James Tilly Matthews: Bedlam patient and catalyst for "Madhouse" reform

By Dana Rovang

In May of 1815, a Select Committee in Britain's House of Commons was formed to examine the state of "madhouses" and whether they should be better "regulated." One star of the proceedings was a former Bedlam patient who had already died, James Tilly Matthews, and whose situation was a catalyst for the formation of the Select Committee. Matthews' sad situation was a key subject during the proceedings and helped to lead to reform of mental health institutions in nineteenth-century England.

Also under the spotlight was John Haslam, the "Apothecary" of Bedlam, whose role was to supply medicines to patients. But over the years, Haslam had taken on an outsized role at Bedlam, virtually running the establishment. Haslam was indignant that his authority was being questioned, especially by someone who was as "clearly insane" as Matthews. Try as he might to squelch the testimony, over the course of the Select Committee meetings, the figure of James Tilly Matthews challenged Haslam's methods again and again, all from the grave. This eventually lead to structural reform of Bedlam and Haslam's dismissal from his post.


James Tilly Matthews (1770-1815) was a young merchant in London when revolutionary tensions in France began to rise in the 1780s-1790s. With a French Huguenot lineage, Matthews and some friends took it upon themselves to go to France and see about mediating friction with England's government -- he was not sent there in any official capacity. However, he seemed to have gained the ear of some in the Girondin government, but they were supplanted by the Jacobins. Matthews' association with the Girondins did not put him in good graces with the new regime; after the Jacobin uprising, he was imprisoned as a suspected "double agent." During his three year confinement, he lived in constant fear of being executed by guillotine. He was released in 1796 after the French authorities determined he was a "lunatic."


Matthews returned to England, but he became fixated on the idea that one member of Parliament, Lord Liverpool, could help relations between the two countries. Lord Liverpool (1770-1828) was the same age as Matthews, but he was a new member of Parliament, and it is otherwise unclear why Matthews chose Liverpool to appeal to for aid. Matthews wrote two letters to Liverpool, but did not receive a reply. In 1796, Matthews interrupted a session of the Commons at Parliament, and loudly accused Liverpool of "treason" from a public viewing gallery. Because of this, Matthews was sent first to Bridewell, which was a workhouse, and then in January 1797, he was admitted to the "incurable" wing of Bethlem Hospital, known as "Bedlam."


Bedlam: confinement for political "incurables"

Bedlam Asylum, officially Bethlem Royal Hospital, had likely been housing the "insane" since the fourteenth-century, but officially from 1403. By the eighteenth-century, Bedlam had become emblematic of all "madhouses," the term for places that housed and treated people with mental illnesses. Bedlam was also the place for mentally ill people who committed political transgressions: Margaret Nicholson attempted to assassinate King George III with a blunt knife in 1786, and James Hadfield also attempted an assassination of the King in 1800. Hadfield's case set a precedent for "reason of insanity" defense, and both he and Nicholson were sent to Bedlam for life.

A drawing of a destitute man, with a shaven head, being shackled by Bedlam staff, while surrounded by other people exhibiting mental health disorders.
William Hogarth's Plate 9 from "Rake's Progress" (1735), depicting the chaos of Bedlam and members of genteel society viewing the patients for sport. Note that The Rake (front ground) is being shackled.
Matthews' drawing of the Air Loom. From John Haslam's Illustrations of Madness (1810).

Matthews was sent to Bedlam because he publicly accosted Lord Liverpool at the House of Commons. But his particular delusion was also political in nature. He thought of himself as a political prisoner, an extension of his imprisonment in France. Specifically, he came to think that there was a treasonous group sympathetic to the Jacobins located in Moorfields in a building very close to Bedlam. Matthews believed that this nefarious group had designed and was operating a giant "pneumatic" device called an "Air Loom" that poisoned the air of those in the government. He thought that the group sent out invisible "magnetic" rays that influenced the minds of government officials, and could conversely read their minds. He was a specific target of the group, and Matthews described in great detail the tortures they inflicted upon him, and how they communicated with him using "brain-sayings."


