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Bethlem Royal Hospital

May 17, 2023

Bethlem Royal Hospital, also known as St. Mary Bethlehem, Bethlehem Hospital and Bedlam, is a psychiatric hospital in London. Its famous history has inspired several horror books, films, and TV series, most notably Bedlam, a 1946 film with Boris Karloff.

Bethlem Royal Hospital
South London and Maudsley NHS Foundation Trust
Bethlem Royal Hospital
Shown in Bromley
Geography
LocationMonks Orchard Road, Beckenham, London, England
Organisation
Care systemNational Health Service
TypeSpecialist
Services
Emergency departmentAdmissions through A&E
BedsApprox 350
SpecialityPsychiatric hospital
History
Opened1247 as priory
1330 as hospital
Links
Websitewww.slam.nhs.uk/our-services/hospital-care/bethlem-royal-hospital
ListsHospitals in England

The hospital is closely associated with King's College London and, in partnership with the Institute of Psychiatry, Psychology and Neuroscience, is a major centre for psychiatric research. It is part of the King's Health Partners academic health science centre and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health.

Founded in 1247, the hospital was originally near Bishopsgate just outside the walls of the City of London. It moved a short distance to Moorfields in 1676, and then to St George's Fields in Southwark in 1815, before moving to its current location in Monks Orchard in 1930.

The word "bedlam", meaning uproar and confusion, is derived from the hospital's nickname. Although the hospital became a modern psychiatric facility, historically it was representative of the worst excesses of asylums in the era of lunacy reform.

1247–1633

Foundation

 
Plan of the first Bethlem.[1]
 
Map of London in c. 1300. St Mary Spital is shown north of the city wall, outside Bishopgate.

The hospital was founded in 1247 as the Priory of the New Order of our Lady of Bethlehem in the city of London during the reign of Henry III.[2]

It was established by the Bishop-elect of Bethlehem, the Italian Goffredo de Prefetti, following a donation of personal property by the London alderman and former sheriff, Simon FitzMary.[3] The original location was in the parish of St. Botolph, Bishopsgate's ward, just beyond London's wall and where the south-east corner of Liverpool Street Station now stands.[4] Bethlem was not initially intended as a hospital, in the clinical sense, much less as a specialist institution for the insane,[5] but as a centre for the collection of alms to support the Crusader Church and to link England to the Holy Land.[6]

De Prefetti's need to generate income for the Crusader Church and restore the financial fortunes of his see had been occasioned by two misfortunes: his bishopric had suffered significant losses following the destructive conquest of Bethlehem by the Khwarazmian Turks in 1244, and his immediate predecessor had further impoverished his cathedral chapter through the alienation of a considerable amount of its property.[7] The priory, obedient to the Church of Bethlehem, would also house the poor and, if they visited, provide hospitality to the bishop, canons, and brothers of Bethlehem.[6] Thus, Bethlem became a hospital, in medieval usage, "an institution supported by charity or taxes for the care of the needy". The subordination of the priory's religious order to the bishops of Bethlehem was further underlined in the foundational charter, which stipulated that the prior, canons, and inmates were to wear a star upon their cloaks and capes to symbolise their obedience to the church of Bethlehem.[8]

Politics and patronage

During the thirteenth and fourteenth centuries, with its activities underwritten by episcopal and papal indulgences, the hospital's role as a centre for alms collection persisted,[9] but its linkage to the Order of Bethlehem increasingly unravelled, putting its purpose and patronage in doubt.[10] In 1346, the master of Bethlem, a position at that time granted to the most senior of London's Bethlemite brethren,[11] applied to the city authorities seeking protection; thereafter metropolitan office-holders claimed power to oversee the appointment of masters and demanded in return an annual payment of 40 shillings.[12] It is doubtful whether the city really provided substantial protection and much less that the mastership fell within their patronage but, dating from the 1346 petition, it played a role in the management of Bethlem's finances.[13] By this time, the Bethlehemite bishops had relocated to Clamecy, France, under the surety of the Avignon papacy.[10] This was significant as, throughout the reign of Edward III (1327–77), the English monarchy had extended its patronage over ecclesiastical positions through the seizure of priories under the control of non-English religious houses.[14] As a dependent house of the Order of Saint Bethlehem in Clamecy, Bethlem was vulnerable to seizure by the crown and this occurred in the 1370s when Edward III took control.[15] The purpose of this appropriation was, in the context of the Hundred Years' War between France and England, to prevent funds raised by the hospital from enriching the French monarchy via the papal court.[16] After this event the masters of the hospital, semi-autonomous figures in charge of its day-to-day management, were normally crown appointees and it became an increasingly secularised institution.[17] The memory of its foundation became muddied and muddled; in 1381, the royal candidate for the post of master claimed that from its beginnings it had been superintended by an order of knights and he confused its founder, Goffredo de Prefetti, with the Frankish crusader, Godfrey de Bouillon.[18] The removal of the last symbolic link to the Bethlehemites was confirmed in 1403 when it was reported that master and inmates no longer wore the star of Bethlehem.[18]

 
"The Prospect of Bridewell" from John Strype's, An Accurate Edition of Stow's "A Survey of London" (1720). From 1557, Bethlem was administered by the Bridewell Governors.

In 1546, the Lord Mayor of London, Sir John Gresham, petitioned the crown to grant Bethlem to the city.[19] This petition was partially successful and Henry VIII reluctantly ceded to the City of London "the custody, order and governance" of the hospital and of its "occupants and revenues".[20] This charter came into effect in 1547.[21] The crown retained possession of the hospital while its administration fell to the city authorities.[22] Following a brief interval when it was placed under the management of the governors of Christ's Hospital, from 1557 it was administered by the governors of Bridewell, a prototype house of correction at Blackfriars.[23] Having been thus one of the few metropolitan hospitals to have survived the dissolution of the monasteries physically intact, this joint administration continued, not without interference by both the crown and city, until incorporation into the National Health Service in 1948.[24]

From Bethlem to Bedlam

A Church of Our Lady that is named Bedlam. And in that place be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man

William Gregory, Lord Mayor of London, c. 1450 [25]

It is unknown when Bethlem, or Bedlam, began to specialise in the care and control of the insane,[26] but it has been frequently asserted that Bethlem was first used for the insane from 1377.[27] This date is derived from the unsubstantiated conjecture of the Reverend Edward Geoffrey O'Donoghue,[28] chaplain to the hospital,[29] who published a monograph on its history in 1914.[30] While it is possible that Bethlem was receiving the insane during the late fourteenth century, the first definitive record of their presence in the hospital is in the details of a visitation of the Charity Commissioners in 1403.[31] This recorded that amongst other patients there were six male inmates who were "mente capti", a Latin term indicating insanity.[32] The report of the visitation also noted the presence of four pairs of manacles, 11 chains, six locks and two pairs of stocks but it is not clear if any or all of these items were for the restraint of the inmates.[33] While mechanical restraint and solitary confinement are likely to have been used for those regarded as dangerous,[34] little else is known of the actual treatment of the insane for much of the medieval period.[35] The presence of a small number of insane patients in 1403 marks Bethlem's gradual transition from a diminutive general hospital into a specialist institution for the confinement of the insane. This process was largely completed by 1460.[36]

 
Curtain Theatre circa 1600 (cylindrical building in the background). Some authorities believe this to be a depiction of The Theatre, the other Elizabethan theatre at Shoreditch in west Moorfields. Both playhouses were a stone's throw away from the original Bethlem site at Bishopsgate.

From the fourteenth century, Bethlem had been referred to colloquially as "Bedleheem", "Bedleem" or "Bedlam".[37] Initially "Bedlam" was an informal name but from approximately the Jacobean era the word entered everyday speech to signify a state of madness, chaos, and the irrational nature of the world.[38] This development was partly due to Bedlam's staging in several plays of the Jacobean and Caroline periods, including The Honest Whore, Part I (1604); Northward Ho (1607); The Duchess of Malfi (1612); The Pilgrim (c. 1621); and The Changeling (1622).[39] This dramatic interest in Bedlam is also evident in references to it in early seventeenth-century plays such as Epicœne, or The Silent Woman (1609), Bartholomew Fair (1614), and A New Way to Pay Old Debts (c. 1625).[40] The appropriation of Bedlam as a theatrical locale for the depiction of madness probably owes no little debt to the establishment in 1576 in nearby Moorfields of The Curtain and The Theatre, two of the main London playhouses;[41] it may also have been coincident with that other theatricalisation of madness as charitable object, the commencement of public visiting at Bethlem.[42]

Management

The position of master was a sinecure largely regarded by its occupants as means of profiting at the expense of the poor in their charge.[43] The appointment of the masters, later known as keepers, had lain within the patronage of the crown until 1547.[44] Thereafter the city, through the Court of Aldermen, took control and, as with the King's appointees, the office was used to reward loyal servants and friends.[45] Compared to the masters placed by the monarch, those who gained the position through the city were of much more modest status.[46] In 1561, the Lord Mayor succeeded in having his former porter, Richard Munnes, a draper by trade, appointed to the position. The sole qualification of his successor in 1565, a man by the name of Edward Rest,[47] appears to have been his occupation as a grocer.[45] Rest died in 1571, at which point the keepership passed on to John Mell in 1576,[48] known for his abuse of "the governors, those who gave money to the poor, and the poor themselves."[47] The Bridewell Governors largely interpreted the role of keeper as that of a house manager and this is clearly reflected in the occupations of most appointees as they tended to be inn-keepers, victualers, or brewers, and the like.[49] When patients were sent to Bethlem by the Governors of the Bridewell the keeper was paid from hospital funds. For the remainder, keepers were paid either by the families and friends of inmates or by the parish authorities. It is possible that keepers negotiated their fees for these latter categories of patients.[50]

John Mell's death in 1579 left the keepership open for the long-term keeper[47] Roland Sleford, a London cloth-maker, who left his post in 1598, apparently of his own volition, after a 19-year tenure.[51] Two months later, the Bridewell Governors, who had until then shown little interest in the management of Bethlem beyond the appointment of keepers, conducted an inspection of the hospital and a census of its inhabitants for the first time in over 40 years.[51] Their purpose was "to view and p[er]use the defaultes and want of rep[ar]ac[i]ons".[52] They found that during the period of Sleford's keepership the hospital buildings had fallen into a deplorable condition with the roof caving in and the kitchen sink blocked, and reported that[53] "...it is not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fit for any man to come into the house".[54]

The committee of inspection found 21 inmates with only two having been admitted during the previous 12 months. Of the remainder, six at least had been resident for a minimum of eight years and one inmate had been there for around 25 years.[55] Three were from outside London, six were charitable cases paid for out of the hospital's resources, one was supported by a parochial authority, and the rest were provided for by family, friends, benefactors or, in one instance, out of their own funds.[56] The reason for the Governors' new-found interest in Bethlem is unknown but it may have been connected to the increased scrutiny the hospital was coming under with the passing of poor law legislation in 1598 and to the decision by the Governors to increase hospital revenues by opening it up to general visitors as a spectacle.[57] After this inspection, the Governors initiated some repairs and visited the hospital at more frequent intervals. During one such visit in 1607, they ordered the purchase of clothing and eating vessels for the inmates, presumably indicating the lack of such basic items.[58]

Helkiah Crooke

 
The title page of Helkiah Crooke's Microcosmographia (1615). Crooke was appointed keeper-physician to Bethlem Hospital in 1619.

At the bidding of James VI and I, Helkiah Crooke (1576–1648) was appointed keeper-physician in 1619.[59] As a Cambridge graduate, the author of an enormously successful English language book of anatomy entitled Microcosmographia: a Description of the Body of Man (1615)[60] and a member of the medical department of the royal household,[n 1] he was clearly of higher social status than his city-appointed predecessors (his father was a noted preacher, and his elder brother Thomas was created a baronet). Crooke had successfully ousted the previous keeper, the layman Thomas Jenner, after a campaign in which he had castigated his rival for being "unskilful in the practice of medicine".[44] While this may appear to provide evidence of the early recognition by the Governors that the inmates of Bethlem required medical care, the formal conditions of Crooke's appointment did not detail any required medical duties.[44] Indeed, the Board of Governors continued to refer to the inmates as "the poore" or "prisoners" and their first designation as patients appears to have been by the Privy Council in 1630.[63]

From 1619, Crooke unsuccessfully campaigned through petition to the king for Bethlem to become an independent institution from the Bridewell, a move that while likely meant to serve both monarchial and personal interest would bring him into conflict with the Bridewell Governors.[64] Following a pattern of management laid down by early office-holders, his tenure as keeper was distinguished by his irregular attendance at the hospital and the avid appropriation of its funds as his own.[59] Such were the depredations of his regime that an inspection by the Governors in 1631 reported that the patients were "likely to starve".[65] Charges against his conduct were brought before the Governors in 1632.[61] Crooke's royal favour having dissolved with the death of James I,[66] Charles I instigated an investigation against him in the same year. This established his absenteeism and embezzlement of hospital resources and charged him with failing to pursue "any endeavour for the curing of the distracted persons".[67] It also revealed that charitable goods and hospital-purchased foodstuffs intended for patients had been typically misappropriated by the hospital steward, either for his own use or to be sold to the inmates. If patients lacked resources to trade with the steward they often went hungry.[65] These findings resulted in the dismissal in disgrace of Crooke,[n 2] the last of the old-style keepers, along with his steward on 24 May 1633.[n 3][70]

Conditions

In 1632 it was recorded that the old house of Bethlem had "below stairs a parlour, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in".[71] It is likely that this arrangement was not significantly different in the sixteenth century.[71] Although inmates, if deemed dangerous or disturbing, were chained or locked up, Bethlem was an otherwise open building with its inhabitants at liberty to roam around its confines and possibly the local neighbourhood.[72] The neighbouring inhabitants would have been quite familiar with the condition of the hospital as in the 1560s, and probably for some considerable time before that, those who lacked a lavatory in their own homes had to walk through "the west end of the long house of Bethlem" to access the rear of the hospital and reach the "common Jacques".[n 4][72] Typically the hospital appears to have been a receptacle for the very disturbed and troublesome and this fact lends some credence to accounts such as that provided by Donald Lupton in the 1630s who described the "cryings, screechings, roarings, brawlings, shaking of chaines, swearings, frettings, chaffings" that he observed.[72]

Bethlem had been built over a sewer that served both the hospital and its precinct. This common drain regularly blocked, resulting in overflows of waste at the entrance of the hospital.[73] The 1598 visitation by the Governors had observed that the hospital was "filthely kept", but the Governors rarely made any reference to the need for staff to clean the hospital. The level of hygiene reflected the inadequate water supply, which, until its replacement in 1657, consisted of a single wooden cistern in the back yard from which water had to be laboriously transported by bucket.[74] In the same yard since at least the early seventeenth century there was a "washhouse" to clean patients' clothes and bedclothes and in 1669 a drying room for clothes was added. Patients, if capable, were permitted to use the "house of easement",[n 4] of which there were two at most, but more frequently "piss-pots" were used in their cells.[75] Unsurprisingly, inmates left to brood in their cells with their own excreta were, on occasion, liable to throw such "filth & Excrem[en]t" into the hospital yard or onto staff and visitors. Lack of facilities combined with patient incontinence and prevalent conceptions of the mad as animalistic and dirty, fit to be kept on a bed of straw, appear to have promoted an acceptance of hospital squalor.[76] However, this was an age with very different standards of public and personal hygiene when people typically were quite willing to urinate or defecate in the street or even in their own fireplaces.[77]

For much of the seventeenth century the dietary provision for patients appears to have been inadequate. This was especially so during Crooke's regime, when inspection found several patients suffering from starvation. Corrupt staff practices were evidently a significant factor in patient malnourishment and similar abuses were noted in the 1650s and 1670s. The Governors failed to manage the supply of victuals, relying on "gifts in kind" for basic provisions, and the resources available to the steward to purchase foodstuffs was dependent upon the goodwill of the keeper.[78] Patients were fed twice a day on a "lowering diet" (an intentionally reduced and plain diet) consisting of bread, meat, oatmeal, butter, cheese, and generous amounts of beer. It is likely that daily meals alternated between meat and dairy products, almost entirely lacking in fruit or vegetables.[79] That the portions appear to have been inadequate also likely reflected contemporary humoral theory that justified rationing the diet of the mad, the avoidance of rich foods, and a therapeutics of depletion and purgation to restore the body to balance and restrain the spirits.[80]

1634–1791

Medical regime

 
James Monro was elected to the post of Bethlem physician in 1728, a position which he retained until his death in 1752. This marked the beginning of a 125-year Monro family dynasty of Bethlem physicians.

