The National Council For Lunacy Reform and Montagu Lomax.

(A review of the NCLR minute books 1920-22)

The Minerva Cafe in London’s Holborn district had acquired a whiff of dissent at the beginning of the twentieth century. It had strong associations with the women’s suffrage movement, the British Socialist Party and Sylvia Pankhurst’s Communist Workers Party. On 29th April 1920, the cafe hosted the first of two private meetings for a group of men and women  who were determined to improve care for the mentally ill. Montagu Lomax was not amongst them, and indeed his name would have been entirely unknown to these people. At the second meeting, held on 19th May 1920, a provisional committee was appointed and a new campaigning society was formed and named ‘The National Council For Lunacy Reform’ (NCLR).

The first official  meeting of the NCLR took place the following week on 28th May 1920. Minutes were hand-written in a blue exercise book, with members names and addresses inscribed randomly on the left hand pages, sometimes upside down 1. Whilst the appearance of the notebook is slightly ‘village fete’, the NCLR was in fact highly organised, and effective. It played a crucial role in the events unleashed by Dr Lomax’s 1921 book ‘Experiences of an Asylum Doctor’, and was instrumental in the campaign for a Royal Commission on Lunacy and Mental Disorder, and the subsequent 1930 Mental Treatment Act. The NCLR created the wave of publicity which Lomax subsequently rode, and the story of the Council’s formation is fascinating.

In 1920, the members of the newly formed NCLR committee were an extraordinary group of individuals. As far as I can tell, their connection seems to have been through the socialist movement including the Labour Party and Independent Labour Party. Some were theosophists, some anti-vivisectionists and many had also been active in the agitation for women’s suffrage prior to the first world war. J. Ernest Parley, an erstwhile asylum attendant and author of ‘Life In A Madhouse’ (1920), was a founder member but he was highly unlikely to have had the background  required  to attract his fellow committee members. It is not clear from the available records who was first to suggest the NCLR, but many of the 14 men and women of the first executive committee and its 5 co-opted members would have been well known to the British public of the time. The following are just a few of the names from the minute book:

  • Harold Baillie-Weaverwas a barrister. He was a strong supporter of feminism and was a theosophist and humanitarian. With his wife Gertrude, he had campaigned against vivisection.
  • Lizzie Lind-af-Hageby. A wealthy member of Swedish nobility, she trained as a medical student in order to expose the cruelty of vivisection. She was famous for the ‘brown dog affair’ of 1903 and the brown dog riots. Worth reading about. She was also a feminist, suffragist  and a theosophist.
  • Leisa Katharina Schartau. A Swedish school friend of Lizzie Lind, and also antivivisectionist, animal rights and environmental rights campaigner in the UK.
  • Mrs. H.W. Nevinsonwas a J.P.. She was married to Henry Nevinson, a war correspondent on The Daily Chronicle and The Manchester Guardian. (His son by his first marriage was Christopher Nevinson, the celebrated first world war artist). 
  • (Alice) Honora Enfieldprominent advocate of women’s rights and founder of The International Women’s Co-operative Guild.
  • Daphne Oliviercoming  from a Fabian background, she studied at Cambridge University where she mixed with Rupert Brooke and John Maynard Keynes. She  later became interested in the educational methods of Rudolph Steiner and established the first Steiner school in the UK. 
  • Dorothea Sanger –  aristocracy from the Pease family, married Charles Percy Sanger, a barrister and part of Lady Ottoline Morrell’s Bloomsbury set.
  • Lord Henry Cavendish-Bentinckfrom an old aristocratic family and Member of Parliament

There were a number medical doctors, including  Dr Hector Munro, founder of the Munro Flying Ambulance Corps in the first world war and  a director of the London Medico-Psychological Clinic. He was a socialist, vegetarian, suffragette and nudist2

So the NCLR founder members were well connected to the aristocracy; the literary ‘glitterati’ of the day; economists; journalists; the legal and medical professions; the Labour and Conservative parties, and MPs. Many founder members were veteran campaigners. Their previous experience and their contacts were to prove crucial in the success of the NCLR.

The First Two Years of the NCLR:

Conditions for patients within lunatic asylums had long been an issue of public concern. Dorothea Dix started an asylum reform movement in the United States around 1840, yet by the turn of the century, treatment of the mentally ill was still inhumane as described by Clifford Beers in his 1908 book ‘A Mind That Found Itself’. In Britain, the Alleged Lunatics Friend Society was started by ex-patients in the mid 19th Century to campaign for improvement in the mental health services. Historian, Nicholas Hervey considered that the Society played an important role in raising public consciousness of the threat psychiatric practices raised to civil liberties, and that it acted as an alter ego to the Lunacy Commission 3. Richard Paternoster, the founder of the Alleged Lunatics Friend Society followed Jeremy Bentham’s aphorism that “Publicity is the very soul of justice”. This principle was very much at the heart of the NCLR.

One of the first tasks of the committee was to devise a list of ‘Objects’ to define the Council’s raison d’être. This included the promotion of research into the nature and causes of insanity; investigation of the present system for the care and treatment of the mentally unsound; securing more effective measures for the recovery of mental health with attractive hostels (‘rest homes’);  safeguarding the liberty of the subject; reducing the burden of asylum expenditure; and finally to educating public opinion on the whole subject of the nature and treatment of mental disorder. The initial ‘Objects’ lacked a clear focus, although perhaps the broad scope of the mandate was deliberate. The committee set about publicising their existence from the outset. A letter was sent to the Ministry of Health to introduce the council, and the hunt for ‘persons of influence’ to endorse the work of the Council was set in motion. By the second committee meeting, 23 persons of influence had agreed to give their names, and further letters of invitation were sent out with these 23 names attached – an early version of celebrity endorsement.

The national press was provided with publicity leaflets outlining the work of the Council from an early stage. On 1st  November 1920, most of the national papers for England, Scotland and Wales carried a notice identical to that found on page 10 of The Scotsman:

Notices of response appeared the following week in a number of papers, commenting anonymously that the formation of the NCLR was ‘greatly welcomed’ and attaching the names of several members of the Council including the Bishop of Kensington, Lord Henry Bentinck and Sir Sydney Olivier, a prominent Fabian and father of committee member Daphne Olivier. During the committee meeting of November 18th 1920, the secretary reported that a good number of letters had been received from those interested in lunacy reform.

