96
adequately met in completely open conditions. They are now an urgent necessity since, by default, these patients are sent inappropriately to prisons and the special hospitals, thus adding to the pressures on these institutions. Bennett32 has consistently warned against the wholesale acceptance of the open-door policy in mental hospitals, arguing that freedom of choice usually means the freedom to dispose of undesirable patients so that staff with most skill and training can concentrate on treating those who are least disabled. The urgent need for secure regional units is shown by the fall of nearly 40% in the number of closed beds in one region over the past five years. But a regional policy is also needed because the proposed secure units can improve matters only if they enable psychiatric units and mental hospitals to take on again these "objecting and objectionable"33 patients by facilitating their management outside a secure setting. I am grateful to Professor T C N Gibbens who supervised this work; the study was supported by a grant from the DHSS. Dr John Gunn and Dr Douglas Bennett have both provided valuable criticism and advice.
References Webster, D (1834), quoted by Szasz, T D, Law, Liberty and Psychiatry; An Inquiry into the Social uses of Mental Health Practices. London, Routledge and Kegan Paul, 1974. 2 Stern, E S, Lancet, 1957, 1, 577. 3Mandlebrote, B, Mental Hygiene, 1958, 42, 3. 4Bell, G M, British Medical7Journal, 1962, 1, 462.
BRITISH MEDICAL JOURNAL
11 OCTOBER 1975
Folkard, S, Mental Hygiene, 1960, 44, 155. Jones, K, History of the Mental Health Services, London, Routledge and Kegan Paul, 1972. 7Ministry of Health, Planning of Hospital Services for the Mentally Ill, HM(61)25. London, Ministry of Health, 1961. 8 Bransby, E R, Health Trends, 1974, 6, 56. 9 Penrose, L S, American Journal of Mental Deficiency, 1943, 47, 462. 10 Rollin, H R, British Medical journal, 1963, 1, 786. 1 Rollin, H R, Proceedings of the Royal Society of Medicine, 1966, 59, 701. 12 Lancet, 1968, 1, 463. 13 Lancet, 1971, 2, 1360. 14 Street, D R K, British Medical_Journal, 1962, 1, 462. 15 Smith, S, and Gibb, G M, Lancet, 1969, 2, 893. 16 Wing, J K, Psychological Medicine, 1971, 1, 188. 17 Crawford Little, J, Psychiatry in a General Hospital. London, Butterworth, 1974. 18 The Times, 25 Jan 1967, p 13. 9 Home Office, Report on the Work of the Prison Department, 1963, 1966, 1970,1972,1973. London, HMSO, 1964-74. 20 Brandon, D, Decline and Fall of the Common Lodging-House. London, Christian Action Publications, 1972. 21 National Assistance Board, Homeless Single People. London, HMSO, 1966. 22 Beresford, P, New Society, 1973, 25, 212. 23 Beacock, N, Social Services Quarterly, 1973, 47, 15. 24 Edwards, G, Williamson, V, and Hensman, C, Lancet, 1966, 1, 249. 25 Edwards, G, et al, British3Journal of Psychiatry, 1968, 114, 1031. 26 Lodge Patch, I C, British Journal of Psychiatry, 1971, 118, 313. 27 Ministry of Health, Special Hospitals Report of a Working Party. London, HMSO, 1961. 28 British Medical Journal, 1970, 3, 537. 29 Department of Health and Social Security, Revised Report of the Working Party on Security in NHS Psychiatric Hospitals. London, DHSS, 1974. 30 Home Office and Department of Health and Social Security, Committee on Mentally Abnormal Offenders. Interim Report. London, HMSO, 1974. 31 Scott, P D, British Medical_Journal, 1974, 4, 640. 32 Bennett, D, Commnunity Health, 1973, 5, 58. 33 Mapother, E, Journal of the Royal Sanitary Institute, 1929, 3, 165. 5
6
Outside Medicine Edward Tyson CHARLES NEWMAN British Medical3Journal, 1975, 4, 96-97
Great discoveries in science have usually been made by one man: standing, no doubt, on the shoulders of his predecessors, but for all that making the intellectual leap by himself. Great popular movements, on the other hand, usually result from the coalescence of several original notions, produced by several people. Each of these may involve an intellectual leap, but any one might have been ineffective without the co-operation of the others. In the first half of the eighteenth century western thought underwent a considerable revolution, the adoption of the naturalist theory, attempting to base society on "natural (primitive) man, natural religion, natural law, natural rights, natural economic laws."' This was a development from the mathematical, physical systems of the preceding century, which had culminated in Newton; it took the form of a search for an organic system, to replace the mechanical system of Newton, a man whom they might attempt to transcend, but whose greatness they both acknowledged and imitated. Royal College of Physicians of London, London NW1 CHARLES NEWMAN, MD, FRCP, harveian librarian
Noble Savage One of the foundations on which the new attitude was based was the concept of "the noble savage," the natural man, unspoiled by misguiding civilization. But in the path to this ideal stood what they knew of "natural man," the pygmies, satyrs, dogfaced men, wild men, men of the woods, orang-outangs, and similar creatures reported by the ancients and found by more or Jess credible travellers. They were even vouched for by St. Jerome, who described a long conversation between St. Anthony and one of them.2 They seemed to be men, and they were in a state of nature, but so far from being noble, they were very ignoble indeed. Some could be explained away as defective specimens of men, already spoiled by civilization, who had deserted it. In less organized societies it was not uncommon for the mentally abnormal to escape to the maquis, rather than risk imprisonment in asylums; there are tramps of that kind today; there were boys who had been abandoned or thrown out: the Wild Boy of Aveyron, Peter the Wild Boy of Hanover,3 the later Kaspar Hauser. Some of these were genuine, even if some were frauds. They did not affect the theory of the "noble savage." The rest were accepted as being degenerate men, who had fallen from the perfection of man in the Golden Age, and the inference would have been that the state of nature had not prevented their becoming ignoble. And so they stood in the way of any idealiza-
