¹ Frank Fish, ‘David Skae, M.D., F.R.C.S.: founder of the Edinburgh School of Psychiatry’, Med. Hist., 1965, 9 (1): 36–53.

² See Allan Beveridge, ‘Thomas Clouston and the Edinburgh School of Psychiatry’, in German E Berrios and Hugh Freeman (eds), 150 years of British psychiatry, 1841–1991, London, Gaskell, 1991, pp. 359–88, on pp. 370–1.

³ See Michael Barfoot (ed.), “To ask the suffrages of the patrons” : Thomas Laycock and the Edinburgh chair of medicine, London, Wellcome Institute for the History of Medicine, 1995, Introduction, pp. 1–52, on pp. 50–1.

⁴ See Andrew Scull, Charlotte MacKenzie and Nicholas Hervey, Masters of Bedlam: the transformation of the mad-doctoring trade, Princeton University Press, 1996, where the Scottish masters include W A F Browne and Alexander Morison but not Skae.

⁵ T S C[louston], ‘David Skae MD’, J. Ment. Sci., 1873–4, 19 (86): 323–4.

⁶ J Crichton Browne, ‘Skae’s classification of mental disease: a critique’, J. Ment. Sci., 1875–6, 21 (95): 339–65; T S Clouston, ‘Skae’s classification of mental disease’, J. Ment. Sci., 1875–6, 21 (96): 532–50; N M, ‘Skae’s classification of mental disease’, J. Psych. Med. Ment. Path., 1876–7, 2 (2): 195–237. See also David Skae, ‘A rational and practical classification of insanity’, J. Ment. Sci., 1863–4, 9 (47): 309–19.

⁷ Four influential reviews that situate the history of the asylum within the wider field are Joseph Melling, ‘Accommodating madness: new research in the social history of insanity and institutions’, in Joseph Melling and Bill Forsythe (eds), Insanity, institutions, and society, 1800–1914: a social history of madness in comparative perspective, London, Routledge, 1999, pp. 1–30; Andrew Scull, ‘Rethinking the history of asylumdom’, in ibid., pp. 295–315; Leonard D Smith, ‘Cure, comfort and safe custody’: public lunatic asylums in early nineteenth-century England, Leicester University Press, 1999, pp. 1–12; Akihito Suzuki, Madness at home: the psychiatrist, the patient, and the family in England, 1820–1860, University of California Press, 2006, pp. 3–9.

⁸ Lothian Health Services Archive, Edinburgh University Library (hereafter LHSA) in GD16/1, David Skae, Lectures on insanity.

⁹ For Skae’s appointment, see LHSA, LHB7/1/2, REA Minutes 1816–49, meeting of managers and Medical Board, 27 Oct. 1846, p. 573. Fish adopts this view. The specialization and professionalization of alienists has also been a major strand of Scull’s work. A relevant example is the treatment of Morison’s early career, including his time in Scotland, found in Scull, et al., op. cit., note 4 above, pp. 123–60.

¹⁰ Irvine Loudon, Medical care and the general practitioner, 1750–1850, Oxford, Clarendon, 1987; Anne Digby, Making a medical living: doctors and patients in the English market for medicine, 1720–1911, Cambridge University Press, 1994. After attending the arts course at St Andrews University (1828–30), Skae obtained the licentiateship (1835) then fellowship (1836) of the Royal College of Surgeons of Edinburgh. There is no record of him attending any University of Edinburgh medical courses.

¹¹ Little is known about Skae’s early general practice partnership with a Dr Davidson. He never became a Fellow of the Royal College of Physicians despite an honorary MD from St Andrews in 1842. For his Lock Hospital work, see David Skae and John Benbow, ‘Memoir on the statistics of the Lock Hospital of Edinburgh from the year 1835 to 1844’, North. J. Med., 1845, 2 (12): 321–39; David Skae, ‘Condyloma, a primary form of venereal disease identical with sibbens’, ibid., 1844, 1 (2): 89–104.

¹² Testimonials in favour of David Skae, MD, FRCSE, [Edinburgh], Paton, 1846. (Copy at LHSA, LHB7/30/1/1.)