The initial objective of the Council was the provision of rest homes for early mental cases which would not come under the lunacy laws. It is interesting that Dr Helen Boyle had been providing exactly this facility for impoverished women  in Brighton since 1905 where she steadfastly refused to cooperate with the lunacy law commissioners. The committee decided to petition Parliament on the matter. This seems to be where previous campaigning experience confirmed that going to the very top was an effective first move.  Honora Enfield clearly knew her way around the various consultative committees in Parliament. She was aware that the Ministry of Health were trying to get a Miscellaneous Provisions Bill through which contained sections bearing on Lunacy. A deputation to the Minister of Health was proposed and a subcommittee established to work on proposals to present to the Minister.

The committee knew that co-operation with other pressure groups was vital to produce maximum leverage. The Ex-Services Welfare Society (ESWS) was also campaigning for rest homes for members of the military suffering from neurasthenia. The appalling treatment of some soldiers detained within lunatic asylums had shocked the British public, so as campaigning partners go, the ESWS was a good choice. Representatives from the NCLR and ESWS attended each other’s committee meetings, from time to time shared platforms in public meetings. The ESWS was later mired in controversy over misappropriation of funds at which point the partnership with the NCLR was terminated. The committee made great efforts to educate the public on all aspects of lunacy reform. They contacted adult schools, sending information leaflets for their members, and offering to supply speakers. Public meetings were proposed but hiring suitable venues meant that appeals for funds became necessary. It soon became clear that considerable amounts of money would be required to cover not only hall hire but also printing costs, and speakers’ expenses.

The drive to raise sufficient funds required an intensive campaign to bring the whole subject of lunacy reform to the public attention, again through adverts and articles placed in national  newspapers. The committee members were urged to use any contacts they had within the national press who might be able to further the campaign.  ‘Asylum Sunday’ was introduced by Miss Maude Royden who preached on lunacy at the London Guild house when literature was distributed and a collection taken. Several vicars were inspired to take the  ‘Asylum Sunday’ format back to their own churches. Drawing Room Meetings were set in motion. This seemed to be a recognised method of raising large donations from the wealthy members of the community. A ‘person of influence’ offered the use of their drawing room for an afternoon or evening, their friends were invited, the NSLR supplied a speaker for the occasion and a collection was taken. Drawing room meetings sometimes attracted in excess of 70 folk, so this was a lucrative source of funding. Many of the drawing room meetings were hosted by titled men and women in aid of the NCLR over the next few years. Lord Henry Cavendish Bentinck was involved in this manner and later became honorary treasurer for the Society. Finances began to improve slowly such that the  first public meeting of the Society could be held in London at the King’s Weigh House in June 1921.  Ernest Parley described his experiences as an asylum attendant, and Lizzie Lind-af-Hageby, an articulate public speaker, discussed the aims and objectives of the NCLR.

Invitation to a Drawing Room meeting at the house of Dr Octavia Lewin

Lomax’s book ‘Experiences of an Asylum Doctor’ was published in June 1921. The NCLR voted unanimously to admit him to the organisation. He  was soon speaking  at many public meetings around the country on their behalf.

Miss Margaret Cameron was appointed as an experienced fund raiser to cover the London area and was paid £3 per week. Miss Gabrielle Bell was engaged as a professional fundraiser for the north of England in February 1922. She had been one of the most successful organisers for the Save The Children Fund. Miss Bell was to act for the ESWS as well, and it was agreed that she should be paid 5% of the funds raised. By March 1922, Miss Bell had set about forming local fundraising committees in the north of England and arranging a lecture tour for Dr Lomax. An arrangement was made with George Alan and Unwin that they would supply ‘Experiences’ to the Council for 2/4d per copy which they could sell on at 3/6d. Lomax wrote to his publisher describing his lecture  in Leeds where he had sold a number of his books 4, so this was a lucrative source of income..

Publicity and the fund-raising drive quickly raised the public profile of the NCLR. Prominent figures such as G.K.Chesterton and H.G.Wells endorsed the Council as did a number of titled ladies and gentlemen from the aristocracy. Prominent psychiatrists joined the council – Dr Helen Boyle in May 1921, and Dr Lionel Weatherly in November 1921. Sir Frederick Milner, a retired MP, offered to chair the Council.  In November 1921, the Labour Party Public Health Advisory Committee asked for input from the NCLR to their programme of lunacy reforms to be incorporated into their official legislation programme. The NCLR was also invited to attend the Board of Control Conference in January 1922, and sent Dr Octavia Lewin as its representative. The Board of Control was the semi-autonomous authority within the Ministry of Health with responsibility for regulating the mental hospitals and other institutions concerned with mental illness and mental “deficiency’. Slowly gaining in credibility and with reasonable  financial reserves, the NCLR was beginning to make its mark.

In September 1921, the NCLR secretary expressed his belief that the time had come to transform the NCLR into a more active organisation with a wider scope and more vigorous propaganda. He suggested taking on a professional administrator and recommended Mrs Barbara Ayrton-Gould, who he said had ‘so successfully worked with other reform movements and raised money for propagandist causes’. Barbara Ayrton-Gould was an excellent choice but came with a high price tag of £500 per annum to cover her salary and office expenses. Ayrton-Gould set out her aim for a ‘Royal Commission Of Enquiries’ (into lunacy reform) and from this point onward, the original object  of ‘rest homes’ was quietly sidelined from the NCLR’s objectives,  and obtaining a Royal Commission became its main focus.

The NCLR and the Ministry of Heath Inquiry

The Board of Control’s response to the publication of Lomax’s experiences was to set up  an internal inquiry into the truth of his allegations about Prestwich Asylum. This was clearly an attempt to whitewash the problem, but by the time the internal report was presented to the Ministry of Health, it was clear that the public reaction to the book demanded a more robust response. The MOH commissioned a more thorough inquiry under the chairmanship of Sir Cyril Cobb, which sat in February 1922, less than 8 months after the book was published.