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11 OCTOBER 1975
97
College of Physicians by his great-nephew in 1764. He looks a stubborn and intransigent man.
Edward Tyson, F.R.C.P., F.R.S. (Reproduced by courtesy of the Royal College of Physicians.)
tion. Monkeys were a matter of opinion: some seemed to be degenerate men, the baboons were presumably the "'dog--faced men. Others, especially if they were small enough, were animals, apes, when they were seen, which was seldom, were accepted as being wild men" Career It was Edward Tyson who settled the matter. He was bom in 1650 at Clevedon near Bristol, though he came of a Cumberland family. He was educated at Magdalen, Oxford, though he took a Cambridge M.D. from Benet College in 1673. He took up practice in London as a physician, became a Fellow of the Royal College in 1683, and was physician to Bethlehem Hospital and lecturer on anatomy at the Barber-Surgeons Hall. He was later made a Fellow of the Royal Society. He was not one of the men who felt that they had been overlooked, and were foisted on the College by the new Charter of James II: he had been elected in the ordinary way. That was not the explanation of his troubles: he was just a difficult man, with a chip on his shoulder, always against the government, though he does not seem to have been actuated by any principle. He reported to the College that the Apothecaries, in 1694, were seeking an Act of Parliament which would have been detrimental to the College. The two bodies had been trying to co-operate in the College's plan for a Dispensary for the Sick Poor, with varying success, because the Apothecaries were at bottom averse from the plan; but, having alerted the College, Tyson changed sides, and supported the Apothecaries. Later, when College secrets started to leak, and the Fellows were asked to bind themselves not to divulge them, Tyson refused to sign. He also sided with the Apothecaries in trying to restrict the use of the dispensary to those under the Poor Law, not to those reconunended as poor by a responsible person. He was satirized for this in Garth's Dispensary under the name of Carus, and a very unflattering portrait it is. He made further trouble over wanting free use of the Annals, the official minutes of the College proceedings, on which question the College voted unanimously against him. He was, however, a considerable scholar and book collector, he published a Philosophical Essay on the Rhymes of the Ancients. The Barber-Surgeons had more respect for him (and perhaps he for them), and they had his portrait painted for their Hall. They sold it for ten guineas to a relative of his in 1746, and it was presented to the
Comparative Anatomist The importance of Tyson was that he was the first of the modern comparative anatomists. Many before him had dissected animals, but for other reasons, not to compare one with the other. His work was both general and particular: he dissected an opossum, a lion, and an ostrich; and published monographs on the anatomy of the porpoise, the rattlesnake and the tapeworm and the roundworm (it was he, incidentally, who first demonstrated that the hydatid cyst was caused by an animal, and was not a form of tumourous growth). In 1699 he published Orang-Outang, sive Homo Sylvestris. Or, the anatomy of a Pygmie compared with that of a Monkey, an Ape, and a Man. To which is added, A Philosophical Essay concerning the Pygmies, the Cynocephali, the Satyrs, and the Sphynges of the ancients. Wherein it will appear that they are all either Apes or Monkeys, and not Men, as formerly pretended. The book does just what its title describes, and leaves no doubt that all these creatures were animals, not men. The specimen he dissected was not an orang-outang, but an infant chimpanzee from Africa, which, because it was an infant, had a brain a good deal larger, proportionately to its size, than it would have had if it had been an adult, and so Tyson missed one of the things which most clearly differentiate apes from men. The accident that he was dissecting a young specimen saved him from having to face the heresy that quantitative changes in matter might produce qualitative differences in function, which would, in 1700, have led to theological antagonism. He found 48 respects in which the chimpanzee resembled men more than monkeys, and 34 the other way round. In this way he established a new family of anthropoid apes, standing between the monkeys and man. He stressed the importance of the nobler faculties, speech, and so on, and regarded the ape as the connecting link between the animal and the rational "just as Your Lordship [Lord Chancellor Sommers] and those of your High Rank and Order for Knowledge and Wisdom, approaching nearest to that kind of being which is next above us [the Angels], connect the Visible and Invisible world."4 The Philosophical Essay demonstrated by argument that the half-humans of Aristotle and the ancients were also animals.