¹³ Loudon, op. cit., note 10 above, pp. 112–13, observes that the Scottish market for general medical practice produced much lower incomes than in England. Therefore, public pedagogy, as well as posts, were important ways of developing a remunerative medical practice.

¹⁴ For a discussion of the origins and causes of the testimonial system with respect to Edinburgh, see Barfoot, op. cit., note 3 above, p. 32.

¹⁵ Skae, Testimonials, op. cit., note 12 above, pp. [5]–7, in a covering letter to the Parochial Board dated 20 Mar. 1846.

¹⁶ Testimonials in favour of David Skae … candidate for the appointment of Resident Physician to the Edinburgh Royal Lunatic Asylum, Morningside, [Edinburgh], Paton, 1846. (Copy at LHSA, LHB7/30/1/2.) The vacancy arose due to the resignation on grounds of ill health of Skae’s predecessor Dr William M’Kinnon, who was appointed in 1840.

¹⁷ Ibid., pp. 5–7.

¹⁸ Ibid., p. 7.

¹⁹ For example, see the testimonials of James Y Simpson, professor of medicine and midwifery, William Henderson, professor of medicine and pathology, William Walker, surgeon to the Eye Dispensary and extra-academical lecturer, and John Goodsir, professor of medicine and anatomy, ibid., pp. [9]–10, 10–11, 24, 34.

²⁰ Ibid., p. 7.

²¹ The Medical Board consisted of the presidents of Edinburgh’s two Royal Colleges and three others. At the time of the election Dr James Simpson, president of the Royal College of Surgeons of Edinburgh, Dr William Beilby, president of the Royal College of Physicians, Professor William Pulteney Alison, Dr Andrew Combe and Dr John Macfarlane were its members. Professor Robert Christison was one of two medical men who were ordinary managers of the REA, the other being a Dr John Scott. Dr Alexander Gillespie was the Asylum’s visiting physician.

²² LHSA, LHB7/1/2, REA Minutes, meeting of managers, 31 Aug. 1846, p. 569. M’Kinnon had previously been house surgeon and apothecary to Aberdeen Lunatic Asylum.

²³ Robert Christison, The life of Sir Robert Christison, Bart, edited by his sons, 2 vols, Edinburgh, Blackwood, 1885–6, vol. 1, pp. 165–7.

²⁴ LHSA, LHB7/1/2, REA Minutes, meetings of managers, 31 Aug., 3 and 7 Sept. 1846, pp. 568–72. On Browne, see Scull, et al., op. cit., note 4 above, pp. 84–122; Andrew Scull (ed.), The asylum as utopia: W A F Browne and the mid-nineteenth century consolidation of psychiatry, London, Routledge, 1991, Introduction, pp. vii–lxxvii.

²⁵ LHSA, LHB7/1/2, REA Minutes, meeting of managers, 27 Oct. 1846, p. 573.

²⁶ See, for example, The Scotsman, 11 Nov. 1846, p. 3, where the lack of a proper public election procedure and the hand of the Medical Board in the private decision making were equally condemned.

²⁷ Scull, et al., op. cit., note 4 above, pp. 88–9.

²⁸ LHSA, LHB7/1/2, REA Minutes, letter to managers dated 24 Aug. 1846, read at a meeting on the same day and transcribed therein, pp. 562–5.

²⁹ Andrew Combe, Observations on mental derangement: being an application of the principles of phrenology to the elucidation of the causes, symptoms, nature, and treatment of insanity, Edinburgh, Anderson, 1831.

³⁰ Skae’s belief that insanity was a bodily condition that affected the mind was also related more to his scientific general practice than to specialized medical knowledge shared by alienists as a professional group.

³¹ Skae claimed that fifteen of his former assistants went on to become medical superintendents of asylums. See ‘Physician’s annual report …’, in Annual report of the Royal Edinburgh Asylum for the Insane for the year ending 31st December 1870, Edinburgh, Royal Asylum Press, 1871, pp. [17]–30, on p. 30.