Barbara Ayrton-Gould visited Lomax at home in early January 1922. He had been ill and had asked initially that the Cobb Inquiry be postponed until he recovered. However, by the time of Mrs Ayrton-Gould’s visit, he had decided that the whole inquiry was valueless and that he would rather save his own evidence and witnesses for a Royal Commission. The National Asylum Workers Union was of the same mind and had declared that they would have nothing to do with Cobb. Ayrton-Gould thought that the Cobb Inquiry would generate considerable public interest, so it was crucial that the NCLR should call as much evidence as possible on the question of asylum conditions and administration. She also suggested that the membership of the Cobb committee was biased so should be criticised publicly, and that questions should be put to the Minister of Health in Parliament. NCLR representatives including Dr Helen Boyle attended the Cobb Inquiry. They reported to the NCLR committee meeting of 21/2/22 that the Cobb inquiry ‘appeared to be quite farcical’.  Dr Hubert Bond from the Board of Control had visited the Prestwich Asylum and found everything in order and claimed that Lomax’s allegations were groundless. The Cobb Committee report  was thus generally considered to be another  ‘whitewash’.. Lomax wrote a long rebuttal of its findings, published by the NCLR 5.

In February 1922, the NCLR committee reported that the press campaign continued to push the topic of lunacy reform. The NCLR had had three long letters published in the Times, with two leaders devoted to the subject of lunacy reform. These had drawn replies in the Press from Sir Alfred Mond  (Minister of Health) and Sir Frederick Willis (chairman of the Board of Control). Interviews with Dr Lomax and Mrs Ayrton-Gould had also appeared in the Herald. Mr Bennet, the editor of Truth magazine had been approached by the committee and was very willing to cooperate. (Truth magazine subsequently played an important  role in the campaign for a Royal Commission). Dr Lionel Weatherly had received a personal letter from Sir Alfred Mond, the Minister for Health, in which he acknowledged that there ‘was a need for a properly constituted Public Enquiry’. The NCLR sent a deputation to Mond on 16th March 1922, and felt that the Minister acknowledged the NCLR’s concerns and admitted the urgent need of reform. Mrs Ayrton-Gould, who lead the deputation, felt that this was very encouraging ‘since it was obvious that the authorities were trying to placate the council’.

In May 1922, the BMJ carried an article on the formation of the National Council for Mental Hygiene (NCMH) 6. The members list reads like a Who’s Who for the celebrated psychiatrists and physicians of its day – Henry Head; Frederick Mott; Maurice Craig; W.H.H. Rivers; Bedford Pierce; George Robertson; Humphrey Rolleston to name but a few. Dr Helen Boyle was also a member as was the aforementioned Hubert Bond from the Board of Control who was then the president of the Medico-Psychological Association. Many of the objectives of the new council were similar to those of the NCLR, and indeed overlapped with some of the recommendations that Lomax had made in ‘Experiences’ in 1921, particularly the need for outpatient clinics for treatment of early cases of mental disorders. The NCLR was quick to ally itself with the new NCMH and wrote to the Press to confirm its proposed partnership with the great and good of the medical world. The inaugural meeting of the NCMH was attended by Dr Lomax and Dr Sara White along with Mrs Ayrton-Gould.

After a prolonged and difficult campaign, Barbara Ayrton-Gould’s declared goal of a Royal Commission was finally achieved and the Royal Commission on Lunacy and Mental Disorder was established in 1924, reporting in July 1926. The focus of the NCLR then changed to ensuring that the recommendations of the Royal Commission were enshrined in law. This particular battle was long and hard. The NCLR minute books contain several newspaper cuttings commenting on the lack of action in Parliament. In 1928, the NCLR changed its name to The National Society For Lunacy Law Reform, to reflect the need to drive through the recommendations of the Royal Commission. Eventually the Mental Treatment Act of 1930 was passed through Parliament, a decade after the formation of the NCLR and nine years after Lomax’s book was published. 

Summary:

Lomax wrote: ‘ When in the summer of 1921 I published my book of ‘Asylum Experiences” I was quite unprepared for the immense amount of public interest it immediately excited……..The fact that a book written by an obscure and hitherto unknown medical man, and having no pretensions to do more than skim the surface of the matter dealt with, should have such a striking and immediate effect proved at least two things: that the subject was recognised to be of pressing importance and appealed to public interest, and that I had quite unexpectedly struck the ‘psychological moment’ for its discussion’ 5.It seems from review of the NCLR minute books that Lomax’s book was indeed well-timed, launched just as the highly organised NCLR campaign for lunacy reform was gathering momentum. The NCLR was able to provide professional campaign support for Lomax, lobbying members of parliament;  funding public meetings, managing the national Press interest, publishing supporting literature and giving  Lomax influential contacts with the political, literary and medical movers and shakers of the day. Lomax in turn, provided the NCLR with an articulate witness of the horrors of the lunacy system, who wrote clear, well-argued articles which could be understood by the layman, and was prepared to take every opportunity to campaign for reform. Certainly the synergy between Lomax and the NCLR was a significant factor in the success of the lunacy reform campaign, and the subsequent 1930 Mental Treatment Act. 

Acknowledgements:

With many thanks to Dr Claire Hilton, historian in residence at the RCPsych, for her input and editing skills.

References:

1)  National Council for Lunacy Reform Minute Books, 1920-1922 Welcome Collection. SA/MIN/1/1-3

2) Elsie and Marie Go to War. (Extracts) Diane Atkinson (https://www.dianeatkinson.co.uk/excerpt_EandM.html)

3) Hervey, N. (1986). Advocacy or folly: The Alleged Lunatics’ Friend Society, 1845–63. Medical

History, 30(3), 245-275. doi:10.1017/S0025727300045701 p252

4)  Letters to and from Montagu Lomax: correspondence between publishers George Allen and 

     Unwin and Montagu Lomax. University of Reading, Special Collections, AUC 8/17. 1923-24.

