The problem of the ‘idiot’ child

The care of a mentally handicapped child has posed a problem to society for centuries. Prior to the 18th century, many of these children would have been looked after at home, perhaps by an older sibling. The more affluent might have employed a maid servant whose duties would have included care of a handicapped child. When the Industrial Revolution in Britain resulted in migration to the cities for work, a non-productive child became a drain on the families resources. Whilst there was a system of ‘boarding out’ where some parishes paid families to look after ‘idiot children’, this all but vanished with the introduction of the new Poor Laws of 1834. Idiot children who could not be cared for by their families were then required to be admitted to the workhouses as ‘pauper lunatics’. Workhouses soon began to fill up with the elderly, the chronic sick and the mentally disabled such that parishes had difficulty in obtaining places for their temporary paupers. The solution provided by the 1845 Lunatics Act was harsh – the Act decreed that all insane persons should be admitted to the County Asylums, and idiots were defined as a subgroup of the insane. Unfortunately, this just shifted the problem to the Asylums and they too began to fill up with ‘harmless and incurable idiots’ [1]. Families became reluctant to send their idiot children away from their own parish to a County Asylum, and kept them at home often resulting in significant hardship for the family. Some idiot children were retained in the parish workhouse, some from wealthier families were sent to private madhouses. By 1850, it was evident that there were more handicapped children in the community and the workhouses than in the County Asylums [1].

The plight of the handicapped child captured the attention of the Victorian philanthropists in the 1840s. Some attempt had been made to set up training schemes for the ‘educable idiot’ in France, and Dr John Connolly had also experimented at the Hanwell asylum. The philanthropist movement picked up and ran with the idea of schools for the mentally handicapped, setting up Asylums as ‘training establishments’. The Earlswood Asylum for Idiots came about through the efforts of Dr Connolly and the reverend Andrew Reid. It opened in 1847 and accepted private cases from wealthy families which helped to finance the care and education of pauper children. There was a general feeling that handicapped children would benefit from being with their own kind and that they would not have to endure mockery and bullying common in the wider community. Some of the milder cases of idiocy  were trained for domestic service or manual trades such as gardening. 

With the rise of the therapeutic Asylums in the mid to late nineteenth century, a small group of doctors began to specialise in idiocy. Dr Fletcher Beach was one of the early pioneers and highly influential in the field of idiocy. He believed that idiot children fared much better within training establishments away from their families, and should be admitted at the youngest age possible [2]. He may have had his own agenda, since it is clear from the records that he was a talented business man who wasn’t averse to bending the rules on advertising his own private establishment for the feeble minded. However there is no doubt that he and his colleagues made great strides in the classification and treatment of the idiot child. 

Bibliography

1. Wright, D., Mental disability in Victorian England : the Earlswood Asylum, 1847-1901. Oxford historical monographs. 2001, Oxford ; New York: Clarendon Press. vii, 244 p.

2. Beach, F., The Treatment And Education Of Mentally Feeble Children. 1895, London: J.A.Churchill.

A Doctor in Victorian Britain.

P1000545
1891 medical directory

The medical profession at the beginning of the 19th century was in disarray. Most doctors were trained through apprenticeship, often within their own families which saved money in tuition fees. The  medical schools, particularly in Edinburgh, and London offered lectures in a wide range of subjects  as well as practical training in anatomy but attendance was by no means compulsory for aspiring doctors. The need to standardise training and exclude quacks was seen as imperative. The 1815 Apothecaries Act and The 1858 Medical Act defined curriculum content and prescribed the routes to medical qualification. The medical apprenticeship was taken away from the family setting and transplanted into the hospital system where established physicians and surgeons headed ‘firms’ of doctors in training. Examinations became the only method to obtain a license to practice. By the mid 19th century, medicine had become a true profession and its practitioners were an intelligent elite who had earned their position in society on merit not through accident of birth. 

The rise of the medical profession during the Victorian era paralleled the rise of the middle classes whose new money came from the industrial revolution. Montagu Lomax was a perfect example of this new professional class whose training was paid for from profits his father’s family had made through the leather industry. 