Towards the French Revolution So he cleared the way for his successors in the next couple of generations to add the "natural man," the noble savage, to their philosophy of the natural law, the natural religion and so on, the doctrine which added the organic to the structure of the universe, and led to the Romantic Revolution and ultimately to the French Revolution and the century of bourgeois ideals which followed it. To have laid one stone, and certainly a comer-stone, to such an edifice was an achievement of which any doctor could be proud. It was these same arguments, used to stress similarities rather than differences, which were used in 1860 to suggest the family relationship between man and the apes. Tyson, who was orthodox, would have disapproved: he might even have followed Professor Owen in his misuse of science in denying the existence of the hippocampus minor in the brains of apes, so as to prove that apes could not possibly be related to man. But Tyson also disapproved of officialdom: he would probably have joined Darwin and the rebels. References 1
Haber, F. C., The Age of the World, p. 100. Baltimore, 1959. Hieronymus, Opera Omnia, Tom. 1. fol. 108v. Basle, 1516. Greene, J. C., The Death of Adam, pp. 215 and 219. Iowa, 1959. Tyson, E., in Epistle Dedicatory. London, Bennet & Brown, 1699. 6 Carter, J., and Muir, P. H., Printing and the Mind of Man, p. 101. London, Cassell, 1967.
2
3 4
adequately met in completely open conditions. They are now an urgent necessity since, by default, these patients are sent inappropriately to prisons and the special hospitals, thus adding to the pressures on these institutions. Bennett32 has consistently warned against the wholesale acceptance of the open-door policy in mental hospitals, arguing that freedom of choice usually means the freedom to dispose of undesirable patients so that staff with most skill and training can concentrate on treating those who are least disabled. The urgent need for secure regional units is shown by the fall of nearly 40% in the number of closed beds in one region over the past five years. But a regional policy is also needed because the proposed secure units can improve matters only if they enable psychiatric units and mental hospitals to take on again these "objecting and objectionable"33 patients by facilitating their management outside a secure setting. I am grateful to Professor T C N Gibbens who supervised this work; the study was supported by a grant from the DHSS. Dr John Gunn and Dr Douglas Bennett have both provided valuable criticism and advice.
References Webster, D (1834), quoted by Szasz, T D, Law, Liberty and Psychiatry; An Inquiry into the Social uses of Mental Health Practices. London, Routledge and Kegan Paul, 1974. 2 Stern, E S, Lancet, 1957, 1, 577. 3Mandlebrote, B, Mental Hygiene, 1958, 42, 3. 4Bell, G M, British Medical7Journal, 1962, 1, 462.
