London: Lord Chancellor’s Visitor in Lunacy

Visitor in Lunacy

Overwork in Schools - Government Report

Lectures and Publications

A Seance

Interest in Children

Tooth Culture

Robert Burns

Freud and Psychoanalysis

Abruptly, Crichton-Browne changed his life and work completely. At 36 years of age, in 1876, he became the Lord Chancellor’s Visitor in Lunacy and moved to London. . Within a few years he had abandoned research, abandoned Brain and his neurological colleagues, and re-invented himself as a public man.

His new appointment was lucrative, prestigious and much coveted He gained it in stiff competition, which included Henry Maudsley, perhaps the most noted psychiatrist of this period, whose name is remembered in London’s Maudsley Hospital.

He became one of three Lord Chancellor’s Visitors: two doctors and one lawyer. Their duties involved examining, at least annually, all detained psychiatric patients who had property over £1000, or annual income of more than £50. Some in hospital, but many were ‘boarded out’ in private homes. This was no sinecure. He had to examine and report on over a thousand cases in some years, and in 1913-14 travelled 21,171 miles. Each report took 45 minutes and they averaged fifty a month. Three days weekly were spent travelling. The post suited his love of travel, public activity, and gave him the status both for private practice and for making public pronouncements. He was to hold this post for 46 years, until 1922 when he was 82!

He was one of the first to set up a flourishing consulting room practice in psychiatry. He had some distinguished patients: Principal Tulloch, the theologian, came from Scotland to consult him; Sir Charles Eliot, later British Ambassador to Japan, who had been tarred and feathered at school; Henry Arthur Jones, the playwright.

Over-Pressure of Work in Elementary Schools

He launched his career as a public spokesman for psychiatry with an investigation and report for parliament. In June 1884 the government published a report by Crichton-Browne ‘upon the alleged Over-Pressure of work in Public Elementary Schools.’ It runs to some fifty pages, with an attached memorandum of twenty pages by J G Fitch, H.M. Principal Inspector of Schools.

Following the increase in these schools after the Education Acts of 1870, there was concern about their teaching methods. Payments to the schools were ‘by results’, based on attendance records and examination results. Classes were large – seventy was not unusual – most of the learning was by rote, and corporal punishment was routine. Many thought that these changes were affecting the children, especially the poorer ones.

Crichton-Browne, after briefly visiting fourteen schools, concluded ‘that educational overpressure does exist to some extent, that it is even now exerting appreciable evil effects, and that if unchecked, it is likely to entail very serious consequences on future generations.’ He predicted future rises in tuberculosis and insanity.

He begins his report by saying that ‘the general result of my observations on the schools which I have visited, is to confirm the opinions which I ventured to state at our interview’. This is addressed to the Rt Hon Anthony J Mundella, Vice President of Council. It is not clear whether Crichton-Browne was asked to undertake this investigation, or whether he volunteered for the task. He would seem to have been an unlikely choice, although he had already written and spoken about the subject, and much of his report was copied from his own ‘Education and the Nervous System.’ He was on record as believing that health and the nation were threatened by the ‘grinding tyranny of education.’

Fitch’s memorandum is perhaps more revealing than the report itself, and casts a critical eye on Crichton-Browne’s methods and report:

‘It was with some surprise that I learned from the author of these emphatic sentences that he had no personal knowledge of the working of our educational system.’ He notes that as a doctor Crichton-Browne had had no direct experience of examining or caring for children, and that he had never in the past set foot in an elementary school.

Fitch accompanied him on visits to schools in the Lambeth area of London. He was under the impression that he was showing round a ‘private enquirer’ and was not told by Crichton-Browne that he was conducting an official enquiry and preparing a report. He says that, if he had, he would have arranged for him to talk to local general practitioners, to parents, and would have selected a more typical mix of schools for him to visit.

He calls his methods ‘neither judicious nor trustworthy’. Crichton-Browne would stand before these large classes with his notebook, and ask the pupils to raise their hands if they suffered from headaches. He would note the result in his book, then similarly ask if the headaches were at the front, on top, or at the back of the head, and whether they occurred early or late in the day. He then claimed in his report that 46.1% of the pupils in elementary schools in London suffered from habitual headache, and linked this to ‘overpressure’. No individual examinations of children were made, and the inspector points out that most of the children seemed bewildered by the questions. He later had a letter from the headmaster of one of the schools complaining of an increase in symptoms and absences after the doctor’s visit.