The year 1634 is typically interpreted as denoting the divide between the mediaeval and early modern administration of Bethlem.[81] It marked the end of the day-to-day management by an old-style keeper-physician and its replacement by a three-tiered medical regime composed of a non-resident physician, a visiting surgeon and an apothecary,[82] a model adopted from the royal hospitals. The medical staff were elected by the Court of Governors and, in a bid to prevent profiteering at the expense of patients that had reached its apogee in Crooke's era, they were all eventually salaried with limited responsibility for the financial affairs of the hospital.[62] Personal connections, interests and occasionally royal favour were pivotal factors in the appointment of physicians, but by the measure of the times appointees were well qualified as almost all were Oxford or Cambridge graduates and a significant number were candidates for or fellows of the Royal College of Physicians.[83] Although the posts were strongly contested, nepotistic appointment practices played a significant role. The election of James Monro as physician in 1728 marked the beginning of a 125-year Monro family dynasty extending through four generations of fathers and sons.[84] Family influence was also significant in the appointment of surgeons but absent in that of apothecaries.[85]

The office of physician was largely an honorary and charitable one with only a nominal salary. As with most hospital posts, attendance was required only intermittently and the greater portion of the income was derived from private practice.[86] Bethlem physicians, maximising their association with the hospital, typically earned their coin in the lucrative "trade in lunacy"[87] with many acting as visiting physicians to, presiding over, or even, as with the Monros and their predecessor Thomas Allen, establishing their own mad-houses.[88] Initially both surgeons and apothecaries were also without salary and their hospital income was solely dependent upon their presentation of bills for attendance to the Court of Governors.[89] This system was frequently abused and the bills presented were often deemed exorbitant by the Board of Governors. The problem of financial exploitation was partly rectified in 1676, when surgeons received a salary, and from the mid-eighteenth century elected apothecaries were likewise salaried and normally resident within the hospital.[90] Dating from this latter change, the vast majority of medical responsibilities within the institution were undertaken by the sole resident medical officer, the apothecary, owing to the relatively irregular attendance of the physician and surgeon.[91]

But is there so great Merit and Dexterity in being a mad Doctor? The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit, and a Vomit and a Purge over again, and sometimes a Bleeding, which is no great mystery

Alexander Cruden, The London Citizen Exceedingly Injured, 1739.[92]

The medical regime, being married to a depletive or antiphlogistic physic until the early nineteenth century,[n 5] had a reputation for conservatism that was neither unearned nor, given the questionable benefit of some therapeutic innovations,[n 6] necessarily ill-conceived in every instance.[98] Bathing was introduced in the 1680s at a time when hydrotherapy was enjoying a recrudescence in popularity. "Cold bathing", opined John Monro, Bethlem physician for 40 years from 1751, "has in general an excellent effect";[99] and remained much in vogue as a treatment throughout the eighteenth century.[100] By the early nineteenth century, bathing was routine for all patients of sufficient hardiness from summer "to the setting-in of the cold weather".[99] Spring signalled recourse to the traditional armamentarium; from then until the end of summer Bethlem's "Mad Physick" reigned supreme as all patients, barring those deemed incurable, could expect to be bled and blistered and then dosed with emetics and purgatives.[101] Indiscriminately applied, these curative measures were administered with the most cursory physical examination, if any, and with sufficient excess to risk not only health but also life.[101] Such was the violence of the standard medical course, "involving voiding of the bowels, vomiting, scarification, sores and bruises,"[102] that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught.[102]

The reigning medical ethos was the subject of public debate in the mid-eighteenth century when the Paper War of 1752–1753 erupted between John Monro and his rival William Battie, physician to the reformist St Luke's Asylum of London, founded in 1751.[102] The Bethlem Governors, who had presided over the only public asylum in Britain until the early eighteenth century,[103] looked upon St. Luke's as an upstart institution and Battie, formerly a Governor at Bethlem, as traitorous.[104] In 1758 Battie published his Treatise on Madness which castigated Bethlem as archaic and outmoded, uncaring of its patients and founded upon a despairing medical system whose therapeutic transactions were both injudicious and unnecessarily violent.[91] In contrast, Battie presented St. Luke's as a progressive and innovative hospital, oriented towards the possibility of cure and scientific in approach.[105] Monro responded promptly, publishing Remarks on Dr. Battie's Treatise on Madness in the same year.[91]

Bethlem rebuilt at Moorfields

 
The new Bethlem Hospital, designed by Robert Hooke, 1676, "primarily as a piece of fundraising rhetoric"[106]
 
Most of Bethlehem Hospital by William Henry Toms for William Maitland's History of London, published 1739.

Although Bethlem had been enlarged by 1667 to accommodate 59 patients,[107] the Court of Governors of Bethlem and Bridewell observed at the start of 1674 that "the Hospitall House of Bethlem is very olde, weake & ruinous and to[o] small and streight for keepeing the greater numb[e]r of lunaticks therein att p[re]sent".[108] With the increasing demand for admission and the inadequate and dilapidated state of the building it was decided to rebuild the hospital in Moorfields, just north of the city proper and one of the largest open spaces in London.[109] The architect chosen for the new hospital, which was built rapidly and at great expense between 1675 and 1676,[n 7] was the natural philosopher and City Surveyor Robert Hooke.[112] He constructed an edifice that was monumental in scale at over 500 feet (150 m) wide and some 40 feet (12 m) deep.[n 8] The surrounding walls were some 680 feet (210 m) long and 70 feet (21 m) deep while the south face at the rear was effectively screened by a 714-foot (218 m) stretch of London's ancient wall projecting westward from nearby Moorgate.[114] At the rear and containing the courtyards where patients exercised and took the air, the walls rose to 14 feet (4.3 m) high. The front walls were only 8 feet (2.4 m) high but this was deemed sufficient as it was determined that "Lunatikes... are not to [be] permitted to walk in the yard to be situate[d] betweene the said intended new Building and the Wall aforesaid."[114] It was also hoped that by keeping these walls relatively low the splendour of the new building would not be overly obscured. This concern to maximise the building's visibility led to the addition of six gated openings 10 feet (3.0 m) wide which punctuated the front wall at regular intervals, enabling views of the facade. [114] Functioning as both advertisement and warning of what lay within, the stone pillars enclosing the entrance gates were capped by the figures of "Melancholy" and "Raving Madness" carved in Portland stone by the Danish-born sculptor Caius Gabriel Cibber.[115]

 
Late seventeenth-century map showing the placement of the new Bethlem Hospital in Moorfields. It shows the large gardens of Moorfields to the north of the front face of the building. The hospital is shown as a very long and thin structure.

At the instigation of the Bridewell Governors and to make a grander architectural statement of "charitable munificence",[116] the hospital was designed as a single- rather than double-pile building,[n 9] accommodating initially 120 patients.[110] Having cells and chambers on only one side of the building facilitated the dimensions of the great galleries,[110] essentially long and capacious corridors, 13 feet (4.0 m) high and 16 feet (4.9 m) wide, which ran the length of both floors to a total span of 1,179 feet (359 m).[117] Such was their scale that Roger L'Estrange remarked in a 1676 text eulogising the new Bethlem that their "Vast Length ... wearies the travelling eyes' of Strangers".[118] The galleries were constructed more for public display than for the care of patients as, at least initially, inmates were prohibited from them lest "such persons that come to see the said Lunatickes may goe in Danger of their Lives".[n 10][121]

 
Melancholia and Raving Madness (mania) carved by Caius Gabriel Cibber (1680),[122] and which adorned the entrance portal of the new Bethlem Hospital at Moorfields

The architectural design of the new Bethlem was primarily intended to project an image of the hospital and its governors consonant with contemporary notions of charity and benevolence. In an era prior to the state funding of hospitals and with patient fees covering only a portion of costs, such self-advertisement was necessary to win the donations, subscriptions and patronage essential for the institution's survival.[123] This was particularly the case in raising funds to pay for major projects of expansion such as the rebuilding project at Moorfields or the addition of the Incurables Division in 1725–39 with accommodation for more than 100 patients.[124] These highly visible acts of civic commitment could also serve to advance the claims to social status or political advantage of its Governors and supporters.[125] However, while consideration of patients' needs may have been distinctly secondary, they were not absent. For instance, both the placement of the hospital in the open space of Moorfields and the form of the building with its large cells and well-lit galleries had been chosen to provide "health and Aire" in accordance with the miasmatic theory of disease causation.[n 11][127]

It was London's first major charitable building since the Savoy Hospital (1505–17) and one of only a handful of public buildings then constructed in the aftermath of the Great Fire of London (1666).[128] It would be regarded, during this period at least, as one of the "Prime Ornaments of the City ... and a noble Monument to Charity".[129] Not least due to the increase in visitor numbers that the new building allowed, the hospital's fame and latterly infamy grew and this magnificently expanded Bethlem shaped English and international depictions of madness and its treatment.[107]

Public visiting

 
Eighteenth-century Bethlem was most notably portrayed in a scene from William Hogarth's A Rake's Progress (1735), the story of a rich merchant's son, Tom Rakewell, whose immoral living causes him to end up in Bethlem.[n 12]

Visits by friends and relatives were allowed and it was expected that the family and friends of poor inmates would bring food and other essentials for their survival.[72] Bethlem was and is best known for the fact that it also allowed public and casual visitors with no connection to the inmates.[107] This display of madness as public show has often been considered the most scandalous feature of the historical Bedlam.[131]

On the basis of circumstantial evidence, it is speculated that the Bridewell Governors may have decided as early as 1598 to allow public visitors as means of raising hospital income.[n 13] The only other reference to visiting in the sixteenth-century is provided in a comment in Thomas More's 1522 treatise The Four Last Things,[133] where he observed that "thou shalt in Bedleem see one laugh at the knocking of his head against a post".[134] As More occupied a variety of official positions that might have occasioned his calling to the hospital and as he lived nearby, his visit provides no compelling evidence that public visitation was widespread during the sixteenth century.[135] The first apparently definitive documentation of public visiting derives from a 1610 record which details Lord Percy's payment of 10 shillings for the privilege of rambling through the hospital to view its deranged denizens.[n 14][139] It was also at this time, and perhaps not coincidentally, that Bedlam was first used as a stage setting with the publication of The Honest Whore, Part I, in 1604.[140]

Evidence that the number of visitors rose following the move to Moorfields is provided in the observation by the Bridewell Governors in 1681 of "the greate quantity of persons that come daily to see the said Lunatickes".[141] Eight years later the English merchant and author, Thomas Tryon, remarked disapprovingly of the "Swarms of People" that descended upon Bethlem during public holidays.[142] In the mid-eighteenth-century a journalist of a topical periodical noted that at one time during Easter Week "one hundred people at least" were to be found visiting Bethlem's inmates.[143] Evidently Bethlem was a popular attraction, yet there is no credible basis to calculate the annual number of visitors.[144] The claim, still sometimes made, that Bethlem received 96,000 visitors annually is speculative in the extreme.[n 15] Nevertheless, it has been established that the pattern of visiting was highly seasonal and concentrated around holiday periods. As Sunday visiting was severely curtailed in 1650 and banned seven years later, the peak periods became Christmas, Easter, and Whitsun.[152]

... you find yourself in a long and wide gallery, on either side of which are a large number of little cells where lunatics of every description are shut up, and you can get a sight of these poor creatures, little windows being let into the doors. Many inoffensive madmen walk in the big gallery. On the second floor is a corridor and cells like those on the first floor, and this is the part reserved for dangerous maniacs, most of them being chained and terrible to behold. On holidays numerous persons of both sexes, but belonging generally to the lower classes, visit this hospital and amuse themselves watching these unfortunate wretches, who often give them cause for laughter. On leaving this melancholy abode, you are expected by the porter to give him a penny but if you happen to have no change and give him a silver coin, he will keep the whole sum and return you nothing

Inveterate letter-writer César de Saussure's account of Bethlem during his 1725 tour of London's sights.[153]

The Governors actively sought out "people of note and quallitie" – the educated, wealthy and well-bred – as visitors.[154] The limited evidence would suggest that the Governors enjoyed some success in attracting such visitors of "quality".[155] In this elite and idealised model of charity and moral benevolence the necessity of spectacle, the showing of the mad so as to excite compassion, was a central component in the elicitation of donations, benefactions, and legacies.[156] Nor was the practice of showing the poor and unfortunate to potential donators exclusive to Bethlem as similar spectacles of misfortune were performed for public visitors to the Foundling Hospital and Magdalen Hospital for Penitent Prostitutes.[156] The donations expected of visitors to Bethlem – there never was an official fee[n 16] – probably grew out of the monastic custom of almsgiving to the poor.[158] While a substantial proportion of such monies undoubtedly found their way into the hands of staff rather than the hospital poors' box,[n 17] Bethlem profited considerably from such charity, collecting on average between £300 and £350 annually from the 1720s until the curtailment of visiting in 1770.[160] Thereafter the poors' box monies declined to about £20 or £30 per year.[161]

Aside from its fund-raising function, the spectacle of Bethlem offered moral instruction for visiting strangers.[161] For the "educated" observer Bedlam's theatre of the disturbed might operate as a cautionary tale providing a deterrent example of the dangers of immorality and vice. The mad on display functioned as a moral exemplum of what might happen if the passions and appetites were allowed to dethrone reason.[162] As one mid-eighteenth-century correspondent commented: "[there is no] better lesson [to] be taught us in any part of the globe than in this school of misery. Here we may see the mighty reasoners of the earth, below even the insects that crawl upon it; and from so humbling a sight we may learn to moderate our pride, and to keep those passions within bounds, which if too much indulged, would drive reason from her seat, and level us with the wretches of this unhappy mansion".[163]

Whether "persons of quality" or not, the primary allure for visiting strangers was neither moral edification nor the duty of charity but its entertainment value.[164] In Roy Porter's memorable phrase, what drew them "was the frisson of the freakshow",[165] where Bethlem was "a rare Diversion" to cheer and amuse.[166] It became one of a series of destinations on the London tourist trail which included such sights as the Tower, the Zoo, Bartholomew Fair, London Bridge and Whitehall.[167] Curiosity about Bethlem's attractions, its "remarkable characters",[168] including figures such as Nathaniel Lee, the dramatist, and Oliver Cromwell's porter, Daniel,[n 18][170] was, at least until the end of the eighteenth-century, quite a respectable motive for visiting.[171]

From 1770 free public access ended with the introduction of a system whereby visitors required a ticket signed by a Governor.[158] Visiting subjected Bethlem's patients to many abuses, including being poked with sticks by visitors or otherwise taunted, given drinks, and physically assaulted or sexually harassed, but its curtailment removed an important element of public oversight. In the period thereafter, with staff practices less open to public scrutiny, the worst patient abuses occurred.[172][173][174]

1791–1900

Despite its palatial pretensions, by the end of the eighteenth century Bethlem was physically deteriorating with uneven floors, buckling walls, and a leaking roof.[175] It resembled "a crazy carcass with no wall still vertical – a veritable Hogarthian auto-satire".[176] The financial cost of maintaining the Moorfields building was onerous and the capacity of the Governors to meet these demands was stymied by shortfalls in Bethlem's income in the 1780s occasioned by the bankruptcy of its treasurer; further monetary strains were imposed in the following decade by inflationary wage and provision costs in the context of the Revolutionary wars with France.[177] In 1791, Bethlem's Surveyor, Henry Holland, presented a report to the Governors detailing an extensive list of the building's deficiencies including structural defects and uncleanliness and estimated that repairs would take five years to complete at a cost of £8,660: only a fraction of this sum was allocated and by the end of the decade it was clear that the problem had been largely unaddressed.[178] Holland's successor to the post of Surveyor, James Lewis, was charged in 1799 with compiling a new report on the building's condition. Presenting his findings to the Governors the following year, Lewis declared the building "incurable" and opined that further investment in anything other than essential repairs would be financially imprudent. He was, however, careful to insulate the Governors from any criticism concerning Bethlem's physical dilapidation as, rather than decrying either Hooke's design or the structural impact of additions, he castigated the slipshod nature of its rapid construction. Lewis observed that it had been partly built on land called "the Town Ditch", a receptacle for rubbish, and this provided little support for a building whose span extended to over 500 feet (150 m).[179] He also noted that the brickwork was not on any foundation but laid "on the surface of the soil, a few inches below the present floor", while the walls, overburdened by the weight of the roofs, were "neither sound, upright nor level".[180]

Bethlem rebuilt at St. George's Fields

 
Bethlem Hospital at St George's Fields, 1828

While the logic of Lewis's report was clear, the Court of Governors, facing continuing financial difficulties, only resolved in 1803 behind the project of rebuilding on a new site, and a fund-raising drive was initiated in 1804.[181] In the interim, attempts were made to rehouse patients at local hospitals, and admissions to Bethlem, sections of which were deemed uninhabitable, were significantly curtailed such that the patient population fell from 266 in 1800 to 119 in 1814.[182] Financial obstacles to the proposed move remained significant. A national press campaign to solicit donations from the public was launched in 1805. Parliament was successfully lobbied to provide £10,000 for the fund under an agreement whereby the Bethlem Governors would provide permanent accommodation for any lunatic soldiers or sailors of the French Wars.[183] Early interest in relocating the hospital to a site at Gossey Fields had to be abandoned due to financial constraints and stipulations in the lease for Moorfields that precluded its resale. Instead, the Governors engaged in protracted negotiations with the city to swap the Moorfields site for another municipally owned location at St. George's Fields in Southwark, south of the Thames. The swap was concluded in 1810 and provided the Governors with a 12 acres (4.9 ha; 0.019 sq mi) site in a swamp-like, impoverished, highly populated, and industrialised area where the Dog and Duck tavern and St. George's Spa had been.[184][185]

 
A view of Bethlem Hospital, published in 1896.

