Dr Cotton and the Collegium Insanorum at St Albans

Richard Stern

Dr Nathaniel Cotton (1705-88) is usually remembered for his association with the poets William Cowper and Edward Young, but he was a successful poet in his own right, and a physician who was highly regarded, not least by Cowper himself.  This article will indicate where Cotton might figure, in terms of the treatment of madness and melancholia, as an evangelically minded physician in the middle part of the eighteenth century.  By drawing attention to Cotton’s own writing, in his poetry, fables, letters, sermons, and medical commentary, I will suggest something of the nature of the doctor’s practice, and how it might be regarded as part of earlier and later traditions  This will involve a discussion of Cotton’s Visions in Verse, and other works from the collected edition, Various Pieces in Prose and Verse (1791), with some reference to Cowper’s first-person account of his experience under Cotton’s care in Adelphi and in the letters.  I will begin by briefly recalling the important aspects of Cotton’s relationship with Cowper.

In a letter to Lady Hesketh dated 4 July 1765, Cowper expresses his affinity with the man who ran the ‘Collegium Insanorum’ in St Albans, where Cowper had been treated from December 1763 to June 1765 during a major mental crisis.  Cotton’s qualities as a religious guide are what stand out in Cowper’s description, and are indeed presented as a crucial factor in the poet’s recovery:

I reckon it one instance of the Providence that has attended me throughout this whole event, that instead of being delivered into the hands of one of the London physicians, who were so much nearer that I wonder I was not, I was carried to Doctor Cotton.  I was not only treated by him with the greatest tenderness, while I was ill… but when my reason was restored to me, and I had so much need of a religious friend to converse with… I could hardly have found a fitter person for the purpose…  The Doctor was as ready to administer relief to me in this article likewise, and as well qualified to do it as in that which was more immediately his province.  How many physicians would have thought this an irregular appetite, and a symptom of remaining madness! But if it were so, my friend was as mad as myself, and it is well for me that he was so….1

Set against the very suspiciously regarded ‘London physicians’, such an encomium demonstrates the strength of Cowper’s regard for Dr Cotton, but it is Cotton’s religious temperament rather than his medical expertise that clearly affords him the most satisfaction.  Earlier in the letter, Cowper draws attention to his evangelical conversion, which took place at Cotton’s madhouse, and muses on its peculiar circumstances.  It would be an ‘absurdity’ to ascribe such a thoroughgoing ‘amendment of life and manners, and a reformation of the heart itself, to madness’, Cowper notes, ‘for by so doing, he ascribes a reasonable effect to an unreasonable cause, and a positive effect to a negative.  But when Christianity only is to be sacrificed, he that stabs deepest is always the wisest man’.2  The madness that operates on the site where Christianity stands to be relinquished is both a negative effect and an unreasonable cause, but nevertheless some good emerges from it, and this must in part be due to Cotton’s influence.  One might recall in this ambiguity of effects and causes that Cowper, by his own account in Adelphi, literally makes as if to stab himself, and accordingly, if by inference alone, owed both his spiritual and physical integrity, at this point, to the doctor’s work.  In Adelphi, Cotton’s religiosity is presented as part of a bulwark between Cowper and the very worst effects of his deluded self – most notably as protection against the sin of self-murder that, for Cowper, presaged eternal damnation.

Cotton received a first-rank medical education, having been a pupil of Herman Boerhaave (1688-1738) at Leiden, where he matriculated on 23 September 1729, and graduated MD on 7 August 1730.  Leiden was the leading centre of medical research and training in Europe at the time.  From 1721, Bernhard Siegfried Albinus was the Professor of Anatomy and Surgery, while Boerhaave held three chairs there, from 1718 to 1729, in Medicine, Botany, and Chemistry.  He was the Professor of Medicine for twenty-nine years from 1709 up until his death, and the Professor of Botany from 1709 to 1729.  Boerhaave’s pupils included such substantial figures as Linnaeus and von Haller.  Given the reflections in Cotton’s own work, it is worth emphasizing how widely conceived a discipline medicine was at Leiden, where chemistry and botany were included as part of its theoretical under-pinnings.3  Samuel Johnson’s account of Boerhaave’s life, written a year after the doctor’s death in 1738, celebrates the diversity of his achievements, but emphasizes, above all, his piety.  Boerhaave is lauded not only for his empirical approach to different branches of science, but for his theological pursuits which are regarded as having a central place in his understanding.  According to Johnson, an oration by Boerhaave on ‘attaining to certainty in natural philosophy’ was ‘filled… with piety, and a true sense of the greatness of the Supreme Being’.  So far from accepting abstract speculations or hypotheses, this discourse ‘proved that we are entirely ignorant of the principles of things, and that all the knowledge we have is of such qualities alone as are discoverable by experience, or such as may be deduced from them by mathematical demonstration’.4  Alongside Boerhaave’s interests in botany and pedagogy, I would argue that this interesting blend of piety and empiricism, and a corresponding sense of the smallness of human understanding, is reflected in Cotton’s published work.

Both as poet and physician, there is a studied anonymity around Cotton.  The first sketch of his life, by Robert Anderson in The Poets of Great Britain, Vol. 11 (1795), begins by upbraiding the editor of Cotton’s collected works, Various Pieces in Prose and Verse (1791), for the laxity of its presentation:

Of the family, birth-place, and education of Nathaniel Cotton, there are no written memorials.  A collection of his Various Pieces in Prose and Verse, was printed in 1791; but, by an unpardonable neglect in the editor, without any information concerning his life, family connections, or even the times and places of his birth and death.5

Given that the editor of Various Pieces was Cotton’s son, the Reverend Nathaniel Cotton, these omissions were possibly deliberate.  Cotton’s best known work, Visions in Verse for the Entertainment and Instruction of Younger Minds, was first published anonymously in 1751, and was then reprinted at least twelve times running up to Various Pieces.  This popular and explicitly pedagogical text wears its didacticism relatively lightly, as the authorial figure presents nine quirky visions in relation to important moral themes that range from ‘Slander’ to ‘Death’.  I want to introduce the essential themes of Visions, as a whole, alongside an exploration of Cotton the physician, before later returning to discuss in more detail the particular visions of ‘Health’, and ‘Death’.