Unfortunately, by the time Lomax qualified in 1883, the profession was overcrowded. The vast majority of medical graduates followed the path of general practice at this time. It was possible with enough money to buy into an existing general practice, but most new doctors ‘set up their plates’ on their own. Some newly qualified men took on salaried appointments with local dispensaries, occupational schemes or within the poor law hospitals and asylums. This ‘club practice’ provided an income as they began to build their own lists of paying  patients. However, club practice was perceived as low status work, poorly paid and  with the added disadvantage that doctors were supervised by laymen (Peterson 1978).

There is no doubt that some doctors found it hard to make a decent living and were forced to look for other options. Some joined the military where they signed on for a set period and were able to accumulate funds to buy a practice at the end of their service. The pay was reasonable, there was usually travel and sport in every posting and much less drudgery than general practice at home. Astonishing numbers of young Irish graduates (around 20%) signed up for the Indian Medical Service between 1860 and 1905 (Jones 2010). This allowed retirement on half pay after 20 year’s service, and a severance honorarium which would pay for the purchase of a practice. Others went to the colonies, often to Australia where prospects were considered to be better than Britain, and  society to be less hierarchical (Peterson 1978).

It is a fascinating exercise to browse through medical directories of the late 19th century – doctors are listed under ‘London’; ‘Provincial’, ‘Hospitals, Dispensaries and Lunatic Asylums’,‘Local Government Medical Services’, ‘Scotland’, ‘Ireland’, Practitioners Resident Abroad’, and ‘Services and Mercantile Marine’. Of the many practitioners registered abroad in the 1891 edition, British doctors were working all over the world including Uruguay, China and Tasmania. The majority of Irish doctors who went abroad settled for good  in their adopted country, but around 40% returned to set up practice at home after ten years (Jones 2010). This was certainly the case for Dr Montagu Lomax whose six years spent as a GP in New Zealand were both lucrative and personally challenging. (see New Zealand 1890-1896).

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The Medical Directory 1891

Bibliography

Jones, G. (2010). “”Strike out boldly for the prizes that are available to you”: medical emigration from Ireland 1860-1905.” Med Hist 54(1): 55-74.

Peterson, M. J. (1978). the Medical Profession in Mid-Victorian London. Berkley, Los Angeles California, University of California Press.

Exciting Times – Becoming A Doctor in 1883

Montagu Lomax went to Trinity College, Cambridge to start his medical studies  in 1878. He qualified in 1883, having completed his clinical training at St Bartholomew’s hospital in London. It was arguably one of the most exciting times to be a medical student with rapid innovations in medicine and surgery. Anaesthesia had been in routine use for only a decade, asepsis, pasteurisation and bacteriology was just around the corner, and X-rays were just on the horizon. 

At the turn of the 19th century, British doctors were divided those who had been to university –  an intellectual elite known as physicians, and those who had learned by apprenticeships – the surgeons and the apothecaries.  The university-educated physicians took medical degrees, whilst the surgeons and apothecaries took licensing exams. There were no nationally organised curricula and standards were set by colleges of physicians and surgeons and the London Society of Apothecaries, with no Government input. This contrasted with the continent, where governments were predominantly concerned with having high quality doctors to service their armies. In France, some Parisian hospitals  treated the poor for free simply to provide case material for doctors in training. The British Government had no control over numbers entering the profession, and consequently by the 1830s, medicine was overcrowded and medical incomes were falling. After a prolonged campaign by the doctors, the 1858 Medical Act was passed with the avowed aim of protecting the public from quacks and standardising the medical curriculum so that there was a legally enforceable guarantee of a minimum standard of competence. The General Medical Council was established to police standards. Doctors were divided by the Act into hospital-based consultants and community based GPs, although some GPs also held part time surgical posts in their local hospitals. The apothecaries were given some years to transition into the  medical profession, but some split off and became  chemists and druggists. Doctors could then view themselves as part of a single profession with a collective identity. 

So when Montagu Lomax qualified in 1883, he became a member of a fairly new and rapidly evolving profession. His clinical studies would have taken part within small cohorts of young men, who trained and played sport within their ‘cliniques’, forming lifelong allegiances. His studies would have been conducted in English, a complete contrast from the latin and greek used at Cambridge University for the old Physicians in training. The Anatomy Act of 1832 guaranteed that the bodies need for anatomical studies were legally acquired. Knowledge was being shared widely through a plethora of local and national medical societies, and through medical journals, the first of which  was the Lancet founded in 1823. Great strides were being made in surgery, facilitated by the relatively new use of anaesthetics, and asepsis.  