Fitch’s scrutiny of the report and its methods is detailed, and his conclusions harshly critical:

‘Every one of his judgments is hasty and inaccurate, arrived at by a loose and partial method of enquiry.’ …… ‘language characterised by very serious exaggeration, and calculated to do great public mischief.’

‘It must be observed that although the opinion expressed in this document is that of an eminent medical man, it is not in any sense a medical opinion. For it is not based on any medical examination, either by himself, or any other professional person, of teachers or scholars; or on any medical reports or statistics which apply to masters, mistresses, pupil teachers, or scholars as such.’

‘Everywhere, as it seems to me, the writer’s observations and suggestions , which might otherwise have been so valuable, are vitiated by his foregone conclusions, and by the habit of stating an opinion as if it represented a fact.’

This is severe and justified criticism, and may have damaged Crichton-Browne’s reputation then and in the future. But not with the great and the good: he was knighted two years after completing the report by Queen Victoria at Osborne House.

Lectures and Publications

In his first years in London he continued to publish work begun at Wakefield and there are many publications in the new neurological journal, Brain. Gradually thereafter his publications become more and more the record of his public addresses.

All his papers, especially the published public addresses emphasise religion, moral principles, the dangers of socialism, and ‘family values.’ He opposed the materialistic tendencies of the time, perhaps the reason why he did not associate himself as much as he could have done with Darwin, and why he began to distance himself from Brain and his neurological colleagues. He opposed trade unions, feminism, and psychoanalysis, but supported eugenic solutions to the problems of mental health, becoming (like many psychiatrists) disillusioned with the results of therapy as he grew older. In old age he was especially despondent about the part of the population he called the ‘half’mad’ – what would nowadays be called neuroses and personality disorders.

From this time he devoted his formidable energy to his new post, to building a private practice, and to writing, lecturing, on every conceivable subject. (see appendix )

He took an interest in everything, making his mark in many fields. Here are some examples:

A Séance

In 1883 he attended a demonstration or experiment in thought transference in Deans Yard, Westminster. F W H Myers, the founder of the Society for Psychical Research and Francis Galton were among those present. One of the two men was seen alone by the committee who drew an owl. The man then returned to the other room where his colleague was, blindfolded, and stood behind him. After a few minutes the colleague drew an owl of sorts.

Crichton-Browne was unconvinced. He persuaded the committee to draw an abstract squiggle, because he thought words were involved, and insisted on checking the blindfold and putting cotton wool in the colleagues ears. He believed that the other was chinking coins in his pocket in morse code. From then on the experiment was a failure. Myers was not amused: 'It must be allowed that this demonstration has been a total failure, and I attribute that to the offensive incredulity of Dr Crichton-Browne.’

Interest in Children

He had a life-long interest in the mental and physical health of children, beginning in his student days at Edinburgh. In 1883 he contributed to Cassell’s Book of Health a chapter on Education and the Nervous System. He regarded the years between birth and ten as critical for preventing psychiatric illness in the adult. He believed that the mother’s health, the correct mixture of physical and mental training in childrearing, and the child’s diet were of great importance. For the time he had very progressive views, admiring Froebel and Montessori, and deploring corporal punishment. He believed that lying and stealing were common and normal in children and not a sign of illness or criminality. His views on adults were much harsher. In 1892, eight years after his government report on education, he remained concerned about ‘overpressure’ in schools, especially on adolescent girls.

In a paper to the Medical Society of London he sought to demonstrate anatomical and intellectual differences between the sexes, by quoting at length his results from Wakefield on brain weights of lunatics, showing that males had heavier brains, and wider carotid arteries to supply them. He claimed to have studied girls attending a private secondary school, ranging in age from 10 to 17 years, and shown that two-thirds of them ‘sometimes’ had headaches, and usually later in the day. This he interpreted as clearly due to ‘overpressure’ and recommended that girls in this age group should on no account be allowed to undertake ‘brain-work’ after 7pm. He added that the recent decision to allow women to attend classes at St Andrews University was ‘ a downhill step to confusion and disaster.’

