By the end of the first world war, the mental health services in Britain were chaotic. The asylums, built with altruistic motives in the mid 19th century, were dangerously overcrowded, understaffed, and underfunded. The Lunacy Laws were thirty years out of date, and the Lunacy Board of Control was entrenched in a turf war with the recently established Ministry of Health. The Medico-Psychological Association (MPA) representing the psychiatric profession, recognised the deficiencies inherent in a failing system. However, there was no clear leadership or appetite for reform from amongst its ranks. Pressure groups for lunacy reform had been ever present but often consisted of ex-patients and had little political clout or a national voice. Then in 1921, one man published a book which crystalised for the public a dreadful picture of the suffering lunatic, acted as a catalyst for lunacy reform, and provided the basis for our modern mental health services.
‘The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform’ by Dr Montagu Lomax was a shocking exposure of conditions for patients within the Prestwich County Asylum. Lomax acknowledged that his findings were not new and had been recognised and deplored for a long time by those who worked within the asylum system. However, his book was the first of its kind written for general consumption in attempt to bring the subject to public notice. Lomax made it clear throughout his book that whilst his experiences were based on having worked in two asylums, he intended to attack the system, not individual asylums – principles not persons. This all sounds eminently sensible to modern readers but they were ground-breaking sentiments at the time. The newspapers and professional journals published reviews of the book with the Times entitling its article “Asylum Horrors – A Doctors Indictment’. There was an overwhelming response from the public. Within weeks of publication, questions were asked in the House of Commons.
So who was Montagu Lomax?. The press of the time carried his own line that he was a retired GP. When the war broke out he said that he had wanted to ‘do his bit’ and looked about for some means of making himself useful. He claimed to have had a lifelong interest in psychiatry, and hearing that there was a dearth of asylum doctors he applied for a post as an asylum medical officer, initially at Bracebridge in Lincolnshire, and then at Prestwich Asylum in Lancashire where he stayed for two years. There are to my mind many holes in the picture he painted of his background and his motivation. Why would a 57 year old choose to leave his wife and his home on the south coast to live in a doctors mess in Lancashire? Why would an experienced GP choose to work as junior doctor in a gloomy lunatic asylum? It is hard to escape the suspicion that Lomax was armed with an agenda for lunacy reform before he started work as an asylum medical officer. He had been well advised where and how he could obtain ammunition to make the greatest impact, presumably by someone who knew the asylum system well and was keen to obtain national reforms. Lomax already had a good track record as a medical writer, and he had a tragic family secret which gave him a personal insight into the workings and failures of the asylum system. He was in many ways, an ideal front man.
I can’t claim to have a complete picture of Dr Lomax’s life. However, I have managed to unearth some fascinating information about his background which might help to explain his foray into the mental health services. My aim is to write a more complete account of a remarkable man and to explore his story within the framework of the Victorian/Edwardian society in which lived.
This is very much a ‘work in progress’ and I welcome comments and suggestions.