5) A Reply to the ‘Report of the Committee on the Administration of Mental Hospitals’ 1922 by 

    Montagu Lomax. Welcome Collection 

6) National Council for Mental Hygiene, BMJ May 13th 1922 p766

Charles Mercier and Montagu Lomax

H. Bryan Donkin – Charles Arthur Mercier M.D.Lond., F.R.C.P.Lond., F.R.C.S.Eng. B. 1852: D. 1919 The British Journal of Psychiatry Jan 1920, 66 (272) 1-10

When Lomax published his ‘Experiences of an Asylum Doctor’ in 19211, he was well aware that nothing he described was a revelation to the psychiatric establishment.  Prominent psychiatrists including  J.R.Lord, Lionel Weatherly and Charles Mercier had written books aimed at improving  the  appalling care of the insane poor within the British asylum system. Mercier’s  ‘Lunatic Asylums, their Organisation and Management2 predated Lomax’s book ‘Experiences of an Asylum Doctor’ by a quarter of a century, and as Lomax pointed out, nothing had changed much in the interim. If anything, the exigencies of the first world war had worsened the situation, with overcrowding and near-starvation rations resulting in a shocking death rate amongst the asylum inmates. Lomax quoted Mercier’s handbook of asylum management extensively in ‘Experiences’. He professed to hold Mercier in high regard, claiming that there  was no man for whose opinion he had greater respect 3. 

Charles Mercier was born in 1852. He was the son of an impecunious vicar, but managed to put himself through medical school where it became apparent that he was a high achiever. He won many prizes and accolades throughout his medical career, specialising in mental science. Mercier was a prolific author, and later served on several government committees and Royal Commissions. He championed the conditions of the asylum assistant medical officers and tried to use his considerable influence to improve their working lives. As a longstanding president of the MedicoPsychological Society (the forerunner of the Royal College of Psychiatrists), Mercier was a revered and respected alienist at the top of his profession by the time of the first world war.

There is  a comment in the introduction of Lomax’s ‘Experiences’ where Lomax asserted that he had ‘broken many a lance with him {Mercier} in controversial tourney in the medical papers’ 3. This is  an intriguing statement since it would have been highly unusual for an eminent psychiatrist of Mercier’s stature, to have engaged in public debate with a locum asylum medical officer. It needed a little investigation, but I found that it was true – Mercier and Lomax had indeed exchanged views through the pages of the Medical Press and Circular. This weekly medical journal was less formal than the British Medical Journal and the Lancet, and allowed discussions on topical matters. It might perhaps be viewed as an Edwardian version of modern day social media, where medical themes were tossed around for discussion and sometimes quite heated exchanges could be followed through its pages.

Lomax was a regular contributor to the medical papers during  the early part of the 20th century. The Medical Press and Circular carried a number of his letters on assorted topics including manipulative surgery; medical representation in Parliament, and prevention of venereal disease. It was a discussion on telepathy in October 1917 that brought him to the attention of Charles Mercier. Lomax, waded in to a dispute on telepathy between Charles Mercier and Oliver Lodge. Lomax wrote ‘I am only one of the “smallest fry” of the profession of which Dr Mercier is so great an ornament and cannot expect that he will condescend to “flesh” the tempered steel of his dialectic in any poor arguments that I may offer…………..Sir Lancelot would never have refused a challenge to combat with a sneer, and it is not worthy of Dr Mercier’s reputation’ 4. Lomax followed up his letter with a long article entitled ‘Telepathy, or Thought-Transference’ 5. Mercier had been appalled at the behaviour of spiritualists who claimed to contact the war dead on behalf of their relatives. In 1919, he would go on to write a satire – Spirit Experiences 6 – which mocked  the credulity shown by believers in spiritualism, telepathy and levitation. So he had little patience for Lomax’s mystical beliefs, and wrote to the editor of the Medical Press and Circular criticising Lomax’s ‘vile English’ and accusing Lomax of being a spiritualist. Lomax’s reply was published the following week, and defended his views on spiritualism. He ended his letter with the following comment: ‘I can suggest the manner in which his {Mercier’s} answer may have been given – I cannot provide him with manners’ 7. Clearly, Lomax was deeply offended by Mercier’s criticism of his carefully argued thesis on telepathy. 

In April 1919, while Lomax was still working at Prestwich Asylum, The Medical Press and Circular published Lomax’s critique of Mercier’s 1918 book, Crime and Criminals. Lomax made some astonishing statements in this article, which were not only derogatory but frankly rude. He warned readers of Mercier’s latest book to ‘ defer reading the preface until after they have read the book, otherwise they may be tempted to throw away the book in disgust’. According to Lomax, the book contained ‘blemishes of taste, which all readers of Dr Mercier’s work have unfortunately become familiarised’. Lomax noted that Mercier’s attitude towards the psychology of crime and human conduct was ‘eminently unscientific and unsound’ 8.  

Lomax wrote of having recieved a personal communication from Mercier following his review of Crime and Criminals, which he said he was not at liberty to publish, but Lomax then went on to outline the letter’s contents 9. Charles Mercier responded with a letter to the editor of the Medical Press and Circular saying that rules of ethics bind on every honourable man, and that Lomax had broken these by indirectly publishing the contents of his private letter without his permission 10. Lomax did have the good grace to apologise in a letter to the editor in the next edition 11.

Lomax claimed that he had had so many inquiries on his criticism of Dr Mercier’s definition of insanity following his review of Crime and Criminals, that he felt obliged to expand on it further 9. Entitled What is Insanity, it was published as an original paper in July 1919 by the Medical Press and Circular 12. Lomax dissected Mercier’s definition of insanity. The whole article appears to me to be an attempt at vicious iconoclasm, so presumable he was still smarting from Mercier’s attack on him in 1917. Sentences such as ‘In his masterful and dogmatic way he {Mercier} announced that he defined insanity thirty years ago and all that remains for an awed and chastened medical world is to accept his definition with becoming gratitude and respect’,  and ‘I have said and thought that not only is Dr Mercier confused in his thought and perverse in his reasoning , but that at times he contradicts himself outright’. 