A competition was held to design the new hospital at Southwark in which the noted Bethlem patient James Tilly Matthews was an unsuccessful entrant.[186] The Governors elected to give James Lewis the task.[187] Incorporating the best elements from the three winning competition designs, he produced a building in the neoclassical style that, while drawing heavily on Hooke's original plan, eschewed the ornament of its predecessor.[187] Completed after three years in 1815, it was constructed during the first wave of county asylum building in England under the County Asylum Act ("Wynn's Act") of 1808.[188] Extending to 580 feet (180 m) in length, the new hospital, which ran alongside the Lambeth Road, consisted of a central block with two wings of three storeys on either side.[187] Female patients occupied the west wing and males the east; as at Moorfields, the cells were located off galleries that traversed each wing.[187] Each gallery contained only one toilet, a sink and cold baths. Incontinent patients were kept on beds of straw in cells in the basement gallery; this space also contained rooms with fireplaces for attendants. A wing for the criminally insane – a legal category newly minted in the wake of the trial of a delusional James Hadfield for attempted regicide[189] – was completed in 1816.[187] This addition, which housed 45 men and 15 women, was wholly financed by the state.[190]

The first 122 patients arrived in August 1815 having been transported to their new residence by a convoy of Hackney coaches.[191] Problems with the building were soon noted as the steam heating did not function properly, the basement galleries were damp and the windows of the upper storeys were unglazed "so that the sleeping cells were either exposed to the full blast of cold air or were completely darkened".[192] Although glass was placed in the windows in 1816, the Governors initially supported their decision to leave them unglazed on the basis that it provided ventilation and so prevented the build-up of "the disagreable effluvias peculiar to all madhouses".[193] Faced with increased admissions and overcrowding, new buildings, designed by the architect Sydney Smirke, were added from the 1830s. The wing for criminal lunatics was increased to accommodate a further 30 men while additions to the east and west wings, extending the building's facade, provided space for an additional 166 inmates and a dome was added to the hospital chapel.[194] At the end of this period of expansion Bethlem had a capacity for 364 patients.[195]

1815–16 Parliamentary Inquiry

 
James (William) Norris, Bethlem Patient, 1815

The late eighteenth and early nineteenth centuries are typically seen as decisive in the emergence of new attitudes towards the management and treatment of the insane.[196] Increasingly, the emphasis shifted from the external control of the mad through physical restraint and coercion to their moral management whereby self-discipline would be inculcated through a system of reward and punishment.[197] For proponents of lunacy reform, the Quaker-run York Retreat, founded in 1796, functioned as an exemplar of this new approach that would seek to re-socialise and re-educate the mad.[197] Bethlem, embroiled in scandal from 1814 over its inmate conditions, would come to symbolise its antithesis.[198]

Through newspaper reports initially and then evidence given to the 1815 Parliamentary Committee on Madhouses, the state of inmate care in Bethlem was chiefly publicised by Edward Wakefield, a Quaker land agent and leading advocate of lunacy reform.[n 19] He visited Bethlem several times during the late spring and early summer of 1814.[n 20] His inspections were of the old hospital at the Moorfields site, which was then in a state of disrepair; much of it was uninhabitable and the patient population had been significantly reduced.[203] Contrary to the tenets of moral treatment, Wakefield found that the patients in the galleries were not classified in any logical manner as both highly disturbed and quiescent patients were mixed together indiscriminately.[204] Later, when reporting on the chained and naked state of many patients, Wakefield sought to describe their conditions in such a way as to maximise the horror of the scene while decrying the apparently bestial treatment of inmates[n 21] and the thuggish nature of the asylum keepers.[n 22] Wakefield's account focused on one patient in particular, James Norris, an American marine reported to be 55 years of age who had been detained in Bethlem since 1 February 1800. Housed in the incurable wing of the hospital, Norris had been continuously restrained for about a decade in a harness apparatus which severely restricted his movement.[n 23][207] Wakefield stated that:

... a stout iron ring was riveted about his neck, from which a short chain passed to a ring made to slide upwards and downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar about two inches wide was riveted; on each side of the bar was a circular projection, which being fashioned to and enclosing each of his arms, pinioned them close to his sides. This waist bar was secured by two similar iron bars which, passing over his shoulders, were riveted to the waist both before and behind. The iron ring about his neck was connected to the bars on his shoulders by a double link. From each of these bars another short chain passed to the ring on the upright bar ... He had remained thus encaged and chained more than twelve years.[208]

Wakefield's revelations, combined with earlier reports about patient maltreatment at the York Asylum,[n 24] helped to prompt a renewed campaign for national lunacy reform and the establishment of an 1815 House of Commons Select Committee on Madhouses, which examined the conditions under which the insane were confined in county asylums, private madhouses, charitable asylums and in the lunatic wards of Poor-Law workhouses.[209]

In June 1816 Thomas Monro, Principal Physician, resigned as a result of scandal when he was accused of 'wanting in humanity' towards his patients.[210] The Superintendent from 1852 to 1862 was William Charles Hood, who did much to reform and improve conditions for patients at the hospital.[211][212]

Dr T. B. Hyslop came to the hospital in 1888 and rose to be physician in charge, bringing the hospital into the 20th century and retiring in 1911.[213]

1930 to the present

In 1930, the hospital moved to the suburbs of Croydon,[214] on the site of Monks Orchard House between Eden Park, Beckenham, West Wickham and Shirley. The old hospital and its grounds were bought by Lord Rothermere and presented to the London County Council for use as a park; the central part of the building was retained and became home to the Imperial War Museum in 1936.[215] The hospital was absorbed into the National Health Service in 1948.[24]

750th anniversary and "Reclaim Bedlam" campaign

In 1997 the hospital started planning celebrations of its 750th anniversary. The service user's perspective was not to be included, however, and members of the psychiatric survivors movement saw nothing to celebrate in either the original Bedlam or in the current practices of mental health professionals towards those in need of care. A campaign called "Reclaim Bedlam" was launched by Pete Shaughnessy, supported by hundreds of patients and ex-patients and widely reported in the media. A sit-in was held outside the earlier Bedlam site at the Imperial War Museum. The historian Roy Porter called the Bethlem Hospital "a symbol for man's inhumanity to man, for callousness and cruelty."[216]

Recent developments

 
Bethlem Royal Hospital in 2011

In 1997, the Bethlem Gallery was established to showcase the work of artists that have experienced mental distress.[217]

In 1999, Bethlem Royal Hospital became part of the South London and Maudsley NHS Foundation Trust ("SLaM"), along with the Maudsley Hospital in Camberwell, and the merger of mental health services in Lambeth and Lewisham took place.[218]

In 2001, SLaM sought planning permission for an expanded Medium Secure Unit and extensive works to improve security, much of which would be on Metropolitan Open Land. Local residents' groups organised mass meetings to oppose the application, with accusations that it was unfair that most patients could be from inner London areas and were, therefore, not locals and that drug use was rife in and around the hospital. Bromley Council refused the application, with Croydon Council also objecting. However the Office of the Deputy Prime Minister overturned the decision in 2003 and development started. The 89-bed, £33.5m unit (River House) opened in February 2008.[219] It is the most significant development on the site since the hospital opened in 1930.[219]

Fatal restraints

Olaseni Lewis (known as Seni; aged 23) died in 2010 at Bethlem Royal Hospital[220] after police subjected him to prolonged restraint of a type known to be dangerous. Neither police nor medical staff intervened when Lewis became unresponsive. At coroner's inquest, the jury found many failures by both police and medical staff which played a part in Lewis's death. They said "The excessive force, pain compliance techniques and multiple mechanical restraints were disproportionate and unreasonable. On the balance of probability, this contributed to the cause of death." Ajibola Lewis, Olaseni Lewis's mother, claimed a nurse at Maudsley Hospital where Lewis had been earlier warned against allowing his transfer to Bethlem. "She said to me, 'Look, don't let him go to the Bethlem, don't let him go there'," his mother said. A doctor later persuaded her to take her son to Bethlem hospital. She was concerned about the conditions there. "It was a mess," she told the court, "It was very confused, a lot of activity, a lot of shouting. I was not happy; I was confused."[221]

Police were trained to view Lewis's behaviour as a medical emergency, but the jury found police failed to act on this. The jury found that "The police failed to follow their training, which requires them to place an unresponsive person into the recovery position and if necessary administer life support. On the balance of probability this also contributed to the cause of death." A doctor did not act when Lewis became unresponsive while his heart rate dramatically slowed.[222]

The Independent Police Complaints Commission first cleared officers over the death, but following pressure from the family, they scrapped the conclusions and started a new inquiry. The IPCC was planning disciplinary action against some of the police officers involved. Deborah Coles of the charity Inquest, who has supported the Lewis family throughout their campaign, said the jury had reached the most damning possible conclusions on the actions of police and medics. "This was a most horrific death. Eleven police officers were involved in holding down a terrified young man until his complete collapse, legs and hands bound in limb restraints, while mental health staff stood by. Officers knew the dangers of this restraint but chose to go against clear, unequivocal training. Evidence heard at this inquest begs the question of how racial stereotyping informed Seni's brutal treatment."[223]

A disciplinary hearing conducted by the Metropolitan Police found the officers had not committed misconduct.[224] The hearing was criticised by the family because it was held behind closed doors with neither press nor public scrutiny.[225]

In 2014, Chris Brennan (aged 15) died of asphyxiation while at Bethlem hospital after repeated self-harming. The coroner found lack of proper risk assessment and lack of a care plan contributed to his death. The hospital claimed staffing problems and low morale were factors. Lessons were learned and the adolescent unit where Brennan died was assessed as good in 2016.[226] F In November 2017, a bill was debated in the House of Commons that would require psychiatric hospitals to give more detailed information about how and when restraints are used. This bill is referred to as "Seni's law".[227] In November 2018, the bill received Royal Assent as the Mental Health Units (Use of Force) Act 2018.[228]

Facilities

 
Entrance to the Occupational therapy Department

The hospital includes specialist services such as the National Psychosis Unit.[229]

Other services include the Bethlem Adolescent Unit, which provides care and treatment for young people aged 12–18 from across the UK.[230]

The hospital has an occupational therapy department, which has its own art gallery, the Bethlem Gallery, displaying work of current and former patients.[217]

The Bethlem Museum of the Mind features exhibits about the history of Bethlem Royal Hospital and the history of mental healthcare and treatment. It features a permanent collection of art created by some of its patients, as well as changing exhibitions.[231]

Every Saturday morning, a parkrun is held in the grounds of Bethlem Royal Hospital.[232]

Media

In 2013, the South London and Maudsley NHS Foundation Trust (SLaM) took part in a Channel 4 observational documentary, Bedlam.[233] Staff and patients spent two years working with television company The Garden Productions. The four-part series started on 31 October.[234]

The first programme, Anxiety, followed patients through the 18-bed Anxiety Disorders Residential Unit. This national unit treats the most anxious people in the country—the top one per cent—and claims a success rate of three in four patients.[234]

The next programme was called Crisis; cameras were allowed in Lambeth Hospital's Triage ward for the first time. In a postcode with the highest rates of psychosis in Europe, this is the Accident and Emergency of mental health, where patients are at their most unwell.[234]

The third programme, Psychosis, films a community mental health team. South London and Maudsley NHS Foundation Trust provides support for more than 35,000 people with mental health problems.[234]

The final programme, Breakdown, focuses on older adults, including the inpatient ward for people over 65 with mental health problems at Maudsley Hospital.[234]

Notable patients

See also

Notes

  1. ^ Although accepted by many historians, including Roy Porter,[61] as Jonathan Andrews points out, Crooke's claim that he was physician to the king, made in the first three editions of his popular medical textbook of human anatomy, Microcosmographia (1615, 1616 and 1618), was baseless.[62]
  2. ^ Crooke claimed that his keepership of Bethlem had cost him £1,000. Following his dismissal, the additional financial burden imposed by the royal inquiry's lengthy legal process led him to sell his College of Physicians fellowship, attained in 1620, back to that corporate body for £5. In 1642 he was still futilely campaigning for his reinstatement, and he died in relative obscurity in 1648.[60] He was immortalised on stage in the character of the grasping asylum doctor, Alibius, in the Jacobean tragedy, The Changeling (1622).[68]
  3. ^ The first evidence for the existence of a steward in Bethlem is during Crooke's tenure as keeper-physician.[69]
  4. ^ a b A toilet.
  5. ^ Medical knowledge, particularly in the field of anatomical pathology, made significant advances throughout the eighteenth century but medical treatment remained largely moribund.[93] Despite a declining intellectual foundation,[94] the humoral-based medical practices of depletion and purgation, later called antiphlogistic (anti-inflammatory) therapy, had undergone little change since the time of Galen in the second century AD.[95] Under this tradition, challenged increasingly from the seventeenth century,[94] physical and mental health was dependent upon the maintenance of a proper balance between the four bodily humours of blood, phlegm, black bile and yellow bile (choler). The humours were replenished through the ingestion of food and discharged naturally when they became noxious.[96] Disease could arise when there was an overabundance or plethora in a given humour and this necessitated its removal from the body through venesection, purging, or a reduction in dietary intake.[95]
  6. ^ For instance Thomas Allen, Bethlem physician from 1667 until his death in 1684, happily dismissed the expressed wish of his colleagues in the Royal Society that he should try the then experimental treatment for insanity of animal-to-human blood transfusion "upon some mad person in ... Bethlem".[97]
  7. ^ The total cost of the new Bethlem built at Moorfields came to £17,000.[110] This expense served to underline the philanthropic magnificence of the presiding governors and rendered Bethlem's patients, in Edward Hatton's words: "great Objects of Charity; for this new Structure cost erecting about [£]17000 whereby not only the Stock of the Hospital is expended, but the Governours are out of Pockets several Sums which they were obliged to take up for that purpose ..."[111]
  8. ^ Estimates of the scale of the building run from 528 to 540 feet (161 to 165 m) wide and 30 to 40 feet (9.1 to 12.2 m) deep.[113]
  9. ^ A double-pile building has two rooms arranged longitudinally along a central corridor. A single-pile has only one.[110]
  10. ^ The Governors debated whether to install iron grates at the entrance to the galleries, which would have allowed patients the freedom to walk in them while preventing intercourse between male and female patients. This proposal was resisted, however, by those who thought it would have spoiled the view offered by the galleries. However, iron grates with a door to allow visitors to pass through them were installed in 1689 and presumably it is from this date patients who were not otherwise violent were permitted to walk the galleries. Patients, if deemed well enough, could use the rear yards for exercise both before and after this date.[119] This allowed them to "take the aire in order to [aid] their Recovery".[120]
  11. ^ In 1676 there were 34 cells on one side of each of the four galleries, or 136 cells in all. The cells, large and well ventilated for the time by any measure, were 12 feet (3.7 m) deep by 8 feet 10 inches (2.69 m) wide and 12 feet 10 inches (3.91 m) high.[126]
  12. ^ The image shows a shaven-head and near-naked Rakewell in one of galleries of Bethlem, reclining in a position reminiscent of one of Cibber's figures. An attendant (barely visible in this painted version) is in the process of manacling his leg. The figure standing over Rakewell wearing a wig and with his head bowed forward is likely a physician and may have just bled the patient. Scull and Andrews opine that this figure "bears more than a passing resemblance to" James Monro, the father of John Monro.[130]
  13. ^ This position, argued by Andrews et al., principally relies on a reading of the last line of the report of the 1598 visitation, quoted above, which refers to the fact that Bethlem was then "so loathsomely and filthely, kept not fitt for any man to come into". While conceding that "come into" here may refer to admissions they thought this unlikely given that the Bridewell Governors in the same line had already disparaged the hospital's patient accommodation. Instead, they argue, a more plausible interpretation is that it evinces the concern of the Governors that the hospital conditions might dissuade public visitors which they were anxious to increase as a means of augmenting Bethlem's revenues.[132]
  14. ^ While in London, the young Percy and his troupe also "saw the lions, the shew of Bethlem, the places where the prince was created and the fireworks at the Artillery Garden".[136] Carol Neely, however, thinks it improbable that an eight-year-old Lord Percy and his equally young cousins, while his father, Henry Percy, was then ensconced in the Tower of London, would have visited Bethlem at this date, particularly in consideration of the ramshackle condition of the hospital in the early seventeenth-century.[137] This is to ignore, however, the fact that there are many references to children visiting Bethlem.[138]
  15. ^ It is still frequently and erroneously asserted that either during the eighteenth-century or as late as 1814 or 1815, the period depending on the source, there were 96,000 visits in a given year.[145] For example, Michel Foucault in his History of Madness (2006) claimed "As late as 1815, if a report presented to the House of Commons is to be believed, Bethlem Hospital showed its lunatics every Sunday for one penny. The annual revenue from those visits amounted to almost 400 pounds which means that an astonishing 96,000 visitors came to see the mad each year."[146] As Andrews et al. have noted, none of the claims in the above paragraph have any basis in fact.[29] The notional figure of 96,000 visitors, which was first applied to the eighteenth century, derives from the original archival research of O'Donoghue and his 1914 history of the hospital.[147] From this source Robert R. Reed arrived at the above dubious calculation of visitations per annum by dividing the contents of the Bethlem poors' box for a single year by the supposed entrance fee per person. However, there is no credible evidence to suggest that there was an official entrance charge of one penny, there is no way of knowing how much individual visitors donated and the figure of £400 includes the entirety of the contents of the poors' box and hence all the charitable donations that Bethlem received.[148] It is likely that Foucault's source is Reed, and he transposes it to the nineteenth century.[149] The report of the parliamentary inquiry of 1815–16 does not support any of his claims.[150] The impossibility of his account is underlined by the fact that Sunday visits were banned in 1657 and public visitations were curtailed from 1770.[151]
  16. ^ However, during the seventeenth- and eighteenth-centuries staff at the asylum did try to exact such a fee and by 1742 it was customary for the porter to demand a minimum of one penny from visiting strangers.[157]
  17. ^ The servants of Bethlem were allowed their own poors' box from 1662. The diversion of other monies into the pockets of the hospital staff undoubtedly helped to keep wages down. [159]
  18. ^ Daniel was purportedly 7 feet 6 inches (2.29 m) tall and the model for Cibber's figure of "Raving madness".[169]
  19. ^ In 1812, Wakefield had determined to establish a new London asylum to be modelled on the Retreat and formed a committee to this end. As part of the planning process for this scheme, the committee first resolved to survey the metropolitan institutions for the care of the insane: St. Luke's, Guy's Hospital and Bethlem.[199]
  20. ^ The initial attempts by Wakefield to gain access to Bethlem were rebuffed by the hospital authorities who were particularly keen to protect Bethlem's image at a time when they were applying to parliament for funds to finance the move to Southwark.[200] Wakefield, mindful of the difficulties reformers had had in accessing other institutions, persisted and, having secured an invitation to visit from one of Bethlem's Governors, began the first of his many visits to the hospital on 25 April 1814.[200] This visit was cut short by the hospital steward, but Wakefield returned on 2 May accompanied by Charles Western, a Member of Parliament.[201] Wakefield returned for a final unauthorized visit on 7 June 1814.[202]
  21. ^

    One of the side rooms contained about ten [female] patients, each chained by one arm to the wall; the chain allowing them merely to stand up by the bench or form fixed to the wall, or sit down on it. The nakedness of each patient was covered by a blanket only ... Many other unfortunate women were locked up in their cells, naked and chained on straw ... In the men's wing, in the side room, six patients were chained close to the wall by the right arm as well as by the right leg ... Their nakedness and their mode of confinement gave the room the complete appearance of a dog kennel.