BRITISH MEDICAL JOURNAL
11 OCTOBER 1975
Folkard, S, Mental Hygiene, 1960, 44, 155. Jones, K, History of the Mental Health Services, London, Routledge and Kegan Paul, 1972. 7Ministry of Health, Planning of Hospital Services for the Mentally Ill, HM(61)25. London, Ministry of Health, 1961. 8 Bransby, E R, Health Trends, 1974, 6, 56. 9 Penrose, L S, American Journal of Mental Deficiency, 1943, 47, 462. 10 Rollin, H R, British Medical journal, 1963, 1, 786. 1 Rollin, H R, Proceedings of the Royal Society of Medicine, 1966, 59, 701. 12 Lancet, 1968, 1, 463. 13 Lancet, 1971, 2, 1360. 14 Street, D R K, British Medical_Journal, 1962, 1, 462. 15 Smith, S, and Gibb, G M, Lancet, 1969, 2, 893. 16 Wing, J K, Psychological Medicine, 1971, 1, 188. 17 Crawford Little, J, Psychiatry in a General Hospital. London, Butterworth, 1974. 18 The Times, 25 Jan 1967, p 13. 9 Home Office, Report on the Work of the Prison Department, 1963, 1966, 1970,1972,1973. London, HMSO, 1964-74. 20 Brandon, D, Decline and Fall of the Common Lodging-House. London, Christian Action Publications, 1972. 21 National Assistance Board, Homeless Single People. London, HMSO, 1966. 22 Beresford, P, New Society, 1973, 25, 212. 23 Beacock, N, Social Services Quarterly, 1973, 47, 15. 24 Edwards, G, Williamson, V, and Hensman, C, Lancet, 1966, 1, 249. 25 Edwards, G, et al, British3Journal of Psychiatry, 1968, 114, 1031. 26 Lodge Patch, I C, British Journal of Psychiatry, 1971, 118, 313. 27 Ministry of Health, Special Hospitals Report of a Working Party. London, HMSO, 1961. 28 British Medical Journal, 1970, 3, 537. 29 Department of Health and Social Security, Revised Report of the Working Party on Security in NHS Psychiatric Hospitals. London, DHSS, 1974. 30 Home Office and Department of Health and Social Security, Committee on Mentally Abnormal Offenders. Interim Report. London, HMSO, 1974. 31 Scott, P D, British Medical_Journal, 1974, 4, 640. 32 Bennett, D, Commnunity Health, 1973, 5, 58. 33 Mapother, E, Journal of the Royal Sanitary Institute, 1929, 3, 165. 5
6
Outside Medicine Edward Tyson CHARLES NEWMAN British Medical3Journal, 1975, 4, 96-97
Great discoveries in science have usually been made by one man: standing, no doubt, on the shoulders of his predecessors, but for all that making the intellectual leap by himself. Great popular movements, on the other hand, usually result from the coalescence of several original notions, produced by several people. Each of these may involve an intellectual leap, but any one might have been ineffective without the co-operation of the others. In the first half of the eighteenth century western thought underwent a considerable revolution, the adoption of the naturalist theory, attempting to base society on "natural (primitive) man, natural religion, natural law, natural rights, natural economic laws."' This was a development from the mathematical, physical systems of the preceding century, which had culminated in Newton; it took the form of a search for an organic system, to replace the mechanical system of Newton, a man whom they might attempt to transcend, but whose greatness they both acknowledged and imitated. Royal College of Physicians of London, London NW1 CHARLES NEWMAN, MD, FRCP, harveian librarian
Noble Savage One of the foundations on which the new attitude was based was the concept of "the noble savage," the natural man, unspoiled by misguiding civilization. But in the path to this ideal stood what they knew of "natural man," the pygmies, satyrs, dogfaced men, wild men, men of the woods, orang-outangs, and similar creatures reported by the ancients and found by more or Jess credible travellers. They were even vouched for by St. Jerome, who described a long conversation between St. Anthony and one of them.2 They seemed to be men, and they were in a state of nature, but so far from being noble, they were very ignoble indeed. Some could be explained away as defective specimens of men, already spoiled by civilization, who had deserted it. In less organized societies it was not uncommon for the mentally abnormal to escape to the maquis, rather than risk imprisonment in asylums; there are tramps of that kind today; there were boys who had been abandoned or thrown out: the Wild Boy of Aveyron, Peter the Wild Boy of Hanover,3 the later Kaspar Hauser. Some of these were genuine, even if some were frauds. They did not affect the theory of the "noble savage." The rest were accepted as being degenerate men, who had fallen from the perfection of man in the Golden Age, and the inference would have been that the state of nature had not prevented their becoming ignoble. And so they stood in the way of any idealiza-
BRITISH MEDICAL JOURNAL
11 OCTOBER 1975
97
College of Physicians by his great-nephew in 1764. He looks a stubborn and intransigent man.
Edward Tyson, F.R.C.P., F.R.S. (Reproduced by courtesy of the Royal College of Physicians.)