The volume opens with ‘An Epistle to the Reader’, in which Cotton modestly and playfully puts across a preference for anonymity, adopting the metre of Gay’s Fables:6

Authors, you know, of greatest fame,
Thro’ modesty suppress their name;
And would you wish me to reveal
What these superior wits conceal?
Forego the search, my curious friend,
And husband time to better end.
All my ambition is, I own,
To profit and to please unknown;
Like streams supply’d from springs below,
Which scatter blessings as they flow.7

Cotton’s take on the modesty of authors may be somewhat generous, but these lines encapsulate the gentle piety of his intentions, and an essential concern that runs throughout his work: how to spend one’s time profitably, which has, here as elsewhere, echoes of the countryside as morally beneficial – how to ‘husband time’?  Judging by Anderson’s sketch, the pious moral sentiment of the poetry is also what may have attracted eighteenth-century readers.  It is recommended by Anderson, who was himself a doctor as well as a literary scholar, more for its moral performance than its technical quality: ‘As piety predominated in his mind, it is diffused over his compositions: Under his direction, poetry may be truly said to be subservient to religious and moral instruction’.8  It might be argued that Cotton’s concern for anonymity is associated with the nature of his work as the proprietor of a madhouse, which was often a veiled undertaking at this time, when mad doctors could be viewed suspiciously.9  However, although it is striking that Cotton rarely touches upon the specifics of his role as a doctor anywhere in his published work, and only indirectly refers to the kind of mental disturbance he must have witnessed in his career, there is no suggestion of anything sinister about the anonymity he maintains.  It seems to come from a genuine evangelical impulse.  What is clear, however, is that piety was diffused over his medical practice just as much as it was through his poetry, and no understanding of either can be separated from it.

The ‘Epistle to the Reader’ captures the essence of Visions in its presentation of a quiet, homely, modest, and independent life in a rural setting.  The reader is reminded of simple joys, but solemnly warned against the corruptions of pleasure and the vanities of society.  Cotton advocates a similar idea of the virtue of a rural retreat to that Cowper later espouses in The Task: ‘I pass the silent rural hour, / No slave to wealth, no tool to power.  / My mansion’s warm, and very neat; / You’d say, a pretty snug retreat’.  In the continuing explication of anonymity, the ‘Epistle’ establishes a stark sense of the limitations of medicine: ‘Now, should the sage [i.e. the doctor] omit his name, / Wou’d not the cure remain the same? / Not but physicians sign their bill, / Or when they cure, or when they kill’.10  In Visions, the notion of a ‘cure’, here attached to physicians, has a wider significance that acknowledges the religious sense of a spiritual charge, as in the office of a curate.  Drawing attention to the garden and its produce, the importance of humility and devotion, the good sense of an independent but removed politics, and of the sufficiency of familial life, the ‘Epistle’ amounts to a short parable of eighteenth-century mental health.  It accords with a comment made by Cotton’s correspondent, the independent dissenting minister, Philip Doddridge, on the importance of a practical religious approach to worldly knowledge: ‘Let me continually endeavour to make all my studies subservient to practical religion and Ministerial usefulness’.11  Cotton pointedly chooses not to make his religious position explicit, placing the responsibility on the reader: ‘Now the religion of your poet – / Does not this little preface show it? / My Visions if you scan with care, / ‘Tis ten to one you’ll find it there’.  In fact, Cotton’s church affiliation remains uncertain, though, like Doddridge, he corresponded with, and was clearly influenced by, the Presbyterian minister Samuel Clark.  The large house which constituted the Collegium Insanorum was on the same St Albans street – Dagnall – as Clark’s Presbyterian church.  In Cotton’s valedictory poem, ‘To the Memory of the Reverend Mr. Samuel Clark’, he writes approvingly that, ‘In his ministerial capacity / He possessed every valuable and happy talent / To rectify the judgment, and improve the heart’.  Leaving aside the riddle of religious position, however, what is important in the ‘Epistle’ is the doing itself, the tilling of the ‘mental soil’, as the poet suggests in the second vision concerning ‘Pleasure’: ‘Now take a simile at hand, / Compare the mental soil to land./ Shall fields be till’d with annual care, / And minds lie fallow ev’ry year?’12  The importance of mental occupation, through a morally and religiously conceived education, is apparent throughout Visions, while time-wasting and idleness are correspondingly reproached.

Where does this concern with mental occupation, and this emphasis on the salutary effects of moral sentiment, over and above the knowledge and resources of medicine, place Cotton as a physician?