    — Edward Wakefield, 1814[205]
  22. ^

    Whilst [we were] looking at some of the bed-lying patients, a man arose naked from his bed, and had deliberately and quietly walked a few paces from his cell door along the gallery; he was instantly seized by the keepers, thrown in his bed, and leg-locked, without enquiry or observation: chains were universally substituted for the straitwaistcoat

    — Edward Wakefield 1815[206]
  23. ^ On a subsequent visit on 7 June of that year, Wakefield brought an artist who made a drawing of the confined Norris.[207] This image, which was engraved and widely distributed, became an important propaganda tool in the cause of lunacy reform.[207]
  24. ^ Not to be confused with the York Retreat.

Footnotes

  1. ^ Tuke 1882, p. 60.
  2. ^ "Bethlem Royal Hospital: why did the infamous Bedlam asylum have such a fearsome reputation?". History Extra. Retrieved 5 November 2022.
  3. ^ Andrews et al. 1997, pp. 15, 23; Vincent 1998, p. 213.
  4. ^ Allderidge 1979a, pp. 144–45; Vincent 1998, p. 224; Porter 1997, p. 41.
  5. ^ Andrews et al. 1997, p. 25
  6. ^ a b Vincent 1998, p. 224
  7. ^ Vincent 1998, p. 217
  8. ^ Vincent 1998, p. 226
  9. ^ Vincent 1998, pp. 230–31.
  10. ^ a b Vincent 1998, pp. 231.
  11. ^ Andrews et al. 1997, p. 84
  12. ^ Vincent 1998, p. 231; Andrews et al. 1997, p. 57
  13. ^ Andrews et al. 1997, p. 56
  14. ^ Phillpotts 2012, p. 200
  15. ^ Andrews et al. 1997, pp. 16, 58; Phillpotts 2012, p. 207.
  16. ^ Andrews et al. 1997, p. 55
  17. ^ Phillpotts 2012, p. 207; Andrews et al. 1997, p. 81
  18. ^ a b Vincent 1998, p. 232
  19. ^ Jones 1955, p. 11
  20. ^ Andrews 1995, p. 11
  21. ^ Andrews 1995, p. 11; Andrews et al. 1997, pp. 17, 60
  22. ^ Allderidge 1979a, p. 148
  23. ^ Allderidge 1979a, p. 149; Porter 2006, pp. 156–57
  24. ^ a b Andrews 1991, p. 1; Allderidge 1979a, p. 149.
  25. ^ Allderidge 1979a, p. 144.
  26. ^ Allderidge 1979a, p. 142
  27. ^ By 1403, 'lunatic' patients formed the majority of Bedlam's population Porter 2006, p. 156; Whittaker 1947, p. 742.
  28. ^ Allderidge 1979a, pp. 142–43
  29. ^ a b Andrews et al. 1997, p. 3
  30. ^ O'Donoghue 1914
  31. ^ Andrews et al. 1997, pp. 115–16
  32. ^ Allderidge 1979a, p. 143; Allderidge 1979b, p. 323.
  33. ^ Porter 1997, p. 41
  34. ^ Scull 1999, p. 249
  35. ^ Andrews et al. 1997, pp. 113–15
  36. ^ Andrews et al. 1997, p. 82
  37. ^ Andrews et al. 1997, p. 131
  38. ^ Andrews et al. 1997, pp. 1–2, 130–31
  39. ^ Andrews et al. 1997, p. 130; Hattori 1995, p. 283
  40. ^ Andrews et al. 1997, p. 130
  41. ^ Andrews et al. 1997, p. 132; Hattori 1995, p. 287
  42. ^ Andrews et al. 1997, p. 132; Jackson 2000, p. 224
  43. ^ Andrews 1991, p. 245
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  48. ^ O'Donoghue, Edward Geoffrey (1 January 1915). The Story of Bethlehem Hospital from Its Foundation in 1247. Dutton.
  49. ^ Andrews et al. 1997, p. 91
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  51. ^ a b Jackson 2005, p. 49
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  54. ^ "A View of Bethalem", 4 December 1598, quoted in Allderidge 1979a, p. 153
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  56. ^ Allderidge 1979b, p. 323
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  59. ^ a b Allderidge 1985, p. 29
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  92. ^ Quoted in Scull, MacKenzie & Hervey 1996, p. 10
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  95. ^ a b Noll 2007, p. x
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  97. ^ Quoted in Andrews et al. 1997, p. 271
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  111. ^ Edward Hatton, A New View of London: Or, an Ample Account of that City, 2 vols. (London, 1708), 2, p. 732, quoted in Stevenson 1996, p. 260
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Sources

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Books
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  • O'Donoghue, Edward Geoffrey. The Story of Bethlem from its Foundation in 1247. London: T.F. Unwin; 1914.
  • Parry-Jones, William Llywelyn. The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries. London: Routledge & Kegan Paul; 1971. ISBN 9780802001559.
  • Phillips, Bob. Overcoming Anxiety and Depression. Eugene OR: Harvest House Publishers; 2007. ISBN 9780736919968.
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  • Reed, Robert R.. Bedlam on the Jacobean Stage. Cambridge, Mass.: Harvard University Press; 1952.
  • Scull, Andrew. The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900. New Haven & London: Yale University Press; 1993. ISBN 0300107544.
  • Scull, Andrew; MacKenzie, Charlotte; Hervey, Nicholas. Masters of Bedlam: The Transformation of the Mad-Doctoring Trade. Princeton NJ: Princeton University Press; 1996. ISBN 0691034117.
  • Skultans, Vieda. English Madness: Ideas on Insanity, 1580–1890. London: Routledge; 1979. ISBN 9780710003294.
  • Smith, Leonard D.. Cure, Comfort and Safe Custody: Public Lunatic Asylums in Early Nineteenth-Century England. London & New York: Leicester University Press; 1999. ISBN 9780718500948.
  • Tuke, Daniel Hack. Chapters in the History of the Insane in the British Isles. London: Keegan Paul, Trench & Co.; 1882.
  • Walford, Edward. Old and New London: Volume 6. Cassell Petter & Galpin; 1878. Chapter XXVI, St. George's Fields.
Journals articles and book chapters
  • Allderidge, Patricia. Management and Mismanagement at Bedlam, 1547–1633. In: Webster, Charles. Health, Medicine and Mortality in the Sixteenth Century. Cambridge: Cambridge University Press; 1979a. ISBN 9780521226431. p. 141–164.
  • Allderidge, Patricia. Hospitals, Madhouses and Asylums: Cycles in the Care of the Insane. British Journal of Psychiatry. 1979b;134(4):321–34. doi:10.1192/bjp.134.4.321.
  • Allderidge, Patricia. In: Bynum, W.F.; Porter, Roy; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. Vol. 2. London & New York: Tavistock; 1985. ISBN 9780415008594.
  • Andrews, Jonathan. 'Hardly a Hospital, but a Charity for Pauper Lunatics'? Therapeutics at Bethlem in the Seventeenth and Eighteenth Centuries. In: Barry, Jonathan; Jones, Colin. Medicine and Charity before the Welfare State. London: Routledge; 1994. ISBN 9780415111362. p. 63–81.
  • Andrews, Jonathan. The Politics of Committal to Early Modern Bethlem. In: Porter, Roy. Medicine in the Enlightenment. Amsterdam & Atlanta GA: Rodopi; 1995. ISBN 9789051835625. p. 6–53.
  • Andrews, Jonathan. Monro, Thomas (1759–1833). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; January 2010. doi:10.1093/ref:odnb/18981. (subscription required)
  • Birken, William. Crooke, Helkiah (1576–1648). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; 2004. doi:10.1093/ref:odnb/6775. (subscription required)
  • Gibson, Katharine. Cibber, Caius Gabriel (1630–1700). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; 2008. doi:10.1093/ref:odnb/5415. (subscription required)
  • Griffiths, Paul. Frith, Mary (1584x9–1659). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; 2008. doi:10.1093/ref:odnb/10189. (subscription required)
  • Hattori, Natsu. 'The Pleasure of your Bedlam': The Theatre of Madness in the Renaissance. History of Psychiatry. 1995;6(23):283–308. doi:10.1177/0957154X9500602302. PMID 11639849.
  • Jackson, Kenneth S.. 'I know not / Where I did lodge last night?': King Lear and the Search for Bethlem (Bedlam) Hospital. English Literary Renaissance. 2000;30(2):213–40. doi:10.1111/j.1475-6757.2000.tb01170.x.
  • Moran, Richard. The Modern Foundation for the Insanity Defense: the Case of James Hadfield (1800) and Daniel McNaughtan (1843). Annals of the American Academy of Political and Social Science. 1985;447:31–42.
  • Moss, David J.. Wakefield, Edward (1774–1854). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; 2008. doi:10.1093/ref:odnb/28414. (subscription required)
  • Phillpotts, Christopher. Richard II and the Monasteries of London. In: Ormrod, W. Mark. 14th Century England. Vol. 7. Woodbridge: Boydell Press; 2012. ISBN 9781843837213. p. 197–224.
  • Porter, Roy. History Today. 1997;47(10):41–8.
  • Scull, Andrew. Medical History. 1999;43:248–55. doi:10.1017/s0025727300065133.
  • Scull, Andrew. The Fictions of Foucault's Scholarship. Times Literary Supplement. 21 March 2007.
  • Stevenson, Christine. Robert Hooke's Bethlem. Journal of the Society of Architectural Historians. 1996;55(3):254–275. doi:10.2307/991148.
  • Stevenson, Christine. The Architecture of Bethlem at Moorfields. History of Bethlem. Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker & Keir Waddington. London & New York: Routledge; 1997. ISBN 0415017734. p. 230–59.
  • Vincent, Nicholas. Goffredo de Prefetti and the Church of Bethlehem in England. Journal of Ecclesiastical History. 1998;49(2):213–35. doi:10.1017/S0022046998006319.
  • Wheelwright, Julie. Snell, Hannah (1723–1792). Oxford Dictionary of National Biography. Online ed. Oxford: Oxford University Press; 2008. doi:10.1093/ref:odnb/25975. (subscription required)
  • Whittaker, Duncan. The 700th Anniversary of Bethlem. Journal of Mental Science. 1947;93(393):740–47. doi:10.1192/bjp.93.393.740.
Theses
  • Andrews, Jonathan. Bedlam Revisited: A History of Bethlem Hospital c.1634 – c.1770 [PhD thesis]. London: Queen Mary and Westfield College, London University; 1991.
Newspapers and news agencies
  • Olden, Mark. Obituary: Peter Shaughnessy. Campaigner who took the stigma out of insanity. Guardian. 23 January 2003:22.
  • Cooke, Matthew. £33m goes to 760-year-old hospital. 30 October 2008 [Retrieved 30 October 2012]. BBC London.
  • Today Programme. Lunatic London. 8 August 2008 [Retrieved 30 October 2012]. BBC, Radio 4.
Webpages
  • Archives and Museum. About the Museum. Archives and Museum, Bethlem Royal Hospital; 30 October 2012(a) [Retrieved 30 October 2012].
  • Archives and Museum. Art. Archives and Museum, Bethlem Royal Hospital; 30 October 2012(b) [Retrieved 30 October 2012].
  • Bethlem Gallery. About Us. Bethlem Gallery; 23 October 2012 [Retrieved 30 October 2012].
  • Gale, Colin S.. The Bethlem Hospital. London: "The Lost Hospitals of London" Monday at One Series, Gresham College; 19 March 2012 [Retrieved 4 November 2012]. [1] [ 29 May 2012].
  • SLaM. Psychosis Service. South London and Maudsley NHS Foundation Trust; 30 October 2012(a) [Retrieved 30 October 2012(a)].
  • SLaM. Interactive Tour of Bethlem Adolescent Unit. South London and Maudsley NHS Foundation Trust; 30 October 2012(b) [Retrieved 30 October 2012].

External links

 
Wikimedia Commons has media related to Bethlem Royal Hospital.
  • Official website  
  • Bethlem Royal Hospital on the NHS website
  • Care Quality Commission inspection reports
  • "Archival material relating to Bethlem Royal Hospital". UK National Archives.  
  • Catholic Encyclopedia: Bedlam
  • Historical images of Bethlem In Monks Orchard Album