tion. Monkeys were a matter of opinion: some seemed to be degenerate men, the baboons were presumably the "'dog--faced men. Others, especially if they were small enough, were animals, apes, when they were seen, which was seldom, were accepted as being wild men" Career It was Edward Tyson who settled the matter. He was bom in 1650 at Clevedon near Bristol, though he came of a Cumberland family. He was educated at Magdalen, Oxford, though he took a Cambridge M.D. from Benet College in 1673. He took up practice in London as a physician, became a Fellow of the Royal College in 1683, and was physician to Bethlehem Hospital and lecturer on anatomy at the Barber-Surgeons Hall. He was later made a Fellow of the Royal Society. He was not one of the men who felt that they had been overlooked, and were foisted on the College by the new Charter of James II: he had been elected in the ordinary way. That was not the explanation of his troubles: he was just a difficult man, with a chip on his shoulder, always against the government, though he does not seem to have been actuated by any principle. He reported to the College that the Apothecaries, in 1694, were seeking an Act of Parliament which would have been detrimental to the College. The two bodies had been trying to co-operate in the College's plan for a Dispensary for the Sick Poor, with varying success, because the Apothecaries were at bottom averse from the plan; but, having alerted the College, Tyson changed sides, and supported the Apothecaries. Later, when College secrets started to leak, and the Fellows were asked to bind themselves not to divulge them, Tyson refused to sign. He also sided with the Apothecaries in trying to restrict the use of the dispensary to those under the Poor Law, not to those reconunended as poor by a responsible person. He was satirized for this in Garth's Dispensary under the name of Carus, and a very unflattering portrait it is. He made further trouble over wanting free use of the Annals, the official minutes of the College proceedings, on which question the College voted unanimously against him. He was, however, a considerable scholar and book collector, he published a Philosophical Essay on the Rhymes of the Ancients. The Barber-Surgeons had more respect for him (and perhaps he for them), and they had his portrait painted for their Hall. They sold it for ten guineas to a relative of his in 1746, and it was presented to the
Comparative Anatomist The importance of Tyson was that he was the first of the modern comparative anatomists. Many before him had dissected animals, but for other reasons, not to compare one with the other. His work was both general and particular: he dissected an opossum, a lion, and an ostrich; and published monographs on the anatomy of the porpoise, the rattlesnake and the tapeworm and the roundworm (it was he, incidentally, who first demonstrated that the hydatid cyst was caused by an animal, and was not a form of tumourous growth). In 1699 he published Orang-Outang, sive Homo Sylvestris. Or, the anatomy of a Pygmie compared with that of a Monkey, an Ape, and a Man. To which is added, A Philosophical Essay concerning the Pygmies, the Cynocephali, the Satyrs, and the Sphynges of the ancients. Wherein it will appear that they are all either Apes or Monkeys, and not Men, as formerly pretended. The book does just what its title describes, and leaves no doubt that all these creatures were animals, not men. The specimen he dissected was not an orang-outang, but an infant chimpanzee from Africa, which, because it was an infant, had a brain a good deal larger, proportionately to its size, than it would have had if it had been an adult, and so Tyson missed one of the things which most clearly differentiate apes from men. The accident that he was dissecting a young specimen saved him from having to face the heresy that quantitative changes in matter might produce qualitative differences in function, which would, in 1700, have led to theological antagonism. He found 48 respects in which the chimpanzee resembled men more than monkeys, and 34 the other way round. In this way he established a new family of anthropoid apes, standing between the monkeys and man. He stressed the importance of the nobler faculties, speech, and so on, and regarded the ape as the connecting link between the animal and the rational "just as Your Lordship [Lord Chancellor Sommers] and those of your High Rank and Order for Knowledge and Wisdom, approaching nearest to that kind of being which is next above us [the Angels], connect the Visible and Invisible world."4 The Philosophical Essay demonstrated by argument that the half-humans of Aristotle and the ancients were also animals.
Towards the French Revolution So he cleared the way for his successors in the next couple of generations to add the "natural man," the noble savage, to their philosophy of the natural law, the natural religion and so on, the doctrine which added the organic to the structure of the universe, and led to the Romantic Revolution and ultimately to the French Revolution and the century of bourgeois ideals which followed it. To have laid one stone, and certainly a comer-stone, to such an edifice was an achievement of which any doctor could be proud. It was these same arguments, used to stress similarities rather than differences, which were used in 1860 to suggest the family relationship between man and the apes. Tyson, who was orthodox, would have disapproved: he might even have followed Professor Owen in his misuse of science in denying the existence of the hippocampus minor in the brains of apes, so as to prove that apes could not possibly be related to man. But Tyson also disapproved of officialdom: he would probably have joined Darwin and the rebels. References 1
Haber, F. C., The Age of the World, p. 100. Baltimore, 1959. Hieronymus, Opera Omnia, Tom. 1. fol. 108v. Basle, 1516. Greene, J. C., The Death of Adam, pp. 215 and 219. Iowa, 1959. Tyson, E., in Epistle Dedicatory. London, Bennet & Brown, 1699. 6 Carter, J., and Muir, P. H., Printing and the Mind of Man, p. 101. London, Cassell, 1967.
2
3 4
