-Committee is a striking feature of these minutes. Patients were now being admitted almost exclusively on Saturdays, between 10 a.m. and 12 noon, after a cautious examination by the physician and committee. The rejection of a great many deemed beyond the curative competence of the hospital would tend to refute any notion that Bethlem was apt 1:o accept any patient recommended to it. Indeed, applicants were occasionally found to be sane, on the scrutiny of Hale and the governors, and might be rejected or discharged if 'appearing to be pretty well in [their] Senses'; if their condition was not considered acute enough (51). These minutes are the ifirst evidence that patients were being rejected or discharged on the doctor's assessment of the strength of their constitution; if 'too weak to take Physick', or likely to 'dye in a short time if continued'; and cast doubt on historians' customary picture of uniform physicking at Bethlem.

Public visiting had continued to be difficult to regulate during Hale's term of office. Directives issued at sub-committee meetings in 1713 (at which Hale was present) and again in 1727 (at which, unusually, his presence was not recorded), repeated almost verbatim one of the standing orders cf the hospital, dating from 1677; that no patients who were 'naked' (or 'unshifted'), or 'in a Course of cure' (or 'physick'), should be seen by any visitor without the physician's consent (52). The reiteration of this rule implies not only difficulties in its enforcement, but also the consistent curative commitment of Hale and the Governors, and some small regard to the privacy and self-respect of their patients, although the Governors were probably just as concerned here about the offence and titillation of visitors bringing discredit upon the hospital. According to O'Donoghue (mis-citing Dod's Harveian Oration of 1729), Hale regarded 'company', 'jollity and merriment, and even a band of music', 'as very beneficial to the patients', especially those suffering from melancholy; an opinion he employed, somewhat anachronistically, to censure Hale for his unenlightened attitude towards visitors (53). Company (and music) had been recommended by physicians since Hippocrates, and while opinion during the eighteenth century turned increasingly in favour of seclusion, many of Hale's contemporaries continued to put faith in society and social diversion when treating the insane (54).

PRIVATE PRACTICE, PROSPERITY AND POLITICS

Nevertheless, in 1718, Hale rather inconsistently forbade 'all Company' from a private patient of his, Dame Sarah Clerke (55). While never referred to as melancholic. Hale's management of Dame Sarah seems to reflect that familiar social disparity between the private and public practice of physicians: Thomas Monro (Bethlem Physician, 1792-1815) used chains for pauper Bedlamites, but

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not for mad gentlefolk whose sensibilities (and families?) would not abide them (56). Company was, perhaps, advocated by Hale and his colleagues only where (as at Bethlem) social expectations, economics and inadequate facilities made it permissible, if not expedient. Yet Sarah Clerke's isolation was also warranted by dissensions within her family and household over her diagnosis, which threatened to interfere with her management. I have dealt with Hale's invol- vement in the case of Sarah Clerke elsewhere (57). Suffice to say here, that the case provides rare insights into Hale's methods of practice, both diagnostic and therapeutic, and reveals not only how renowned colleagues, like Mead and Freind, deferred to his 'expertise' in the treatment of the mad, but also how ambivalent and contentious the expertise of a mad-doctor could be.

At the end of his career, Hale was again the physician concerned with a patient whose custody was a matter of dispute, and whose case has some striking parallels with that of Mrs Clerke. Not only did the custody of Lady Frances Erskine Mar mean the control of considerable assets for her family (58), but (like Dame Sarah) Lady Mar was perceived as suffering from 'melancholy vapours' by some, and as essentially sane by other members of her family (59). In similar fashion, she tried the Spa waters in vain for a remedy (60); was found a lunatic by a Commission of Lunacy, whose decision was attributed by Lord Mar's brother, Lord Grange, to the friendship between the Lord Chan- cellor and Lady Mar's sister, Lady Mary Wortley Montagu; and was very nearly subjected to a further trial, by Lord Grange, three years later (61). As was Sarah Clerke, Lady Mar was committed to the care of someone, Lady Montagu, who clearly had little truck with oddities or susceptibilities of any kind, and became the subject of lively interest from the newspapers and society at large (62). Finally, after Hale's death, Lord Grange enlisted the services not only of Richard Mead, but also of the new 'physician to Bedlame [sic.]', James Monro (whom he may have known as a fellow Scot) (63), and of Dr John Arbuthnot (also a Scot and good friend of Mead's), with the intention of conducting an independent examination of Lady Mar to vouch for 'her condition [of sanity] before the Chancellor' (64) and overturning Hale's former diagnosis. Once again, as in Sarah Clerke's case, we may ascertain here how families tried to adapt the 'expertise' of physicians to their own purposes.

The battle over Lady Mar's custody, however, proceeded in a much more private fashion than that over Mrs Clerke (65), and Hale's management of her evidently at no stage met with public criticism. In fact, Hale died before the dispute reached its height, and his engagement by Lady Montagu clearly had Lord Mar's (belated) approval. Indeed, Hale seems to have been considered by both parties as 'the best' physician available. Lord Mar heard of Hale's death 'by the newspapers' and wrote to Lady Montagu from Paris in November 1728 of his 'great concern' about 'who now attends her in his place', and his certainty

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that she 'would take care to have it one of the best' (66). Neither was Lady Mar isolated in the manner of Mrs Clerke, but was permitted to live in her own lodgings, to keep her own servants and to entertain friends (67), an arrange- ment which suggests the special circumstances of Mrs Clerke's case. Lady Montagu believed 'good Company' one of 'the best medicines', and seclusion a source of unnecessary suffering for the 'vapourish' patient. Indeed, in both these cases and for most private cases during this period, the preference of the patients' families (facilitated by their social standing), rather than the advice of Hale (or any other physician) usually determined the patients' actual environment.

That Lady Montagu had engaged Hale for her sister in the first place seems surprising, when, in correspondence with the increasingly ill Lady Mar only the year before, she had so disdained the 'world of filthy doses and more filthy Doctors' fees' and 'Physic and retirement', as 'good for nothing but to break Hearts and Constitutions' (68). Yet, while Lady Montagu espoused 'galloping', 'moderate [nightly] Champaign', 'Air, Exercise and Company' and pleasant daily diversions, rather than medicine, as the best 'cure for lowness of spirits', her attitude to her sister's disorder was nothing if not pragmatic. In cases of madness, Lady Montagu was later to assert, carrying the afflicted 'to Bedlam...is really all that is to be done' (69). Nor would Hale's opinion have differed much. Air, exercise and company were, of course, the basis of regimen at Bethlem, and were agreed upon as generally salutary by contemporary physicians (70). Yet, whatever her difficulties in empathizing with her sister's vulnerabilities, and her lack of patience for, or an appreciation of, psychological traumas (71), it would be going too far to suggest that Lady Montagu's own attitudes to mental illness were influenced by her choice of Hale as physician. Even so, Hale, as a vociferous adherent of Harvey's circulatory theories (72), would no doubt have echoed the strict tone of Lady Montagu's declaration that madness was 'a corporal distemper', 'lodged in the blood', and 'never occasioned [entirely] by affliction [or 'passion'], or to be cured by the enjoyment of their [the patients'] extravagant wishes' (73).

Hale's engagement by such notable families as the Montagus/Mars and the Turnors, as also in the case of 'Mr. Bl-s', son of 'Sir Charles Bl-s', (74) is suffice to adduce the substance and credit of Hale's private practice, a state of prosperity which he shared with his predecessors and successors as Bethlem physician, and which helps to explain why the post was considered such an acquisition within the profession. The credentials and social connections im- parted by hospital appointments to their holders had obvious advantages in the drumming up of wealthy custom, even if physicians were keen to emphasize 'that they were Men of a Profession, & not a Trade' (75). In somewhat inflated terms, Hale's obituary made this direct connection between the doctor's office

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at Bethlem, his reputation, and his wealthy private practice. The obituarist claimed that, during Hale's twenty years as Bethlem physician,

his indefatigable Care, join'd to his sound Learning and Skill in his Profession, was attended with such Success, as deservedly raised him a great Name, and at the same time, conducted to him innumerable Patients of that most miserable Sort, who apply for the Recovery of their lost Reason;

and that it was 'thus', that 'he heaped Riches' (76). The substance of Hale's practice is also confirmed by the liberal bequests he was able to leave, consisting of about £2500 in cash, £5000 in Orphans Debt Stock and an annuity of £20; quite apart from the property and estates he left.

In 1709 Hale was living in Portugal Row, Lincolns Inn Fields. In 1717, a house in the Fields, owned by Edward Tregenna, Gent, but subsequently leased in 1704 to Sir John Cowper, was assigned to Hale (77). This was clearly a substantial property, with 'Outhouses &c', leased originally at £25 per annum for a term of 61 years; and to Hale, thereafter, 'in consideration of about £700' for the remainder of the term; and is proof enough of the prosperity of the Bethlem doctor, who was further to expend 'a good deal of money in improving it'. That Hale bequeathed the remainder of the lease, after his wife's decease, to whomever was then Bethlem Physician (and his successors), suggests the suitability of his abode, and the extent of his own attachment to the hospital and his profession (78). Indeed, Lincolns Inn Fields was a fashionable residence for members of the professions (besides the inevitable lawyers), and from the 1720s until his death Hale had James Jurin, physician to Guy's Hospital from 1725 to 1732 and a Bethlem governor, as a neighbour (79). Nevertheless, Hale was not one of those 'content with a single fashionable town house', whom Geoffrey Holmes regards as typical of the 'successful' members of the profession (80). His will also mentions houses in Magpie Alley, Fenchurch Street (inherited from his grandfather), and in Hampstead (where Hale based his private practice).