John Haslam recorded this account of Matthews' delusions in his Illustrations of Madness (1810), because Matthews' family was fighting for his release from Bedlam. John Haslam had taken a particular interest in Matthews. While Dr. Thomas Monro was named the head physician of the hospital (the third in a dynasty of "Dr. Monros"), over the years Haslam largely diagnosed and designed treatments, with Dr. Monro's approval.


Many of these "treatments" were standard at the time, including iron restraints, exposure to the elements, freezing baths, spinning chairs, and forced feedings. Haslam also wrote about the benefits of using "metallic manacles" to restrain patients in his 1809 Observations on Madness and Melancholy, (p.290) published just a few years prior to the Select Committee's hearings.


Matthews was exposed to all these interventions at Bedlam. He was kept in the main "gallery" with the others who had been committed, and chained to his bed at night. However, Matthews was by all accounts a very gentle person, and frequently presented as rational and "sane." In fact, as Matthews' relative, Richard Staveley, testified before the Select Committee, Matthews was known at Bedlam for mediating disagreements between patients, and even staff.


Matthews' family had long been under the impression that he was being ill-treated and that his mental illness was either harmless, or had passed. In 1809 they petitioned the King's Bench with a writ of Habeas Corpus, declaring that Matthews was sane and being held against his will. To support their claim, the family enlisted two doctors, George Birkbeck and Henry Clutterbuck, to evaluate Matthews under the noses of Haslam and Monro. Both Birkbeck and Clutterbuck attested to the King's Bench in written statements that Matthews was sane.


While the Habeas Corpus was denied and Matthews remained at Bedlam, John Haslam was not amused.


The Unshackling of Bedlam

At the 1815 Select Committee hearings, Matthew's relative Richard Staveley outlined Haslam's interest in Matthews, and how Matthews' case presented a direct affront to Haslam's authority over the inmates at Bedlam. For their part, the Select Committee was interested in Matthews' medical treatment and especially whether he was confined by chains. At this point in time, the use of chains to confine patients was becoming emblematic of everything wrong in the "mad-doctoring" business.


The late-eighteenth and early-nineteenth centuries in Europe saw several pushes towards better treatment of those with mental conditions, and it largely meant freeing patients from iron chains, literally and symbolically. In a case of seemingly parallel evolution, both late-eighteenth-century England and France had institutions that released inmates from chains and championed a new "moral treatment," instead. These institutions were England's York Retreat (est. 1796) run by William Tuke, a Quaker, and the Paris hospitals led by Philippe Pinel (Bicêtre was freed from chains in 1797, and Salpêtrière followed in 1800).


Moreover, at the time of the Select Committee's proceedings, King George III was considered to have gone completely "mad," and his son had taken over as Regent after George III was deemed "incurable." With a beloved head-of-state stricken with "madness," and with "moral treatments" gaining steam in multiple places, taken together, these signify a growing distaste in the public for treating those with mental issues as violent criminals. Instead, kindness and gentle treatment were urged.


Kindness could not be said to be part of Haslam's treatments, as his use of harsh interventions - including chains - had been documented himself in his Observations text. During the 1815 proceedings, the Select Committee asked those who were familiar with asylums around the country about a hospital's use of chains or restraints, with a discussion about Matthews and Haslam at the top of the hearing. Matthews was a cautionary tale depicting the excesses of restraint.


Richard Staveley, the relative of James Tilly Matthews, documented to the Select Committee that Haslam had a "violent animosity" against Matthews'. According to Staveley, this animosity came from Matthews' disputing the authority of those who sent him there, "or Mr. Haslam's authority to treat him as he did."


Staveley continued,


"Mr. Matthews said to me, that Mr. Haslam said in reply, "you dispute our authority," (with an oath) "Sir, we will soon let you know what our authority is;" and the next day he was leg-locked. (Minutes of evidence taken before the Select Committee on Madhouses, p.14)

The question about Haslam's authority had been at the root of Matthews' family's request to remove him from Bedlam, and why they filed a Habeas Corpus. In reply to this affront, Haslam published Illustrations of Madness, a case study on Matthews. Illustrations of Madness dripped with sarcasm, nearly outright mocking Matthews, calling him an "incurable lunatic." Illustrations of Madness also included statements from other physicians stating that Matthews was "insane." Haslam was so indignant about this affront to his authority that he even took to arguing in public taverns about Matthews, whose case was apparently widely well-known.