Coordinates: 51°22′51″N 0°01′50″W / 51.38087°N 0.03061°W / 51.38087; -0.03061

May 17, 2023
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Bethlem Royal Hospital also known as St Mary Bethlehem Bethlehem Hospital and Bedlam is a psychiatric hospital in London Its famous history has inspired several horror books films and TV series most notably Bedlam a 1946 film with Boris Karloff Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBethlem Royal HospitalShown in BromleyGeographyLocationMonks Orchard Road Beckenham London EnglandOrganisationCare systemNational Health ServiceTypeSpecialistServicesEmergency departmentAdmissions through A amp EBedsApprox 350SpecialityPsychiatric hospitalHistoryOpened1247 as priory 1330 as hospitalLinksWebsitewww wbr slam wbr nhs wbr uk wbr our services wbr hospital care wbr bethlem royal hospitalListsHospitals in EnglandThe hospital is closely associated with King s College London and in partnership with the Institute of Psychiatry Psychology and Neuroscience is a major centre for psychiatric research It is part of the King s Health Partners academic health science centre and the National Institute for Health and Care Research NIHR Biomedical Research Centre for Mental Health Founded in 1247 the hospital was originally near Bishopsgate just outside the walls of the City of London It moved a short distance to Moorfields in 1676 and then to St George s Fields in Southwark in 1815 before moving to its current location in Monks Orchard in 1930 The word bedlam meaning uproar and confusion is derived from the hospital s nickname Although the hospital became a modern psychiatric facility historically it was representative of the worst excesses of asylums in the era of lunacy reform Contents 1 1247 1633 1 1 Foundation 1 2 Politics and patronage 1 3 From Bethlem to Bedlam 1 4 Management 1 5 Helkiah Crooke 1 6 Conditions 2 1634 1791 2 1 Medical regime 2 2 Bethlem rebuilt at Moorfields 2 3 Public visiting 3 1791 1900 3 1 Bethlem rebuilt at St George s Fields 3 2 1815 16 Parliamentary Inquiry 4 1930 to the present 4 1 750th anniversary and Reclaim Bedlam campaign 4 2 Recent developments 4 3 Fatal restraints 5 Facilities 6 Media 7 Notable patients 8 See also 9 Notes 10 Footnotes 10 1 Sources 11 External links1247 1633 EditFoundation Edit Plan of the first Bethlem 1 Map of London in c 1300 St Mary Spital is shown north of the city wall outside Bishopgate The hospital was founded in 1247 as the Priory of the New Order of our Lady of Bethlehem in the city of London during the reign of Henry III 2 It was established by the Bishop elect of Bethlehem the Italian Goffredo de Prefetti following a donation of personal property by the London alderman and former sheriff Simon FitzMary 3 The original location was in the parish of St Botolph Bishopsgate s ward just beyond London s wall and where the south east corner of Liverpool Street Station now stands 4 Bethlem was not initially intended as a hospital in the clinical sense much less as a specialist institution for the insane 5 but as a centre for the collection of alms to support the Crusader Church and to link England to the Holy Land 6 De Prefetti s need to generate income for the Crusader Church and restore the financial fortunes of his see had been occasioned by two misfortunes his bishopric had suffered significant losses following the destructive conquest of Bethlehem by the Khwarazmian Turks in 1244 and his immediate predecessor had further impoverished his cathedral chapter through the alienation of a considerable amount of its property 7 The priory obedient to the Church of Bethlehem would also house the poor and if they visited provide hospitality to the bishop canons and brothers of Bethlehem 6 Thus Bethlem became a hospital in medieval usage an institution supported by charity or taxes for the care of the needy The subordination of the priory s religious order to the bishops of Bethlehem was further underlined in the foundational charter which stipulated that the prior canons and inmates were to wear a star upon their cloaks and capes to symbolise their obedience to the church of Bethlehem 8 Politics and patronage Edit During the thirteenth and fourteenth centuries with its activities underwritten by episcopal and papal indulgences the hospital s role as a centre for alms collection persisted 9 but its linkage to the Order of Bethlehem increasingly unravelled putting its purpose and patronage in doubt 10 In 1346 the master of Bethlem a position at that time granted to the most senior of London s Bethlemite brethren 11 applied to the city authorities seeking protection thereafter metropolitan office holders claimed power to oversee the appointment of masters and demanded in return an annual payment of 40 shillings 12 It is doubtful whether the city really provided substantial protection and much less that the mastership fell within their patronage but dating from the 1346 petition it played a role in the management of Bethlem s finances 13 By this time the Bethlehemite bishops had relocated to Clamecy France under the surety of the Avignon papacy 10 This was significant as throughout the reign of Edward III 1327 77 the English monarchy had extended its patronage over ecclesiastical positions through the seizure of priories under the control of non English religious houses 14 As a dependent house of the Order of Saint Bethlehem in Clamecy Bethlem was vulnerable to seizure by the crown and this occurred in the 1370s when Edward III took control 15 The purpose of this appropriation was in the context of the Hundred Years War between France and England to prevent funds raised by the hospital from enriching the French monarchy via the papal court 16 After this event the masters of the hospital semi autonomous figures in charge of its day to day management were normally crown appointees and it became an increasingly secularised institution 17 The memory of its foundation became muddied and muddled in 1381 the royal candidate for the post of master claimed that from its beginnings it had been superintended by an order of knights and he confused its founder Goffredo de Prefetti with the Frankish crusader Godfrey de Bouillon 18 The removal of the last symbolic link to the Bethlehemites was confirmed in 1403 when it was reported that master and inmates no longer wore the star of Bethlehem 18 The Prospect of Bridewell from John Strype s An Accurate Edition of Stow s A Survey of London 1720 From 1557 Bethlem was administered by the Bridewell Governors In 1546 the Lord Mayor of London Sir John Gresham petitioned the crown to grant Bethlem to the city 19 This petition was partially successful and Henry VIII reluctantly ceded to the City of London the custody order and governance of the hospital and of its occupants and revenues 20 This charter came into effect in 1547 21 The crown retained possession of the hospital while its administration fell to the city authorities 22 Following a brief interval when it was placed under the management of the governors of Christ s Hospital from 1557 it was administered by the governors of Bridewell a prototype house of correction at Blackfriars 23 Having been thus one of the few metropolitan hospitals to have survived the dissolution of the monasteries physically intact this joint administration continued not without interference by both the crown and city until incorporation into the National Health Service in 1948 24 From Bethlem to Bedlam Edit A Church of Our Lady that is named Bedlam And in that place be found many men that be fallen out of their wit And full honestly they be kept in that place and some be restored onto their wit and health again And some be abiding therein for ever for they be fallen so much out of themselves that it is incurable unto man William Gregory Lord Mayor of London c 1450 25 It is unknown when Bethlem or Bedlam began to specialise in the care and control of the insane 26 but it has been frequently asserted that Bethlem was first used for the insane from 1377 27 This date is derived from the unsubstantiated conjecture of the Reverend Edward Geoffrey O Donoghue 28 chaplain to the hospital 29 who published a monograph on its history in 1914 30 While it is possible that Bethlem was receiving the insane during the late fourteenth century the first definitive record of their presence in the hospital is in the details of a visitation of the Charity Commissioners in 1403 31 This recorded that amongst other patients there were six male inmates who were mente capti a Latin term indicating insanity 32 The report of the visitation also noted the presence of four pairs of manacles 11 chains six locks and two pairs of stocks but it is not clear if any or all of these items were for the restraint of the inmates 33 While mechanical restraint and solitary confinement are likely to have been used for those regarded as dangerous 34 little else is known of the actual treatment of the insane for much of the medieval period 35 The presence of a small number of insane patients in 1403 marks Bethlem s gradual transition from a diminutive general hospital into a specialist institution for the confinement of the insane This process was largely completed by 1460 36 Curtain Theatre circa 1600 cylindrical building in the background Some authorities believe this to be a depiction of The Theatre the other Elizabethan theatre at Shoreditch in west Moorfields Both playhouses were a stone s throw away from the original Bethlem site at Bishopsgate From the fourteenth century Bethlem had been referred to colloquially as Bedleheem Bedleem or Bedlam 37 Initially Bedlam was an informal name but from approximately the Jacobean era the word entered everyday speech to signify a state of madness chaos and the irrational nature of the world 38 This development was partly due to Bedlam s staging in several plays of the Jacobean and Caroline periods including The Honest Whore Part I 1604 Northward Ho 1607 The Duchess of Malfi 1612 The Pilgrim c 1621 and The Changeling 1622 39 This dramatic interest in Bedlam is also evident in references to it in early seventeenth century plays such as Epicœne or The Silent Woman 1609 Bartholomew Fair 1614 and A New Way to Pay Old Debts c 1625 40 The appropriation of Bedlam as a theatrical locale for the depiction of madness probably owes no little debt to the establishment in 1576 in nearby Moorfields of The Curtain and The Theatre two of the main London playhouses 41 it may also have been coincident with that other theatricalisation of madness as charitable object the commencement of public visiting at Bethlem 42 Management Edit The position of master was a sinecure largely regarded by its occupants as means of profiting at the expense of the poor in their charge 43 The appointment of the masters later known as keepers had lain within the patronage of the crown until 1547 44 Thereafter the city through the Court of Aldermen took control and as with the King s appointees the office was used to reward loyal servants and friends 45 Compared to the masters placed by the monarch those who gained the position through the city were of much more modest status 46 In 1561 the Lord Mayor succeeded in having his former porter Richard Munnes a draper by trade appointed to the position The sole qualification of his successor in 1565 a man by the name of Edward Rest 47 appears to have been his occupation as a grocer 45 Rest died in 1571 at which point the keepership passed on to John Mell in 1576 48 known for his abuse of the governors those who gave money to the poor and the poor themselves 47 The Bridewell Governors largely interpreted the role of keeper as that of a house manager and this is clearly reflected in the occupations of most appointees as they tended to be inn keepers victualers or brewers and the like 49 When patients were sent to Bethlem by the Governors of the Bridewell the keeper was paid from hospital funds For the remainder keepers were paid either by the families and friends of inmates or by the parish authorities It is possible that keepers negotiated their fees for these latter categories of patients 50 John Mell s death in 1579 left the keepership open for the long term keeper 47 Roland Sleford a London cloth maker who left his post in 1598 apparently of his own volition after a 19 year tenure 51 Two months later the Bridewell Governors who had until then shown little interest in the management of Bethlem beyond the appointment of keepers conducted an inspection of the hospital and a census of its inhabitants for the first time in over 40 years 51 Their purpose was to view and p er use the defaultes and want of rep ar ac i ons 52 They found that during the period of Sleford s keepership the hospital buildings had fallen into a deplorable condition with the roof caving in and the kitchen sink blocked and reported that 53 it is not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fit for any man to come into the house 54 The committee of inspection found 21 inmates with only two having been admitted during the previous 12 months Of the remainder six at least had been resident for a minimum of eight years and one inmate had been there for around 25 years 55 Three were from outside London six were charitable cases paid for out of the hospital s resources one was supported by a parochial authority and the rest were provided for by family friends benefactors or in one instance out of their own funds 56 The reason for the Governors new found interest in Bethlem is unknown but it may have been connected to the increased scrutiny the hospital was coming under with the passing of poor law legislation in 1598 and to the decision by the Governors to increase hospital revenues by opening it up to general visitors as a spectacle 57 After this inspection the Governors initiated some repairs and visited the hospital at more frequent intervals During one such visit in 1607 they ordered the purchase of clothing and eating vessels for the inmates presumably indicating the lack of such basic items 58 Helkiah Crooke Edit The title page of Helkiah Crooke s Microcosmographia 1615 Crooke was appointed keeper physician to Bethlem Hospital in 1619 At the bidding of James VI and I Helkiah Crooke 1576 1648 was appointed keeper physician in 1619 59 As a Cambridge graduate the author of an enormously successful English language book of anatomy entitled Microcosmographia a Description of the Body of Man 1615 60 and a member of the medical department of the royal household n 1 he was clearly of higher social status than his city appointed predecessors his father was a noted preacher and his elder brother Thomas was created a baronet Crooke had successfully ousted the previous keeper the layman Thomas Jenner after a campaign in which he had castigated his rival for being unskilful in the practice of medicine 44 While this may appear to provide evidence of the early recognition by the Governors that the inmates of Bethlem required medical care the formal conditions of Crooke s appointment did not detail any required medical duties 44 Indeed the Board of Governors continued to refer to the inmates as the poore or prisoners and their first designation as patients appears to have been by the Privy Council in 1630 63 From 1619 Crooke unsuccessfully campaigned through petition to the king for Bethlem to become an independent institution from the Bridewell a move that while likely meant to serve both monarchial and personal interest would bring him into conflict with the Bridewell Governors 64 Following a pattern of management laid down by early office holders his tenure as keeper was distinguished by his irregular attendance at the hospital and the avid appropriation of its funds as his own 59 Such were the depredations of his regime that an inspection by the Governors in 1631 reported that the patients were likely to starve 65 Charges against his conduct were brought before the Governors in 1632 61 Crooke s royal favour having dissolved with the death of James I 66 Charles I instigated an investigation against him in the same year This established his absenteeism and embezzlement of hospital resources and charged him with failing to pursue any endeavour for the curing of the distracted persons 67 It also revealed that charitable goods and hospital purchased foodstuffs intended for patients had been typically misappropriated by the hospital steward either for his own use or to be sold to the inmates If patients lacked resources to trade with the steward they often went hungry 65 These findings resulted in the dismissal in disgrace of Crooke n 2 the last of the old style keepers along with his steward on 24 May 1633 n 3 70 Conditions Edit In 1632 it was recorded that the old house of Bethlem had below stairs a parlour a kitchen two larders a long entry throughout the house and 21 rooms wherein the poor distracted people lie and above the stairs eight rooms more for servants and the poor to lie in 71 It is likely that this arrangement was not significantly different in the sixteenth century 71 Although inmates if deemed dangerous or disturbing were chained or locked up Bethlem was an otherwise open building with its inhabitants at liberty to roam around its confines and possibly the local neighbourhood 72 The neighbouring inhabitants would have been quite familiar with the condition of the hospital as in the 1560s and probably for some considerable time before that those who lacked a lavatory in their own homes had to walk through the west end of the long house of Bethlem to access the rear of the hospital and reach the common Jacques n 4 72 Typically the hospital appears to have been a receptacle for the very disturbed and troublesome and this fact lends some credence to accounts such as that provided by Donald Lupton in the 1630s who described the cryings screechings roarings brawlings shaking of chaines swearings frettings chaffings that he observed 72 Bethlem had been built over a sewer that served both the hospital and its precinct This common drain regularly blocked resulting in overflows of waste at the entrance of the hospital 73 The 1598 visitation by the Governors had observed that the hospital was filthely kept but the Governors rarely made any reference to the need for staff to clean the hospital The level of hygiene reflected the inadequate water supply which until its replacement in 1657 consisted of a single wooden cistern in the back yard from which water had to be laboriously transported by bucket 74 In the same yard since at least the early seventeenth century there was a washhouse to clean patients clothes and bedclothes and in 1669 a drying room for clothes was added Patients if capable were permitted to use the house of easement n 4 of which there were two at most but more frequently piss pots were used in their cells 75 Unsurprisingly inmates left to brood in their cells with their own excreta were on occasion liable to throw such filth amp Excrem en t into the hospital yard or onto staff and visitors Lack of facilities combined with patient incontinence and prevalent conceptions of the mad as animalistic and dirty fit to be kept on a bed of straw appear to have promoted an acceptance of hospital squalor 76 However this was an age with very different standards of public and personal hygiene when people typically were quite willing to urinate or defecate in the street or even in their own fireplaces 77 For much of the seventeenth century the dietary provision for patients appears to have been inadequate This was especially so during Crooke s regime when inspection found several patients suffering from starvation Corrupt staff practices were evidently a significant factor in patient malnourishment and similar abuses were noted in the 1650s and 1670s The Governors failed to manage the supply of victuals relying on gifts in kind for basic provisions and the resources available to the steward to purchase foodstuffs was dependent upon the goodwill of the keeper 78 Patients were fed twice a day on a lowering diet an intentionally reduced and plain diet consisting of bread meat oatmeal butter cheese and generous amounts of beer It is likely that daily meals alternated between meat and dairy products almost entirely lacking in fruit or vegetables 79 That the portions appear to have been inadequate also likely reflected contemporary humoral theory that justified rationing the diet of the mad the avoidance of rich foods and a therapeutics of depletion and purgation to restore the body to balance and restrain the spirits 80 1634 1791 EditMedical regime Edit James Monro was elected to the post of Bethlem physician in 1728 a position which he retained until his death in 1752 This marked the beginning of a 125 year Monro family dynasty of Bethlem physicians The year 1634 is typically interpreted as denoting the divide between the mediaeval and early modern administration of Bethlem 81 It marked the end of the day to day management by an old style keeper physician and its replacement by a three tiered medical regime composed of a non resident physician a visiting surgeon and an apothecary 82 a model adopted from the royal hospitals The medical staff were elected by the Court of Governors and in a bid to prevent profiteering at the expense of patients that had reached its apogee in Crooke s era they were all eventually salaried with limited responsibility for the financial affairs of the hospital 62 Personal connections interests and occasionally royal favour were pivotal factors in the appointment of physicians but by the measure of the times appointees were well qualified as almost all were Oxford or Cambridge graduates and a significant number were candidates for or fellows of the Royal College of Physicians 83 Although the posts were strongly contested nepotistic appointment practices played a significant role The election of James Monro as physician in 1728 marked the beginning of a 125 year Monro family dynasty extending through four generations of fathers and sons 84 Family influence was also significant in the appointment of surgeons but absent in that of