Jeremy Schmidt makes a persuasive case that a moral treatment of melancholy, understood within the larger paradigm of madness, was practised long before the much cited example of the York Retreat.13  The Retreat was founded in 1792 by the Society of Friends, under the direction of the tea and coffee merchant, William Tuke, whose grandson, Samuel Tuke, wrote the Description of the Retreat, an institution near York for insane persons of the Society of Friends.  Containing an account of its origin and progress, the modes of treatment, and a statement of cases (1813).  A highly influential institution, the Retreat, unlike Cotton’s private madhouse which commanded substantial fees, was run on a non-profit basis, though it may have had a similar emphasis to the Collegium Insanorum in terms of treatment, where Christianity and the encouragement of occupation and moral discipline was favoured over medical curatives and external, physical coercion.14  However, a human-centred approach by moralists and clergymen, which took in moral-philosophical and religious ideas, is discernible, Schmidt argues, in the early modern world, and is evidenced by such seventeenth-century writers as Robert Burton (1577-1640), Simon Patrick (1626-1707), and Gilbert Burnet (1643-1715), among others: ‘[For instance] Burnet’s ideal clergyman is very involved, not just with the sufferer’s body, but with their beliefs; he treats them as an individual with fears and anxieties which are to be addressed with sensitivity and attention’.15  The figure of Burnet’s ideal clergyman recalls the presentation of Cotton in Adelphi, where, even before his arrival at St Albans in the narrative, Cowper alludes to the ‘well known humanity’ of Cotton.  Indeed, this leads to ‘a sudden ecstasy of joy’ on the part of the author:

I mention this sudden, and extraordinary change because I believe it was affected on purpose to incline me to go willingly to a physician who would treat me with skill and tenderness, who was himself a pious man and able to converse with me on the subject which lay so near my heart…16

Although there is a dearth of evidence from a medical and institutional perspective, it is arguable that Cotton’s practice corresponded to a form of moral treatment, as further references to Cowper’s account, and to Cotton’s own published material, will help to suggest below.  Cotton has, at the very least, a similar moral-philosophical outlook to that of some earlier Physicians of the Soul, with their assertion of the value of air, labour, and the home which they shared with later adherents of moral management.  The idea of the asylum – removal from the city, proximity to nature – often seems implicit in Cotton’s work.  I will return to these points below.

What is perhaps most interesting about Dr Cotton is that he combines a moral understanding of illness, which often involves a pious stoicism in the face of disease and old age, with a deeply rooted scepticism over the contemporary possibilities of medicine.  As he revealingly comments in an extract from a letter to another unnamed doctor, presented in Various Pieces: ‘I have said candle-snuffers, as bearing some allusion to our profession; for you know we trim the wick of life.  Indeed, we sometimes snuff the candle out, and, what is worse, cannot blow it in again when we have done it’.17  Given its connotations of religious hope and faith, the candle is a suggestive metaphor, and the imagery lends an almost farcical sense of impotence and mismanagement to medical endeavours in Cotton’s time.  It is not doctors that keep the light of life aflame – they merely keep off the smoke.18  The clear sense of a hierarchy running down from the mind as soul, to the body, is well conveyed in the Vision on ‘Pleasure’.  Explicitly and patriotically addressed to mothers (‘ye fair mothers of our isle’), Cotton warns against overmuch reliance on the cane or steel rod when disciplining the young, in favour of a concentration on the mind-soul.19  Cotton’s Visions, like Cowper’s Adelphi, which is presented as ‘a history of my heart so far as religion has been its object’,20 adopts an evangelical focus on the heart as a spiritual site for growth or sinful aberration:

Deformity of heart I call
The worst deformity of all.
Your cares to Body are confin’d,
Few fear obliquity of Mind.
Why not adorn the better part?
This is a nobler theme for art.
For what is form, or what is face,
But the soul’s index, or its case?

This passage immediately precedes the simile of ‘the mental soil’ alluded to above.  The ideal types that are to be produced from this moralistic tilling of the mental soil are those who combine the fruits of natural inquiry with reasonable religion.  Cotton claims Francis Bacon, for instance, ‘whose vast capacious plan / Bespoke him angel, more than man!’21  A similar alignment is made by Cotton’s son in the preface to Various Pieces, where the elder Cotton is placed alongside Boyle, Locke, Isaac Newton, and Addison, ‘that being laymen, and having no temporal interests relative to religion, their influence in support of it has been extensive and effectual’.22  In Cotton, any commitment to natural inquiry is framed by a belief in God the creator, and also by a profound realism regarding the state of contemporary medical knowledge.

Observations on a particular kind of Scarlet Fever (1749) candidly describes Cotton’s attempts to manage an outbreak of the disease in St Albans.  Cotton demonstrates a flexible approach based on precise observation and a sensitivity to variable factors of age and symptomatology; the efficacy of traditional treatments such as bleeding, purging, and blistering comes under close scrutiny in Cotton’s ‘careful representation of facts.’23  This epistolary work is addressed to Dr Richard Mead, who, in the same year of 1727, had been appointed physician to George II, and had attended the final illness of Isaac Newton.  Mead was also a collector and patron of the arts, and Cotton was among those who consulted with him about antiquities.24  In his Observations, Cotton is quite transparent about where treatment has failed completely, and where it has only been partially successful.  Opiates were found to neither ‘remove watchfulness’ nor ‘calm the delirium’; as for blistering, ‘oftentimes no good effect accrued hereby to the fever’, though the pulse of the patient ‘was generally raised’, ‘the difficulty of deglutition [swallowing]   somewhat abated’, and the ‘spirits too were improved’;  soreness around the inflammation was ‘alleviated much by solutions of sperma ceti, light oleaginous mixtures, broths, etc.’.  It is noteworthy that Cotton is alive to the shattering effects of the illness upon ‘the nervous system [of the patient]   the dejection of spirits, which had accompanied the disease thro’ all its stages’ and which often continued after the distemper had gone.  The approach adopted to counter this is revealing in that Cotton dismisses ‘nervous medicines’ in favour of ‘air and a restorative diet.’  Most revealing of all, though, is the sceptical tone that characterizes Cotton’s opening and closing remarks.  On the first page of the work, he baldly states, in implied criticism of other physicians as writers, that he will not ‘obtrude upon you any vague conjectures, or precarious hypotheses, relating to the cause of this disease; much less take up your valuable moments in the pursuit of useless, unmeaning quotations from other authors.’  One wonders what texts and authors he had in mind.  ‘We are apt to expect too much from them,’ he notes of medical writers at the end of his commentary.  What counts is the physician’s own judgement, as the collective endeavour of medicine, according to Cotton, is a kind of navigation through uncertain ground:

Rules may be laid down, and Charts exhibited; but when a man hath made himself master of all these, he will often find himself among shelves and quicksands; and must at last have recourse to his own natural sagacity, to extricate himself out of these difficulties.25

As will become clear below, in reference to one of Cotton’s sermons, this ‘natural sagacity’ is understood to be a mind receptive to God.