Charles Mercier wrote a three page reply with another original paper – What Is Madness – in August 1919 13. He defended his definition of insanity and then proceeded to undermine Lomax, matching and perhaps exceeding Lomax’s levels of sarcasm. The paper is scattered with sentences such as ‘If Dr Lomax has arrived at his conclusions by means of spiritualism, I advise him to change his medium’. Not content to let things lie, Lomax countered with a two page rebuttal on August 20th 1919 which he conclude with ‘I must henceforth regard him {Mercier} as a pretentious but extinct volcano, still capable of generating noxious vapours but whose mental lava has ceased to flow’ 14. 

Mercier sent a final letter to the editor, complaining that Lomax’s real grievance against him was that when Lomax attacked him, he Mercier had had the bad taste to defend himself 15. Mercier died on 2nd September 1919 following a long and serious illness the day before this last letter was published. As a rather sad little postscript to this very public spat, Lomax wrote an appreciation to follow Mercier’s obituary printed in the Medical press and Circular 17th September 1919. In it, Lomax noted that he had ‘unwittingly given pain to a dying man’. He said that he wanted to testify publicly to the great admiration he had for Mercier’s brilliant mental gifts, and that he had only attacked Mercier’s writing in the cause of clear thinking 16.

It is so hard to understand why Lomax should have chosen to battle against this respected bastion of 20th century English psychiatry. At the end of the day, they were both on the same side with Lomax aiming to improve on the suggestions for asylum reform made by Mercier a quarter of a century earlier.  Lomax was well used to fighting his corner through the press , and it is possible that Lomax enjoyed the ‘joust’ (his analogy) through the medium of the written word. Perhaps this was a simply a personal vendetta. However, and here I am speculating, I wonder if he was courting controversy deliberately in order to raise his profile. Between October 1917 and June 1919, he was working as an assistant medical officer in the Prestwich Lunatic asylum – his letters to the Medical Press and Circular are signed ‘Montagu Lomax, Prestwich, Lancashire’. He was gathering material for his book at this time and perhaps he considered that any sort of publicity would be helpful for his cause – the Edwardian equivalent of a Twitter storm. 

Of course we will never know his motivation, but his attacks on Mercier almost certainly alienated  the psychiatric profession even before he had  published his book. Dr Doris Odlum wrote to Dr Tim Harding in 1973 about her recollections of Lomax -‘The older psychiatrists, of course resented Lomax very much and the younger psychiatrists were very much under the authority of their seniors and if they had any views they did not express them as far as I am aware’ 17. A rather sniffy letter to the BMJ in October 1921, commented that ‘Dr Lomax in his book records his great admiration for the late Dr Charles Mercier, but there can be little doubt as to the value that eminent  psychiatrist would have attached to the views of any assistant medical officer…..” 18

The million dollar question here is whether Lomax would have achieved asylum reform with the psychiatric community on his side. Personally, I suspect he would always have been seen as an outsider and a whistleblower and would have been shunned and shamed by his own profession with or without the battle against Charles Mercier.

References are available on request.

Next Page

The M.D. from Brussels University (M.D.Brux).

In the late Victorian and early Edwardian times, a curious set of letters was often appended to the list of qualifications of medical doctors – the M.D.Brux. This signified that the clinician had obtained the degree – Doctor of Medicine from Brussels University. Dr Montagu Lomax  was thought to have achieved an M.D.Brux 1. This was not in fact true, as he pointed out in 1924 that he had never obtained more than his basic medical qualifications 1b. However, the M.D.Brux is interesting in itself, and worth reviewing as it sheds light on medical status in the late 19th and early 20th centuries.

Studying outside of the UK was relatively common in the years prior to the First World War (WW1), particularly amongst those elite doctors seeking specialist experience in the great medical centres of Paris, Berlin and Vienna. However, to travel abroad in order to obtain a higher degree seems odd, particularly when the qualification of M.D. was available in the British Isles.

In the first place it is necessary to understand a little about medical qualifications. In the early part of the 19th century, anyone could set themselves up as a medical man. Most were trained by apprenticeship to a practicing physician or surgeon, but there were charlatans who had little or no formal training. Clinicians tried for many years to weed out these ‘quacks’ and to professionalise the business of medicine. Eventually the first Medical Act of 1858 decreed that nobody could practice medicine without being placed on the Medical Register. The necessary registrable qualifications could be obtained from one of 22 British licensing bodies including the Society of Apothecaries whose registrable qualification was Licentiate of the Society of Apothecaries (LSA). Most primary medical qualifications were licences to practice or diplomas, not degrees. In 1884, the Royal colleges introduced the first conjoint diploma in surgery and medicine  MRCS/LRCP and this became the standard first qualification for generations of doctors 2.

Lomax was typical of his generation, obtaining diplomas and licences in medicine, surgery and midwifery. His application for entry to the New Zealand Medical Register read as follows:

I, Montagu Lomax-Smith, of Christchurch, Member Royal College of Surgeons England, Licentiate in Medicine and  Midwifery Royal College of Physicians Edinburgh registered 1883, Fellow Medical Society London, and Member of the British Medical Association, hereby give notice that I have, this 2nd day of April, 1890, deposited my diplomas, in evidence of the above qualifications, with the Registrar of Christchurch District, and that I shall apply to be registered under the New Zealand Medical Act on the 2nd day of May, 1890.3

The issue of a degree in medicine was debated from time to time in the medical press. The BMJ noted that ‘most medical students in London did not seek a university degree, so that a large proportion of medical men in England possess diplomas to practice but not degrees in medicine . This is a fact which they sometimes find reason to regret’ 4. Without a degree in medicine, a medical man was not strictly speaking, able to use the title of ‘doctor’ before his name, although his patients would style him ‘doctor’ 5.  The growing middle classes in late Victorian Britain were educated and discerning, so that the magic letters ‘M.D.’ became a significant indicator of professional status for the British public 6. The BMJ noted that ‘the possession of an M.D. degree gives a practitioner a decided advantage in the eyes of the public, and on this account, the desirability of obtaining one must be urged on every student’.7.