apothecaries 85 The office of physician was largely an honorary and charitable one with only a nominal salary As with most hospital posts attendance was required only intermittently and the greater portion of the income was derived from private practice 86 Bethlem physicians maximising their association with the hospital typically earned their coin in the lucrative trade in lunacy 87 with many acting as visiting physicians to presiding over or even as with the Monros and their predecessor Thomas Allen establishing their own mad houses 88 Initially both surgeons and apothecaries were also without salary and their hospital income was solely dependent upon their presentation of bills for attendance to the Court of Governors 89 This system was frequently abused and the bills presented were often deemed exorbitant by the Board of Governors The problem of financial exploitation was partly rectified in 1676 when surgeons received a salary and from the mid eighteenth century elected apothecaries were likewise salaried and normally resident within the hospital 90 Dating from this latter change the vast majority of medical responsibilities within the institution were undertaken by the sole resident medical officer the apothecary owing to the relatively irregular attendance of the physician and surgeon 91 But is there so great Merit and Dexterity in being a mad Doctor The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit and a Vomit and a Purge over again and sometimes a Bleeding which is no great mystery Alexander Cruden The London Citizen Exceedingly Injured 1739 92 The medical regime being married to a depletive or antiphlogistic physic until the early nineteenth century n 5 had a reputation for conservatism that was neither unearned nor given the questionable benefit of some therapeutic innovations n 6 necessarily ill conceived in every instance 98 Bathing was introduced in the 1680s at a time when hydrotherapy was enjoying a recrudescence in popularity Cold bathing opined John Monro Bethlem physician for 40 years from 1751 has in general an excellent effect 99 and remained much in vogue as a treatment throughout the eighteenth century 100 By the early nineteenth century bathing was routine for all patients of sufficient hardiness from summer to the setting in of the cold weather 99 Spring signalled recourse to the traditional armamentarium from then until the end of summer Bethlem s Mad Physick reigned supreme as all patients barring those deemed incurable could expect to be bled and blistered and then dosed with emetics and purgatives 101 Indiscriminately applied these curative measures were administered with the most cursory physical examination if any and with sufficient excess to risk not only health but also life 101 Such was the violence of the standard medical course involving voiding of the bowels vomiting scarification sores and bruises 102 that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught 102 The reigning medical ethos was the subject of public debate in the mid eighteenth century when the Paper War of 1752 1753 erupted between John Monro and his rival William Battie physician to the reformist St Luke s Asylum of London founded in 1751 102 The Bethlem Governors who had presided over the only public asylum in Britain until the early eighteenth century 103 looked upon St Luke s as an upstart institution and Battie formerly a Governor at Bethlem as traitorous 104 In 1758 Battie published his Treatise on Madness which castigated Bethlem as archaic and outmoded uncaring of its patients and founded upon a despairing medical system whose therapeutic transactions were both injudicious and unnecessarily violent 91 In contrast Battie presented St Luke s as a progressive and innovative hospital oriented towards the possibility of cure and scientific in approach 105 Monro responded promptly publishing Remarks on Dr Battie s Treatise on Madness in the same year 91 Bethlem rebuilt at Moorfields Edit The new Bethlem Hospital designed by Robert Hooke 1676 primarily as a piece of fundraising rhetoric 106 Most of Bethlehem Hospital by William Henry Toms for William Maitland s History of London published 1739 Although Bethlem had been enlarged by 1667 to accommodate 59 patients 107 the Court of Governors of Bethlem and Bridewell observed at the start of 1674 that the Hospitall House of Bethlem is very olde weake amp ruinous and to o small and streight for keepeing the greater numb e r of lunaticks therein att p re sent 108 With the increasing demand for admission and the inadequate and dilapidated state of the building it was decided to rebuild the hospital in Moorfields just north of the city proper and one of the largest open spaces in London 109 The architect chosen for the new hospital which was built rapidly and at great expense between 1675 and 1676 n 7 was the natural philosopher and City Surveyor Robert Hooke 112 He constructed an edifice that was monumental in scale at over 500 feet 150 m wide and some 40 feet 12 m deep n 8 The surrounding walls were some 680 feet 210 m long and 70 feet 21 m deep while the south face at the rear was effectively screened by a 714 foot 218 m stretch of London s ancient wall projecting westward from nearby Moorgate 114 At the rear and containing the courtyards where patients exercised and took the air the walls rose to 14 feet 4 3 m high The front walls were only 8 feet 2 4 m high but this was deemed sufficient as it was determined that Lunatikes are not to be permitted to walk in the yard to be situate d betweene the said intended new Building and the Wall aforesaid 114 It was also hoped that by keeping these walls relatively low the splendour of the new building would not be overly obscured This concern to maximise the building s visibility led to the addition of six gated openings 10 feet 3 0 m wide which punctuated the front wall at regular intervals enabling views of the facade 114 Functioning as both advertisement and warning of what lay within the stone pillars enclosing the entrance gates were capped by the figures of Melancholy and Raving Madness carved in Portland stone by the Danish born sculptor Caius Gabriel Cibber 115 Late seventeenth century map showing the placement of the new Bethlem Hospital in Moorfields It shows the large gardens of Moorfields to the north of the front face of the building The hospital is shown as a very long and thin structure At the instigation of the Bridewell Governors and to make a grander architectural statement of charitable munificence 116 the hospital was designed as a single rather than double pile building n 9 accommodating initially 120 patients 110 Having cells and chambers on only one side of the building facilitated the dimensions of the great galleries 110 essentially long and capacious corridors 13 feet 4 0 m high and 16 feet 4 9 m wide which ran the length of both floors to a total span of 1 179 feet 359 m 117 Such was their scale that Roger L Estrange remarked in a 1676 text eulogising the new Bethlem that their Vast Length wearies the travelling eyes of Strangers 118 The galleries were constructed more for public display than for the care of patients as at least initially inmates were prohibited from them lest such persons that come to see the said Lunatickes may goe in Danger of their Lives n 10 121 Melancholia and Raving Madness mania carved by Caius Gabriel Cibber 1680 122 and which adorned the entrance portal of the new Bethlem Hospital at Moorfields The architectural design of the new Bethlem was primarily intended to project an image of the hospital and its governors consonant with contemporary notions of charity and benevolence In an era prior to the state funding of hospitals and with patient fees covering only a portion of costs such self advertisement was necessary to win the donations subscriptions and patronage essential for the institution s survival 123 This was particularly the case in raising funds to pay for major projects of expansion such as the rebuilding project at Moorfields or the addition of the Incurables Division in 1725 39 with accommodation for more than 100 patients 124 These highly visible acts of civic commitment could also serve to advance the claims to social status or political advantage of its Governors and supporters 125 However while consideration of patients needs may have been distinctly secondary they were not absent For instance both the placement of the hospital in the open space of Moorfields and the form of the building with its large cells and well lit galleries had been chosen to provide health and Aire in accordance with the miasmatic theory of disease causation n 11 127 It was London s first major charitable building since the Savoy Hospital 1505 17 and one of only a handful of public buildings then constructed in the aftermath of the Great Fire of London 1666 128 It would be regarded during this period at least as one of the Prime Ornaments of the City and a noble Monument to Charity 129 Not least due to the increase in visitor numbers that the new building allowed the hospital s fame and latterly infamy grew and this magnificently expanded Bethlem shaped English and international depictions of madness and its treatment 107 Public visiting Edit Eighteenth century Bethlem was most notably portrayed in a scene from William Hogarth s A Rake s Progress 1735 the story of a rich merchant s son Tom Rakewell whose immoral living causes him to end up in Bethlem n 12 Visits by friends and relatives were allowed and it was expected that the family and friends of poor inmates would bring food and other essentials for their survival 72 Bethlem was and is best known for the fact that it also allowed public and casual visitors with no connection to the inmates 107 This display of madness as public show has often been considered the most scandalous feature of the historical Bedlam 131 On the basis of circumstantial evidence it is speculated that the Bridewell Governors may have decided as early as 1598 to allow public visitors as means of raising hospital income n 13 The only other reference to visiting in the sixteenth century is provided in a comment in Thomas More s 1522 treatise The Four Last Things 133 where he observed that thou shalt in Bedleem see one laugh at the knocking of his head against a post 134 As More occupied a variety of official positions that might have occasioned his calling to the hospital and as he lived nearby his visit provides no compelling evidence that public visitation was widespread during the sixteenth century 135 The first apparently definitive documentation of public visiting derives from a 1610 record which details Lord Percy s payment of 10 shillings for the privilege of rambling through the hospital to view its deranged denizens n 14 139 It was also at this time and perhaps not coincidentally that Bedlam was first used as a stage setting with the publication of The Honest Whore Part I in 1604 140 Evidence that the number of visitors rose following the move to Moorfields is provided in the observation by the Bridewell Governors in 1681 of the greate quantity of persons that come daily to see the said Lunatickes 141 Eight years later the English merchant and author Thomas Tryon remarked disapprovingly of the Swarms of People that descended upon Bethlem during public holidays 142 In the mid eighteenth century a journalist of a topical periodical noted that at one time during Easter Week one hundred people at least were to be found visiting Bethlem s inmates 143 Evidently Bethlem was a popular attraction yet there is no credible basis to calculate the annual number of visitors 144 The claim still sometimes made that Bethlem received 96 000 visitors annually is speculative in the extreme n 15 Nevertheless it has been established that the pattern of visiting was highly seasonal and concentrated around holiday periods As Sunday visiting was severely curtailed in 1650 and banned seven years later the peak periods became Christmas Easter and Whitsun 152 you find yourself in a long and wide gallery on either side of which are a large number of little cells where lunatics of every description are shut up and you can get a sight of these poor creatures little windows being let into the doors Many inoffensive madmen walk in the big gallery On the second floor is a corridor and cells like those on the first floor and this is the part reserved for dangerous maniacs most of them being chained and terrible to behold On holidays numerous persons of both sexes but belonging generally to the lower classes visit this hospital and amuse themselves watching these unfortunate wretches who often give them cause for laughter On leaving this melancholy abode you are expected by the porter to give him a penny but if you happen to have no change and give him a silver coin he will keep the whole sum and return you nothing Inveterate letter writer Cesar de Saussure s account of Bethlem during his 1725 tour of London s sights 153 The Governors actively sought out people of note and quallitie the educated wealthy and well bred as visitors 154 The limited evidence would suggest that the Governors enjoyed some success in attracting such visitors of quality 155 In this elite and idealised model of charity and moral benevolence the necessity of spectacle the showing of the mad so as to excite compassion was a central component in the elicitation of donations benefactions and legacies 156 Nor was the practice of showing the poor and unfortunate to potential donators exclusive to Bethlem as similar spectacles of misfortune were performed for public visitors to the Foundling Hospital and Magdalen Hospital for Penitent Prostitutes 156 The donations expected of visitors to Bethlem there never was an official fee n 16 probably grew out of the monastic custom of almsgiving to the poor 158 While a substantial proportion of such monies undoubtedly found their way into the hands of staff rather than the hospital poors box n 17 Bethlem profited considerably from such charity collecting on average between 300 and 350 annually from the 1720s until the curtailment of visiting in 1770 160 Thereafter the poors box monies declined to about 20 or 30 per year 161 Aside from its fund raising function the spectacle of Bethlem offered moral instruction for visiting strangers 161 For the educated observer Bedlam s theatre of the disturbed might operate as a cautionary tale providing a deterrent example of the dangers of immorality and vice The mad on display functioned as a moral exemplum of what might happen if the passions and appetites were allowed to dethrone reason 162 As one mid eighteenth century correspondent commented there is no better lesson to be taught us in any part of the globe than in this school of misery Here we may see the mighty reasoners of the earth below even the insects that crawl upon it and from so humbling a sight we may learn to moderate our pride and to keep those passions within bounds which if too much indulged would drive reason from her seat and level us with the wretches of this unhappy mansion 163 Whether persons of quality or not the primary allure for visiting strangers was neither moral edification nor the duty of charity but its entertainment value 164 In Roy Porter s memorable phrase what drew them was the frisson of the freakshow 165 where Bethlem was a rare Diversion to cheer and amuse 166 It became one of a series of destinations on the London tourist trail which included such sights as the Tower the Zoo Bartholomew Fair London Bridge and Whitehall 167 Curiosity about Bethlem s attractions its remarkable characters 168 including figures such as Nathaniel Lee the dramatist and Oliver Cromwell s porter Daniel n 18 170 was at least until the end of the eighteenth century quite a respectable motive for visiting 171 From 1770 free public access ended with the introduction of a system whereby visitors required a ticket signed by a Governor 158 Visiting subjected Bethlem s patients to many abuses including being poked with sticks by visitors or otherwise taunted given drinks and physically assaulted or sexually harassed but its curtailment removed an important element of public oversight In the period thereafter with staff practices less open to public scrutiny the worst patient abuses occurred 172 173 174 1791 1900 EditDespite its palatial pretensions by the end of the eighteenth century Bethlem was physically deteriorating with uneven floors buckling walls and a leaking roof 175 It resembled a crazy carcass with no wall still vertical a veritable Hogarthian auto satire 176 The financial cost of maintaining the Moorfields building was onerous and the capacity of the Governors to meet these demands was stymied by shortfalls in Bethlem s income in the 1780s occasioned by the bankruptcy of its treasurer further monetary strains were imposed in the following decade by inflationary wage and provision costs in the context of the Revolutionary wars with France 177 In 1791 Bethlem s Surveyor Henry Holland presented a report to the Governors detailing an extensive list of the building s deficiencies including structural defects and uncleanliness and estimated that repairs would take five years to complete at a cost of 8 660 only a fraction of this sum was allocated and by the end of the decade it was clear that the problem had been largely unaddressed 178 Holland s successor to the post of Surveyor James Lewis was charged in 1799 with compiling a new report on the building s condition Presenting his findings to the Governors the following year Lewis declared the building incurable and opined that further investment in anything other than essential repairs would be financially imprudent He was however careful to insulate the Governors from any criticism concerning Bethlem s physical dilapidation as rather than decrying either Hooke s design or the structural impact of additions he castigated the slipshod nature of its rapid construction Lewis observed that it had been partly built on land called the Town Ditch a receptacle for rubbish and this provided little support for a building whose span extended to over 500 feet 150 m 179 He also noted that the brickwork was not on any foundation but laid on the surface of the soil a few inches below the present floor while the walls overburdened by the weight of the roofs were neither sound upright nor level 180 Bethlem rebuilt at St George s Fields Edit Bethlem Hospital at St George s Fields 1828 While the logic of Lewis s report was clear the Court of Governors facing continuing financial difficulties only resolved in 1803 behind the project of rebuilding on a new site and a fund raising drive was initiated in 1804 181 In the interim attempts were made to rehouse patients at local hospitals and admissions to Bethlem sections of which were deemed uninhabitable were significantly curtailed such that the patient population fell from 266 in 1800 to 119 in 1814 182 Financial obstacles to the proposed move remained significant A national press campaign to solicit donations from the public was launched in 1805 Parliament was successfully lobbied to provide 10 000 for the fund under an agreement whereby the Bethlem Governors would provide permanent accommodation for any lunatic soldiers or sailors of the French Wars 183 Early interest in relocating the hospital to a site at Gossey Fields had to be abandoned due to financial constraints and stipulations in the lease for Moorfields that precluded its resale Instead the Governors engaged in protracted negotiations with the city to swap the Moorfields site for another municipally owned location at St George s Fields in Southwark south of the Thames The swap was concluded in 1810 and provided the Governors with a 12 acres 4 9 ha 0 019 sq mi site in a swamp like impoverished highly populated and industrialised area where the Dog and Duck tavern and St George s Spa had been 184 185 A view of Bethlem Hospital published in 1896 A competition was held to design the new hospital at Southwark in which the noted Bethlem patient James Tilly Matthews was an unsuccessful entrant 186 The Governors elected to give James Lewis the task 187 Incorporating the best elements from the three winning competition designs he produced a building in the neoclassical style that while drawing heavily on Hooke s original plan eschewed the ornament of its predecessor 187 Completed after three years in 1815 it was constructed during the first wave of county asylum building in England under the County Asylum Act Wynn s Act of 1808 188 Extending to 580 feet 180 m in length the new hospital which ran alongside the Lambeth Road consisted of a central block with two wings of three storeys on either side 187 Female patients occupied the west wing and males the east as at Moorfields the cells were located off galleries that traversed each wing 187 Each gallery contained only one toilet a sink and cold baths Incontinent patients were kept on beds of straw in cells in the basement gallery this space also contained rooms with fireplaces for attendants A wing for the criminally insane a legal category newly minted in the wake of the trial of a delusional James Hadfield for attempted regicide 189 was completed in 1816 187 This addition which housed 45 men and 15 women was wholly financed by the state 190 The first 122 patients arrived in August 1815 having been transported to their new residence by a convoy of Hackney coaches 191 Problems with the building were soon noted as the steam heating did not function properly the basement galleries were damp and the windows of the upper storeys were unglazed so that the sleeping cells were either exposed to the full blast of cold air or were completely darkened 192 Although glass was placed in the windows in 1816 the Governors initially supported their decision to leave them unglazed on the basis that it provided ventilation and so prevented the build up of the disagreable effluvias peculiar to all madhouses 193 Faced with increased admissions and overcrowding new buildings designed by the architect Sydney Smirke were added from the 1830s The