Hale's will fails to specify the extent of his real estate on his death, yet The Daily Journal records that he 'left an Estate of near £100 000' (81). Apart from the Essex and Cheshire farms (already mentioned), Hale had also purchased the manor of Hexham from Sir John Eden; which, in Holmes's terms, might qualify him as one of the 'exceptions to the rule', amongst a medical elite indifferent to land ownership (82). By 1727, moreover, Hale had bought a perpetual advowson of the rectory at Farnham, Essex, and a plot of pasture adjoining, with the apparent intent of augmenting his social status, and safe- guarding his interests, in an area where he (and his family) were landlords. Indeed, Hale's grandfather had also bequeathed a small-holding in Farnham to Hale (as his father's heir). I suspect that the interests beyond the capital of

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a good many London physicians were more extensive than Holmes gives them credit for (83), even if physicians like Hale aspired much more to the image of the learned and respectable urbanite of the enlightenment than to that of the physician-squire. It is certainly in the light of the former that we should place his legacy of £500 to the newly established Charity School at his family seat of New Windsor, where Hale and most of his family were interred (84).

The contemporary image of physicians as predominantly concerned with their purses is one that needs tempering, however. The only instance I have discovered which specifies what Hale charged for a single consultation records a very modest rate. Hale's fee to the churchwardens of St Bride, London, for 'comeing to see [John] Taylor a Madman' on 10 June 1718 was only one guinea; purportedly half of what Richard Mead usually charged for a visit (85). Following Hale's consultation, Taylor was admitted to Bethlem on 7 June 1718. He remained for the standard year until discharged on 13 June 1719, with 40s. of Tyson's Gift (86) in his pocket. It was highly irregular for the Bethlem physician to visit a parish patient, but Taylor seems to have been 'in Bridewell' itself rather than at home on Hale's attendance, and to have been arrested on a felony. Hale's consultation was more likely at the governors', than the churchwardens', instigation. Moreover, physicians were apt to mitigate their levies in cases they perceived as deserving of charity (87). Hale's own legacies to the incurables of Bethlem and the charity school in New Windsor demon- strate how caught up he was with the contemporary verve for grand statements of munificence.

According to another source (88), George I's notorious Turkish body servant and keeper of accounts, Mehemet ('Mahomet'), was also a private patient of Hale's. Indeed, Hale was said to have been 'instrumental in protracting the life of Mahomet by his great skill and care'. As a result, Hale's career might have received its crowning glory, for 'he was offer'ed a Patent of Baronetship, and the post of Physician to George I'. However, George's favouritism for Mehemet (89) and Mustapha (his other Turkish attendant), was generally looked upon as a scandal, one satirist even styling the King 'Sultan GALGA, the present Chan of Tartary' (90). According to Sophia Dorothea, the King's Consort, Mehemet and Mustapha 'were allowed to drive a considerable trade, by trafficking in places of small emolument', and by acting 'as agents for ... greedy parasites who disposed of state appointments' (91). In this light, it is neither surprising that Hale's attendance on Mehemet secured him such offers, nor that he was praised by his Oxonian biographer for 'nobly, civilly, and prudently' refusing. It was perhaps to this episode in particular and to John Freind's defection to the Court party, that Michael Mattaire referred in a private poem of 1727, dedicated and (presumably) sent to Hale (92). Berating, with double- edged irony, those who out of 'mad .. ambition' ('Vesana ... Ambitio'), 'follow

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Royal Courts and Titles' ('Sectantur Aulas et Titulos'), Mattaire praised Hale's 'tenacious heart' for never being 'moved by these enticements' ('pectus pro- posti tenax /Istis moveri blanditiis nequit'). Yet this episode also supports the esteem in which Hale was held by his contemporaries, and may suggest something about the politics of the man.

Lady Mary Wortley Montagu, like Lord Mar, had been involved in plotting against the government before 1728, and Hale's association with other well- known dissenters, Jacobites, or Jacobite sympathisers - like the Rawlinson family, Thomas Hearne, Michael Mattaire, Bishop Francis Atterbury, John Freind and Thomas Morrice (93) - provokes questions about Hale's own

political allegiances. Hale's circle was certainly a tight one, but social connections are hardly a reliable guide to political affiliations, and the absence of comment about Hale's politics from his contemporaries suggests detachment, or even orthodoxy. Moreover, Hale's nephews, Christopher and Thomas Tower, zealous Whig MPs well-renowned as Walpole's creatures, were signifi- cant beneficiaries in Hale's will (94).

Not all of Hale's patients were 'psychiatric' cases of course. In 1726, for example, he attended the antiquarian and librarian, Humphrey Wanley, when suffering from 'dropsy', just before the latter's death. Wanley was arranging to be married, and Hale advised him against it in his characteristically blunt manner, telling him 'that he cannot last long'. Wanley ignored Hale's counsel and died within a month.*

FRIENDS, COLLEAGUES AND THE ACCOMPLISHMENTS OF LEARNING

Nevertheless, Hale's relations with the Oxonian scholars Wanley, Thomas Rawlinson, Hearne and Mattaire reveal how Hale (like most of his Oxbridge colleagues) had retained firm connections with his academic roots, despite his

inauspicious departure from the city before 1708. Indeed, Hale bequeathed his Farnham advowson to the Senior Fellow and his successors at Trinity College a privilege which, during his lifetime, Hale had also bestowed on a Trinity man (95). By 1716 at least, keen to expand his book-learning, Hale had become (like Mead, Freind and Pellet) a subscriber to the Bodleian Library, and was obtaining books and manuscripts through Hearne (the keeper of the library)

* For this account, see letters from Dr William Stratford to Edward Harley, in Report of the MSS of the Duke of Portland to WelbeckAbbey. Hist. MSS Comm. 7, (London, HMSO, 1901), letters dated 13 June and 10 July 1726, 439 and 441; DNB; G.E. Wright, 'Humphrey Wanley: Saxonist library keeper', British Academy Proceedings, 1960, vol. xivi, 99-129. Wanley was on friendly terms with Mead, Freid and Mattaire, but did not mention Hale in his diary. See The diary of Humphrey Wanley, 1715-26, ed. C.E. Wright & Ruth C. Wright, (London, The Bibliographical Society, 1966). 2 vols.

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and Rawlinson (a renowned bibliophile) (96). A passion for book learning does not alone, of course, prove erudition, as Thomas Rawlinson was to discover when penned by Addison as 'Tom Folio' (97). However, the accuracy and scholarship of Hale's Harveian Oration (1724) met with general recognition, and even the grudging Hearne acknowledged on Hale's death that he 'was an excellent Scholar'; an opinion reiterated by Harveian Orator after Orator (98). Indeed, although doctors were often pilloried for their bombast, within the profession itself erudite display was regarded as an essential accoutrement of a respectable physician. As Robert Hopwood observed, it was to encourage physicians in their pursuit of such learning that Hale bequeathed so generous a sum for the purchase of books (99).

However, Hale's zeal for classical literature seems to have got him somewhat carried away on occasion. Michael Mattaire satirized the doctor in argument with Mead and Freind, 'prating to them of nothing except Homer' (100). Likewise, Edward Wilmot's account of how Hale 'held Homer ... in such esteem, that he ... joyfully recited him upon any occasion' (101), suggests that Hale's company had sometimes proved a trifle tiresome. In his own Oration, Hale had observed that there were traces of Harvey's circulatory theory in Homer. Homer had not only understood a great deal about anatomy, argued Hale, but had 'also noted the strength of the heart and the use of the blood' (102). While Wilmot commended Hale for this insight, his vindication of such Homeric enthusiasm lest Hale be 'rashly ... accused of error', implies that Hale's observations had not passed without criticism from the Faculty (103). Yet Hale freely admitted that Homer had given only 'hints' on the subject of anatomy 'in passing', and conformed to the standard view that 'the anatomical art lay hidden in its cradle' and that no one had understood the circulation of the blood before Harvey (104).

Although an exposition of Harvey's discoveries was naturally de rigueur for Harveian Orators, this section of Hale's Oration was unusually detailed, and is not only revealing of the doctor's mechanistic theoretical stance towards disease, but is also suggestive of his attitude to the aetiology and treatment of mental illness (105). Hale's account is indeed quite conventional and straightforward. Dismissing the criticism of Primrose, Parisan et al. (106) as obscurantism, Hale stressed how much the complexity of disease had been mitigated as a result of Harvey's findings. Since the blood moved through every part of the body, it could affect any part of the body, the same cause could arouse almost any disease, and the causes of disease could be reduced to a much smaller number. Moreover, Hale observed, the practice of medicine had become easier, since any medicine applied would be mingled with the blood and distributed to every part of the body, and thus relieve any part. Accepting that 'we are machines' ('sumus machinae'), and that the body was composed

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of vessels through which both diseases and remedies flow, Hale maintained that the object of the physician was to restore the condition of the bodily fluids and so 'the tone of the solid parts' ('tonumque solidarum partium'). Hale was convinced that 'it is the same crasis of blood in all inflamations', and that it was irrelevant which part of the body was disordered; whether it be 'the membranes of the brain or lungs ... inflamed', or 'the muscles of the head or the limbs ... assailed by convulsions' (107). This has obvious connotations for his under- standing of insanity, and helps to explain why Hale and most of his colleagues put so much faith in the use of powerful medicaments in its treatment.

