The first important step in the very obscure subject of the connection of the anatomy of the brain with mental derangement.

Sir John Batty Tuke (1835 - 1913) was one of the most influential psychiatrists in Scotland in the late nineteenth century. Tuke’s career in Edinburgh from 1863 to 1910 spanned a period of significant social and political changes in asylum governance and care in Scotland. Tuke’s professional success in public and private practice and his powerful role in several prominent medical societies allowed him to influence his colleagues toward a more physiological understanding of mental illness and its treatment.

He graduated from the Edinburgh University Medical School in 1856 and was registered at the Royal College of Surgeons of Edinburgh. Shortly thereafter he went to New Zealand as a medical surgeon for seven years in the Maori War.
Upon his return to Edinburgh in 1863 Tuke was appointed to the Royal Edinburgh Asylum (later re-named the Royal Edinburgh Hospital) as an assistant physician. Under the tutelage of the then superintendent Dr. David Skae he quickly developed a niche in puerperal insanity and published influential articles on the subject.
As his career progressed Tuke also occupied positions of leadership within the Royal College of Physicians of Edinburgh and wrote an influential article on the "cottage system" of care for insane people where he criticised the traditional Scottish practices of caring for "incurable" insane people by boarding them out with often destitute members of the community in exchange for meager compensation.
Tuke also contributed to a series of “Health Lectures for the People” delivered in Edinburgh during the winter of 1881-2. His lectures on “The Brain and its Functions” debunked the science of phrenology (Something P.P. Quimby had done some 20 years earlier) and used visual demonstrations to teach the public about the brain.
In 1894 , as the appointed to the Morison Lectureship at the RCPE, he chose “The Insanity of Over-exertion of the Brain” as his topic. This series would be the culmination of Tuke’s theory of physical disease as the cause of mental illness. Tuke proposed that both the public and profession had been hampered by Hippocratic classifications of insanity that were entirely psychological and led to an ignorance of brain anatomy, physiology and pathology, and a focus on behavioural symptoms. He condemned the popular notion the public needed protection from lunatics as well as the idea that insanity was manifested through perversion of the intellect. According to Tuke these elements had combined to create communities and medical terminology that regarded insanity as “a disease of the mind.”
Tuke directly avoided the task of trying to explain “the dynamics of delusion” and focused on his theory of cell overexertion by injury, parasitism, deficient cell functioning or defective cell growth. By focusing on cell functioning and cure through rest and nutrition, Tuke rejected attributions of moral infirmity or deficiency in the insane. Tuke saw these ideas as slowing the progress of treatment and scientific understanding since they “construct a psychological nexus between cause and symptom without demonstration of structural change in cortical tissues.” Tuke heralded the study of mental illness through brain anatomy as the way to “a rational system of treatment”and enjoined his colleagues to consider their patients “first as invalids and as an insane person after.”
Aside from the immediate exposure of the lecture hall Tuke’s talks were published in London and Edinburgh as well as in the Journal of Mental Science. He was noticed and respected by his contemporaries and a few years later received his first honorary degree (D. Sc.) from Trinity College, Dublin where he was praised for having made “the first important step in the very obscure subject of the connection of the anatomy of the brain with mental derangement.”
In 1898 he was knighted.