Montagu Lomax published his book The Experiences of an Asylum Doctor in 1921(1). The newspapers, local and national picked up on the book and published reviews, mostly concentrating on the shocking nature of its revelations. Montagu gave them interviews and wrote articles. Questions were asked in the House of Commons within a short time of its publication. He was indefatigable in keeping the momentum of the initial public outrage going. He wrote the foreward to a pamphlet previously published by an ex-patient Rachel Grant Smith, and in 1922 republished it as ‘The Experiences of an Asylum Patient’ (2). He allied himself with the newly formed Society for Lunacy Reform, crisscrossing the country giving public lectures about his book. He also tried to harness the public sympathy for the plight of the shell-shocked soldiers, many of whom were incarcerated as pauper lunatics. The medical profession was unanimous in denouncing, and attempting to discredit him. He did not seem to mind the opprobrium heaped upon him by his own profession and wrote carefully considered responses to the attacks launched on him through the medical press. Lomax became the recipient of many letters from ex-patients and even asylum staff thanking him for his support and offering accounts of their experiences, many of which were far more harrowing than those described by Lomax himself. Some of these letters were also published in the newspapers and medical press. The ‘Lomax Affair’ refused to go away.
In many senses, the timing of Lomax’s revelations was fortuitous. There had been an enquiry into the treatment of 268 ex-servicemen at Prestwich barely a year before Lomax’s book appeared. Allegations had been made to the Minister of Pensions that the men were being badly treated, received an inadequate diet and refused any privileges of clothing or treatment. The Ministry of Pensions representative had been unhappy with conditions at Prestwich but his recommendations had been overruled by the Board of Control. In October 1921, there were still 6,435 ex-soldiers under treatment for war neurosis in the public asylums where they were classed as ‘pauper lunatics’ (3). Many members of the public would have been aware of the plight of these soldiers through their own friends and families. There was already public anger at allegations in the press that the Ministry of Pensions had refused to pay the pensions and allowances for shell-shock victims unless they accepted treatment in the public asylums. Lomax’s book provided a focus for the national disgust at the way in which the sacrifices of ex-servicemen had been rewarded by their country.
Correspondence from the Ministry of Health at the time demonstrated considerable contempt for the lunacy services. A position paper by Sir Aubery Symonds ( Second Secretary, Ministry of Health ) commented that ‘The Lunacy Act is over 30 years old. In that time most branches of medicine have made enormous strides; the treatment of lunacy in the public asylums has practically stood still’(4). The Ministry of Health needed an exchequer grant to use as leverage to reform the mental health services. The Minister of Health, Alfred Mond was acutely aware that an exchequer grant would only be forthcoming with the support of a Royal Commission. The Experiences of an Asylum Doctor presented Mond with the perfect stalking horse (3). The Board of Control was asked to investigate the book within a month of its publication.
The speed and degree of the reaction to the book are astonishing even by today’s standards, and it would be fascinating to know whether Lomax was frightened or thrilled by the power he had released. He prefaced his book with a dedication: ‘To all the insane poor, in sympathy with their sufferings, and in the hope of alleviating their hardships’, and it is clear from his writings and from public records that he devoted the remainder of his life to this cause.
The complex political manoeuvring and historiography behind the Lomax Affair has been well described by better pens than mine. If the reader is interested, Towers 1984 assessment of the Prestwich Inquiry (3), and Harding’s evaluation of the Lomax Affair (5, 6) are all excellent articles. Essentially, the Board of Control’s report was rejected as ‘disappointing’ by the Ministry of Health, being too partisan and defensive of the asylums (5). The Ministry went on to set up an independent enquiry through the Cobb Committee convened in 1922. Lomax refused to attend the Cobb Committee meetings. It is likely that he had been advised that an independent enquiry would be toothless, and that he should hold out for a Royal Commission. The press agreed that a Royal Commission was needed, with the Daily Herald commenting in 1922 ‘…what is wanted is not an enquiry into specific questions of administration within a radically bad system, but an enquiry into the system itself’ (3). Eventually, in 1924 the Royal Commission on Lunacy and Mental Disorder (the MacMillan Commission) was established. Lomax’s evidence to the commission covered 26 printed pages, which was warmly received by the commissioners, who thanked him for ‘the very great care you have taken in considering this whole topic’ (5).
The recommendations of the Commission lead to The Mental Treatment Act 1930. This Act of Parliament replaced the term ‘asylum’ with ‘mental hospital’, and laid down the principle that mental illness treatment should be conducted as nearly as possible on the lines of physical illness treatment. For the first time, Local Authorities could establish out-patient clinics and mental hospitals could admit voluntary patients. GPs as well as specialists were encouraged to share the care of mentally ill patients. The Act was designed to demystify madness and to ensure that patients were treated with dignity and respect. Harding noted that ‘many of Lomax’s suggestions made in 1921 were curiously similar to the provisions of the 1930 Mental Health Act, the single most important legislative reform affecting psychiatry in England and Wales’(5).
Montagu Lomax died in 1933. The Lancet obituary was short and noncommittal while the British Medical Journal failed to notify their readers at all. He was a persona non grata to the medical profession, a whistleblower who would never be forgiven for breaking ranks.
1. Lomax M. The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform.
2. Smith RGp, Lomax M. The Experiences of an Asylum Patient … With an introduction and notes by Montagu Lomax.
3. Towers BA. The management and politics of a public expose: the Prestwich Inquiry 1922. J Soc Policy. 1984;13(1):41-61.
4. PRO. Summary Paper by Symonds. November 20th. MH58/2221921.
5. 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.
6. Harding TW. The Lomax affair. The British Journal of Psychiatry. 1990;157(6):935a-a.