Hale certainly seems to have made a staunch ally for those with whom he was on intimate terms. Disillusioned by the desertion of friends, Michael Mattaire wrote to Dr William Stukeley singling out 'honest Dr Hale', amongst the medical profession, as one whom 'I still stick to ... [and] who hath not yet been so fickle & inconstant as to cast me off (108). In a like fashion, Mattaire told Thomas Hearne that when their mutual friend Thomas Rawlinson grew, in his dotage, 'so very satirical and free with his tongue that he spoke ill of every body whatsoever', Hale was the 'last' with whom 'he began to find fault' (109).

Yet it is his relations with his colleagues, particularly with Richard Mead, that reveal most about Hale as a physician. Mead not only consulted Hale in his private practice, but cited the Bethlem doctor in his writings as an authority on mental illness (110). Mead quoted Hale's observations on the psychological impact of the South Sea Bubble to illustrate how prolonged and immoderate joy might 'upset mental balance', 'as well as depressing events' (111):

I have formerly heard Dr Hale, physician to Bethleem-[sic]-hospital, and of great experience in these matters, say more than once, that in the year 1720, ever memorable for the iniquitous south-sea scheme, he had more patients committed to his care, whose heads were turned by the immense riches which fortune had

suddenly thrown in their way, than of those, who had been completely ruined by the abominable bubble ...

Besides being trusted as an expert on insanity, then, Hale evidently had some appreciation of its psychological aetiology.

At the same time as Hale was active in the provision for incurables at Bethlem, Mead was likewise involved in the provision at Guy's (112). Given the evident rapport that existed between Mead and Hale, Mead's writings on insanity might provide a further access (however hazardous) by which Hale's own ideas can be approached. Although Mead wrote copiously on the subject of mental disorder, this particular aspect of his scholarship has received little attention from historians. Mead's notions on insanity and its treatment were largely conventional and were no doubt shared by most contemporary physicians. Yet some of his ideas (for example, that mania was interchangeable with melancholia and 'that insanity was incompatible with [and often dispelled]

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other major disease'), were more challenging, and had possibly been discussed, if not confirmed, by Hale (113).

Hale certainly shared Mead's aversion to 'stripes and other rough treatment' (114), and preference for 'powerful medicines', whether or not this was founded, as for Mead, on the belief that maniacs were 'cowards' and that 'the nerves are not easily stimulated' (115). James Monro believed that Hale's peculiar distinction in running 'Sparta' (i.e. Bethlem) so well, was in 'dealing with the furious violence of maniacs not so much by restraining them with chains or bars ['carcere'], as by sedating ['sedans'] them with appropriate medicaments, and driving all vexations from their minds' (116) This statement recalls Hale's former Oxonian practice and may connote the early use of opiates at Bethlem. However, the word 'sedans' was probably used to convey nothing more specific than the 'soothing' design of other, more orthodox medicines, like the host of contemporary evacuants. Other Orators, likewise, praised Hale for his supreme 'benevolence' and 'humanity' in the care of the insane and in general during his life (117). This would suggest that the use of forcible restraint was curtailed at Bethlem under Hale's guidance, although I have found no supporting evidence for this implication elsewhere (Mead thought 'binding' absolutely necessary) (118).

Hale also appears to have accepted, with Mead, the traditional diagnostic and therapeutic division between 'maniacs' and 'melancholics'. Mead maintained, in his Precepts, that the 'outragious' behaviour of the former should be 'conquered' by 'authority', 'chiding & threatening', while the 'despondency' of the latter should be 'dissipated by giving them hopes, & raising their spirits', by 'music' and by 'such diversions as they formerly took delight in' (119). Similarly, Hale was depicted by Edward Wilmot as a doctor who 'boldly cast down ... Kings and Queens ... from their straw thrones' and 'reduced the raving to a sane mind', and more genially, as one who 'cheered up ['erexit'] those overcome by black bile [melancholy]' (120). Mead was no doubt thinking of Hale in particular when he claimed, in his Mechanical account ofpoisons, that the efficacy of cold bathing (employed at Bethlem since the 1680s), was a matter of consensus amongst the physicians 'most conversant in the cure of these maladies', and proven by their 'daily experience' (121). Likewise, Mead's admonishment that therapy should be continued 'after the patient has recovered', to prevent relapse, had been recognized at Bethlem since Tyson's establishment there of a facility for out-patients' physic (122). Mead's faith in evacuants, but stress upon the dangers of their excessive use and the need to assess what degree 'the patient is able to bear', is echoed by the policy at Bethlem, during Hale's physicianship, of examining the fitness of patients 'to take Physick' (123). Ultimately, however, it is impossible to be sure how much, or even where, Hale's views on insanity coincided with Mead's.

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Hale's relationship with his colleagues was certainly not free from differences of opinion. Doggedly patriotic, Hale was very much opposed to the cosmopoli- tanism of both Mead and Freind over the issue of foreign physic and physicians. Scholarship abroad was all the rage amongst the physicians of the late seventeenth and early eighteenth centuries. The legacy of Mead's great patron, John Radcliffe, for the foundation of two medical travelling fellowships, is well known (124). It was partly as a result of this and also of his own education and travelling in Holland and Italy (125), that Mead was such a keen advocate of the benefits of foreign travel and education for medical students. Hale, however, took firm exception to this practice in his 1724 Harveian Oration (126). Lauding the achievements of English physicians, Hale emphasized the home- based opportunities for medical scholarship. He accused foreigners of plagiarizing earlier discoveries and of thrusting errors and inanities on the public. Hale portrayed English physicians who returned from abroad as 'certainly no more learned and never more skilful physicians', even if they might be considered 'cultivated men', and referred to Padua as 'degenerate' ('degen- eri') (127). According to Hearne, Hale was generally understood by academicians to be sniping at Mead in this section of his Oration (128). However, lest Hale be condemned for insularity, it was less physicians going abroad that he objected to, than the somewhat touristic way in which they did so (129).

Mead, with Freind's support, had also recommended the recognition of foreign physicians on the same footing as graduates of the College, an opinion to which, according to Mattaire, Hale was equally hostile, but one which, by 1725, according to Hearne's friend West of Balliol College, both doctors regretted and were attempting to disown (130). Yet, judging by Mattaire's satirical comments in his Ode addressed to Dr Noel Broxholme on his birthday (131), this was not before the quarrel had run quite deep. Mattaire represented all three doctors as proud and vain creatures, prone by nature to disputes, and advised Broxholme 'if you have any sense' to 'avoid the quarrels of these opposing factions' (132). Coming from an especially close friend, Mattaire's description of Hale as 'stern' ('asper') and 'not knowing how to yield' ('cedere nescius'), carries conviction (however playful), and is borne out by the posthumous comments of his colleagues, who spoke of him in identical terms, as 'stern' ('asper') and 'ferocious' ('ferocius introeat') (133). Yet no one seems to have accused Hale of choler. On the contrary, Mattaire portrayed Mead ('the Dutchman') roaring in anger and Freind as his fierce guard, while Hale responded with the proverbial imperturbability of the mad-doctor, knowing better than any other (joked Mattaire) 'how to restrain the insane crowd' (134).

Indeed, the reaction of Mead and Freind to Hale's Oration may itself have involved a touch of envy, for, as West told Hearne in 1725, 'twas the general

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opinion that Dr Hale's Speech ... is better than any that hath been printed, not excepting even Dr Mead's and Dr Freind's' (135). Hale was justifiably recognized as the first Orator who had paid proper regard to the achievements of 'our English Physicians'. Only Edward Wilmot of all the Orators who succeeded Hale, accused him of 'excessive ... partisanship since he loved his native land' (136). Now, however, it might be said that Hale's account began rather late, with the thirteenth century, and hardly offered an in-depth analysis before Linacre (137); and that the majority of his Oration was still taken up with famous English physicians whose work previous Orators had covered de rigueur.

Hale's difference with Mead was soon mended, for the latter attended Hale on his death-bed and was one of the pallbearers at Hale's funeral in 1728 (138).

THE EMINENT COLLEGIAN AND POSTHUMOUS ESTEEM

Hale attained a position of considerable eminence in the Royal College of Physicians, by the time of his death. Having been admitted a Candidate of the College on 23 December 1708 (largely, no doubt, as a result of his appointment to Bethlem) (139), Hale was elected a Fellow on 9 April 1716 (140). He was subsequently appointed to the responsible post of Censor on three separate occasions, in 1718, 1719 and 1724, the first of which was only two years after his Fellowship (141).

One of the very first prosecutions in which Hale was involved as a Censor, was a case with which he was personally concerned, and which reveals the intimate, almost familial way in which the College could operate in overseeing medical practice. The case of John Sampson, an alehouse keeper, summoned before the Censors for practising without a licence, is typical of the invigilatory role of the Censors, except that one of the complainants was 'John Barnes, Dr Hale's [own] servant', and the other, William Otway, lived 'in Whetstone Park, by Dr Hale' and was subsequently a witness for Hale's will (142). Barnes had no doubt sought the ruling of the College on Hale's advice. Indeed, it is likely that this case proceeded to the lengths of a prosecution because of the particular interest of one of the Censors. In other similar cases, the Censors had not usually pursued so far (143).

Most of Hale's employment as a Censor was taken up with the ordinary duties familiar to historians (144). His visitation, with the other three Censors in 1719, of the dispensary and the apothecaries' shops in the capital, upon which the Censors ordered the flinging into the street of medicines found to be 'decayed and unfit for use', is illustrative of the extensiveness of the Censors' authority and characteristic of the haughty way in which it was often imposed (145). Obviously, Hale had to be conversant with the composition and application of an enormous number and variety of medicaments, in his ordinary

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capacity as a Censor, and his appointment is enough to establishhis esteem as a fully- competent general practitioner (146).