However, one cynic noted that ‘the attraction of a university degree lay too often in its marketability than its mental cultivation’ 8. Certainly, 90% of the elite physicians working in the lucrative medical businesses based around Harley Street held a higher medical degree such as M.D. compared with  only 13% of GPs 9. Even outside of Harley Street, an M.D. made a material difference to salary, attracting a bonus of £50 per annum for an ungraded medical officer 10.

How an M.D. could be obtained:

Having established that the possession of and M.D. or equivalent university degree was a prerequisite for a financially successful medical career, the problem was how to obtain such a qualification. The different licensing bodies which included the medical schools, did not all issue M.D.s, and those that did had vastly different rules and requirements. In Scotland, St Andrews gave all its graduates an MD once they reached 40 years of age and it wasn’t until 1907 that the MD was granted on the basis of a written examination. Aberdeen University’s M.D.  required written testimonials and several years of practice 11. Durham required practitioners to be at least 40 years of age with a minimum of  fifteen years in practice. If a Durham candidate didn’t have an arts degree, he had to translate latin passages from the classic texts into English as well as sit written examinations in medical subjects in exchange for an enormous fee of 50 guineas. The London universities required three years clinical experience after matriculation,  knowledge of organic chemistry12,  and an M.D. was only granted after attending a course of prescribed study followed by written examinations. The London M.D. was recognised as being difficult with a high failure rate and consequently it was  accorded high prestige 13.

Effectively then, to gain an M.D., one had to wait until one was well into middle age for the Scottish universities, and Durham. Durham was enormously expensive and required evidence of education in the classics and the Arts, The  London M.D. was prestigious precisely because it was notoriously difficult to pass the examinations. A doctor  writing in the Lancet noted that ‘One reads in almost every issue of the medical press complaints against the English Royal Colleges and other licensing bodies that their members and licentiates are prevented from obtaining the coveted title of M.D.’ 14 .

 However, there was another option open to clinicians hoping to improve their prospects. The Brussels M.D. had been available  to British graduates since the 1870s, and a steady stream of hopeful candidates crossed the channel every year to take its examinations. Even accounting for  travel, living expenses for a week  and exam fees, the whole venture cost less than two thirds of the examination fee for the  Durham M.D. 15 . Prior to WW1, there was no requirement to have studied at the University of Brussels, no additional courses to take,  no written papers, and candidates were examined in English through an interpreter. The standard was considered to be  lower than the English Royal Colleges although the failure rate was still 50-60% 16. The Lancet felt confident that the possession of the degree would amply repay the candidate in social status and it was ‘well worth the time and trouble’ 16. The attractions of the Brussels M.D. were clear, and it became a popular option. In 1914, the BMJ reported that there were 600 Brussels graduates known to be in practice in England and the colonies 17.

Correspondents to the Lancet in 1903 noted that the exam taken by British candidates was exactly the same as that sat by Belgium doctors who were awarded a legal M.D with licence to practice. The British candidates were awarded a scientific M.D., with no automatic right to practice in Belgium. However,  if the a successful candidate decided to live in Belgium, it was thought  that he would have no difficulty in obtaining a State permit to practice without the need for further examinations 18.

Looking through the medical press around the turn of the century, there was a good deal of publicity about the M.D. Brux from the British side of the channel. Letters appeared frequently in the British Medical Journal and the Lancet offering to clarify the terms and conditions of the examination 19 . A small pamphlet  published in 1903 by Dr Albert Henchley, provided  hints and tips on passing the examination and even recommended the best rail route and hotels in Brussels for aspiring candidates 15. There was an active association for the alumni of the Brussels M.D. in the UK – The Brussels Medical Graduates Association. The association provided a link between  existing and aspiring British graduates and the Free University of Brussels. It also lobbied hard for the claim of its members to register their degrees as an additional medical qualification in the UK.

The main drawback of the M.D. Brux. was that it was not ‘registrable’, namely it could not be inscribed as a qualification in the British Medical Register. There was much debate in the medical press as to whether practitioners were breaking the law by putting ‘M.D. Brux’ after their names. There had been a court case but no action was taken against the offending doctor 20. The general feeling seemed to be that if doctors wished to add their degree to their name plate, they should do so 21. Many were proud to place ‘M.D.Brux’ on their list of qualifications. Helen Boyle’s entry in the 1895 Medical Directory is a typical example where the degree of M.D.Brux takes precedence over her basic qualifications of licentiate in surgery and medicine: 

For obvious reasons, the granting of the Brussels  M.D. was suspended during WW1, and was formerly discontinued after the armistice. In 1921 the university announced that the examinations would no longer be open to British doctors and nor would the M.D.Brux be granted to foreign medical practitioners ad eundem 22.The Secretary of the Brussels Medical Graduates Association prepared a petition to the University of Brussels 23. The petition had little effect and letter to the BMJ from the Secretary of Brussels University explained that university regulations meant that it was no longer possible to grant an M.D. without at least one year’s attendance in Brussels on  relevant courses 22. Furthermore, the exams had to be taken in French with no interpreter available 24. It was claimed that the change in university regulations was brought about in order to standardise degrees with other foreign universities so that British medical graduates should no longer be granted special status. However, the Lancet noted that the special reciprocity between Belgium and British doctors set up after the armistice whereby there was a free movement of medics between the two countries, was formerly ended by the British government  in December 1920 25. Perhaps some tit-for-tat was at play, but whatever the reason,  the new regulations  effectively saw the end of the M.D. Brux for British graduates. However, the degree was already becoming an irrelevance as the drive for post graduate medical education grew stronger in  1920s  Britain. 

(References available on request)

Shell Shock And Lunacy Reform

Wilfred Owen (1883-1918), Treated for shell shock Craiglockhart hospital.

By the time Dr Montagu  Lomax wrote The Experiences of An Asylum Doctor (1) in 1921, the campaign for lunacy reform had been ongoing for over half a century. There had been some successes such as the 1890 Lunacy Act, designed to reduce the number of unregulated madhouses.  However, little had been achieved to improve living conditions for pauper lunatics in the asylums. This was partly because the campaigners were often ex-patients as in the Alleged Lunatics Friend Society, so had little status, and partly because  psychiatrists were resistant to change. Dr Lionel Weatherly published his ‘Plea for The Insane’ in 1918. This book was aimed at the medical profession and was largely ignored. Lomax’s book was written for the public. His writing style was clear, and direct, perhaps with an overtone of sensationalism. However, it could be understood by any lay person and more importantly, by members of the Press. The book set in motion a wave of public outrage. 

