What do you give a brand new knight?

by Dr Claire Hilton, Honorary Archivist at the Royal College of Psychiatrists.

A handwritten, postcard-size note was found loose among the generous donation of books to the RCPsych from Professor Sir David Goldberg's (1934-2024) personal library. The card, dated 1996, was from Professor Alwyn Lishman (1931-2021) of Organic Psychiatry fame, to David Goldberg, congratulating him on his knighthood. It says: ‘It is difficult to know what to give a brand new Knight.'

Given where the card was found, and the Sellotape marks, the gift was perhaps a book, although the card may have been attached to wrapping paper. Sellotape is our librarian Fiona Watson's pet hate: it degrades quickly, flaking off and leaving dried glue behind. Unless the marks can be matched up with those in or on a book we may never know what Alwyn chose to give to David. It must have been rather special though: professor of psychiatry Sir Denis Hill (1913-82) had owned it, and his widow Laura gave it to Alwyn, who passed it to David.

Alwyn also wrote: ‘As you will know, Mott was primarily responsible for the idea of the Maudsley', suggesting that the gift which accompanied the card related to Sir Frederick Mott (1853-1926), Henry Maudsley (1835-1918) and/or the foundation of the Maudsley Hospital. David may have known, but many people remain less clear about the story. As Trevor Turner, psychiatrist and historian wrote: ‘the facts are fixed in legend'.

In contrast to Alwyn Lishman's statement, the South London and Maudsley NHS Foundation Trust website, tells us:

“Maudsley Hospital opened in 1923 and was founded by the eminent psychiatrist Henry Maudsley. His vision was for a hospital in an urban centre where mental healthcare, teaching and research came together. Henry Maudsley's original vision lives on today, through our close partnership with the world-leading Institute of Psychiatry, Psychology and Neuroscience at Kings College London.”

A website statement needs to be concise, but it also needs to be accurate. This website version seems to replicate legend over fact.

With the touching content of Alwyn's message to his colleague, plus his comment about Sir Frederick Mott and Dr Henry Maudsley, we decided to display the card in the Cabinet of Curiosities, and to offer some sort of explanation here.

Image by Dr Claire Hilton and used with her permission.

So, what was the story of Frederick Mott, Henry Maudsley and the eponymous hospital?

Frederick Mott was a psychiatrist, neurologist, pathologist and scientist. He was director of the London County Council (LCC) asylums' Central Pathological Laboratory, at Claybury, Essex. In 1907, inspired by a visit to Emil Kraepelin's psychiatric clinic in Munich where mental healthcare, teaching and research were brought together, Mott argued the need for a similar institution in the UK (Archives of Neurology from the Pathological Laboratory of the London County Asylums 1907, 3: v-vii). Years later, Mott recalled:

“Shortly after this was published Dr Maudsley called upon me but I was out, and he wrote me a letter saying that he would give £30,000 to the London County Council if they would build a hospital in London for the study and treatment of acute mental disorders.”

Patricia Alderidge, when archivist at the Bethlem Royal Hospital, speculated on the sequence of events:

“Whether [Mott's] article arrived on Maudsley's breakfast table in March 1907 like a bolt from the blue, or whether it might even have been a piece of subtle coat-trailing for a scheme which they were already working out together, there is no doubt that they made common cause from that time on.”

Alderidge described the proposal which Mott presented to the LCC Asylums Committee in July 1907, as ‘clearly the product of careful collusion.' Mott took the lead in the planning and drawn-out negotiations with the LCC; and Maudsley, wealthy from private practice and childless, wrote to his American colleague Dr Vernon Briggs: ‘it is to be called “The Maudsley Hospital”, and I have secured my place among those who try to perpetuate themselves.'

The Maudsley opened its doors during the First World War, as a military hospital treating mentally traumatised casualties. It finally opened to civilian patients in 1923. Dr Edward Mapother was the Medical Superintendent at that time. He and Mott took the 'opportunity to modify the benefactor's blueprint', suggesting that plans needed adjusting, either from their inception and/or in the light of new learning.

Mott seemed to understand Maudsley's desire for recognition, and gave Maudsley much credit for founding the eponymous hospital. This overshadowed Mott's own role. One obituary of Mott noted that he had ‘promoted the founding of the Maudsley Hospital' but it listed his pathological research studies as his main achievements. Another obituary, in the Lancet, was similarly vague about his role in founding the institution.

Collaboration or collusion?

Neither the precise story of the foundation of the Maudsley Hospital, nor the details of the gift Alwyn Lishman gave to David Goldberg in 1996, may ever be clear. Founding the Maudsley Hospital required collaboration and/or collusion between Mott and Maudsley: Maudsley, happy to donate money to the cause and wanting to secure a memorial for himself; and Mott, the scientist, negotiator and pragmatist.

Eponyms in medicine are unfashionable, and the Maudsley story points to some of the reasons why: myths, legends, suppositions and potential for inaccuracies abound, and money can weigh-in more than other factors.

Further reading

Patricia Alderidge, The foundation of the Maudsley Hospital, 79–88. In: 150 Years of British Psychiatry 1841–1991 (eds. German Berrios and Hugh Freeman) Gaskell, 1991 (book available in RCPsych library)

Acknowledgement: I am grateful to Fiona Watson for her comments.