It was during his last term as Censor, in 1724, that Hale was accorded the rarer honour of giving the annual Harveian Oration, at the end of which address he paid elaborate tribute to the role of the Censors (147). His description of the Censors as the 'guardians of public health' ('curatores publicae salutis'), and the sole protectors of 'the common herd' ('vulgus') from the dissemination of false, unnatural and potent drugs, reflects an attitude that was shared by most Collegians and suggests the depth of Hale's own allegiances (148). Indeed, Hale was acknowledged after his death as 'a most zealous champion of the College' (as also 'of both Universities') (149).

Not all of Hale's colleagues, of course, accorded him such respect. As a new Fellow of only two years standing, Hale's rapid promotion to the position of Censor in 1718, above the heads of other much longer-serving Fellows, did not pass without resentment. His somewhat humble background, set against his subsequent success and prosperity, made Hale (and other lower-born physicians) the target of real indignation from some Collegians who regarded themselves as 'the Regulars'. Hale and his ilk were carped at as part of 'an Inundation [into the College] of Tinkers, Drapers, Dragoons, and other Trade- smen, who were still Mechanics [an obvious allusion to Hale's mechanistic stance in the ongoing debate with the iatrochemical school], as much as when they first set out', and whose admission tarnished 'the Honour of the College' (150). Edward Wilmot made apologetic reference to Hale's lack of breeding in his Harveian Oration of 1735, and seems to have conceived a connection between this and Hale's rather blunt and belligerent character. Yet, his declaration that Hale should be no 'less welcome to your company', 'because his toga has a little too countrified an appearence, and he enters with too fierce an air', was evidently the consensus of opinion amongst the vanguard of Hale's colleagues (151).

From 1718 until his death, Hale was a regular attender and well-respected member of the College (152). His largesse of £500 to fill the library shelves of the College certainly assured him a more enduring place in the memory of his fellows than he otherwise would have merited. Surveying Hale's numerous book plates in the present College library, it is not difficult to understand why his memory was perpetuated for so long by its frequenters (153). Indeed, Hale's legacy was mentioned by every Orator who accorded him special notice, and the majority mentioned nothing else (154). By the 1760s even this distinction had been forgotten, and Hale was scarcely referred to. As, by the latter eighteenth century, medical theorists began to put more faith in management and moral therapy, than in a mechanistic, medicinal approach to mental illness, Hale's brand of 'psychiatry' may have been regarded as old hat. Most symboli-

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cally, Dr Richard Jebb passed Hale by, in 1774, with the comment 'Halaei antiquos mores' ('the ancient ways of Hale') (155). Even when Orators paid more respect, their remarks are so rhetorical and derivative that they can only be taken with a generous dose of salt (156). The majority of Orators who mentioned Hale could not have known him at all personally (157). While, partly to excuse their own ignorance on the subject, some Orators appealed to 'the records of Bethlehem' and Hale's patients themselves, to speak of the success of the doctor's treatment, these sources in fact remain rather silent before the historian (158).

However, Orators unfamiliar themselves with Hale's career, must have been partly filled in by their older colleagues. While much praise of Hale was standard flourish, the testimony of Orator after Orator to his austerity, indomitable rationality, and forthrightness in his opinions, rings truer, is confirmed by the remarks of his friend, Michael Mattaire, and seems a plausible reflection of the peculiar characteristics of the mad-doctor. Whereas Orators concurred, then, that Hale was somewhat forbidding because of 'a natural authority in his countenance', such a demeanour was recognized as the distinc- tive mark of the mad-doctor, and essential for any physician when dealing with the more volatile insane (159). Medical theorists like Thomas Willis had long stressed the 'necessity' of severity in 'the curing of Mad people', and of the patient being kept 'in awe' by the physician (160). Another Orator, John Hollings, excused Hale's intolerance for 'the follies and stupidities of mankind which one must put up with all day' (particularly when one is physician to Bethlem) by the 'frank and candid' manner of his 'distaste'. Yet Hollings's comments suggest that if Hale was blunt and impatient with some of his colleagues, he would be more so with the delusions of his patients (161). At least six Orators made some reference to Hale's uncompromising veracity and rationality, and his 'acumen in distinguishing between truth and falsehood' (162), an obvious claim to make for the mad-doctor who specialized in sorting out reality from delusion. Evidently, despite the sensitive nature of his profession, Hale was never one to mince his words. While Robert Hopwood gushed 'there was no falsehood that he ventured to utter, no truth that he did not dare to speak'; and Edward Wilmot described, with more restraint, how Hale 'was considered a straightforward man', because of 'his frankness of speech' (163), this may have been part disguise for the occasional gaucheness of the mad- doctor.

If by the latter eighteenth century Hale's 'psychiatry' was considered out- dated, for 30 years after his death 'psychiatrist' Orators still paid their respects. Most emphatically of all, in his Harveian Oration of 1737, James Monro, praised the character of his predecessor and singled out Hale as an exemplar in the treatment of the insane; a model, indeed, which 'we are compelled to

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follow' but 'cannot match' (164). James's comments were echoed by his son and successor, John Monro, in his Harveian Oration of 1757, and in William Battie's Oration of 1746, although neither went into much detail (165). Most interestingly, Battie, despite his criticism of therapeutics at Bethlem, acknowledged Hale as 'the shade of great name and the sure salvation of those afflicted in their mind'. As late as 1761, Battie's old pupil, George Baker, still afforded detailed praise of Hale's medical skill, commending him as much as Harvey for his 'patience in experimentation' (166).

Hale died 'of an apoplexy' on 28 September, 1728. His death was greeted with numerous expressions of regret. Thomas Morrice, for example, wrote to Bishop Atterbury a week later: 'we have lost Doctor Hale ... His death is very much regretted by all who knew him' (167). Hale's obituary described him as '...so kind and beneficient, that his death will be universally lamented' (168). His lapidary inscription at New Windsor, claimed that 'His great Knowledge in every part of his profession and more eminently, in that branch relating to madness, made him an ornament and benefit to the age he lived in' (169).

Alexander Cruden, however, the Bedlamite and eccentric private patient of the Monros, disputed this consensus on Hale's worth. The moralistic Cruden accused Hale of having been scandalously involved with a nurse at Bethlem, and alleged that this same nurse was now wife of Matthew Wright, keeper of Bethnal Green private madhouse, in which Cruden then was (in 1738, when he was writing), and which he preferred to describe as 'a Bawdy-house' where the patients suffered from 'Crimes and Barbarities' (170). Cruden cast further aspersions on Hale's character by claiming that the doctor had visited a 'Mr Bl-s', son of 'Sir Charles Bl-s', when a patient at Wright's house, and that Wright had connived to make the patient 'much worse than he really was'. Cruden's allegations concerning Hale and Mrs Wright may not have been without substance, for the nurse at Bethlem, from 1718, was a Sarah Wright, who was accused in 1727 by the Steward and servants there of profiteering at the patients' expense (171). Although the charge against her, of demanding money from visitors to show them the 'Chequer', seems to have been proven, no order for her discharge was recorded, and the circumstances under which she relinquished her post remain unclear. However, the Mrs Wright at Bethnal Green Madhouse, in 1743, appears to have been called 'Ellin', not Sarah (172). Cruden's overall testimony is subject to obvious doubts, and his account of Hale finds no support elsewhere.

CONCLUSION

I chose in my title to highlight the antithesis which still haunts psychiatry in its efforts to establish itself as a scientific branch of medicine. By this I mean

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the antithesis between the kudos of psychiatric expertise, and the disrepute germane to the compulsory diagnosis and treatment of types of illness which are so much subject to social arbitration. Even those who assert 'the reality of mental illness' must concurrently assert its profound potentials for unreality (173). The hybrid figures presented by mad-doctors like Richard Hale encap- sulate this antithesis at a period when it was at its most acute. In one guise a representative of the traditional, urbane and highly esteemed London medical elite, epitomizing the erudition and beneficence of the enlightened physician, Hale emerges in another guise as the rather rough-shod and blunt mad-doctor, slightly sullied by an undercurrent of scandal. Hindsight has too often tended to deprive the forerunners of modern psychiatry of their context. While, for example, Hale (along with his colleagues at Bethlem) has been criticized for publishing nothing on insanity, historians have seldom owned that 'hospitals did not provide physicians with fields of experience from which publication was expected' (174). Failure to publish did not prevent friends and fellow practitioners from paying liberal tribute to the quality of Hale's actual practice, both public and private. Although the historian might regret the extensiveness of Hale's commitments outside the hospital, this was the standard pattern amongst the hospital physicians of the eighteenth century and seems exemplary of Holmes's claim 'that the aristocrats of London medicine often worked extremely hard' (175). Mattaire remarked with admiration how his friend burned the candle at both ends (176). While Hale contributed little to the advance of physic during his career, he still managed to attain a level of prestige in the medical world almost on a par with the likes of Mead and Freind. Ultimately, if one feels closer to Hale and to a grasp of his medical practice from reading of Sarah Clerke's case than from the eulogistic comments of his friends and associates, there seems little reason to doubt the general respect which he was accorded, nor the mildness of his methods, within their proper context. Although the mad-doctor (before William Battie) could never be an entirely respectable figure, Hale seems to have come as close to it as contemporary opinion, and modern historians, might see fit to allow.