Cleverly, Lomax keyed into public concern over the treatment of shell shocked soldiers. He wrote about the plight of these young men who had been sent back from the trenches with shattered minds only to find themselves incarcerated within the lunatic asylums. Lomax allied himself with the Ex-Services Welfare Society (ESWS), and was a guest speaker at a number of the Society’s public meetings. The aim of the ESWS was to raise public awareness and funds to help these veterans, some 5000 of whom were still in the asylums five years after the end of the war. Lomax was a good public orator and the national press reported his speeches. The wave of public outrage became a tsunami.

It is worth considering what a diagnosis of ‘shell shock’ meant. On 12 December 1914, the British Medical Journal published an article on functional paralysis following shell explosions (2). The author noted that although there was no obvious physical injury, the proximity to explosions was seen as a causative factor and from the winter of 1914/15 ‘Shell Shock’ became a valid medical diagnosis (2). 

There was a running debate between the top psychiatrists of the day as to whether the diverse collection of signs and symptoms which contributed to the diagnosis of shell shock were functional (psychological) or had an organic (physical) origin. The psychiatrist, Dr Frederick Mott noted the presence of microscopic brain hemorrhages in post mortems of men with shell shock, and hypothesised that the condition was due to blast trauma. This lead him to believe that shell shock had an organic cause (3). The Maudsley psychiatrists believed that shell shock was due to a breakdown of psychological mechanisms. Doctors could find no identifiable organic pathology in 38% of admissions for shell shock (2). This dichotomy between psychodynamic and physiological explanations for shell shock was never resolved (3). There was however a military classification which attempted to distinguish between men who were physically damaged, categorised as ‘Shell Shock (Wounded)’ and a second category of ‘Shell Shock (Sick)’ (4). The Shell shock (W) cases were entitled to a wound stripe and a pension. If a soldier’s neurosis did not follow a shell explosion, he was to be labelled Shell shock (S) and was not entitled to a wound strip or pension. Many of the 306 British soldiers shot for cowardice would probably have fallen into this latter category, now recognised as Post Traumatic Stress Disorder (PTSD).

At the start of the Great War, the military hospitals absorbed psychologically damaged men, who could be treated by specialist doctors without the stigma of certification. As the war progressed, casualty number rose and young soldiers with shell shock were increasingly shunted into the County Asylums (4). Estimates vary, but one study found 63% of shell shock cases in 1916 were placed within the asylum system (3). These men were officially classified as private patients, so that their fees were paid by the government, but their private status was effectively meaningless in times of war and carried no special privileges  for the soldiers. The asylums were understaffed, and overcrowded with patient food reported as ‘starvation rations’ (5). The asylum medical staff were overworked, and had no facilities or specialist skills to treat broken soldiers. For those young men who weren’t insane, there was a significant risk that they would be made insane by their surroundings.

For relatives, there was a very real stigma to having a soldier son in a County Asylum. The asylums were viewed as the domain of the pauper lunatic. Admission was by ‘certification’ under the 1890 Lunacy Act, and a certified pauper lunatic in the family carried with it great shame. This was partly because poverty was a frightening spectre for the working class, but also because of the  strongly hereditarian discourse of mental health which dominated through the 1920s (4). 

Towards the end of the war, the British public were growing increasingly uneasy that ex-soldiers were being treated as ‘ordinary lunatics’ (4). The Ex-Services Welfare Society (ESWS) was founded in 1919 to support the ex-servicemen who were effectively trapped within the County Asylum system. The aim of the Society was to set up residential homes for traumatised veterans so that they could be released from the totally unsuitable environs of the lunatic asylums. It was an ambitious project which required enormous financial input. Fundraising and a prominent public profile was therefore crucial to the success of the ESWS. The Society appointed Captain Charles Loseby, to speak on its behalf. He was a lawyer by training and had a distinguished military service record. As an MP between 1918 to 1922, he concentrated on veteran welfare, eventually taking a keen interest in the plight of shell shocked veterans detained within the lunatic asylums. He took the ESWS under his wing, organising and speaking at a number of public meetings on their behalf. Dr Montagu Lomax used the ESWS public platforms as an opportunity to drive forward his case for lunacy reform. Unfortunately, the ESWS’s association with the  campaign for lunacy reform was subsequently viewed as controversial, and after a series of financial scandals, the Society’s supporters quietly distanced themselves. By the mid 1920s, the British Legion had assumed responsibility for much of the practical support required by veterans including liaison with the Ministry of Pensions, and the ESWS was sidelined. 

It is heartbreaking to read Lomax’s account of the shell shocked soldiers in his book The Experiences of An Asylum Doctor. Men such as these were usually ‘other ranks’, whilst the officer class with shell shock were sent to exclusive military hospitals such as Craiglockhart. For the interested reader, Pat Barker’s Regeneration trilogy portrays shell shock amongst the officer class at Craiglockhart.

Bibliography

1. Lomax M. The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. [S.l.]: Allen and Unwin; 1921.

2. Linden SC, Jones E. ‘Shell shock’ revisited: an examination of the case records of the National Hospital in London. Med Hist. 2014;58(4):519-45.

3. Jones E. Shell shock at Maghull and the Maudsley: models of psychological medicine in the UK. J Hist Med Allied Sci. 2010;65(3):368-95.