³² For Skae’s first bout of protracted illness soon after he was appointed, see LHSA, LHB7/1/2, REA Minutes, meetings of managers, 26 and 27 Feb. 1847, pp. 581–2. On Skae’s fears for the sanity of his wife, see George S Keith, Plea for a simpler life, London, Black, 1895, pp. 70–1; LHSA, in GD17; Keith to Clouston, 25 Sept. 1895, ibid., tipped-in after title page of LHSA copy. Details of Skae’s bankruptcy can be found in National Archives of Scotland, CS318/19/256, Sederunt book in sequestration of Dr David Skae deceased. (Date of sequestration 14 Nov. 1873.)

³³ William F Bynum, ‘Rationales for therapy in British psychiatry: 1780–1835’, Med. Hist., 1974, 18 (4): 317–34; R J Cooter, ‘Phrenology and British alienists, c.1825–1845’, Med. Hist., 1976, 20 (1–2): 1–21, 135–51; Andrew T Scull, Museums of madness: the social organization of insanity in nineteenth-century England, London, Allen Lane, 1979; idem (ed.), Madhouses, mad-doctors and madmen: the social history of psychiatry in the Victorian era, London, Athlone, 1981; L S Jacyna, ‘Somatic theories of mind and the interests of medicine in Britain, 1850–1879’, Med. Hist., 1982, 26 (3): 233–58. See also Edwin Clarke and L S Jacyna, Nineteenth-century origins of neuroscientific concepts, Berkeley, University of California Press, 1987, pp. 221–5, 238–41.

³⁴ Cooter, op. cit., note 33 above, pp. 147–8; [David Skae], ‘Phrenology’, Brit. Q. Rev., 1846, 4: 397–419. See also Bynum, op. cit., note 33 above, p. 331; Scull, et al., op. cit., note 4 above, pp. 98–9.

³⁵ James Straton, Contributions to the mathematics of phrenology; chiefly intended to aid students, Aberdeen, Russel, 1845; Daniel Noble, The brain and its physiology: a critical disquisition on the methods determining the relations subsisting between the structure and functions of the encephalon, London, Churchill, 1846.

³⁶ Edinburgh University Library microfilm, F/N 96835/38, Royal Medical Society dissertations, David Skae, ‘Are the phenomena of mental alienation consistent with the views regarding the mental faculties adopted by phrenologists?’, vol. 102, 1837–8, pp. 707–72, read to the Society on 9 Mar. 1837.

³⁷ Ibid., pp. 711–12.

³⁸ Ibid., pp. 714–67. Despite his subsequent publications on forensic psychiatry, Skae never considered the possibility that these murderers were mad rather than bad.

³⁹ Skae, op. cit., note 34 above, p. 398.

⁴⁰ Ibid., pp. 417–19.

⁴¹ Ibid., p. 417. Skae referred to himself as “a searcher after truth”. See ‘To the Editor …’, Phren. J., 1847, 20 (92): 273–83, p. 283. For a rejoinder, probably by George Combe, see ‘Remarks on Dr Skae’s letter’, ibid., 283–90. See also the late 1846 exchanges between Skae and Combe concerning this episode: National Library of Scotland, MS 7390, fol. 558, George Combe to David Skae, 30 Nov. 1846; MS 7282, fols 86–7, David Skae to George Combe, 3 Dec. 1846; MS 7390, fol. 571, George Combe to David Skae, 14 Dec. 1846; MS 7282, fols 84–5, David Skae to George Combe, 15 Dec. 1846.

⁴² See L S Jacyna, Philosophic Whigs: medicine, science, and citizenship in Edinburgh, 1789–1848, London, Routledge, 1994.

⁴³ See Anand C Chitnis, The Scottish Enlightenment and early Victorian English society, London, Croom Helm, 1986, pp. 173–7.

⁴⁴ Scull, et al., op. cit., note 4 above, pp. 99–100.

⁴⁵ Ibid., pp. 85–8.

⁴⁶ See Matthew H Kaufman, Edinburgh Phrenological Society: a history, Edinburgh, Henderson Trust, 2005, pp. 65, 93, 101.