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192 Jonathan Andrews

APPENDIX. The family tree of Dr Richard Hale, F.R.S.

Richard Hale m ? (d. 1678) i

| 1666

Richard m Eliz Church (1640-1703) (1649-?) Gent. of Of Henly-on New Windsor, -Thames, Berks Oxon., d of

-Townsend & Eliz Church

m Xtopher Tower

(1658-1728) Gent. Dep. Collector of Customs for London

1719 m 1. Jane Proctor

(d. 1739) 1746 m 2. Jane Tash

Sarah (spinster)

I Dr Richard (1670-1728) Bethlem Phvsician

m Frances Henry John m Sarah

(1672-7()7) (d. 1720) (d. 1737) Of St Marv at Hill

Thomas m Sarah Hale Frances n --Gwyn (1698-1778) (d. ?1813) Lawyer, Whig MP. Councilman for Georgia Soc. Inherited Bucks & Essex estates from Dr Richard

Williaml

Eliz m Dr Richard Tyson (1680-1750) Favourite nephew of Dr Edward Tyson & Physician to St Barts (1725-5)) Failed candidate for Bethlem. 1728

NOTES

(1) For this image of Bethlem, see e.g. Max Byrd, Visits To Bedlam. Madness in literature in the eighteenth century (Columbia: University of South Carolina Press, 1974); A.

Masters, Bedlam (London: Michael Joseph, 1977); R.R. Reed, Bedlam on the Jacobean stage (Cambridge, Mass.: Harvard University Press, 1952); Richard Hunter & Ida Macalpine, Three hundred years of psychiatry 1535-1860 (London: Oxford University Press, 1963); Andrew Scull, Museums of madness (London: Allen Lane, 1979), and idem, (ed.), Madhouses, mad-doctors, and madmen: the social history ofpsychiatry in the Victorian era (London: Athlone Press, 1981).

(2) See Patricia H. Allderidge, 'Bedlam: Fact or Fantasy', in W.F. Bynum, Roy Porter & Michael Shepherd (eds), The anatomy of madness: essays in the history of psychiatry (London: Tavistock, 1985), 2 vols, ii, 17-33. For a more critical account, see Roy Porter, Mind-forg'd manacles. A history of madness in England from the Restoration to the Regency (London: Athlone Press, 1987), pp. 121-31.

(3) See Jonathan Andrews, ' "Hardly a hospital, but a charity for pauper lunatics".

Therapeutics at Bethlem in the seventeenth and eighteenth centuries', forthcoming in Charity and medicine (the proceedings of the 1988 conference of the Society for

Dr John Hale (d. before 1678)

John John

dmund Hal Edmund Hale

Sarah dith Judith

I Elizabeth (eldest)