In this same sceptical vein, the opening of the poem’s vision on ‘Health’ seems calculated to dampen any faith in the professional prestige of medicine.  Singling out ‘thoughtless youths’, the poet begins by confronting them with the fact that a course of vice and folly in their younger years will inevitably entail disease: ‘Poison shall rage in ev’ry vein, – / Nor penitence dilute the stain: / And when each hour shall urge his fate, / Thought, like the doctor, comes too late’.26  The limitations of medicine are rendered starkly apparent shortly afterwards:

How fruitless the physician’s skill,
How vain the penitential pill,
The marble monuments proclaim,
The humbler turf confirms the same!
Prevention is the better cure,
So says the proverb, and ‘tis sure.27

Seen in the context of present-day understanding of mental health, the emphasis on prevention, here, is quite modern, albeit drawn from an old proverb.  But what does the concept of ‘Health’ mean to an eighteenth-century physician like Cotton?  In his Sermon on Ecclesiastes (12: 1-8), Cotton is highly sceptical about contemporary knowledge of the body, as he draws attention to its material operations:

…as the human body is a complicated structure, and as little more than the external parts of the building have been considered at present, let us carry our researches further, and examine what is doing in the more private and retired chambers of this wonderful fabric.

Cotton goes on to discuss the brain and the spinal cord in religio-physical terms, focusing on the debilitating effects of old age in order to encourage increased devotion.  The brain, in particular, is a source of wonder which ought to reaffirm a sense of the ‘all-wise Creator [who] hath securely lodged it in a strong citadel of bone, which, from its circular cavity, and the inestimable value of its treasures, may with propriety be styled the golden bowl’.28  The sermon ends by describing the return of the spirit to God after the physical mechanism of the body has broken down.  Health is, then, a primarily religious and moralistic concept for Cotton, albeit one which acknowledges harsh physical and material realities.

As the vision on ‘Health’ amply demonstrates, the concept is ultimately elusive, at least in a physical sense.  Where it does occur, in the poet’s dream, Cotton anticipates Cowper by connecting health with retirement and a rural idyll: ‘Hail, thou sweet, calm, unenvied seat! / I said, and bless’d the fair retreat: / Here would I pass my remnant days, / Unknown to censure, or to praise; / Forget the world, and be forgot…’.  At the extremity of life, where ‘med’cines cannot save’, Cotton earlier advocates in the vision the importance of temperance as ‘Our best physician, friend, and guide!’  Adding to the sense of the circumscribed importance of the physician’s medical role, the logic behind Cotton’s recourse to visions is then laid bare.  In order to perform its pedagogical function, the moral message requires some art, since ‘morals, unadorn’d by art, / Are seldom known to reach the heart. / I’ll therefore strive to raise my theme / With all the scenery of dream’.  Like Adelphi, and like Cowper’s moral satires, the driving impulse behind this production is the evangelical theme of the heart.

This theme is set within a visionary battle for ‘Health’ as the poem gently satirizes an earthly attack on its key moral components: ‘Virtue’, ‘Innocence’, and ‘Peace’.  In the vision, these latter three are attendants on the beauteous queen of ‘Health’, who is threatened by ‘Luxury’, ‘Wealth’, and ‘Faction’.  Towards the end of the vision, despite the best efforts of ‘Disease’, ‘Repentance’, ‘Excess’, ‘Pride’, ‘Sickness’, ‘Pain’, and ‘Poverty’, in the war against ‘Health’, ‘Luxury’ sues for peace: ‘… Let fraud prevail, / Since all my numerous hosts must fail; / Henceforth hostilities shall cease, / I’ll send to Health and offer peace’.  In a physical sense, ‘Health’ is a fraud, an illusion, impossible to reach, and here, in the vision, the deceitful mediation of ‘Pleasure’ – ever the foe – complicates matters by compromising both sides: ‘Thro ev’ry troop the poison ran, / All were infected to a man’.  Nevertheless, that health in a spiritual sense remains a worthy vision is rendered explicit by the closing lines of the episode, which constitutes a final judgement wherein the queen of ‘Health’ is restored to the skies:

Jove held the troops in high disgrace,
And bade diseases blast their race;
Look’d on the queen with melting eyes,
And snatch’d his darling to the skies:
Who still regards those wiser few,
That dare her dictates to pursue.
For where her stricter law prevails,
Tho’ Passion prompts, or Vice assails;
Long shall the cloudless skies behold,
And their calm sun-set beam with gold.29

The passage highlights Cotton’s own evangelical sympathies in its evocation of a ‘stricter law’ which ‘those wiser few’ regard, and through its closing sense of salvation and sanctuary.