wing for criminal lunatics was increased to accommodate a further 30 men while additions to the east and west wings extending the building s facade provided space for an additional 166 inmates and a dome was added to the hospital chapel 194 At the end of this period of expansion Bethlem had a capacity for 364 patients 195 1815 16 Parliamentary Inquiry Edit James William Norris Bethlem Patient 1815 The late eighteenth and early nineteenth centuries are typically seen as decisive in the emergence of new attitudes towards the management and treatment of the insane 196 Increasingly the emphasis shifted from the external control of the mad through physical restraint and coercion to their moral management whereby self discipline would be inculcated through a system of reward and punishment 197 For proponents of lunacy reform the Quaker run York Retreat founded in 1796 functioned as an exemplar of this new approach that would seek to re socialise and re educate the mad 197 Bethlem embroiled in scandal from 1814 over its inmate conditions would come to symbolise its antithesis 198 Through newspaper reports initially and then evidence given to the 1815 Parliamentary Committee on Madhouses the state of inmate care in Bethlem was chiefly publicised by Edward Wakefield a Quaker land agent and leading advocate of lunacy reform n 19 He visited Bethlem several times during the late spring and early summer of 1814 n 20 His inspections were of the old hospital at the Moorfields site which was then in a state of disrepair much of it was uninhabitable and the patient population had been significantly reduced 203 Contrary to the tenets of moral treatment Wakefield found that the patients in the galleries were not classified in any logical manner as both highly disturbed and quiescent patients were mixed together indiscriminately 204 Later when reporting on the chained and naked state of many patients Wakefield sought to describe their conditions in such a way as to maximise the horror of the scene while decrying the apparently bestial treatment of inmates n 21 and the thuggish nature of the asylum keepers n 22 Wakefield s account focused on one patient in particular James Norris an American marine reported to be 55 years of age who had been detained in Bethlem since 1 February 1800 Housed in the incurable wing of the hospital Norris had been continuously restrained for about a decade in a harness apparatus which severely restricted his movement n 23 207 Wakefield stated that a stout iron ring was riveted about his neck from which a short chain passed to a ring made to slide upwards and downwards on an upright massive iron bar more than six feet high inserted into the wall Round his body a strong iron bar about two inches wide was riveted on each side of the bar was a circular projection which being fashioned to and enclosing each of his arms pinioned them close to his sides This waist bar was secured by two similar iron bars which passing over his shoulders were riveted to the waist both before and behind The iron ring about his neck was connected to the bars on his shoulders by a double link From each of these bars another short chain passed to the ring on the upright bar He had remained thus encaged and chained more than twelve years 208 Wakefield s revelations combined with earlier reports about patient maltreatment at the York Asylum n 24 helped to prompt a renewed campaign for national lunacy reform and the establishment of an 1815 House of Commons Select Committee on Madhouses which examined the conditions under which the insane were confined in county asylums private madhouses charitable asylums and in the lunatic wards of Poor Law workhouses 209 In June 1816 Thomas Monro Principal Physician resigned as a result of scandal when he was accused of wanting in humanity towards his patients 210 The Superintendent from 1852 to 1862 was William Charles Hood who did much to reform and improve conditions for patients at the hospital 211 212 Dr T B Hyslop came to the hospital in 1888 and rose to be physician in charge bringing the hospital into the 20th century and retiring in 1911 213 1930 to the present EditIn 1930 the hospital moved to the suburbs of Croydon 214 on the site of Monks Orchard House between Eden Park Beckenham West Wickham and Shirley The old hospital and its grounds were bought by Lord Rothermere and presented to the London County Council for use as a park the central part of the building was retained and became home to the Imperial War Museum in 1936 215 The hospital was absorbed into the National Health Service in 1948 24 750th anniversary and Reclaim Bedlam campaign Edit In 1997 the hospital started planning celebrations of its 750th anniversary The service user s perspective was not to be included however and members of the psychiatric survivors movement saw nothing to celebrate in either the original Bedlam or in the current practices of mental health professionals towards those in need of care A campaign called Reclaim Bedlam was launched by Pete Shaughnessy supported by hundreds of patients and ex patients and widely reported in the media A sit in was held outside the earlier Bedlam site at the Imperial War Museum The historian Roy Porter called the Bethlem Hospital a symbol for man s inhumanity to man for callousness and cruelty 216 Recent developments Edit Bethlem Royal Hospital in 2011 In 1997 the Bethlem Gallery was established to showcase the work of artists that have experienced mental distress 217 In 1999 Bethlem Royal Hospital became part of the South London and Maudsley NHS Foundation Trust SLaM along with the Maudsley Hospital in Camberwell and the merger of mental health services in Lambeth and Lewisham took place 218 In 2001 SLaM sought planning permission for an expanded Medium Secure Unit and extensive works to improve security much of which would be on Metropolitan Open Land Local residents groups organised mass meetings to oppose the application with accusations that it was unfair that most patients could be from inner London areas and were therefore not locals and that drug use was rife in and around the hospital Bromley Council refused the application with Croydon Council also objecting However the Office of the Deputy Prime Minister overturned the decision in 2003 and development started The 89 bed 33 5m unit River House opened in February 2008 219 It is the most significant development on the site since the hospital opened in 1930 219 Fatal restraints Edit Olaseni Lewis known as Seni aged 23 died in 2010 at Bethlem Royal Hospital 220 after police subjected him to prolonged restraint of a type known to be dangerous Neither police nor medical staff intervened when Lewis became unresponsive At coroner s inquest the jury found many failures by both police and medical staff which played a part in Lewis s death They said The excessive force pain compliance techniques and multiple mechanical restraints were disproportionate and unreasonable On the balance of probability this contributed to the cause of death Ajibola Lewis Olaseni Lewis s mother claimed a nurse at Maudsley Hospital where Lewis had been earlier warned against allowing his transfer to Bethlem She said to me Look don t let him go to the Bethlem don t let him go there his mother said A doctor later persuaded her to take her son to Bethlem hospital She was concerned about the conditions there It was a mess she told the court It was very confused a lot of activity a lot of shouting I was not happy I was confused 221 Police were trained to view Lewis s behaviour as a medical emergency but the jury found police failed to act on this The jury found that The police failed to follow their training which requires them to place an unresponsive person into the recovery position and if necessary administer life support On the balance of probability this also contributed to the cause of death A doctor did not act when Lewis became unresponsive while his heart rate dramatically slowed 222 The Independent Police Complaints Commission first cleared officers over the death but following pressure from the family they scrapped the conclusions and started a new inquiry The IPCC was planning disciplinary action against some of the police officers involved Deborah Coles of the charity Inquest who has supported the Lewis family throughout their campaign said the jury had reached the most damning possible conclusions on the actions of police and medics This was a most horrific death Eleven police officers were involved in holding down a terrified young man until his complete collapse legs and hands bound in limb restraints while mental health staff stood by Officers knew the dangers of this restraint but chose to go against clear unequivocal training Evidence heard at this inquest begs the question of how racial stereotyping informed Seni s brutal treatment 223 A disciplinary hearing conducted by the Metropolitan Police found the officers had not committed misconduct 224 The hearing was criticised by the family because it was held behind closed doors with neither press nor public scrutiny 225 In 2014 Chris Brennan aged 15 died of asphyxiation while at Bethlem hospital after repeated self harming The coroner found lack of proper risk assessment and lack of a care plan contributed to his death The hospital claimed staffing problems and low morale were factors Lessons were learned and the adolescent unit where Brennan died was assessed as good in 2016 226 F In November 2017 a bill was debated in the House of Commons that would require psychiatric hospitals to give more detailed information about how and when restraints are used This bill is referred to as Seni s law 227 In November 2018 the bill received Royal Assent as the Mental Health Units Use of Force Act 2018 228 Facilities Edit Entrance to the Occupational therapy Department The hospital includes specialist services such as the National Psychosis Unit 229 Other services include the Bethlem Adolescent Unit which provides care and treatment for young people aged 12 18 from across the UK 230 The hospital has an occupational therapy department which has its own art gallery the Bethlem Gallery displaying work of current and former patients 217 The Bethlem Museum of the Mind features exhibits about the history of Bethlem Royal Hospital and the history of mental healthcare and treatment It features a permanent collection of art created by some of its patients as well as changing exhibitions 231 Every Saturday morning a parkrun is held in the grounds of Bethlem Royal Hospital 232 Media EditIn 2013 the South London and Maudsley NHS Foundation Trust SLaM took part in a Channel 4 observational documentary Bedlam 233 Staff and patients spent two years working with television company The Garden Productions The four part series started on 31 October 234 The first programme Anxiety followed patients through the 18 bed Anxiety Disorders Residential Unit This national unit treats the most anxious people in the country the top one per cent and claims a success rate of three in four patients 234 The next programme was called Crisis cameras were allowed in Lambeth Hospital s Triage ward for the first time In a postcode with the highest rates of psychosis in Europe this is the Accident and Emergency of mental health where patients are at their most unwell 234 The third programme Psychosis films a community mental health team South London and Maudsley NHS Foundation Trust provides support for more than 35 000 people with mental health problems 234 The final programme Breakdown focuses on older adults including the inpatient ward for people over 65 with mental health problems at Maudsley Hospital 234 Notable patients EditRichard Dadd artist 235 John Frith would be assailant of King George III 236 Mary Frith also known as Moll Cutpurse or The Roaring Girl released from Bedlam in 1644 according to Bridewell records 237 Daniel M Naghten catalyst for the creation of the M Naghten Rules criteria for the defence of insanity in the British legal system after the shooting of Edward Drummond 238 Jonathan Martin set fire to York Minster 239 William Chester Minor surgeon who was committed for murder best known for being one of the largest contributors to the Oxford English Dictionary 240 James Hadfield would be assassin of King George III 241 Margaret Nicholson would be assassin of King George III 242 Edward Oxford tried for high treason after the attempted assassination of Queen Victoria and Prince Albert 243 Augustus Welby Northmore Pugin 1812 1852 English architect best known for his work on the Houses of Parliament as well as many churches in the last year of his life he had a breakdown possibly due to hyperthyroidism and was for a short period confined in Bethlem 244 Hannah Snell 1723 1792 a woman cross dressing as a male soldier spent the last six months of her life in Bethlem 245 Bannister Truelock conspirator who plotted to assassinate George III 246 Louis Wain artist 247 See also EditAbraham men History of psychiatric institutions John Cutting psychiatrist Lists of hospitals Tom o Bedlam an anonymous poem c 1600 about a Bedlamite List of hospitals in England King s Health Partners Bethlem Museum of the MindNotes Edit Although accepted by many historians including Roy Porter 61 as Jonathan Andrews points out Crooke s claim that he was physician to the king made in the first three editions of his popular medical textbook of human anatomy Microcosmographia 1615 1616 and 1618 was baseless 62 Crooke claimed that his keepership of Bethlem had cost him 1 000 Following his dismissal the additional financial burden imposed by the royal inquiry s lengthy legal process led him to sell his College of Physicians fellowship attained in 1620 back to that corporate body for 5 In 1642 he was still futilely campaigning for his reinstatement and he died in relative obscurity in 1648 60 He was immortalised on stage in the character of the grasping asylum doctor Alibius in the Jacobean tragedy The Changeling 1622 68 The first evidence for the existence of a steward in Bethlem is during Crooke s tenure as keeper physician 69 a b A toilet Medical knowledge particularly in the field of anatomical pathology made significant advances throughout the eighteenth century but medical treatment remained largely moribund 93 Despite a declining intellectual foundation 94 the humoral based medical practices of depletion and purgation later called antiphlogistic anti inflammatory therapy had undergone little change since the time of Galen in the second century AD 95 Under this tradition challenged increasingly from the seventeenth century 94 physical and mental health was dependent upon the maintenance of a proper balance between the four bodily humours of blood phlegm black bile and yellow bile choler The humours were replenished through the ingestion of food and discharged naturally when they became noxious 96 Disease could arise when there was an overabundance or plethora in a given humour and this necessitated its removal from the body through venesection purging or a reduction in dietary intake 95 For instance Thomas Allen Bethlem physician from 1667 until his death in 1684 happily dismissed the expressed wish of his colleagues in the Royal Society that he should try the then experimental treatment for insanity of animal to human blood transfusion upon some mad person in Bethlem 97 The total cost of the new Bethlem built at Moorfields came to 17 000 110 This expense served to underline the philanthropic magnificence of the presiding governors and rendered Bethlem s patients in Edward Hatton s words great Objects of Charity for this new Structure cost erecting about 17000 whereby not only the Stock of the Hospital is expended but the Governours are out of Pockets several Sums which they were obliged to take up for that purpose 111 Estimates of the scale of the building run from 528 to 540 feet 161 to 165 m wide and 30 to 40 feet 9 1 to 12 2 m deep 113 A double pile building has two rooms arranged longitudinally along a central corridor A single pile has only one 110 The Governors debated whether to install iron grates at the entrance to the galleries which would have allowed patients the freedom to walk in them while preventing intercourse between male and female patients This proposal was resisted however by those who thought it would have spoiled the view offered by the galleries However iron grates with a door to allow visitors to pass through them were installed in 1689 and presumably it is from this date patients who were not otherwise violent were permitted to walk the galleries Patients if deemed well enough could use the rear yards for exercise both before and after this date 119 This allowed them to take the aire in order to aid their Recovery 120 In 1676 there were 34 cells on one side of each of the four galleries or 136 cells in all The cells large and well ventilated for the time by any measure were 12 feet 3 7 m deep by 8 feet 10 inches 2 69 m wide and 12 feet 10 inches 3 91 m high 126 The image shows a shaven head and near naked Rakewell in one of galleries of Bethlem reclining in a position reminiscent of one of Cibber s figures An attendant barely visible in this painted version is in the process of manacling his leg The figure standing over Rakewell wearing a wig and with his head bowed forward is likely a physician and may have just bled the patient Scull and Andrews opine that this figure bears more than a passing resemblance to James Monro the father of John Monro 130 This position argued by Andrews et al principally relies on a reading of the last line of the report of the 1598 visitation quoted above which refers to the fact that Bethlem was then so loathsomely and filthely kept not fitt for any man to come into While conceding that come into here may refer to admissions they thought this unlikely given that the Bridewell Governors in the same line had already disparaged the hospital s patient accommodation Instead they argue a more plausible interpretation is that it evinces the concern of the Governors that the hospital conditions might dissuade public visitors which they were anxious to increase as a means of augmenting Bethlem s revenues 132 While in London the young Percy and his troupe also saw the lions the shew of Bethlem the places where the prince was created and the fireworks at the Artillery Garden 136 Carol Neely however thinks it improbable that an eight year old Lord Percy and his equally young cousins while his father Henry Percy was then ensconced in the Tower of London would have visited Bethlem at this date particularly in consideration of the ramshackle condition of the hospital in the early seventeenth century 137 This is to ignore however the fact that there are many references to children visiting Bethlem 138 It is still frequently and erroneously asserted that either during the eighteenth century or as late as 1814 or 1815 the period depending on the source there were 96 000 visits in a given year 145 For example Michel Foucault in his History of Madness 2006 claimed As late as 1815 if a report presented to the House of Commons is to be believed Bethlem Hospital showed its lunatics every Sunday for one penny The annual revenue from those visits amounted to almost 400 pounds which means that an astonishing 96 000 visitors came to see the mad each year 146 As Andrews et al have noted none of the claims in the above paragraph have any basis in fact 29 The notional figure of 96 000 visitors which was first applied to the eighteenth century derives from the original archival research of O Donoghue and his 1914 history of the hospital 147 From this source Robert R Reed arrived at the above dubious calculation of visitations per annum by dividing the contents of the Bethlem poors box for a single year by the supposed entrance fee per person However there is no credible evidence to suggest that there was an official entrance charge of one penny there is no way of knowing how much individual visitors donated and the figure of 400 includes the entirety of the contents of the poors box and hence all the charitable donations that Bethlem received 148 It is likely that Foucault s source is Reed and he transposes it to the nineteenth century 149 The report of the parliamentary inquiry of 1815 16 does not support any of his claims 150 The impossibility of his account is underlined by the fact that Sunday visits were banned in 1657 and public visitations were curtailed from 1770 151 However during the seventeenth and eighteenth centuries staff at the asylum did try to exact such a fee and by 1742 it was customary for the porter to demand a minimum of one penny from visiting strangers 157 The servants of Bethlem were allowed their own poors box from 1662 The diversion of other monies into the pockets of the hospital staff undoubtedly helped to keep wages down 159 Daniel was purportedly 7 feet 6 inches 2 29 m tall and the model for Cibber s figure of Raving madness 169 In 1812 Wakefield had determined to establish a new London asylum to be modelled on the Retreat and formed a committee to this end As part of the planning process for this scheme the committee first resolved to survey the metropolitan institutions for the care of the insane St Luke s Guy s Hospital and Bethlem 199 The initial attempts by Wakefield to gain access to Bethlem were rebuffed by the hospital authorities who were particularly keen to protect Bethlem s image at a time when they were applying to parliament for funds to finance the move to Southwark 200 Wakefield mindful of the difficulties reformers had had in accessing other institutions persisted and having secured an invitation to visit from one of Bethlem s Governors began the first of his many visits to the hospital on 25 April 1814 200 This visit was cut short by the hospital steward but Wakefield returned on 2 May accompanied by Charles Western a Member of Parliament 201 Wakefield returned for a final unauthorized visit on 7 June 1814 202 One of the side rooms contained about ten female patients each chained by one arm to the wall the chain allowing