Xtopher (1694-1771) Whig MP, Director of Bank of England, Trustee of Georgia Soc.

~~~~~~1 4·~~ ,ram

I i I

X~~~~~~~~ II

!

I



A respectable mad-doctor 193

the Social History of Medicine); and idem, 'The lot of the "incurably" insane in

Enlightenment England,' Eighteenth Century Life, 12, n.s.1, 1-18 (1988). (4) Denis Leigh, The historical development of British psychiatry (Oxford: Pergamon,

1961) p. 148; Edward G. O'Donoghue, The story of Bethlehem Hospital, 1247-1914

(London: Fisher and Unwin, 1914), p. 234. The lapidary inscription, composed by Hale's executors, which claimed to 'add but little to the perpetuating of a reputation which will remain when time shall have rendered this Inskription no longer legible', now has a rather ironic ring. See M.S. Rawlinson, J.4.1, fol.284, in the Bodleian Library.

(5) Geoffrey Holmes, Augustan England Professions, state and society 1680-1730

(London: George Allen & Unwin, 1982), Chaps 6 & 7. (6) Irvine Loudon, Medical care and the General Practitioner 1750-1850 (Oxford:

Clarendon, 1986). (7) See Holmes, op. cit. (note 5), p. 206. (8) Ibid, p. 209 and Thomas Browne, Physic lies a bleeding (London, 1697). For Hale's

father's and grandfather's wills, see P. C.C. Prob.ll, 471/60 and 357/84.

(9) See Dr Hale's own will for verification, P.C.C. Prob.11, 625/291.

(10) This was Hough Farm, in Barrow, Cheshire, mentioned in Dr Richard's will, and

probably identical to Milton Brook Farm, mentioned in that of his father, as situated in the same parish, and bequeathed to Hale's great uncle John. Frances Hale's jointure lands are referred to, though not named, in her husband's will.

(11) See William Munk, The roll of the Royal College of Physicians of London, 2nd

edition, (London, 1878), ii, 48; D.N.B. 24-5; M.S. Admission Book of Trinity College, Oxford; and Joseph Foster, Alumni Oxonienses (Oxford, 1892).

(12) See Romney Sedgwick, The history of Parliament. The House of Commons 1715-54

(London: Unwin, 1970), ii, 470.

(13) A. Rupert Hall, 'English medicine in the Royal Society's Correspondence', Medical

History, xv, 111-25 (1971) and idem, 'Medicine and the Royal Society', in Allen G.

Debus, Medicine in seventeenth century England (Berkeley: University of California

Press, 1974), pp. 421-52.

(14) Copy Journal Books of the Royal Society, ix, fol.261 and Richard Hale, 'The humane allantois fully discovered and the reasons assigned why it has not hitherto been found out, even by those who believed its existence. With an answer to their

objections, who deny it still', in Phil. Trans. R. Soc. Lond., xxii, no.271, 835-50 May and June, 1701.

(15) Ibid, 839, (16) Branthwait, as a Censor of the Royal College of Physicians and former Gulstonian

Lecturer (see Munk, Roll, ii, 6), was, by all appearances, a more established

physician than Hale. His candidacy was strongly advocated by George Buckley and Lawrence Parker, two amongst the governors of the hospital, but he lost the ballot

by a resounding majority of almost 2:1; Bethlem Court of Governors Minutes

(henceforth, BCGM) 10 September 1708.

(17) See A letter from the facetious Dr Andrew Tripe at Bath to his loving brother the



Jonathan Andrews

profound Greshamite; i.e. from William Wagstaffe (rather than Richard Mead, as some thought), to John Woodward; p. 45.

(18) See W.F. Bynum, 'Physicians, hospitals and career structures in eighteenth-century London', in W.F. Bynum & Roy Porter (eds), William Hunter and the eighteenth- century medical world (Cambridge University Press, 1985), pp. 118 and 121.

(19) See William Cadogan, Harveian Oration (henceforth H.O.), (1792), 19-20. For translation of numerous Latin texts used in this article, I am most gratefully indebted to Dr Jenny Hall. Any errors are entirely my own.

(20) Richard Tyson was a prominent beneficiary in both of the wills of his uncles.

(21) See Appendix (22) Thomas Hearne, Remarks and collections, (ed. C.E. Doble), (Oxford: Clarendon

Press, 1889), viii, 372-3. Dod was, however, elected 2nd physician to St Barts just two months later, on 22 July 1725, and his uninhibited praise of Hale in his Harveian

Oration, four years later, makes it clear that he harboured no grudges about Hale's earlier preference. Hale had examined and approved Dod, during his term as a

Censor, in 1719, and in 1724/5, the doctors served together in this capacity. See Dod's 1729 Oration, in the R.C.P. Library, 14-15 and R.C.P. Register Book, viii, 5

August, 4 September and 18 September 1719 and ix, 5 October 1724. Dod was

subsequently elected a governor of Bethlem, in 1742. BCGM 8 October 1742.

(23) For more on which see note 110.

(24) The significance of the patronage system in the careers of medical men has been

readily owned by historians, but little investigated. For a beginning, see N. Jewson, 'Medical knowledge and the patronage system in eighteenth century England', in

Sociology viii 369-85 (1974). (25) For this election, see BCGM9 October 1728. Tyson won through to the final ballot

with James Monro, out of a large, but rather mixed bunch, namely, Charles Bale, Sir Richard Manningham, William Marlin, George Owen, William Rutty and John

Tempest. The Daily Journal (No. 2410, 26-28 September 1728), erroneously claimed that, in his will, Hale had recommended Tyson to succeed him at Bethlem, and only on this 'Condition' had bequeathed £10 000 and his house in Lincolns Inn Fields to the hospital. This was rightly refuted by the more authoritative London

Evening Post (No. 126, 26-28 Sept. 1728). Tyson was not elected a governor of Bethlem until 1743. BCGM 13 October 1743.

(26) See A. George W. Whitfield, The first thirty seven registrars of the college (Privately published, 1981), in the R.C.P. Library, 87; and Michael Hunter, The Royal Society and its Fellows, 1660-1700: The morphology of an early scientific institution (The British Society for the History of Science, 1982).

(27) 'An account of the external maxillar, and other salivary glands: Also of the insertions of all the Lymphaticks (as well above as below the subclavians) into the veins; which glands and insertions have not hitherto been mention'd, or not truly described by any authors', in Phil. Trans. R. Soc. Lond. xxxi, no. 364, January-April, 1721,5-8. Hale, more than likely, read Cowper's Glandularum quarundam, nuper detectarum, ductuumque earum excretriorum, descriptio, cum figuris, (London,

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1702), although his own reasearch was not mentioned in Cowper's work (28) See for example Cowper's The anatomy of human bodies (London, 1698); and

Biglow's Atlas (Leyden, 1688) andAnatomicus humani corporis (Leyden, 1725). I take much of this account from an unpublished paper by Professor A. Luyendijk entitled 'Anatomy mother of art and science. Controversies between English and Dutch scientists 1690-1725', and delivered at a 1989 Conference on Anglo-Dutch medical connections, at the Wellcome Institute for the History of Medicine, London.

(29) This school sought to explain vital processes by hypotheses which governed inor- ganic matter and drew close analogies between the human body and a machine.

(30) George Cheyne, as one of Pitcairn's most ardent pupils, continually stressed, in his writings on nervous diseases and fevers, the need to free blockages in the glands. See, The English malady, or, a treatise of nervous diseases of all kinds, as spleen, vapours, lowness of spirits, hypochondriacal, and hysterical distempers, &c. In three

parts (London, 1733), pp. 206, 211 and passim. In his A new theory of continual

fevers (London, 1702), Cheyne had argued that glandular obstructions produced fevers by increasing pressure on the arteries and inhibiting free respiration. See Charles F. Mullett (ed.), The letters of Dr George Cheyne to the Countess of Huntingdon (Huntingdon Library, California 1940), v-xxiv.

(31) See e.g. Thomas Birch, The history of the Royal Society of London (London, 1756), iv, 501-2; and Phil. Trans. R. Soc. Lond. xvi, No. 185, Nov. and Dec. 1686, 229-31 and 19, No. 228, 533-7.

(32) See Hale, Oratio comitiis anniversariis Harveiana memoriae sacris... .1724 (London, 1725), in the R.C.P. Library 13-21, and infra.

(33) R.S. CJB, fol.74. For his admittance as a Fellow, see ibid, 20 April 1721, fol.110.

(34) Ibid, 26 January 1721, fols.71-2. This paper was reproduced in the same number of the Phil. Trans. R. Soc. Lond. 14 (see note 27), and suggests another connection between Hale and Dr Richard Mead, who wrote copiously on the plague.

(35) Thomas Hearne, Remarks, ii, 130; and M.S. Rawlinson J.4.1, fol.284.

(36) See, Willis, De anima brutorum (London, 1672), trans. as Two discourses concerning the soul of brutes (London, 1683), by Samuel Pordage; Pitcairn, A dissertation upon the circulation of the blood in bon animals and embryons, in The whole works of Dr Archibald Pitcaim, published by himself, in the Latin trans. by George Sewell and J.T. Desaguliers, (London, 1725), 2nd edn; pp. 175-191; Morton, Phisiologia: or, a treatise of consumptions (London, 1694); Mead's 'Essay of opium', in his A mechanical account ofpoisons (London, 1702), 1708 version, with additions, in his The medical works of Dr RichardMead (Edinburgh, 1763) pp. 125-37; and John Jones's

Mysteries of opium reveal'd (London, 1700). Mead, writing at around the same time that Hale was practising at Oxford, regarded opium as 'in a small dose ... one of the most noble remedies in the World', but believed it entirely unsuitable for 'maniacal people'. Mead, op.cit., pp. 125 and 131-6.

(37) Willis maintained that opium destroyed the animal spirits, by obstructing the nerves and their 'fluids', but Pitcairn, with the benefit of Harvey's discoveries about the

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circulation of the blood, averred that it blocked the arteries and the blood. See

Pitcairn, Circulation, p. 181.

(38) See, for example, The modem quack ormedicinal impostor..., 2nd edition (London, 1724) pp. 57-62; originally, The modem quack, or thephysical impostor detected...by a Londonphysician (London, 1718). Indeed, this London physician remarked that he had 'seen within the seven Years past, at least half a Dozen [patients killed by the use of opiates]'; ibid, p, 59.

(39) See for example George Young, in his A treatise on opium, founded upon practical observations (London, 1753); Samuel Crumpe, in his Inquiry into the nature and

properties of opium (London, 1793); and even George Cheyne, in his An essay of health and long life (London, 1724), 213-220.

(40) See Munk, Roll, ii, 42 & D.N.B. 24-5.

(41) For example that of 26 patients, on 10 May, 1712, BSCM.

(42) BCGM, 15 November 1723.

(43) BCGM, 12 November 1725.

(44) BCGM, 12 July. (45) For more on the meaning of the novel provision for incurables, in this period, see

Andrews, 'Incurably Insane' (note 3). (46) BCGM, 14 February & 15 December 1718.

(47) See Yates's will, P.C.C. Prob.ll, 532/388, dated 18 April 1713.

(48) See Bethlem auditors' accounts for Michaelmas 1708-Michaelmas 1709, for

example Hale's salary was identical to that of his predecessor, but Edward Tyson had received a gratuity of only £10 (initially), and then £15 per annum. See BCGM, 19 June 1685 and 24 May 1689, for example.