The sections of ‘Life’ and ‘Death’ that close Visions articulate the terms of a struggle between the power of a reasonable religion that ultimately defeats the armies of ‘Death’, just as it lends hope and solace to an otherwise disconsolate  ‘Life’ on earth, and a slavery to the passions which enchains the mind-soul in bondage to the physical senses.  The poet treads an uneasy line here between the outright dismissal of life with all its attendant miseries, vanities, passions, slights of fate, and disappointments, and the embrace of faith on a reasonable footing.  The self-conscious pessimism of the vision of ‘Life’, in which ‘That harlot Fortune bubbles all’,  recalls moments of Cowper’s poetry.  The vision, like Cowper’s in the moral satires, is couched as an appeal to spiritual understanding, as conveyed by the authorial explication of its severity, which continues to record the physician’s undertaking in almost exclusively religious terms: ‘’Tis truth (receive it ill or well) / ‘Tis melancholy truth I tell. / Why should the preacher take your pence, / And smother truth to flatter sense? / I’m sure, physicians have no merit, / Who kill, thro’ lenity of spirit’.  Nevertheless, the overall message is not a melancholy or austere one, and the melancholic stance adopted within the ‘Life’ vision makes way for an affirmation of faith, through the contemplation of ‘Death’ in the final vision of the poem: ‘I wear no melancholy hue, / No wreaths of cypress or of yew’.30  The recommendations, here, have striking parallels with Cowper’s reflections in Adelphi and the letters.  At the heart of Cotton’s didacticism is the same kind of self-examination which runs throughout Adelphi, and which corresponds to a Puritan tradition of spiritual autobiography, and manifestations of it in the eighteenth century by figures like Doddridge and Newton.31  Cotton again links his exhortations to the spiritual value of retirement:

And shall a man arraign the skies,
Because man lives, and mourns, and dies?
Impatient reptile! Reason cry’d;
Arraign thy passion and thy pride.
Retire, and commune with thy heart,
Ask, whence thou cam’st, and what thou art.
Explore thy body and thy mind,
Thy station too, why here assign’d.
The search shall teach thee life to prize,
And make thee grateful, good, and wise.32

The insistent concern to assert religion as a reasonable endeavour has its echoes in John Newton’s preface to Cowper’s Poems (1782).33  The emphasis on the practical dimension of this is neatly encapsulated by the lines: ‘Go, man, and act a wiser part, / Study the science of your heart’.  This self-knowledge of the soul, both for itself and as a marker of identity, is seen to triumph over all other sources of knowledge, whether from books or externally from travel: ‘But whence the soul? From heav’n it came! / Oh! prize this intellectual flame. / This nobler Self with rapture scan, / ‘Tis mind alone which makes the man’.  Conversely, the absolute centrality of the soul is seen through the imagery of confinement and liberation: ‘As sure as Sense (that tyrant!) reigns, / She holds the empress, Soul, in chains. / Inglorious bondage to the mind, / Heaven-born, sublime, and unconfin’d!’.34  The above lines are mirrored in Adelphi, which describes confinement and liberation in religious rather than spatial terms, where the concentration on the liberation of Cowper’s soul shapes the narrative in a way that his actual physical confinement in Cotton’s madhouse does not.

How might the views expressed in Cotton’s poetry have been played out in terms of treatment at the Collegium Insanorum?  Given the lack of records, it is impossible to offer a comprehensive idea of this.  Cowper’s account in Adelphi provides little or nothing by way of material detail, and only hints as to the institutional set-up.  However, there is enough there, and in Cotton’s own writing, to suggest an outline.  It is clear enough that Cotton’s establishment challenges stereotypes of incarceration in the eighteenth century, the doctor emerging as a considerate and thoughtful figure who always appears to have had his patients’ interests in mind.  Nevertheless, in Adelphi, right at the outset of Cowper’s description of his stay in St Albans, there is a dramatic sense of what confinement entailed there, as the reality of a physical restraint is laid bare:

We arrived at the doctor’s house.  He had no sooner taken me by the hand than my spirits sunk, and all my jealousy returned….  But perceiving now that I had trepanned myself into danger of close confinement, I refused to go into it, and made such resistance that three or four persons were employed to compel me, and as many to take me out again, when I arrived at the place of my destination.

Confinement is soon reconstituted in a religious sense, however, in lines which are both elusive and revealing:

It will be proper to draw a veil over the ‘secrets of my prison house’.  Let it suffice to say that the low state both of body and mind to which I was here reduced was perfectly well calculated to humble the natural pride and vainglory of my heart….  These were the efficacious means which infinite wisdom thought meet to make use of for these purposes.35

These tantalising lines are at the crux of the matter, and, like the letter cited at the beginning of this article, touch on a paradoxical question: how can a madness understood as darkness and disorder result in a full spiritual (and bodily) revival?  The allusion to the ghost’s appearance before Hamlet brings with it associations of murder, revenge, and purgatory, which add powerfully to the representation of mental disturbance.36  Cowper may also have been alluding to the prison-house in Isaiah.37  This results in an ambiguity around the stated intention ‘to draw a veil over the “secrets of my prison house”’.  While Cowper seems to reference the Collegium itself, and ‘the low state of both body and mind to which I was here reduced’ (my italics), the emphasis is placed on the spiritual purgatory of the narrator – his own mental and spiritual prison house.  As such, the physical details of the institution become almost irrelevant.  There is no indication of any other patients who may have been in the institution at the same time as Cowper, for instance, or what may have occurred on a daily basis.  There is no sense of the paraphernalia of a madhouse, or what ‘close confinement’ meant in actual physical terms.38

In the other direction, Cowper immediately goes on to describe the important spiritual events that took place there.  The lines cited above lead into a remarkable passage that goes on to describe how conviction of sin paralyses movement, intensifying guilt to such an extent that the narrator considers it incumbent upon him to remove himself from the world.   The sense that confinement only has meaning insofar as it pertains to spirituality is very strong throughout the sequence, to the point that the Collegium Insanorum is portrayed as less an institution – or even an external space – than another recess of a mind already imprisoned in its conviction of eternal damnation.  Of the period prior to his conversion, Cowper summarizes: ‘All that passed in this long interval of eight months may be classed under the two general heads – conviction of sin and despair of mercy’.  In short, the narrative is organized around an internalized representation of Cowper’s conversion, not by any methodology at work in the institution.