⁴⁷ Although he advocated phrenology, Browne had been critical of the REA’s failure to appoint a resident physician before 1839. See W A F B[rowne], ‘Annual reports of the Glasgow, Hanwell, Dundee, Wakefield, Armagh, Belfast, York, Montrose, Perth, Aberdeen, Edinburgh, and Dumfries Lunatic Asylums, for 1840’, Phren. J., 1841, 14 (67): 159–65, p. 165.

⁴⁸ Skae, op. cit., note 6 above, p. 309.

⁴⁹ For the REA, see Allan Beveridge, ‘Madness in Victorian Edinburgh: a study of patients admitted to the Royal Edinburgh Asylum under Thomas Clouston, 1873–1908’, Hist. Psych., 1995, 6 (21–22): 21–54, 133–56, especially pp. 38–42. For the REA in comparison with three other Scottish asylums, see Gayle Davis, ‘The cruel madness of love’: sex, syphilis and psychiatry in Scotland, 1880–1930, Amsterdam, Rodopi, 2008. For England (Devon) see, for example, Joseph Melling and Bill Forsythe, The politics of madness: the state, insanity and society in England, 1845–1914, Routledge, New York, 2006, pp. 61–5. For strengths and weaknesses of this approach generally, see Gayle Davis, ‘Some historical uses of clinical psychiatric records’, Scot. Arch., 2005, 11: 26–36.

⁵⁰ David Skae, ‘Physician’s report for 1846 …’, in Annual report of the Royal Lunatic Asylum for the year 1846, Edinburgh, Royal Asylum Press, 1847, pp. [9]–17, on p. [9]. He also kept his own case summaries for a brief period. See LHSA, LHB7/50/1–2, Physician’s record, 2 vols, 1849–51.

⁵¹ David Skae, ‘The Morisonian lectures on insanity for 1873 … edited by T S Clouston MD’, J. Ment. Sci., 1873–4, 19 (87): 340–55, pp. 343–4. The final three of six lectures in total were entirely Clouston’s.

⁵² For a discussion, see Hilary Marland, Dangerous motherhood: insanity and childbirth in Victorian Britain, Basingstoke, Palgrave Macmillan, 2004, pp. 95–134.

⁵³ David Skae, ‘Clinical lectures on insanity in the Royal Edinburgh Asylum … (Delivered 7th May 1853)’, M. J. Med. Sci., 1853, 16: 558–67, p. 559.

⁵⁴ Ibid., p. 560. Skae also acknowledged that the post-mortem pathological examination of asylum patients was an important aspect of their final diagnosis. Yet in keeping with alienist contemporaries, he acknowledged there were many difficulties associated with it. He seems to have moved away from the often fruitless search for brain lesions towards a more quantitative approach. See his ‘Of the weight and specific gravity of the brain in the insane’, M. J. Med. Sci., 1854, 19: 289–300.

⁵⁵ David Skae, ‘The legal relations of insanity’, Edin. Med. J., 1860–1, 6: 867–90, p. 870.

⁵⁶ For a comment on the divide between social and clinical historians, see Andrew Scull, ‘Rethinking the history of asylumdom’, in Melling and Forsythe (eds), op. cit., note 7 above, pp. 295–315, on p. 296. For a brief discussion of treatment at the REA in the Clouston era, see Beveridge, op. cit., note 49 above, pp. 144–5.

⁵⁷ See John Harley Warner, ‘Therapeutic explanation and the Edinburgh bloodletting controversy: two perspectives on the medical meaning of science in the mid-nineteenth century’, Med. Hist., 1980, 24 (3): 241–58, pp. 242–4. For a more contemporary, but not altogether consistent, British physician’s perspective, see Keith, op. cit., note 32 above, pp. vi–vii, 4–6, 8–9.

⁵⁸ See David Skae, ‘Physician’s annual report …’, in Annual report of the Royal Edinburgh Asylum for 1848, Morningside, Royal Asylum Press, 1849, pp. [13]–34, on p. 30, where Skae concluded that, apart from its use in one or two cases of delirium tremens, chloroform had no curative role within asylum practice.

⁵⁹ Skae, op. cit., note 8 above, Acute mania, treatment, 3 June 1854?, p. 2. Dates of Skae’s lectures should be treated with caution as it can be difficult to distinguish between composition and delivery.