(49) Bynum, op.cit. (note 18), p. 118.

(50) BSCM, 31 August 1717 and 1 January 1726. Tyson's Gift was the legacy given by Edward Tyson to the hospital, to provide discharged patients with a little money (never in excess of 40 shillings) towards their future subsistence and clothing. It was also intended to enable them to purchase physic in order to prevent their

relapse. (51) See, for example, BSCM 22 July 1710; 22 November 1718 and 12 January 1723.

(52) BSCM, 29 August 1713 and 12 May 1727; BCGM, 25 March 1677.

(53) See O'Donoghue, op.cit. (note 4), pp. 234-5 and note. Pierce Dod's Oration, in

fact, contains no reference to Hale's attitude towards company or music, nor have I managed to substantiate this reference in any other Harveian Oration.

(54) Sir Richard Blackmore, himself a governor of Bethlem, recommended 'new Com-

pany' and 'agreeable diversions' for the cure of melancholy, in his A treatise of the

spleen and vapours: or, hypochondriacal and hysterical affections. With three discourses on the nature and cure of the cholick, melancholy, and palsies (London, 1725), pp. 174.

(55) See Mrs Clark's case (London, 1718), p. 4, and The true case of Mrs Clerke: set forth by her brothers Sir Edward and Mr Arthur Tumor. To which are added, all the

depositions on that occasion. In answer to a scandalous pamphlet, lately publishd,

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call'd Mrs Clerke's Case (London, 1718), p. 24.

(56) See First report of the Select Committee appointed to consider of provision for the better regulation of madhouses in England (London: House of Commons, 1815), p. 96.

(57) Jonathan Andrews,' "In her vapours ... [or] indeed in her madness" ? Mrs Clerke's case: an early eighteenth century psychiatric controversy', forthcoming in History of Psychiatry, I, i, i, March 1990, 125-44.

(58) Her brother-in-law, James Erskine, Lord Grange, had to pay her £1 000 per annum for the rent of her husband's estates, which had been confiscated after his exile, and purchased by Lord Grange. There was also the matter of £500, which Lady Mar's sister, Lady Mary Wortley Montagu, was receiving for her support. Lord Grange accused Lady Mary of seeking to prolong her sister's affliction, by constant 'vexing', 'teasing' and 'plaguing', whereas Lady Montagu had apparently accused Lord Mar of treating his wife so badly that he 'had turned her mad', and likewise (and, probably, with more justification), regarded the brothers' motives as purely financial. See Miscellany ofthe Spalding Club (Aberdeen, 1841-52), iii, (1846), 4-6, letter of Lord Grange to Thomas Erskine, from Edinburgh, 22 March 1731; and Robert Halsband, The life of Lady Mary Wortley Montagu (London: Oxford Univer-

sity Press, 1961), originally (Clarendon, 1956), pp. 135-8. (59) See The complete letters of Lady Mary Wortley Montagu, Robert Halsband ed.

(Oxford: Clarendon 1966); to Lady Mar, July 1727, 82 and 86, note 4; and Spald. Club Misc. iii, 4 and 16.

(60) See Halsband (ed.), ibid, May 1727, 76 and to Lady Frances Erskine (Lady Mar's daughter), 11 Dec. 1731. 95.

(61) See Halsband, The life, pp. 134-5 and 138; P.R.O. C211, E16, Court of Chancery Proceedings.

(62) See Halsband (ed.), The letters, 76, 81-2 and 224; The London Evening Post, 2-5

March, 25-27 June and 27-29 June 1728; The Daily Post, 23 July 1728; and Folkestone Williams (ed.), Memoirs and correspondence of FrancisAtterbury (Lon- don 1869), ii, 106-7, letter to Mrs Morrice, dated Paris November 1727, for example.

(63) Moreover, James Monro was accused by Alexander Cruden, a private patient of his, of being a Jacobite. See Cruden's, The adventures of Alexander the Corrector

(London, 1754), p. 23. (64) See Spald. Club Misc. iii, (1846), letter of Grange to Thomas Erskine, dated 14 June

1731, 18. (65) Despite her attempted kidnap by Lord Grange, in 1728. See Halsband, The life, p.

134. (66) Lord Mar's solicitations, at this juncture, about his wife's present 'condition' and

the 'hopes ... of her recovery, on which', he claimed, 'depends all the happiness and comfort of my life', do appear to have been genuine enough. Yet his plea for information was plainly, also, by way of a polite admonition and designed to establish when he might hope to have her assets under his control again. By 1731,

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he was not so patient and polite. See Halsband (ed.) The letters, ii, 19 November

1728,89; Halsband, The life, p. 135; and Williams,Atterbury, ii, letter of August/Sep- tember 1728, to Thomas Morrice, from Surenne, 302-3.

(67) See Halsband, The life, 135.

(68) Halsband (ed.), The letters, ii, 76-7.

(69) See Lord Wharncliffe (ed.) The letters and works of Lady Mary Wortley Montagu (London, 1893), 289-90, letter to the Countess of Bute, dated 1755. But in 1731, and in her sister's case, Lady Montagu was prepared to be a little more patient, maintaintaining instead that 'Quiet And Regularity is all that can be done for her in her present state of Health'. See Halsband ed. The letters, ii, 95

(70) Typically, John Freind's last prescription to Mrs Morrice, his mother-in-law, 'was the use of my horse'. See Williams, op.cit. (note 148), ii, p. 287, letter of Mrs Morrice to Atterbury, from Holland House, dated July/August 1728.

(71) For example Lady Montagu dismissed her sister's grief over the death of Lady Gower with the remark 'Of all sorrows those we pay to the Dead are most vain'; and when Lady Mar described the marriage of her daughter as 'a Match of her

making', in 1741, Lady Montagu conceived it as 'very plain proofe of her Lunacy if there was no other'. See Halsband (ed.), The letters, 81, letter dated July 1727, and

224, letter to Wortley, dated 4 February 1741.

(72) See his H.O., 13-21.

(73) See Wharncliffe (ed.), The letters, 290.

(74) See penultimate page of text.

(75) As Freind claimed before the Lord Chief Justice, in 1718. See The true case, 36.

(76) See LEP, No. 126, 26-28 September 1728, and Daniel Defoe, The political state of Great Britain, xxxvi, 296-7 (1728).

(77) For this and the ensuing discussion, see the annotated edition of Munk's Roll, in R.C.P. Library; BCGM, 20 October 1736; and Hale's will, P.C.C. Prob.11, 625/291.

(78) No doubt, it was on the basis of Hale's bequest and his former services to the

hospital, that his widow, Frances, hoped to persuade the governors to intervene, when Cooper, son of Sir John, sought to have her evicted in 1736. See BCGM, 20 October 1736.

(79) See Holmes, op.cit. (note 5), p. 221.

(80) Ibid.

(81) No. 2410, 28 September 1728.

(82) Holmes, op.cit. (note 5), pp. 220-21. Sir John Eden, 2nd Baronet, was MP for Durham from 1713 until his death in 1728.

(83) See ibid.

(84) Holmes notes that Mead himself 'acquired a country house near Windsor'; op.cit. (note 5), p. 222.

(85) For Taylor, see Churchwardens' Accounts for St. Bride 1702-34, Guildhall M.S. 6522/3, under entries from 24 April 1718 to 27 June 1719; BAR fol.48; and BSCM, 13 June 1719, fol.47. For Mead, see Holmes, op.cit. (note 5), p. 223

(86) See note 51.

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(87) See Holmes op.cit. (note 5), p. 223 re. Mead's charity in this.

(88) See M.S. Rawlinson J.4, 1, fol.284. (89) Or Ludwig Maximilian von Konigstreu (literally 'true to the King'), the name he

adopted on his ennoblement in 1716. (90) See The character of Sultan GALGA, the present Chan of Tartary. Drawn by a

Walachian, who had been his favourite for several years', in the British Library; and Ragnhild Hatton, George I, Elector and King (Thames and Hudson, London 1978), pp. 99-100, 333, and 402-5.

(91) Mehemet was also authorized to recommend a medical examination for the King himself, in 1716. See Hatton, George I, p. 206 and Williams, Memoirs of Sophia Dorothea (London, 1845), i, 312-6.

(92) Of this poem only an unfinished draft seems to survive, dated 31 December 1727. See M.S. Rawl. D.347, fol. 19.

(93) Thomas Rawlinson had been an active governor of Bridewell and Bethlem since 1706; Jacobitism and the close association of Rawlinson, Hale, Hearne and Mattaire, is evident in Hearne's Remarks, v; 182, 184-,5, 222, 316; viii, 372-3, 401, 407; ix, 23-4, 35; and x, 54.

(94) See Sedgwick, op.cit. (note 12), 470. Christopher, indeed, had already won his seat as MP for Lancaster (1727-34) before Hale's death.

(95) The recipient, in 1727, was Bernard Peisley, then rector of St Ebbe, Oxford. See Hale's will (note 9), and Foster, Alum. Oxon., Ser. 1, iii-iv, 1138.

(96) See Hearne, Remarks, v. 182, 184-5, 222 and 316. (97) A 'learned idiot' and 'universal scholar so far as the title pages of all authors'. See

Tatler, no. 158.

(98) For example see John Hollings, H.O. (1734), 46-7; '... Graecis & Latinis literis

pereruditum'; Robert Hopwood, H.O. (1741), 17, 'Cujus sane egregii viri, seu multifarium eruditionem ...'; George Baker, H.O. (1761), 17, '... seu rationem studiorum...similis in experiendo patientia...'; and Robert Taylor, H.O. (1755), 23-4.

(99) H.O. (1741), 17. (100) See Mattaire's Ode addressed to Dr Noel Broxholme, on his birthday, in John

Nichols's, Literary anecdotes of the eighteenth century (London, 1887), i, 3, 484.

(101) Wilmot, H.O. (1735), 17; 'Graecis literis addictus, in nullis hospes, Homerum, utpote earum fontem, adeo in deliciis habebat, ut totum memoria retineret, pro re nata festive recitaret...'.

(102) See Hale's H.O., 18-19. (103) Wilmot, H.O., 17. (104) Hale, H.O. 19; 'Qui autem haecce obiter innuit, qualia & quanta exprofesso,

naturae optimus interpres, exponere potuisset?', and 14-15; 'USQUE ad Harveii tempora ars anatomica in cunabulis delituerat. . .donec Harveius ampliavisset artem, & certam viam ad naturam retegendam patefecisset'.

(105) For this discussion see ibid, 13-21. (106) James Primrose (d. 1659) had been a staunch defender of the physiological ideas

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of Galen against the innovations of Harvey. See Munk's Roll, i, 198. For Parisan, see e.g. Sir George Ent's Apologia pro circutione sanguinis qua respondetur A. Parisano etc (London, 1685).

(107) Hale, H. 0., 19-20.

(108) Hale had examined and approved Stukeley while Censor, in 1719. See R.C.P.

RegisterBook ix, 7 August, 4 September and 18 September 1719, and John Nichols, Literary history of the eighteenth century (London, 1817), Kraus Reprint, (New York:

Corp Ams Press Ltd, 1966), ii, 799-800, letter dated 26 October. 1727.

(109) See Hearne, Remarks, ix, 24, 10 September 1725 entry. Mattaire told Hearne how

(appropriately enough) Rawlinson was 'perfectly raving and in a strange delirium for many hours before he died'. This was a common observation made upon the

dying, during this period, helping to excuse any irregularities observed in their behaviour before death.

(110) As indeed, he had formerly cited Edward Tyson; see Mead'sA treatise concerning the influence of the sun and moon upon human bodies and the diseases thereby

produced (London, 1704), trans. from the Latin by Thomas Stack (London, 1748), (originally, 1708), 46-7.

(111) See Hunter and Macalpine, op.cit. (note 1), pp. 385-387, and Mead, Precepts, 89.