4. Reid F. Broken Men: Shell Shock, Treatment And Recovery In Britain 1914-30: Bloomsbury Publishing; 2011.

5. Crammer JL. Extraordinary deaths of asylum inpatients during the 1914-1918 war. Med Hist. 1992;36(4):430-41.

Hospital Scandal

JH Murray-Aynsley

In the spring of 1895 The Christchurch Hospital was in trouble. A series of complaints about the standards of care at the hospital had resulted in an inquiry which dragged on for several long months. It was covered in excruciating detail in the local press, and syndicated across New Zealand. Amongst the many complaints from the citizens of Christchurch was the callous attitude and rudeness of the house surgeon, a certain Dr J.H. Murray-Aynsley. It was alleged that he had often arrived on the wards drunk, sometimes in his slippers and dressing gown if he was called at night. He  smoked during his ward rounds. He was accused of insisting that  the prettiest probationer nurses assist him in theatre and was prone to peculiar behaviour such as placing patients on a bread and water diet, and squirting water in the face of an injured  child to stop it screaming. The inquiry drew to a close  in August 1895, and for lack of convincing evidence, Dr Murray-Aynsley was cleared of all charges.

However, that was not the end of the story.

John Henry Murray-Aynsley was born in Lyttleton, New Zealand but studied at Christ’s College Cambridge , and St Georges Hospital, London before returning to Christchurch, to work as the house surgeon at the hospital. His job was to look after patients who had been operated on by the honorary  surgeons including those of Dr Montagu Lomax-Smith (later Montagu Lomax).

The two doctors shared the same year of birth – 1860 – but they had little else in common. Lomax-Smith came from three generations of tanners, Murray-Aynsley  had an English aristocratic background, his great, great grandfather was the third duke of Athol. Lomax-Smith’s father was a Church of England Vicar. Murray-Aynsley’s father was a wealthy business man who kept a string of race horses and was a member of the New Zealand Parliament. Lomax-Smith was raised to service and duty, Murray-Aynsley had little sense of the professionalism that his role required. It is not difficult to imagine that Murray-Aynsley would have rubbed Lomax-Smith up the wrong way.

Lomax-Smith must have been appalled that Murray-Aynsley was vindicated by the hospital Inquiry in August 1895. Less than two months later, Lomax-Smith brought further charges against Murray-Aynsley, alleging that he was drunk on duty and neglected the care of his patients. The Hospital Board was reluctant to get involved in another inquiry. Lomax-Smith resigned as honorary surgeon, claiming that Murray-Aynsley had systematically neglected his surgical cases. A series of vicious letters were published in the local and national press with both sides making claims about the other which would be considered libellous today. Lomax-Smith was accused of unethical behaviour for complaining about a brother doctor. Two doctors resigned in support of Murray-Aynsley. Eventually, the Hospital Board agreed to another investigation.

In April 1896, The Hospital Board found Murray-Aynsley guilty as charged and asked for his resignation. Lomax-Smith subsequently withdrew his own resignation. 

The outcome of this poisonous dispute was poor for both men. Murray-Aynsley left Christchurch for a small bush town where he worked for a short time as a GP. He tried to work in the UK, but never really established himself and returned  to New Zealand where he died aged 57. Lomax-Smith left New Zealand in the summer of 1896 to return to the UK. He left behind a prosperous, comfortable existence, and never really recovered the standard of life he had had in New Zealand. However, Lomax-Smith did learn about the personal difficulties faced by whistle-blowers.  He learned that attacking a person rather than ‘the system’ which allowed an incompetent to work within it, was  was personally devastating. Finally, he learned how to harness the power of the Press. These tribulations were  to stand him in good stead some thirty years later when he wrote his book: The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921.

More at: 

  1. https://en.wikipedia.org/wiki/The_Experiences_of_an_Asylum_Doctor
  2. The New Zealand years.
  3. Montagu Lomax – montagulomax.org 

Since posting this blog, Professor Geoff Rice (University of Canterbury, New Zealand) has written a comprehensive account of the hospital scandal with a very different take on Lomax’s role in the proceedings. ‘When Doctors Differ – The 1895 Christchurch Hospital Inquiry and the 1896 Ousting of John Murray-Aynsley (1860-1917) by Geoffrey W. Rice; Hawthorne Press, Christchurch February 2022.

Why Montagu Lomax matters.

Montagu Lomax (1860-1833) was a British general practitioner  who wrote The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921[1]. The book was an exposé of conditions within two English lunatic asylums based on Lomax’s experiences as an asylum medical officer between 1917 and 1919. 

The book became a cause célèbre [2]. The national press was outraged by Lomax’s revelations, with The Times publishing an article entitled “Asylum Horrors – A Doctors Indictment’ [3]. Within ten days of the book’s publication, questions were being asked in Parliament [4]. Whilst many attempts at asylum reform had been made previously, it was Lomax’s book and the associated newspaper articles that alerted public opinion on a wide scale [2]. The Ministry of Health decided to use Lomax’s book to start the process of lunacy reform, and to subsume the mental health services, previously managed by the Board of Control [2]. The Lomax affair was a significant prelude to the 1926 Royal Commission on Lunacy and Mental Disorder [5]. The recommendations of the Royal Commission were incorporated into the Mental Treatment Act of 1930 which opened the way to many developments in mental health services over the next thirty years [2].

Lomax had a successful publication which ensured him a place in the tradition of British social reportage [5]. It was an important book because it directed public attention to the defects of the asylum system which had hitherto been taken on trust [2]. Lomax’s vivid descriptions of patients’ behaviour and mental state in asylums and of the institutional process produced insights which were to be rediscovered 30 years later by researchers who themselves went on to influence mental health care from 1959 onwards [2]. However, Lomax did more than contribute to a process of mental health reform. His willingness to write frankly and to criticise provide an example to all mental health professionals who find themselves in settings where abuses occur [2].

More information at montagulomax.org

Bibliography

1. Lomax, M., The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. 1921, [S.l.]: Allen and Unwin.

2. Harding, T.W., “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. The British Journal of Psychiatry, 1990. 156(2): p. 180-187.

3. Asylum Horrors, in The Times. July 23rd, 1921.

4. Soanes, S., REFORMING ASYLUMS, REFORMING PUBLIC ATTITUDES: J. R. LORD AND MONTAGU LOMAX’S REPRESENTATIONS OF MENTAL HOSPITALS AND THE COMMUNITY, 1921-1931. Family & Community History, 2009. 12(2): p. 117-129.

5. Towers, B.A., The management and politics of a public expose: the Prestwich Inquiry 1922. J Soc Policy, 1984. 13(1): p. 41-61.