Madhouses in the Market-Place, 1701–1774

Abstract

During this period, the numbers of private madhouses grew steadily. Smith contends that they were a commercial response to an increasingly sophisticated demand for medically related services. The distinctions between modes of operation in London and the provinces were becoming more pronounced. London consolidated its position as the main centre of the madhouse business. An elite group of specialist physicians were particularly influential, placing patients with favoured madhouse proprietors with whom they had established connections. Some London madhouses became large undertakings, providing both for wealthy private patients and substantial numbers of parish paupers. Provincial madhouses tended to be smaller and were often family businesses. Smith details their increasing geographical dispersal, whilst noting concentrations in the West Country and the Midlands.