Matthews' plea for freedom was denied by the King's Bench. Whether it was the testimony of the disputing physicians or - more likely - the political fact that he had accosted a member of Parliament (the reason for his incarceration at Bedlam), Matthews was not able to be entirely freed. However, Staveley recalls that the King's Bench wanted to know why his family wished him released. "I said we were dissatisfied with his treatment generally, but with his medical treatment particularly," he said. Matthews had developed large lesions on his back from the conditions at Bedlam, and it was agreed that he was in need of a change of location.


The King's Bench granted the request to have Matthews removed from Bedlam, and he was transferred to the home institution of Dr. Samuel Fox in 1813 where he seemed to get better before dying shortly after in January, 1814. Dr. Fox thought that Matthews was sane, and Matthews tended the garden there and continued his drawing before finally succumbing.


Matthews had been so heartened by the public response to his Air Loom drawings that he took classes in drafting, and designed a "new Bedlam." These plates showed wide garden areas that were meant for patient rehabilitation, a far cry from the crowded, dismal galleries of Bedlam at Moorhouse. The ruling committee at Bedlam Hospital granted Matthews' 30£ for his efforts. A move and plan already in the works, Bedlam was moved to St. George's Fields, Lambeth, in 1815.

James Tilly Matthews' plans for the new building for Bedlam. Note the large garden space for patients.

Matthews' death (likely caused by his treatment at Bedlam) loomed large in the Select Committee's proceedings. His case was recounted in the first days of the Select Committee's meetings. Their interest in the use of "metallic manacles" and chains on mentally unwell patients was a particular point made time and again, and they took a dim view of Haslam's use of these restraints, who employed them in such a violent and punitive way.

The actual plans for the new Bedlam building in St. George's Fields, Lambeth.

Following the Select Committee's meetings, Haslam's authority at Bedlam was strippped by its ruling committee and he was removed. Dr. Thomas Monro was also relieved of his post. Haslam tried to go into private medical practice, but never bounced back from his ignominious dismissal. With Matthews a poignant and notable case typifying mistreatment in such facilities, the tide turned in how the mentally ill were cared for as well as how they were viewed by the public. While many medical professionals are given credit to creating reform in mental health institutions, James Tilly Matthews is a rare example of a patient given a voice - especially from the grave - and in so doing, helped to create institutional change.


 

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PRIMARY SOURCES

John Haslam, Illustrations of madness: exhibiting a singular case of insanity and a no less remarkable difference in medical opinion ... with a description of the tortures experienced [by the patient, James Tilly Matthews, in hallucinations] (1810).


John Haslam, Observations on madness and melancholy: including practical remarks on those diseases together with cases : and an account of the morbid appearances on dissection (1809).


House of Commons, First Report: Minutes taken before The Select Committee appointed to consider the provision being made for the better Regulation of Madhouses in England (1815).


Samuel Tuke, Description of the Retreat, an Institution near York for insane persons of the Society of Friends containing an account of its origins and progress, the modes of treatment and a statement of cases (1813).


Information about primary source images:

The Hospital of Bethlem [Bedlam], St. George's Fields, Lambeth: the entrance facade (above), and plans (below), with separate keys to male and female sides, and a scale of feet. Engraving by Roffe after P. Hardwick.


FURTHER READING

Bedlam: The Asylum and Beyond’ is at the Wellcome Collection, London, from 15 September–15 January 2017.


Roy Porter, Madness: A brief history (Oxford, UK: Oxford University Press, 2002).


Andrew Scull, Charlotte MacKenzie, & Nicholas Hervey, Masters of Bedlam: Transformation of the Mad-Doctoring Trade (Princeton: Princeton University Press, 1996).


MUSIC IN AUDIO FILE

The Silent Grove, by Axletree


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