them merely to stand up by the bench or form fixed to the wall or sit down on it The nakedness of each patient was covered by a blanket only Many other unfortunate women were locked up in their cells naked and chained on straw In the men s wing in the side room six patients were chained close to the wall by the right arm as well as by the right leg Their nakedness and their mode of confinement gave the room the complete appearance of a dog kennel Edward Wakefield 1814 205 Whilst we were looking at some of the bed lying patients a man arose naked from his bed and had deliberately and quietly walked a few paces from his cell door along the gallery he was instantly seized by the keepers thrown in his bed and leg locked without enquiry or observation chains were universally substituted for the straitwaistcoat Edward Wakefield 1815 206 On a subsequent visit on 7 June of that year Wakefield brought an artist who made a drawing of the confined Norris 207 This image which was engraved and widely distributed became an important propaganda tool in the cause of lunacy reform 207 Not to be confused with the York Retreat Footnotes Edit Tuke 1882 p 60 Bethlem Royal Hospital why did the infamous Bedlam asylum have such a fearsome reputation History Extra Retrieved 5 November 2022 Andrews et al 1997 pp 15 23 Vincent 1998 p 213 Allderidge 1979a pp 144 45 Vincent 1998 p 224 Porter 1997 p 41 Andrews et al 1997 p 25 a b Vincent 1998 p 224 Vincent 1998 p 217 Vincent 1998 p 226 Vincent 1998 pp 230 31 a b Vincent 1998 pp 231 Andrews et al 1997 p 84 Vincent 1998 p 231 Andrews et al 1997 p 57 Andrews et al 1997 p 56 Phillpotts 2012 p 200 Andrews et al 1997 pp 16 58 Phillpotts 2012 p 207 Andrews et al 1997 p 55 Phillpotts 2012 p 207 Andrews et al 1997 p 81 a b Vincent 1998 p 232 Jones 1955 p 11 Andrews 1995 p 11 Andrews 1995 p 11 Andrews et al 1997 pp 17 60 Allderidge 1979a p 148 Allderidge 1979a p 149 Porter 2006 pp 156 57 a b Andrews 1991 p 1 Allderidge 1979a p 149 Allderidge 1979a p 144 Allderidge 1979a p 142 By 1403 lunatic patients formed the majority of Bedlam s population Porter 2006 p 156 Whittaker 1947 p 742 Allderidge 1979a pp 142 43 a b Andrews et al 1997 p 3 O Donoghue 1914 Andrews et al 1997 pp 115 16 Allderidge 1979a p 143 Allderidge 1979b p 323 Porter 1997 p 41 Scull 1999 p 249 Andrews et al 1997 pp 113 15 Andrews et al 1997 p 82 Andrews et al 1997 p 131 Andrews et al 1997 pp 1 2 130 31 Andrews et al 1997 p 130 Hattori 1995 p 283 Andrews et al 1997 p 130 Andrews et al 1997 p 132 Hattori 1995 p 287 Andrews et al 1997 p 132 Jackson 2000 p 224 Andrews 1991 p 245 a b c Andrews et al 1997 p 261 a b Allderidge 1979a p 149 Andrews et al 1997 pp 91 92 a b c Webster Charles 30 November 1979 Health Medicine and Mortality in the Sixteenth Century CUP Archive ISBN 9780521226431 O Donoghue Edward Geoffrey 1 January 1915 The Story of Bethlehem Hospital from Its Foundation in 1247 Dutton Andrews et al 1997 p 91 Allderidge 1979a p 153 a b Jackson 2005 p 49 Quoted in Jackson 2000 p 223 Allderidge 1979a p 153 Neely 2004 p 171 A View of Bethalem 4 December 1598 quoted in Allderidge 1979a p 153 Andrews et al 1997 p 124 Allderidge 1979b p 323 Jackson 2005 p 49 Jackson 2000 p 223 Andrews et al 1997 p 123 Allderidge 1979a p 154 a b Allderidge 1985 p 29 a b Birken 2004 a b Porter 1997 p 42 a b Andrews 1991 p 246 Andrews et al 1997 pp 63 261 Porter 1997 p 42 Andrews 1991 p 246 a b Andrews 1991 p 181 Andrews 1991 p 247 n 15 Porter 1997 p 42 Andrews 1991 p 245 Birken 2004 Neely 2004 p 199 Andrews et al 1997 p 88 Andrews et al 1997 p 261 Andrews 1991 pp 242 322 a b Allderidge 1979a p 145 a b c d Andrews et al 1997 p 51 Andrews 1991 p 222 Andrews 1991 p 155 Andrews 1991 p 155 56 Andrews 1991 p 157 58 Andrews 1991 p 157 Andrews 1991 p 181 183 Andrews 1991 p 187 Andrews 1991 pp 183 86 Andrews 1991 p 4 Andrews 1991 p 4 Whittaker 1947 p 747 Andrews et al 1997 p 262 Andrews et al 1997 pp 262 63 Andrews 1991 pp 257 260 Andrews et al 1997 pp 265 66 Andrews 1991 p 244 Parry Jones 1971 Andrews et al 1997 p 269 Andrews et al 1997 p 266 Andrews et al 1997 p 266 67 a b c Andrews et al 1997 p 267 Quoted in Scull MacKenzie amp Hervey 1996 p 10 Dowling 2006 pp 22 23 a b Porter 2006 p 72 a b Noll 2007 p x Porter 2006 pp 57 58 Quoted in Andrews et al 1997 p 271 Andrews et al 1997 p 271 a b Quoted in Andrews et al 1997 p 272 Andrews et al 1997 p 272 a b Andrews et al 1997 p 274 75 a b c Andrews et al 1997 p 275 Porter 2006 pp 165 66 Andrews et al 1997 pp 277 Andrews et al 1997 p 267 Porter 2006 pp 164 65 Scull MacKenzie amp Hervey 1996 p 18 a b c Stevenson 1996 p 254 Stevenson 1997 p 233 Allderidge 1979b p 328 Stevenson 1996 p 263 a b c d Stevenson 1996 p 259 Edward Hatton A New View of London Or an Ample Account of that City 2 vols London 1708 2 p 732 quoted in Stevenson 1996 p 260 Porter 2002 p 71 Stevenson 1996 p 258 Stevenson 1996 pp 264 274 n 88 a b c Stevenson 1996 p 260 Stevenson 1996 p 260 Gilman 1996 pp 17 18 Andrews et al 1997 p 154 Andrews 1991 p 234 Andrews 1991 p 172 n 170 Roger L Strange Bethlehems Beauty Londons Charity and the Cities Glory A Panegyrical Poem on that Magnificent Structure lately Erected in Moorfields vulgarly called New Bedlam Humbly Addressed to the Honorable Master Governors and other Noble Benefactors of that most Splendid and useful Hospital London 1676 quoted in Andrews 1991 p 84 Stevenson 1996 p 266 Andrews 1991 p 173 Quoted in Andrews et al 1997 p 152 Gibson 2008 Andrews 1994 p 64 Stevenson 1996 p 271 n 20 Scull 1993 p 22 n 59 Andrews 1994 p 65 Andrews et al 1997 p 150 Allderidge 1979a p 31 Andrews 1994 p 65 Stevenson 1996 p 261 Stevenson 1996 pp 262 67 Andrews 1994 pp 70 171 Stevenson 1996 p 255 Philotheos Physiologus Thomas Tyson A Treatise of Dreams and Visions 1689 A Discourse of the Causes Natures and Cure of Phrensie Madness or Distraction ed Michael V DePorte Los Angeles Augustan Reprint Society 1973 pp 289 91 quoted in Stevenson 1996 p 270 n 10 Andrews amp Scull 2003 p 37 Andrews 1991 p 11 Andrews et al 1997 p 132 See also Jackson 2000 pp 223 24 Neely 2004 p 209 More 1903 p 7 Hattori 1995 p 287 Quoted in Andrews et al 1997 p 132 Jackson 2005 p 15 Jackson 2000 p 224 Andrews et al 1997 p 132 Quoted in Andrews et al 1997 p 187 Neely 2004 pp 202 209 Gale 2012 Andrews et al 1997 p 132 Jackson 2000 p 224 Jackson 2000 p 224 Andrews et al 1997 p 130 Andrews et al 1997 p 178 Thomas Tryon A Treatise of Dreams and Visions 2nd edition London T Sowle 1695 p 290 quoted in Andrews et al 1997 pp 178 195 n 5 The World no xxiii 7 June 1753 p 138 quoted in Andrews et al 1997 pp 178 195 n 6 Andrews 1991 p 14 Today Programme 2008 MacDonald 1981 p 122 Foucault 2006 p 143 Reed 1952 pp 25 26 Covey 1998 p 15 Oberhelman 1995 p 13 Skultans 1979 p 38 Phillips 2007 p 89 Kent 2003 p 51 Kathol amp Gatteau 2007 p 18 Foucault 2006 p 143 O Donoghue 1914 Allderidge 1985 p 23 Allderidge 1985 p 23 Andrews et al 1997 p 180 Neely 2004 p 208 Scull 2007 Allderidge 1985 p 23 Scull 1993 p 51 Andrews 1991 p 18 Saussure 1902 pp 92 93 Andrews et al 1997 p 181 Andrews 1991 p 19 a b Andrews et al 1997 p 182 Andrews 1991 pp 14 15 a b Andrews et al 1997 p 14 Andrews 1991 p 20 23 Andrews 1991 p 16 a b Andrews 1991 p 23 Andrews 1991 pp 23 4 Anonymous The World no xxxiii 7 June 1753 p 138 quoted in Andrews 1991 pp 23 24 Andrews et al 1997 p 186 Porter 2006 p 157 Tyron Dreams p 291 quoted in Andrews 1991 p 38 Andrews et al 1997 p 187 Porter 2006 p 157 William Hutton The Life of William Hutton pub by his daughter Catherine Hutton London 1816 1749 p 71 quoted in Andrews 1991 p 40 Andrews 1991 p 41 n 154 Andrews 1991 p 41 Andrews 1991 p 40 Allderidge 1985 p 28 Andrews 1991 p 99 Walters John 1972 The Royal Griffin Frederick Prince of Wales 1707 51 Jarrolds Publishers pp 51 ISBN 9780091112400 Chambers Paul 29 November 2019 Bedlam London s Hospital for the Mad History Press p 2019 ISBN 978 0 7509 9186 5 Andrews et al 1997 p 397 Porter 1997 p 43 Andrews et al 1997 p 381 Andrews et al 1997 p 398 Andrews et al 1997 p 399 Scull MacKenzie amp Hervey 1996 p 18 Andrews et al 1997 p 400 Andrews et al 1997 pp 400 1 Andrews et al 1997 p 401 Scull MacKenzie amp Hervey 1996 p 19 Andrews et al 1997 p 402 Scull MacKenzie amp Hervey1996 p 19 Andrews et al 1997 p 403 Walford 1878 pp 341 368 Andrews et al 1997 p 406 a b c d e Andrews et al 1997 p 407 Andrews et al 1997 p 407 Smith 1999 p 6 Andrews et al 1997 pp 391 92 404 Andrews et al 1997 pp 403 5 Andrews et al 1997 p 409 Quoted in Andrews et al 1997 p 409 Quoted in Darlington 1955 pp 76 80 Andrews et al 1997 p 409 Andrews et al 1997 p 409 10 Andrews et al 1997 p 410 Andrews et al 1997 p 416 a b Andrews et al 1997 p 417 Andrews et al 1997 p 415 416 417 Scull 1993 p 112 Moss 2008 Scull MacKenzie amp Hervey 1996 p 28 Wakefield 1812 pp 226 29 a b Andrews et al 1997 p 421 Andrews et al 1997 p 422 Andrews et al 1997 p 424 Scull MacKenzie amp Hervey 1996 p 31 Andrews 1991 p 422 Scull 1993 p 113 Andrews et al 1997 p 423 Scull MacKenzie amp Hervey 1996 p 30 Extracts from the Report of the Committee Employed to Visit Houses and Hospitals for the Confinement of Insane Persons With Remarks by Philanthropus The Medical and Physical Journal 32 August 1814 pp 122 8 quoted in Scull 1993 p 113 Committee on Madhouses 1815 p 12 quoted in Scull MacKenzie amp Hervey 1996 p 30 a b c Andrews et al 1997 p 424 Wakefield 1815 quoted in Andrews amp Scull 2001 p 274 n 85 Scull 1993 p 112 Andrews et al 1997 p 415 Andrews 2010 Dr Charles Hood British Museum website OBITUARY SIR WILLIAM CHARLES HOOD M D KNIGHT British Medical Journal 15 January 1870 p 72 Theo Hyslop Bethlem Blog bethlemheritage wordpress com Archived from the original on 22 November 2016 Retrieved 22 November 2016 Bethlem Royal Hospital broughttolife sciencemuseum org uk Imperial War Museum London guidebook London Imperial War Museum 2009 pp 5 ISBN 978 1 904897 95 8 Olden 2003 a b Who we are Bethlem GalleryBethlem Gallery Bethlemgallery com Retrieved 25 May 2018 1900 2000 South London and Maudsley NHS Foundation Trust Retrieved 25 May 2018 a b Cooke 2008 Gayle Damien Marsh Sarah 3 December 2018 From football to dating to TV 10 areas rife with racial bias in UK The Guardian Retrieved 4 December 2018 Gayle Damien 7 February 2017 Man who died after police restraint was gentle giant court told The Guardian ISSN 0261 3077 Retrieved 4 September 2017 Gayle Damien Dodd Vikram 9 May 2017 Mother of man who died after police restraint calls for prosecution The Guardian ISSN 0261 3077 Retrieved 4 September 2017 Olaseni Lewis Excessive force by officers led to death BBC News 9 May 2017 Retrieved 4 September 2017 Gayle Damien 6 October 2017 Six police cleared over death of man restrained in London hospital The Guardian Evans Rob Gayle Damien 11 September 2017 Police watchdog to hold misconduct hearing in secret over man s death The Guardian Hospital neglect contributed to death BBC News 21 September 2016 Seni s Law MPs initial approval to laws on restraint BBC News MPs pass mental health restraint bill after filibuster fears The Guardian 6 July 2018 Retrieved 2 August 2018 SLaM 2012a SLaM 2012b Bethlem Museum of the Mind on shortlist for museum of year award The Guardian 28 April 2016 Retrieved 25 May 2018 Bethlem Royal Hospital parkrun Park Run Retrieved 20 December 2022 Charlton Dan 3 December 2013 Bedlam Trust why we let the cameras in Health Service Journal Retrieved 14 January 2014 a b c d e Bedlam Channel 4 Info Press www channel4 com Porter 2006 p 25 Poole 2000 p 95 Griffiths 2008 Moran 1985 p 41 Harrison 1979 p 211 Winchester Simon 1998 The Professor and the Madman New York Harper Perennial ISBN 978 0 06 083978 9 Eigen 2005 Andrews et al 1997 p 359 Poole 2000 p 286 Hill 2007 pp 484 90 492 Wheelwright 2008 Andrews Jonathan 1997 The History of Bethlem Psychology Press 1997 p 390 ISBN 978 0415017732 Andrews et al 1997 p 657 Sources Edit Primary sources Committee on Madhouses First Report Minutes of Evidence Taken Before the Select Committee Appointed to Consider of Provision Being Made for the Better Regulation of Madhouses in England London House of Commons 1815 More Thomas The Four Last Things 1522 Edited by D O Connor London Art and Book Co 1903 Saussure Cesar de A Foreign View of England in the Reigns of George I amp II the Letters of Monsieur Cesar de Saussure to his Family Edited and translated by Madame Van Muyden London John Murray 1902 Wakefield Edward Plan of an Asylum for Lunatics amp c The Philanthropist 1812 2 226 29 Secondary sources BooksAndrews Jonathan Briggs Asa Porter Roy Tucker Penny Waddington Keir The History of Bethlem London amp New York Routledge 1997 ISBN 0415017734 Andrews Jonathan Scull Andrew Undertaker of the Mind John Monro and Mad Doctoring in Eighteenth Century England California California University Press 2001 ISBN 9780520231511 Andrews Jonathan Scull Andrew Customers and Patrons of the Mad Trade The Management of Lunacy in Eighteenth Century London With the Complete Text of John Monro s 1766 Case Book Berkeley amp Los Angeles CA University of California Press 2003 ISBN 9780520226609 Covey Herbert C Social Perceptions of People with Disability in History Charles C Thomas 1998 ISBN 9780398068370 Darlington Ida ed Survey of London Volume 25 St George s Fields The Parishes of St George The Martyr Southwark and St Mary Newington London London County Council 1955 Chapter 9 Bethlem Hospital Now the Imperial War Museum in Lambeth Road Dowling William C Oliver Wendell Holmes in Paris Medicine Theology and the Autocrat at the Breakfast Table Lebanon NH University of New Hampshire Press 2006 ISBN 9781584655800 Foucault Michel History of Madness Edited by Jean Khalfa Translated by Jonathan Murphy amp Jean Khalfa London amp New York Routledge 2006 ISBN 9780415277013 Gilman Sander L Seeing the Insane Lincoln NE University of Nebraska Press 1996 ISBN 9780803270640 Harrison John Fletcher Clews The Second Coming Popular Millenarianism 1780 1850 London Taylor and Francis 1979 ISBN 9780710001917 Hill Rosemary God s Architect Pugin and the Building of Romantic Britain London Allen Lane 2007 ISBN 978 0 7139 9499 5 Jackson Kenneth S Separate Theaters Bethlem Bedlam Hospital and the Shakespearian Stage Newark University of Delaware 2005 ISBN 9780874138900 Jones Kathleen Lunacy Law and Conscience 1744 1845 New York amp London Routledge 1955 The Sociology of Mental Health ISBN 9780415178020 Kathol Roger G Gatteau Suzanne Healing Body and Mind A Critical Issue for Health Care Reform Westport CT Praeger 2007 ISBN 9780275992019 Kent Deborah Snake Pits Talking Cures and Magic Bullets Brookfield CT Twenty First Century Books 2003 ISBN 9780761327042 MacDonald Michael Mystical Bedlam Madness Anxiety and Healing in Seventeenth Century England Cambridge Cambridge University Press 1981 ISBN 9780521273824 Neely Carol Thomas Distracted Subjects Madness and Gender in Shakespeare and Early Modern Culture New York Cornell University Press 2004 ISBN 9780801489242 Noll Richard The Encyclopedia of Schizophrenia and Other Psychotic Disorders 3rd ed New York Facts on File 2007 ISBN 9780816075089 Oberhelman David D Dickens in Bedlam Madness and Restraint in his Fiction York Press 1995 ISBN 9780919966963 O Donoghue Edward Geoffrey The Story of Bethlem from its Foundation in 1247 London T F Unwin 1914 Parry Jones William Llywelyn The Trade in Lunacy A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries London Routledge amp Kegan Paul 1971 ISBN 9780802001559 Phillips Bob Overcoming Anxiety and Depression Eugene OR Harvest House Publishers 2007 ISBN 9780736919968 Poole Steve The Politics of Regicide in England 1760 1850 Troublesome Subjects Manchester Manchester University Press 2000 ISBN 9780719050350 Porter Roy Madness A Brief History Oxford Oxford University Press 2002 ISBN 9780192802675 Porter Roy Madmen A Social History of Madhouses Mad Doctors amp Lunatics revised ed Stroud Tempus 2006 ISBN 0752437305 Reed Robert R Bedlam on the Jacobean Stage Cambridge Mass Harvard University Press 1952 Scull Andrew The Most Solitary of Afflictions Madness and Society in Britain 1700 1900 New Haven amp London Yale University Press 1993 ISBN 0300107544 Scull Andrew MacKenzie Charlotte Hervey Nicholas Masters of Bedlam The Transformation of the Mad Doctoring Trade Princeton NJ Princeton University Press 1996 ISBN 0691034117 Skultans Vieda English Madness Ideas on Insanity 1580 1890 London Routledge 1979 ISBN 9780710003294 Smith Leonard D Cure Comfort and Safe Custody Public Lunatic Asylums in Early Nineteenth Century England London amp New York Leicester University Press 1999 ISBN 9780718500948 Tuke Daniel Hack Chapters in the History of the Insane in the British Isles London Keegan Paul Trench amp Co 1882 Walford Edward Old and New London Volume 6 Cassell Petter amp Galpin 1878 Chapter XXVI St George s Fields Journals articles and book chaptersAllderidge Patricia Management and Mismanagement at Bedlam 1547 1633 In Webster Charles Health Medicine and Mortality in the Sixteenth Century Cambridge Cambridge University Press 1979a ISBN 9780521226431 p 141 164 Allderidge Patricia Hospitals Madhouses and Asylums Cycles in the Care of the Insane British Journal of Psychiatry 1979b 134 4 321 34 doi 10 1192 bjp 134 4 321 Allderidge Patricia In Bynum W F Porter Roy Shepherd Michael The Anatomy of Madness Essays in the History of Psychiatry Vol 2 London amp New York Tavistock 1985 ISBN 9780415008594 Andrews Jonathan Hardly a Hospital but a Charity for Pauper Lunatics Therapeutics at Bethlem in the Seventeenth and Eighteenth Centuries In Barry Jonathan Jones Colin Medicine and Charity before the Welfare State London Routledge 1994 ISBN 9780415111362 p 63 81 Andrews Jonathan The Politics of Committal to Early Modern Bethlem In Porter Roy Medicine in the Enlightenment Amsterdam amp Atlanta GA Rodopi 1995 ISBN 9789051835625 p 6 53 Andrews Jonathan Monro Thomas 1759 1833 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press January 2010 doi 10 1093 ref odnb 18981 subscription required Birken William Crooke Helkiah 1576 1648 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press 2004 doi 10 1093 ref odnb 6775 subscription required Gibson Katharine Cibber Caius Gabriel 1630 1700 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press 2008 doi 10 1093 ref odnb 5415 subscription required Griffiths Paul Frith Mary 1584x9 1659 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press 2008 doi 10 1093 ref odnb 10189 subscription required Hattori Natsu The Pleasure of your Bedlam The Theatre of Madness in the Renaissance History of Psychiatry 1995 6 23 283 308 doi 10 1177 0957154X9500602302 PMID 11639849 Jackson Kenneth S I know not Where I did lodge last night King Lear and the Search for Bethlem Bedlam Hospital English Literary Renaissance 2000 30 2 213 40 doi 10 1111 j 1475 6757 2000 tb01170 x Moran Richard The Modern Foundation for the Insanity Defense the Case of James Hadfield 1800 and Daniel McNaughtan 1843 Annals of the American Academy of Political and Social Science 1985 447 31 42 Moss David J Wakefield Edward 1774 1854 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press 2008 doi 10 1093 ref odnb 28414 subscription required Phillpotts Christopher Richard II and the Monasteries of London In Ormrod W Mark 14th Century England Vol 7 Woodbridge Boydell Press 2012 ISBN 9781843837213 p 197 224 Porter Roy History Today 1997 47 10 41 8 Scull Andrew Medical History 1999 43 248 55 doi 10 1017 s0025727300065133 Scull Andrew The Fictions of Foucault s Scholarship Times Literary Supplement 21 March 2007 Stevenson Christine Robert Hooke s Bethlem Journal of the Society of Architectural Historians 1996 55 3 254 275 doi 10 2307 991148 Stevenson Christine The Architecture of Bethlem at Moorfields History of Bethlem Jonathan Andrews Asa Briggs Roy Porter Penny Tucker amp Keir Waddington London amp New York Routledge 1997 ISBN 0415017734 p 230 59 Vincent Nicholas Goffredo de Prefetti and the Church of Bethlehem in England Journal of Ecclesiastical History 1998 49 2 213 35 doi 10 1017 S0022046998006319 Wheelwright Julie Snell Hannah 1723 1792 Oxford Dictionary of National Biography Online ed Oxford Oxford University Press 2008 doi 10 1093 ref odnb 25975 subscription required Whittaker Duncan The 700th Anniversary of Bethlem Journal of Mental Science 1947 93 393 740 47 doi 10 1192 bjp 93 393 740 ThesesAndrews Jonathan Bedlam Revisited A History of Bethlem Hospital c 1634 c 1770 PhD thesis London Queen Mary and Westfield College London University 1991 Newspapers and news agenciesOlden Mark Obituary Peter Shaughnessy Campaigner who took the stigma out of insanity Guardian 23 January 2003 22 Cooke Matthew 33m goes to 760 year old hospital 30 October 2008 Retrieved 30 October 2012 BBC London Today Programme Lunatic London 8 August 2008 Retrieved 30 October 2012 BBC Radio 4 WebpagesArchives and Museum About the Museum Archives and Museum Bethlem Royal Hospital 30 October 2012 a Retrieved 30 October 2012 Archives and Museum Art Archives and Museum Bethlem Royal Hospital 30 October 2012 b Retrieved 30 October 2012 Bethlem Gallery About Us Bethlem Gallery 23 October 2012 Retrieved 30 October 2012 Gale Colin S The Bethlem Hospital London The Lost Hospitals of London Monday at One Series Gresham College 19 March 2012 Retrieved 4 November 2012 1 archived 29 May 2012 SLaM Psychosis Service South London and Maudsley NHS Foundation Trust 30 October 2012 a Retrieved 30 October 2012 a SLaM Interactive Tour of Bethlem Adolescent Unit South London and Maudsley NHS Foundation Trust 30 October 2012 b Retrieved 30 October 2012 External links Edit Wikimedia Commons has media related to Bethlem Royal Hospital Official website Bethlem Royal Hospital on the NHS website Care Quality Commission inspection reports Archival material relating to Bethlem Royal Hospital UK National Archives Catholic Encyclopedia Bedlam Historical images of Bethlem In Monks Orchard Album Coordinates 51 22 51 N 0 01 50 W 51 38087 N 0 03061 W 51 38087 0 03061 Retrieved from https en wikipedia org w index php title Bethlem Royal Hospital amp oldid 1155270631, wikipedia, wiki, book, books, library,

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