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Here, Smith considers the business aspects of madhouse proprietorship and the measures that contributed towards individuals achieving success in an increasingly competitive market. Proprietors competed on levels of charges, connected to the nature of service provided and the social class related expectations of their patients. They would highlight their houses’ particular attributes, in regard to location, facilities, comfort and treatment orientation. It is shown that a majority of provincial madhouse proprietors were medical men, whilst in London lay men and women predominated. Smith concludes that, whether they were professionally qualified or otherwise, favourable business outcomes were linked to factors like family connections, inheritance, communication skills and most particularly to the construction of a favourable reputation.