⁶⁰ Ibid., p. 27.

⁶¹ Ibid., p. 21.

⁶² Discussion of Skae’s approach to moral treatment is resumed in the next section.

⁶³ Michel Foucault, The birth of the clinic: an archaeology of medical perception, first published in 1963, transl. by A M Sheridan in 1973, London, Routledge, 1991, pp. 3–21.

⁶⁴ Charles E Rosenberg, ‘Framing disease: illness, society and history’, in Charles E Rosenberg and Janet Golden (eds), Framing disease: studies in cultural history, Rutgers University Press, 1992, Introduction, pp. xiii–xxvi.

⁶⁵ Jan Goldstein, Console and classify: the French psychiatric profession in the nineteenth century, Cambridge University Press, 1987, p. 5.

⁶⁶ German E Berrios, ‘Classifications in psychiatry: a conceptual history’, Aus. N. Z. J. Psych., 1999, 33 (2): 145–60.

⁶⁷ Ibid., pp. 152–4.

⁶⁸ For recent examples of each see, Melling and Forsythe, op. cit., note 49 above, pp. 61–5; Leonard Smith, Lunatic hospitals in Georgian England, 1750–1830, London, Routledge, 2007, pp. 138–41.

⁶⁹ Skae, op. cit., note 6 above, p. 312.

⁷⁰ Skae, op. cit., note 55 above, p. 881.

⁷¹ Ibid., p. 868.

⁷² Ibid., p. 870.

⁷³ Ibid., p. 881 (italics in original).

⁷⁴ Skae, op. cit., note 6 above, p. 312.

⁷⁵ [David Skae], ‘Of the classification of the various forms of insanity’: an address delivered at the Royal College of Physicians, London, at the Annual Meeting of the Association of Medical Officers of Asylums on 9th July 1863, p. 15. (Copy at LHSA, LHB7/14/2/1.) All subsequent page references are to the Journal of Mental Science version.

⁷⁶ Skae, op. cit., note 6 above, p. 311.

⁷⁷ Skae, op. cit., note 51 above, p. 348.

⁷⁸ For example, “General Paralysis, with Insanity”, “General Paralysis of the Insane”; “Climacteric Mania”, “Mania of the Critical Period (Climacteric Mania)”, and “Climacteric Insanity”.

⁷⁹ David Skae, ‘Contributions to the natural history of general paralysis’, Edin. Med. J., 1859–60, 5: 885–905. For a discussion, see Davis, ‘The cruel madness of love’, op. cit., note 49 above, pp. 85–6.

⁸⁰ See T S Clouston, ‘Illustrations of phthisical insanity’, J. Ment. Sci., 1864–5, 10 (49): 220–9; Francis Skae, ‘Climacteric insanity’, Edin. Med. J., 1865, 10: 703–16; J B Tuke, ‘On the statistics of puerperal insanity as observed in the Royal Edinburgh Asylum, Morningside’, ibid., pp. 1013–28; idem, ‘Cases illustrative of the insanity of pregnancy, puerperal mania, and insanity of lactation’, Edin. Med. J., 1867, 12 (2): 1083–101. For a sophisticated interpretation of puerperal insanity cases at the REA featuring Skae and Tuke, see Marland, op. cit., note 52 above, pp. 210–13.

⁸¹ Prior to then, Skae seems to have used the traditional mental symptom-based approach to classification exemplified by Pinel and Esquirol and used data gathered for him in the late 1840s and early 1850s by REA assistant physicians such as Drs Wingett, Grahamsley and Sherlock. This approach is also evident elsewhere. See [David Skae], ‘Mental diseases’, in The encyclopaedia Britannica, 8th ed., Edinburgh, Black, 1857, vol. xiv (MAG-MIH), pp. 526–39.

⁸² Skae, op. cit., note 8 above, Definitions [and] Classifications, May 1864?; Resumé of Mania Monomania and Dementia, n.d. [c.1866?].