Nevertheless, important parts of the arrangement are detailed in Adelphi, or are made apparent elsewhere.  Cowper states that his brother and friends had ‘agreed among them’ that, given the circumstances, the Collegium was a suitable option for him.39  As an expensive institution that only catered for small numbers of patients, it clearly had a reputation to protect.  It commanded fees that Cowper relied on Joseph Hill to pay long after he had left the area.40  It had a manifestly religious atmosphere in which the reading of the Bible appears to have been encouraged as an important aspect of care in itself.  A chance reading of a Bible opened at the ‘twenty-fifth of the third chapter to the Romans’ immediately precedes Cowper’s eruption of joy at conversion.  Cowper was allowed visitors and there was a garden to which he had access, and in which he describes having had an important conversation with his brother.  Cotton is presented as a kindly and attentive Christian friend, important insofar as he brings Cowper back into the spirit of the gospel.  Although Cowper describes some discrepancies between his own internal sense of recovery and the ‘doctor’s representation’, the over-riding sense is that of a mutual understanding between doctor and patient based on a belief in the Gospel as the most efficacious remedy: ‘In a short time Dr Cotton became satisfied and acquiesced in the soundness of the cure, and much sweet communion I had with him….  which was near twelve months after my recovery, and the Gospel was always the delightful theme of our conversation’.41  Beyond the description of Cowper’s arrival, there is little or no sense of discord between Cowper and Cotton, or between patient and institution.

This is perhaps unsurprising when Cotton and Cowper can be seen to share a keen interest in the same poetic subjects.  Cotton’s much anthologised poem, ‘The Fireside’, pools many themes that Cowper also visited, including, again, the virtues of a quiet retirement, and the rejection of pride, luxury, and worldliness: ‘For Nature’s calls are few! / In this the art of living lies’.  A paean to marriage and parenthood, it recommends a humility that is centred in the home and in family life, and as such has an essential optimism, even approaching death:

While conscience, like a faithful friend,
Shall thro’ the gloomy vale attend,
And cheer our dying breath;
Shall, when all other comforts cease,
Like a kind angel whisper peace,
And smooth the bed of death.42

The trust in self and in conscience displayed in these soothing lines strongly contrasts with the misery of a wracked conscience in Cowper’s own meditation on death in ‘The Castaway’.  The ‘faithful friend’ of Cotton’s conscience, and Cowper’s guilt-laden ‘despair of life’, are chasms apart, but the former is surely indicative of the value that Cowper found in Cotton as a Physician of the Soul.  Like Cowper, Cotton seeks to extricate strong religious belief from the ridicule of enthusiasm,43 but he is significantly critical of the mental effects of the doctrine of predestination and election.  ‘When adopted by honest minds’, Cotton writes in a letter that might be read to reference Cowper, ‘it [i.e. election] generally terminates in despair’.44  Such sensitivity to doctrine supports the depiction of Cotton in Adelphi, where he is more valued for his skills as a religious counsellor than for anything purely medical.  This is also conveyed in Cotton’s autobiographical and satiric take on the life of an eighteenth-century doctor, ‘A Fable’.  The poem begins with the doctor-poet-‘Owl’ turning over volumes of literature, as part of a bid for ‘the poet’s bays’.  Having fallen into a non-conformist’s study, the Owl goes on to depreciate both his abilities as a poet (his ‘labour’d lays’) and his skills as a physician: ‘Equipt with powder and with pill, / He takes his licence out to kill’.  The self-parody in the poem is at its most striking when the Owl is taken to task by his wife for his poetic and monetary shortcomings:

Say, you the healing art essay’d,
And piddled in the doctor’s trade;
At least you’d earn us good provisions,
And better this than scribbling visions.

Nevertheless, vision, such as it is, belongs to poetry and religion, while medicine as a profession is presented as something of a social menace, even as it brings undeserved material benefits: ‘Thus ev’ry where he gains renown, / And fills his purse, and thins the town’.45  Being a physician may have been a dark art, but Cowper clearly did not see Cotton in this way, pointedly separating him, in the poem ‘Hope’, from the ‘grave physician, gath’ring fees, / Punctually paid for length’ning out disease, / No COTTON, whose humanity sheds rays / That make superior skill his second praise’.46

To pick up again on the question of Cotton’s relationship to theories of moral treatment, one might highlight the doctor’s stress on ‘self-acquaintance’ which, I would argue, anticipates the remarks of Samuel Tuke on the ‘power of self-restraint at the Retreat’.47  Tuke questions traditional treatments and received wisdom in favour of a more experiential, but moralistically based approach.  Like Cotton, Tuke lays much importance on internal mental processes.  Both encourage personal responsibility, and a recourse to ‘religious principles… as a means of cure’.  Self-examination and self-restraint might be seen as similar kinds of mental activity which require concerted application in order to yield ample rewards.  They are both closely allied with the principle of labour as a moral virtue.  ‘Of all the modes by which the patients may be induced to restrain themselves’, Tuke writes, ‘regular employment is perhaps the most generally efficacious’.48  Cotton’s strictness in this respect is apparent in his fable ‘The Scholar and the Cat’: ‘LABOUR entitles man to eat, / The idle have no claim to meat. / This rule must every station fit, / Because ‘tis drawn from sacred writ’.49  Moreover, Cotton’s sermon on self-acquaintance (Psalm XIX, 12) suggests that an aversion to self-examination is attributable to a morally culpable ‘indolence’ and a pleasure which ‘disqualifies the mind for all laborious pursuits’.50  Allied to this, both Cotton and Tuke celebrate the virtues of retreat, and the salutary effects of exercise and nature on the mind.  Cotton repeatedly makes a connection between nature, industry, and mental well-being, as in these lines from ‘On Husbandry’: ‘The earth seems, as it were, in silent gratitude, amply to repay the industry bestowed upon her; while nature puts on all her gaudy dresses, and appears with a variety of beauties, at once to please and inform the mind…’.51  While this is not explicitly endorsed as treatment for melancholia and madness, it is implicit as such, and there is surely a similar impulse at work in the idea of retreat as salutary and curative in general terms, and the establishment of the York Retreat as an institution.