Anaesthesia was initially used in dentistry, but had been adopted by American surgeons, and popularised in the UK by its use in childbirth by Queen Victoria in 1853. Speed was no longer of the essence so that surgeons were able to experiment with new techniques, some of which are still in use today. In 1853, Pasteur showed that wine was soured by the presence of microorganisms, confirming the germ theory of disease and decay. Pasteur’s germ theories were picked up by Lister, professor of surgery at Glasgow. He was actively seeking for a way to reduce post operative mortality rates, and thought that cleanliness might improve on the filthy hands and operating coats of his colleagues. He introduced antisepsis into his theatre using carbolic acid for hand washing and a spray for the surgical field, first described in the Lancet in 1867. His death rates fell dramatically and gangrene disappeared from his wards. This was nothing short of miraculous at the time, and the technique was disseminated widely by Lister’s students who dubbed him ‘the father of surgery’.

The technique of roentgenography (X-Rays) was discovered in 1895,  and for the first time doctors could observe the bones of a living person. 

The sanitary reform movement which set out to provide clean water and living conditions had already resulted in a decline in deaths from communicable diseases by 1880. The germ theory of disease established by Pasteur in 1853, and confirmed by Koch’s work with the microscope formed the basis of the new science of bacteriology. For the first time, the causes of diseases were being discovered, and very rapidly. Koch determined that  consumption was caused by  the tuberculosis bacillus in 1882, Mott found the syphilis spirochete in the brains of patients with General Paralysis of the Insane in the 1890s. Syphilis and TB caused much of the mortality and morbidity in society at the end of the 19th century. Work by Koch, Mott and fellow bacteriologists laid the foundations for cures which transformed society in the 20th century.

These were indeed exciting times to be a medical practitioner. 

A Family of Tanners

 

Montagu Lomax’s father, Thomas Smith, came from a long line of Ashbourne tanners who can be traced back to the  18th century. Montagu’s grandfather had moved his family from Ashbourne in Derbyshire, down to Bermondsey in London in the early 1800s. Bermondsey, on the south bank of the Thames, was a busy leather processing centre, but contemporary descriptions of the area convey the horrific living conditions endured by the leather workers – Dickens’s Oliver Twist was based in Bermondsey. The Napoleonic wars were raging across Europe at the time, resulting in  a huge demand for boots, saddles and harness. There was money to be made in leather, and the Smith family acquired a great deal of it, investing it shrewdly in property. By today’s standards, Thomas Smith would have been a multimillionaire by the time he was thirty.

Thomas Smith married a cousin from the Ashbourne side of the family. Their first child died as an infant from an unspecified fever, perhaps due to the unhealthy climate of the Bermondsey tanning yards.  It seems that the loss of his child was a crucial moment for Thomas, and he decided to use his wealth to leave Bermondsey behind.  He  bought himself a place at Cambridge University to study theology, eventually becoming a Church of England vicar. An astute businessman, he kept the properties he had bought in London since they were providing rental income, and continued to buy land and property throughout his life.

Montagu Lomax and his siblings were the first generation of his family  to be raised within the emerging middle classes of the mid Victorian era, and to marry the children of  vicars, and solicitors. Their comfortable life styles, public school and university education were bought with money made from the  leather industry (see The Story of the Reverend Smith’s Wealth). So I want to fill in a little detail here, about an industry which in the 18th and 19th centuries was second only to the wool trade in Britain.  It was a crucial source of revenue for the government with taxes imposed on hides bringing in enormous amounts of money. As cities grew at the beginning of the industrial revolution, meat consumption and therefore leather production increased. 

 The new toll roads begun in the 18th century, encouraged the expansion of travel. The increased numbers of carriages created huge demand for saddlery and harness. Leather was needed for upholstery, and shoes while  leather belts powered the factories of the industrial revolution. The demand for leather was endless, pushing  prices up and increasing tax revenue even more. The government needed to protect this lucrative income stream, so they legislated that hides should not be damaged during the slaughtering process. Hides then had to be inspected for quality and stamped by government inspectors. This meant that hides had to be traded through a single outlet in most large towns – Leadenhall Market served this purpose in London, which subsequently set the price for leather across the whole country.