Reading newspaper reports of suicides provoked by losses in the South Sea Scheme

during the 1720s, one is led to doubt the breadth of Hale's judgment. See for

example LEP, No. 2340, 23-25 July, 1724.

(112) See M. Maty, Memoirs of the life of Richard Mead (London, 1755), pp. 60-61.

(113) See Hunter & Macalpine, op.cit. (note 1), 385-387, and Mead, Medica sacra, chaps. ix and x, in The medical works, 617-28, or his Precepts, chap. iii, 88-102.

(114) See infra, Harveian Orations.

(115) See Mead's Precepts, 93 and 98.

(116) See James Munro, H.O. (1737), 22.

(117) For example Pierce Dod (H.O., (1729), 14) claimed that there was no-one 'more

benevolent, more kindly, more learned or more skilled ... in looking after maniacs'; Thomas Lawrence spoke of the general esteem for Hale's 'pleasant disposition' (1748) H.O. 14; Wilmot of 'how good, how pleasing to his friends he was; (1735) H.O., 17; and Baker of his 'gentleness' and 'humanity' (1761) H.O., 17.

(118) See his Precepts, 98.

(119) See ibid, 97-8.

(120) See H.O. (1735), 17-18.

(121) See chap. iii, in The medical works, 94-95, and also Mead's Precepts, 98.

(122) Ibid, 102.

(123) See supra, 9 and Mead's Medica sacra, 627 and Precepts, 91-2.

(124) See Munk, Roll, i, 458.

(125) Mead spent three years at Leyden (1692-5), where he gained the friendship of Boerhaave. He also travelled in Italy (1695) with Dr Thomas Pellett, taking his

degree at Padua, and visiting Naples and Rome. See Munk, Roll, ii, 40.

(126) For the following discussion, see Hale, H.O., 14.

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(127) '... Qui redire saepius solent, certe non magis eruditi, nunquam aptiores medici, forsan belli homines'.

(128) Hearne, Remarks, ix, 3 October. 1725, 35.

(129) See his H.O. 14. (130) See Hearne's Remarks, ix, 3 October 1725,35. This argument must explain, in part,

why Hale was depicted by Harveian Orators as such an ardent supporter of the Academy and the honour of the College.

(131) For which, see Nichols, Lit. Anec. i, 3, 484. (132) 'Haec dissidentium jurgia partium, Broxholme, vita, si sapias. . .'. Broxholme, as

one of the first Radcliffe travelling Fellows, no doubt had more sympathy with Mead and Freind, and was one of the few Harveian Orators in the first decades after Hale's death, who omitted to accord the doctor honourable mention. See his H.O. (1731), in the R.C.P. Library.

(133) See H.O.s of Pierce Dod (1729), 14; Edward Wilmot (1735), 17, and James Monro (1737), 22.

(134) See his Ode; '... Halus ... Nec alter hoc insanientem Scit melius cohibere turbam. Hollandus ira percitus infremat, Nestitulas stet praesidio ferox ...'. Less explicably, Hale was one of the Censors who, in 1720, consented to Dr George Lewis Tessier's admittance as F.R.C.P. without an examination, on the grounds that he was physician to the King's household and a graduate of Leyden University (see, R.C.P. Register Book, viii, 8 January and 25 March 1720). In view of his later vitriol against foreign physicians, one can only assume that Hale was in this instance bound by precedent and decorum.

(135) See Hearne's Remarks, ix, 3 October 1725, 35. (136) H.O. (1735), 18. Even Wilmot who had probably been prejudiced in his account of

Hale by Mead, called Hale's partisanship 'amiable' ('amabili'). Before he gave his Oration Wilmot had married Sarah Mead, and through Mead's influence secured the physicianship to St Thomas's Hospital, in 1731, and subsequently, a physicianship to the Royal Family.

(137) See his H.O. (1724), 2-6.

(138) See LEP, No. 129, 3-5 October 1728. (139) This was after the customary College examinations, of course, at the last of which

(Therapeutics) 'his Answers were very well approved'. See R.C.P. Register Book, vii, fol. 268-71.

(140) At the same time, in fact, as his friends Richard Mead and John Freind. See ibid, viii, fol.117.

(141) Ibid, 30 September 1718, fol.163; 28 September 1719, fol.193, and Book ix, 5 October 1724, fol.47. Hale served as Censor alongside Drs Hugh Chamberlen, John Hawys and Salisbury Cade (all active governors of Bethlem); and also with Freind, Richard Tyson, Mead, and Dod.

(142) See R.C.P. Register Book, viii, Oct. 10 and Nov. 7, 1718, fol.164-5; and 5 June, 3

July, and 7 Aug. 1719, fol. 181-9. Sampson was convicted of treating William Shepherd for smallpox with a fortnightly vomit, and was ordered to satisfy the

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plaintiffs. Barnes had testified to this effect and further, that 'Sampson had arrested him ... as being security'.

(143) For instance, in the case of Blythe, a shopkeeper at Moorfields. See ibid, 8 January and 5 February 1720.

(144) See for example Harold J. Cook, The decline of the old medical regime in Stuart

England (New York and London: Cornell University Press, 1986), p. 82; and A.M. Cooke, A History of the Royal College of Physicians of London (Oxford: Clarendon, 1972),passim.

(145) See R.C.P. Register Book, viii, 9 January 1719, fol.168-9.

(146) Among the remedies mentioned in the R.C.P. Register Books, which came under Hale's surveillance as a Censor, were: Peruvian bark; salivation in cases of palsy; the Indian plants, spikenard and cardamom; and unspecified eye applications and 'Chemical medicines'. See ibid, viii, 6 March and 6 November. 1719; and 5 February 1720; and ix, 2 April 1725. While acting as Censor, Hale in fact served on committees appointed to devise a new edition of the College 'Dispensatory'. Ibid, viii, 10 April 1719 and 25 June 1720.

(147) Hale, H.O. 23-4. (148) Ibid, 24. (149) Wood, 1733 H.O. 10. See also H.O.'s of Dod (1729) 15; Wilmot, (1735) 18 and

Hopwood, 17. (150) See, A letter from the facetious Dr Andrew Tripe at Bath to his loving brother the

Profound Greshamite (London, 1719), 45; and Myles Davies, Athenae Britannicae (London, 1719) vi, 31, where Davies lists Hale, Shadwell, Bateman, the Turners and Pellet, amongst others, as fitting objects for this jibe.

(151) Wilmot, 17; '... nec, quod rusticus paulo defluat toga & ferocius introeat, minus vobis gratus ...'. See Horace, Satires, I iii, 31; 'quod ... rusticius ... toga defluit'.

(152) He also served, while Censor, on committees summoned in the 1720s specifically 'to protect College privileges' in response to Parliamentary interference, to consider the repair of the College, and to view the ante-library, museum and dispensary room. His last attendance was only three months before his decease, on 25 June. 1728. See R.C.P Register Book, Book viii, 12 February and 25 March, 1720, and Book ix, 20 April, 1726 and 25 June 1728.

(153) A list of these plates may be gathered from the library's catalogues. (154) See the Harveian Orations of William Wood (1733), 10, Frank Nicholls (1739), 22,

Robert Bankes (1743), 17-18, Ambrose Dawson (1744), 20, Thomas Lawrence (1748), 14, William Browne (1751), 30-31, and Robert Taylor (1755), 23-4, in the R.C.P. Library. Nicholls was another of Mead's sons-in-law and a distinguished anatomist, but he failed to pay Hale more than the most cursory of respects.

(155) See his H.O. (1774), 15, in R.C.P. Library. (156) For example Richard Conyers's claim, praising Hale's success, that he put Alecto

(one of the three Furies, who, as in Euripides's 'Orestes', caused madness in people as a punishment) 'to flight ... into the lowest depths of the Underworld'. See his H.O. (1756), 18.

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(157) Edward Wilmot did not settle in London until 1725, and was not admitted F.R.C.P. until 1726, two years before Hale's death. Frank Nicholls, Robert Bankes, Ambrose Dawson, William Battie, James Hawley, Thomas Lawrence, John Thomas Batt, Robert Taylor, Richard Conyers, John Monro, Mark Akenside and Sir George Baker, all became M.D.'s after Hale's death. James Monro and Robert Hopwood were not elected F.R.C.P.s until after Hale's death. Sir William Browne did not settle in London until 1749. See Munk, Roll. Only Pierce Dod and Wilmot could have known him well. See (note 167).

(158) See Edward Wilmot, H.O., 17-18, 'Quot Reges ... feliciter reddidit'; and Robert Hopwood, H.O., 17, 'praeclare narrent ... consiliis'.

(159) See Dod, H.O., 14, Hollings, H.O., 47, and James Monro, H.O., 22. Hale's portrait in the R.C.P. library, ordered to be painted by his nephew Richard Tyson in 1733, from an earlier sketch, does present a rather forbidding presence. See figure 1, supra, p.3

(160) See his De anima brutorum (London, 1672), trans. as Two discourses concerning the soul of brutes, by Samuel Pordage (London, 1683), pp. 206-8; and Hunter and Macalpine, op.cit. (note 1), pp. 191-2.

(161) 'Cum hominum ineptias & stultitias, quae quotidie devorandae sunt, non ferret; non iracunde tamen, non morose, sed libero & ingenuo fastidio respuebat'; H.O. 1734, 47.

(162) See George Baker's H.O. (1761), 17. See also the Orations of Dod, Hollings, Wilmot, James Monro and Hopwood.

(163) Hopwood, H.O., 17; Wilmot, H.O., 17. (164) Monro, H.O. (1737), 22-23. (165) See translations of their Orations in R.C.P. Library, Battie'sA treatise on madness

(London, 1758), John Monro's Remarks on DrBattie's treatise on madness (London, 1758) and Hunter and Macalpine, op.cit. (note 1), pp. 402-416.

(166) See his H.O. in R.C.P. Library 17; '... in experiundo patientia ... experimenta testes esse in omni re incorruptissimos. . .& illud, ex veteri Porticu derivatum, & in omnem omnis Scientiae Familiam protinus derivandum, "Sapientem nihil opina- ri". Baker was later to attend George III during his supposed lunacy. See Munk, Roll, ii, 213-7.

(167) See Williams, Memoirs of Atterbury, pp. 315-6, letter dated 3 Oct. 1728. See also, The historical register for 1728, xiv, 52, 26 September 1728. Hale died just seven weeks after he had 'made a fine Entertainment at his House in Lincolns-Inn-Fields, to which he invited the most eminent Physicians in Town'. He had been taken ill three days before his death when riding, and was brought home to Hampstead vomiting blood. He was attended by Mead, Richard Tyson, 'and others', the next day, who found him 'extremely ill and speechless', and gave him up as 'past all Hopes of Recovery' at noon, on 26 September. The pallbearers at his funeral at Windsor were Drs Mead, Pellet, Hulse, Dod, Holland & Willymote (Wilmot). See LEP, Nos. 105, 125 and 129,8-10 August, 24-26 September and 3-5 October, 1728.

(168) See note 76.

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204 Jonathan Andrews

(169) See M.S. Rawlinson, J.4.1, f.284. (170) See Mr. CRUDENgreatly injured (London, 1739), p. 32. (171) See BCGM, 25 January 1718 and 12 May, 1727. (172) Although this could be Sarah's daughter. See signature reproduced in Hunter &

Macalpine, op.cit. (note 1), p. 360. (173) See Martin Roth & Jerome Kroll, The reality of mental illness (Cambridge Univer-

sity Press, 1986). (174) Bynum, op.cit. (note 18), p. 121. (175) Holmes, op.cit. (note 5), p. 183. (176) M.S. Rawl. D.347, fol.19:

Multus tuam aeger sentit opem: utili Tuo labori non requies datur, Seu vesper orbi inducit umbras, Sive redux fugat astra Phoebus'.



Documents

A Respectable Mad-Doctor? Dr Richard Hale, F.R.S. (1670-1728)