The inter-connectedness of Cotton, Cowper, and the Tukes is well conveyed when Samuel Tuke quotes from Cowper to support his argument that ‘clean dry air’ is ‘favourable to the recovery of insane persons’:

… the general effects of fine air upon the animal spirits, would induce us to expect especial benefit from it, in cases of mental depression; and to pay all due respect to the physician, who,

Gives melancholy up to Nature’s care,
And sends the patient into purer air52

The physician cited in the poem is Heberden, but these lines from Cowper’s ‘Retirement’ provide an instance of the painful and laborious self-examination that Cotton describes in his writing.53  Having apparently externalized his own image, Cowper describes the damaging physical effects of melancholy in the poem: ‘This of all maladies that man infest, / Claims most compassion, and receives the least’.54  In being treated by Cotton, Cowper probably received more compassion than many others in a similar predicament, even if the ‘close confinement’ that he reports in Adelphi is seen by Tuke, in the case of melancholy patients, as ‘of all things the most detrimental’.55

In conclusion, Cotton’s work can be tentatively put forward as a precursor to the late eighteenth-  and early nineteenth-century moral treatment of melancholia and madness which ultimately enters into the asylum movement.  As a pious physician craving anonymity, he also embodies elements of an earlier tradition of curative healing based on religious principles.  Among the valuable insights that his work offers, I would posit, above all, Cotton’s sense of the precariousness of human understanding.  While advocating a spirit of inquiry and an industrious approach to all human endeavour, Cotton retains a healthy scepticism at their  findings, particularly in relation to abstract theorizing.  In this, he may downplay his own achievements, whether in the poetic or the medical sphere.

Notes 

1   Cowper to Lady Hesketh, Thurs 4 July, 1765. William Cowper, The Letters and Prose Writings of William Cowper, Volume 1: 1750-1781 ed. James King and Charles Ryskamp (Oxford: Clarendon Press, 1979), pp.100-101

2   Cowper to Lady Hesketh, Thurs 4 July, 1765. King and Ryskamp, p.100

3   Edgar Ashworth Underwood, Boerhaave’s Men: at Leyden and after (Edinburgh: Edinburgh University Press, 1977) pp.7-8

4   Samuel Johnson, The Oxford Authors Samuel Johnson ed. Donald Greene (Oxford: Oxford University Press, 1984), p.62

5   Robert Anderson, A Complete Edition of the Poets of Great Britain, Vol. 11 (London: John & Arthur Arch, 1794), p.1105

6   A nineteenth-century edition of Gay’s Fables includes Cotton’s Visions in Verse: Gay’s Fables and Other Poems (London: J.F. Dove, 1826)

7   Nathaniel Cotton, Various Pieces in Verses and Prose in Two Volumes (London: J. Dodsley, 1791), Vol I, p.131. With the exception of those taken from Cotton’s Observations on a particular kind of Scarlet Fever (1749), all subsequent references to Cotton are taken from this 1791 edition.

8   Anderson, p.1107

9   ‘Trust was an enormously difficult commodity for mad-doctors to acquire, shrouded as the specialty was by the secrecy demanded by the families of patients, no less than it was by scandalous stories about what transpired behind the high walls and barred windows of the mad-house.’ Jonathan Andrews and Andrew Scull, Undertaker of the Mind: John Monro and Mad-Doctoring in Eighteenth-Century England (Berkeley: University of California Press, 2001), p.56

10  Cotton, Vol I, p.132

11  Philip Doddridge, The Correspondence and Diary of Philip Doddridge, Volume I, ed. John Doddridge Humphreys (London: Henry Colburn & Richard Bentley, 1829), p.97

12  Cotton, Vol I, pp. 137, 126, 147

13  Jeremy Schmidt, Melancholy and the Care of the Soul: Religion, Moral Philosophy and Madness in Early Modern England (Aldershot: Ashgate, 2007), p.11

14  Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700-1900 (New Haven and London: Yale University Press, 1993), pp.96-104; Kathleen Jones, Lunacy, Law and Conscience 1744-1845 (London: Routledge, 1955, 2001) p.57 and pp.60-62

15  Schmidt, p.101

16  Cowper, Adelphi. King and Ryskamp, pp.32-33

17  Cotton, Vol II, p.163

18  Perhaps Cotton had in mind Spenser’s line: ‘But true it is, that when the oyle is spent, / The light goes out, and weeke is throwne away’. Edmund Spenser, The Faerie Queene, Book II, Canto X ed. A.C. Hamilton (London: Longman Annotated English Poets, 1977), p.263

19  Cotton, Vol I, p.146

20  Cowper, Adelphi. King and Ryskamp, p.5

21  Cotton, Vol I, pp. 146-7, 149

22  Cotton, Vol I, p.vi

23  Nathaniel Cotton, Observations on a particular kind of Scarlet Fever, that lately prevailed in and about St. Alban’s. In a letter to Dr. Mead (London: R. Manby & H.S. Cox, 1749), p.3