Tanning itself was a filthy, smelly trade. To make leather from hides, the hides had to be cured. They were salted to prevent decay, and then soaked in water to remove the salt and dirt. The hides were then laid in lime pits to loosen hair and soften the skin so that it was easier to scrape away hair and fat. This residue was sold off to manufacturers of glue and soap – also foul-smelling industries, and of necessity, situated close to the tanneries. The lime was then removed from the hides by agitating them in pits containing enzymatic ‘bate’,  which before the production of chemical bate, relied on dog faeces. Next the hides were soaked for several weeks in pits of tanning liquid of increasing strength, usually made from oak bark although human urine could also be added. The stinking process was the tanning  method for centuries and for this reason tanneries tended to be grouped by rivers and outside the city walls downstream of a town’s drinking water. So it was that Bermondsey became the site that the butchers of London deposited their hides from the 14th century onwards. By 1792, a third of the leather in the UK came from Bermondsey, and by 1879 a grand leather exchange had been built in the town.

Tanners and curriers were separate trades before 1813 with entirely separate Guilds and apprenticeships. Curriers  were highly skilled tradesmen who finished the leather prior to its sale to the shoe makers and saddlers. Curriers, of which Thomas Smith was one, made substantial profits, considerably more than tanners, and to protect their income, tanners were forbidden to do any currying by Act of Parliament. After 1813, the old divisions between the trades were abolished and the boundaries blurred, but the curriers continued to act as the middle men between the tanners and the end users of the finished leather, so that many of them became extremely rich.

I found a reference to a court case from 1810 where  Thomas Smith’s servant  was accused of having stolen two pounds of leather. He was initially sentenced to seven  years transportation, but this was commuted to imprisonment because it was his first offence. Seven years transportation does seem a little harsh for such a small quantity of leather, but it was a very valuable commodity.

It would be so interesting to know whether Montagu Lomax ever told his friends about his father’s first career in the leather industry.

Montagu Lomax – a detective story

Welcome to ‘Who was Dr Montagu Lomax’, and to my very first blog page.

I suppose I should explain why anyone should be interested in a man who died nearly a hundred years ago. 

If you put ‘Montagu Lomax’ into Google it will churn up plenty of references to his 1921 book – The Experiences of an Asylum Doctor’ (1), and you will learn that the book shocked the British public to the core by telling them how their relatives were being cared for in the lunatic asylums throughout the country. The ensuing scandal eventually resulted in a change to the law with the 1930 Mental Treatment Act, and the beginnings of the modernisation of our mental health services. That, although interesting in itself, is not the reason for my homage to the man.

Having read his book, it became apparent that there was a missing backstory. How did an obscure, retired GP manage to write a book which had such a profound effect, so that within weeks of publication, questions were being asked in Parliament? The conundrum had also occurred to a certain T.W. Harding  who wrote an appraisal of the  ‘Lomax Affair’ in in his 1990 paper (2). Harding commented that he had very little biographical information on Lomax, and he hoped that he might be able to trace Lomax’s family to ‘allow a more complete account of a remarkable man to be written’. I read this paper in 2010, and as far as I could ascertain, nobody had taken up Harding’s challenge in the interim. 

It has been a detective story – my entertainment through long winter evenings on and off for the past decade. I learned a great deal about Lomax’s background digging through ancestry.com. I was able to read contemporary accounts of his activities through the online newspaper archives, I visited the Public Record Office at Kew, the Bodleian Library in Oxford, the Warwick archives, and corresponded with the Alexander Turnbull Library in New Zealand, the Surrey Archives, and the archivists at Marborough and Gresham’s School. I read history books, medical papers, history papers and began to accumulate an enormous, disorganised collection of facts and ‘interesting snippets’ spread across three computers and spilling out of several drawers. I have always meant to ‘do something with it’ when I had the time. Then in March 2020, COVID-19 arrived and suddenly, I had plenty of time.

The story of Dr Montagu Lomax is laid out in chapters which are arranged in date order through the Home page. The Introduction page explains the background to the story. There are still some gaps in the narrative, so if you are able to help fill them in, dear reader, please contact me. 

 

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

2. Harding TW. “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. The British Journal of Psychiatry. 1990;156(2):180-7.