⁸³ ‘Report of a meeting of members of the Medico-Psychological Association, held at Glasgow, April 27th, 1870’, J. Ment. Sci., 1870–1, 16 (74): 295–306, pp. 303–6; ‘Medico-Psychological Association’, J. Ment. Sci., 1871–2, 17 (80): 613–19, pp. 613–16 (quarterly meeting at Edinburgh, 30 Nov. 1871). For the critical response to his Morison Lectures, see note 6 above.

⁸⁴ Skae, op. cit., note 6 above, p. 313.

⁸⁵ Ibid.

⁸⁶ Ibid., p. 311, for the second part of the quotation. Skae referred to recent nosological publications by Laycock and W H O Sankey as examples.

⁸⁷ Ibid., p. 313.

⁸⁸ Ibid., p. 314.

⁸⁹ Ibid., pp. 313; for respective uses of these terms, see p. 314.

⁹⁰ Ibid., p. 314.

⁹¹ Ibid., p. 318.

⁹² Ibid., pp. 313–14.

⁹³ See Fish, op. cit., note 1 above, pp. 38–9; Beveridge, op. cit., note 49 above, pp. 133–4; William F Bynum, ‘Tuke’s Dictionary and psychiatry at the turn of the century’, in Berrios and Freeman (eds), op. cit., note 2 above, pp. 163–79, on p. 172; Michael J Clarke, ‘The rejection of psychological approaches to mental disorder in late nineteenth-century British psychiatry’, in Scull (ed.), op. cit., note 33 above, pp. 271–312, pp. 302–3 (note 3). Skae actually rejected views expressed by his fellow alienists that were similar to these historical judgements. For example, see Skae (1871–2), op. cit., note 83 above, p. 615: “ … in my classification, the name may suggest that the form is designated from its cause alone, but it is not so.” See also ‘Report of the Committee … [on] … the uniform recording of cases … [and] mental treatment of insanity …’, J. Ment. Sci., 1870–1, 16 (74): 223–9, p. 224, where Skae’s approach is described as “depending on the bodily causes and natural history of the disease”. Skae was a member of the Committee but this does not necessarily mean he approved of this description either.

⁹⁴ In this respect, Skae’s private consultations with Edinburgh and other general practitioners outside the asylum walls—about which next to nothing is known—gave him added opportunities to reflect upon how the classification of insanity was accomplished upon a practical basis.

⁹⁵ On the historiography of nineteenth-century moral therapy and non-restraint, see Smith, op. cit., note 7 above, pp. 2–8.

⁹⁶ Asylum annual reports provide most of the material for recent historical discussions of management. Like many others, Skae’s tend to dwell upon specific examples and responses to particular events rather than the fundamental principles underlying asylum organization found in the lectures.

⁹⁷ Skae, op. cit., note 8 above, Moral Treatment, 12 July 1861?, p. [1].

⁹⁸ Ibid., pp. 2–3. It is unclear how Skae acquired his physiological knowledge, but see Royal College of Physicians of Edinburgh, Lectures on Physiology by Dr Fletcher 1833–4, taken down by David Skae.

⁹⁹ Skae, op. cit., note 8 above, Moral Treatment, p. 3.

¹⁰⁰ Ibid., p. 4. Skae associated the term “distraction” with Joseph Guislain.

¹⁰¹ Ibid., pp. 14–15.

¹⁰² Harvard University, Houghton Library (hereafter HL), in bMS Am 1838 (589), David Skae to Dorothea Lynde Dix, 30 July 1855. On the Scottish part of her 1854–6 European tour, see Thomas J Brown, Dorothea Dix: New England reformer, Harvard University Press, 1998, pp. 219–23.

¹⁰³ See LHSA, LHB7/1/2, REA Minutes, meetings of managers, 13 Feb. to 18 May 1849, pp. 617–23.

¹⁰⁴ The Scotsman, 30 May 1849, p. 2. There were 28 candidates and Skae was eventually defeated by four votes in the last ballot.

¹⁰⁵ See David Skae, Application for commissionership and letters …, Edinburgh, Constable, 1857.

¹⁰⁶ Ibid., pp. 3–4.

¹⁰⁷ Ibid., p. 13, by Dr T T Wingett, one of Skae’s early assistants, who subsequently became physician to Dundee Royal Asylum.