24  Anita Guerrini, ‘Mead, Richard (1673–1754)’, Oxford Dictionary of National Biography, Oxford University Press, 2004; online edn, Jan 2008 [http://0-www.oxforddnb.com.catalogue.ulrls.lon.ac.uk/view/article/18467, accessed 15 April 2015]. Mead was a Newtonian physician from a non-conformist background, and had lived with Boerhaave while they were both students. Later, he may even have attended Boerhaave’s private dissecting sessions. He was appointed a vice-president of the Royal Society in 1713 by Isaac Newton. Interestingly, Gilbert Burnet was counted among his patients. Mead had strong views on the management of the insane, arguing that people suffering from mania did not need to be beaten, but only because they were ‘fearful and cowardly’. See Scull, The Most Solitary of Afflictions, pp.62-63

25  Cotton, Observations, pp. 16, 18, 20, 13, 21, 3, 21, 22

26  Cotton, Various Pieces, Vol I, p.157

27  Cotton, Vol I, p.158

28  Cotton, Vol II, pp.33, 35

29  Cotton, Vol I, pp.160, 159, 165, 166

30  Cotton, Vol I, pp. 227, 218, 223

31  See Bruce D. Hindmarsh, The Evangelical Conversion Narrative: Spiritual Autobiography in Early Modern England (Oxford: Oxford University Press, 2005), p.35 and p.62. Adelphi corresponds to an established Puritan tradition of spiritual autobiography going back to the early seventeenth century, and also forms part of a resurgence of conversion narratives in the eighteenth century which gathers pace from the 1730s and 1740s during the time of the Evangelical Revival. John Newton’s An Authentic Narrative (1765) and Doddridge’s Life of Colonel Gardiner (1747) can also be seen within this tradition.

32  Cotton, Vol I, p.236

33  Newton asserts the value of a religion ‘which alone can relieve the mind of man from painful and unavoidable anxieties, inspire it with stable peace and solid hope, and furnish those motives and prospects, which, in the present state of things, are absolutely necessary to produce a conduct worthy of a rational creature…’ John Newton, ‘Appendix i’ in The Poems of William Cowper, Vol.1, 1748-1782, ed. by John D. Baird and Charles Ryskamp (Oxford: Clarendon Press, 1980), p.569

34  Cotton, Vol I, pp. 237, 238, 239

35  Cowper, Adelphi. King and Ryskamp, p.33

36  ‘I am thy father’s spirit, / Doomed for a certain term to walk the night, / And for the day confined to fast in fires / Till the foul crimes done in my days of nature / Are burnt and purged away. But that I am forbid / To tell the secrets of my prison-house / I could a tale unfold whose lightest word / Would harrow up thy soul…’ William Shakespeare, Hamlet, Act 1, Scene 5, in The Complete Works ed. Stanley Wells and Gary Taylor (Oxford: Clarendon Press, 1988), p.661

37  ‘I the Lord have called thee in righteousness, and will hold thine hand, and will keep thee, and give thee for a covenant of the people, for a light of the Gentiles: To open the blind eyes, to bring out the prisoners from the prison, and them that sit in darkness out of the prison house’ (Isaiah 42: 6-7). Given the context of God rebuking his people, the allusion tends to suggest that this was a prison house that stretched across society as a whole. Bible: King James Version (Cambridge: Cambridge University Press, 1629, 2009), pp.728-729

38  This is a crucial gap in our knowledge of Cotton’s approach to treatment, making it hard to draw firm conclusions about it. It seems unlikely that Cotton was among them, but many eighteenth-century physicians believed in subjugation of the patient, and the imposition of external discipline through physical constraint, as Scull describes. Scull, The Most Solitary of Afflictions, p.63

39  Cowper, Adelphi. King and Ryskamp, pp.33-34, 34, 32

40  Cowper to Joseph Hill, Weds 14 August 1765: ‘You know Joe I am very deep in Debt to my little Physician at St. Albans’, King and Ryskamp, p.111. Cowper owed at least £140 pounds at this point, which he appears to have finally paid with Hill’s help by a letter dated Thurs 3 April 1766, King and Ryskamp, p.135. Cowper discusses a continued correspondence with Cotton in this letter

41  Cowper, Adelphi. King and Ryskamp, pp. 39, 38, 37, 40

42  Cotton, Vol I, pp. 67, 69

43  Cotton defends Edward Young against the accusation of enthusiasm while reflecting on the latter’s death: ‘Infidels and sensualists regard the deceased as an enthusiastic or melancholic. But that period is approaching, when wisdom will be justified of her children, and when intrinsic worth shall shine forth as the stars in the firmament’. Vol II, p.227

44  Cotton, Vol II, p.196

45  Cotton, Vol I, pp. 97, 100, 102, 102, 103

46  Cowper, ‘Hope’, lines 203-6, Baird and Ryskamp, p.322

47  Samuel Tuke, Description of the Retreat, an institution near York for insane persons of the Society of Friends. Containing an account of its origin and progress, the modes of treatment, and a statement of cases (London: Dawsons of Pall Mall, 1813, 1964), p.139. Cotton, Vol II, p.59

48  Tuke, pp. 161, 156

49  Cotton, Vol I, p.8

50  Cotton, Vol II, p.63

51  Cotton, Vol II, p.122

52  Tuke, pp.129-130

53  See also the Olney Hymn, 43, ‘Self-Acquaintance’. The anger and unbelief of ‘a sinful heart’ create an atmosphere of uncertainty in the longing for God in this hymn. Baird and Ryskamp, pp.182-183

54  Cowper, ‘Retirement’, lines 301-2, Baird and Ryskamp, p.385

55  Tuke, p.130

(J5 Article Stern)