Tooth Culture

In 1892 Crichton-Browne gave a lecture with this title to the Eastern Counties Branch of the British Dental Association. He began with a token protest about his lack of specialist knowledge, but seemed to think it quite appropriate to lecture a gathering of dentists on the subject of caries, its wide prevalence at the time, especially in children, and its causes and treatment. After quoting alarming figures for the prevalence of caries, he insists that this is a new phenomenon, and links it to fears of national decline:

‘Depend upon it, that in the England of the past the teeth were not as frail or troublesome as they are today.’……’no nation ever climbed to pre-eminence on carious teeth.’ ……’it is not an edentulous race tht will finally possess the world.’

With great prescience, he blames the increase in dental caries on soft, pulpy food, in particular refined bread, depriving its consumers of fluorine, and suggests that the diet of children and expectant mothers should be supplemented with fluoride!

But he points to other causes, particularly ‘the high nervous tension of our times’ - when ‘parents have eaten sour grapes the children’s teeth are set on edge.’ He believes that the children of the neurotic and the neurasthenic are ‘deformed, half finished’, their teeth delicate and destined to premature decay. His examination of idiots and imbeciles shows that they have gross caries.

Children themselves, if kept in a state of nervous excitement or overstrain, are liable to have more caries. He claims that there is more caries in better class schools for this reason. Living in towns where there is more nervous tension, and more bacteria in the air, contributes to caries, as does smoking.

He recommends regular morning and evening brushing –which ‘exalts self-respect and so has a wholesome effect on moral character.’ He concludes by recommending regular dental examinations in schools.

Electrified Babies

Nothing better illustrates Crichton-Browne’s slap-dash approach, and his gift for publicity, than his 1914 lecture to the Child section of the British Medical Association, which made headlines in the Times the following day. He had reported research by a Swedish Professor Arrhenius, detailing the effect of ‘electrifying the atmosphere’ on children. Crichton-Browne claimed that the group subjected to this treatment grew faster, were healthier, and performed better in exams than a control group. He told his audience that he had talked with the professor, and that although there was a need to be cautious, the electrification had been successful with chickens – they became less chicken-hearted! It was only some years later – in 1918 – that it was discovered that the subjects were in fact babies of less than one year, that the selection was flawed by a nurse choosing the brightest babies for electrification, and that the examinations were an invention (Br.Med J., 1918)

Robert Burns

As in his defence of Carlyle (see below) he was anxious to defend Burns, another man with Dumfries associations, from the charge that he had been drunk and dissolute, and had died from the effects of alcohol or syphilis. He claimed that Burns probably suffered and died from rheumatic fever, not that that would prevent him being drunk and dissolute. Modern Burns research has made many other diagnostic suggestions, none proveable; brucellosis is the current favourite.

Freud and Psychoanalysis

He had little favourable to say about Sigmund Freud, whose works were now appearing in English translations and alarming the conservative English medical profession. His 1920 papers give his opinion that life is a little too short for psychoanalysis, and that there are no trustworthy statistics of its efficacy. He points out that in the mild cases selected for treatment spontaneous remission is common, that suggestion as a method of treatment is common to psychoanalysis and quackery, and that the theory and treatment overemphasise the importance of psychogenic factors, and underestimate the importance of heredity predisposition. Eighty years later most of his criticisms can be sustained.

He illustrated his opinions with many details of soldiers returned from the first world war, who today would be diagnosed as suffering from post-traumatic disorders, and believed that most had helped themselves by repression rather than by psychotherapy which forced them to recall their war experiences. Again, more recent research supports his claim. He believed too in occupational therapy – ‘much sound psychotherapy lurks behind the sweat of the brow.’

Dream interpretation he dismissed out of hand:

‘Any right-minded father who found that his daughter had been subjected to dream interpretation of this kind,’ he suggested, ‘would subject the analyst to a well-placed kick.’ He thought that psychoanalytic theories were ‘ a perversion of the dictum of Socrates, whom Freud resembles as much as a toadstool does a British oak.’

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Sir James Crichton-Browne:

A Very Victorian Psychiatrist

1840-1937

Electrified Babies

^{Sir James
Crichton-Browne:}