¹⁰⁸ Ibid., p. 11.

¹⁰⁹ HL, in bMS Am 1838 (89), W A F Browne to Dorothea Lynde Dix, 10 April 1855.

¹¹⁰ 55 Geo. III c. 69. For a discussion, see Michael Barfoot, ‘The 1815 Act to Regulate Madhouses in Scotland: a reinterpretation’, Med. Hist., 2009, 53 (1): 57–76.

¹¹¹ On the significance of this episode in Browne’s life, see Scull, et al., op. cit., note 4 above, pp. 119–20. See also, An Act for the Regulation of the Care and Treatment of Lunatics, and for the Provision, Maintenance, and Regulation of Lunatic Asylums in Scotland 1857, 20 & 21 Vict. c. 60.

¹¹² HL, in bMS Am 1838 (589), David Skae to Dorothea Dix, 15 Feb. 1855. In private Skae identified Browne as obstructive: “He dislikes a Commission—or commissioners.” See also ibid., Skae to Dix, 29 April 1855, in which Skae reported seeing Browne in person but was unable to bring him round to Dix’s cause: “If Browne had been put on the Commission it would have silenced his opposition I expect. He does not relish the idea of Coxe being placed over him I think.” James Cox was a nephew of George Combe. He and Browne were both active in the Edinburgh Phrenological Society during the 1830s.

¹¹³ HL, in bMS Am 1838 (589), David Skae to Dorothea Dix, 15 Feb. 1855.

¹¹⁴ See Appendix to the Report by Her Majesty’s Commissioners appointed to inquire into the state of lunatic asylums in Scotland…, Edinburgh, Constable for HMSO, 1857, pp. 419–37. Skae was examined on 21 Nov. 1855 and he submitted additional comments by letter a day later. For data about the REA, see ibid., pp. 57–68.

¹¹⁵ HL, in bMS Am 1838 (589), David Skae to Dorothea Dix, 7 July 1858.

¹¹⁶ T S Clouston, The hygiene of mind, London, Methuen, 1906. See also Daniel Pick, Faces of degeneration: a European disorder c.1848–c.1918, Cambridge University Press, 1989; Davis, ‘The cruel madness of love’, op. cit., note 49 above, pp. 207–11.

¹¹⁷ See Leon Stephen Jacyna, ‘Scientific naturalism in Victorian Britain: an essay in the social history of ideas’, PhD thesis, University of Edinburgh, 1980. Roger Smith, Trial by medicine: insanity and responsibility in Victorian trials, Edinburgh University Press, 1981, pp. 9–10, notes the importance of scientific naturalism to alienist polemics but not to their practice.

¹¹⁸ There were significant delays in erecting pauper asylums in south-east Scotland, however. The Midlothian and Peebles District Asylum at Rosslynlee opened in 1874, followed by Bangour Village Hospital in 1907.

¹¹⁹ For a discussion of the impact of Poor Law changes upon a specific asylum, see Jonathan Andrews, ‘Raising the tone of asylumdom: maintaining and expelling pauper lunatics at the Glasgow Royal Asylum in the nineteenth century’, in Melling and Forsythe (eds), op. cit., note 7 above, pp. 200–22. For the wider debate about Scottish asylum provision as a whole, see the exchanges between Andrews and Scull in this volume, pp. 200–2, 305–9 respectively. See also R A Houston, ‘Poor relief and the dangerous and criminal insane in Scotland, c. 1740–1840’, J. Soc. Hist., 2006, 40 (2): 453–76.

¹²⁰ See note 80 above.

¹²¹ Skae, op. cit., note 6 above, p. 311.

¹²² See T S Clouston, ‘Modern medico-psychology and psychiatry: the clinical classification of the insanities’, The Hospital, May 11 1895, p. 91, in which Skae’s classification was described as “eminently British in character, not being strictly logical and consistent, or altogether scientific, yet most practical and helpful to the practitioner of medicine”.

¹²³ Berrios, op. cit., note 66 above, p. 151.

¹²⁴ Skae, op. cit., note 6 above, p. 312.