Victorian London - Health and Hygiene - Hospitals - Bethlehem Hospital

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    The visiting days are two Mondays in each month. The Government pays 15s. a week for each criminal in this hospital. The average change for the pauper lunatic in the county asylums is 7s. a week; and for idiots, or lunatics, in the workhouses, from 2s.10d. to 3s. 6d. a week.
    The income of Bethlem and Bridewell Hospitals amounts to 33,000 per annum, and with the exception of 3000 voted by the city of London for the building of the new hospital, the whole is the accumulation of private benevolence!
    The number of patients in the hospital at the present time is about 390, of whom 194 are supposed to be incurable, and 85 are criminals.

from The Illustrated London News, 1843

Bethlem Hospital ... a noble institution, for the insane, is only accessible to visitors by an order from one of the governors; of whom a list may be seen upon application.

Mogg's New Picture of London and Visitor's Guide to it Sights, 1844

BETHLEHEM HOSPITAL (vulg. BEDLAM), in ST. GEORGE'S FIELDS. An hospital for insane people, founded in Bishopsgate Without, and for a different purpose, in 1246, by Simon Fitz-Mary, one of the Sheriffs of London. "He founded it to have been a privy of canons with brethren and sisters."* (*Stow, p.62) Henry VIII at the Dissolution gave it to the City of London, when it was first converted into an hospital for lunatics ..... Simon Fitz-Mary's Hospital was taken down in 1675, and the Hospital removed to Moorfields, "at the cost of nigh 17,000l." Of this second Bedlam (Robert Hooke, architect) there is a view in Strype. Bedlam, in Moorfields, was taken down in 1814, and the first stone of the present Hospital (James Lewis, architect) laid April 18th 1812. The Cupola, a recent addition, was designed by Sydney Smirke. The first Hospital could accomodate only 50 or 60, and the second 150, the number there in Strype's time. The building in St. George's-fields was originally constructed for 198 patients, but this being found too limited for the purposes and resources of the Hospital, a new wing was commenced for 166 additional patents, of which the first stone was laid July 26th, 1838. The whole building (the House of Occupations included) covers, it is said, an area of 14 acres. In 1845 the Governors admitted 315 Curables, (110 males and 205 females); 7 Incurables (5 males and 2 females); 11 Criminals (7 males and 4 females); and 180 Discharged Cured (62 males and 118 females)* (*The Times, April 14th, 1846). The expenses in 1729 amounted to 2824l. 6s 4d; (Maitland, ed. 1739, p.660) in 1837, to 19,764l. 15s 7d (Mr. Laurie's Narrative, p.61). The way in which the comfort of the patients is studied by every one connected with the Hospital cannot be too highly commended. The women have pianos, and men billiard and bagatelle-tables. There are, indeed, few things to remind you that you are in a mad-house beyond the bone knives in use, and a few cells lined and floored with cork and india-rubber, and against which the insanest patient may knock his head without the possibility of hurting it. Bedlam, till the beginning of the present century, was an exhibition open to the public - a common promenade, like the middle aisle of old St. Paul's, or the gravel walks of Gray's Inn.

Peter Cunningham, Hand-Book of London, 1850

Bethlem Hospital was founded in 1547, and the early treatment of the miserable creatures committed to its brutal rulers, appears to have been characterised by utter indifference to the feelings and comforts of the patients, and a studied aggravation of their miseries. Indeed, to our shame be it recorded, these miseries were made the materials for actual profit to the hospital; a sum of about 400l. being annually collected by exhibiting the poor maniacs, chiefly naked, and uniformly chained to the walls of their dungeons, and by exciting them to the most violent manifestations of their maladies. This practice of showing the patients, like wild beasts, was abolished in 1770, but the abolition was unaccompanied by any other improvement in their treatment. Recently, however, the unfortunate lunatics have been more humanely treated, as will be seen in the following pages.

The Pictorial Handbook of London, 1854

BETHLEHEM, vulgarly called Bedlam, is situated in St. George's Fields. Fitzmary's Hospital for the Insane, founded in 1246, having been bestowed by Henry VIII. upon the citizens of London, was removed in 1675 from Bishopsgate Without to Moorfields, at a cost of nigh 17,000l., and again removed to its present site in 1814. The new hospital was designed by James Lewis, and was originally constructed for 198 patients ; but was enlarged in 1838, by the addition of a new wing for 166 more patients. The entire pile now occupies fourteen acres. The method and regimen adopted are those which have been suggested by the wisdom and humanity of the present school of medicine. Love, and not fear, is the great principle of government, and the unhappy insane are watched over with the tenderest pity.
    The yearly income is 17,000l., and the average number of cases annually treated, 350. The hospital will accommodate 400 patients, but is seldom completely full. 
    Criminal lunatics are confined here.

Cruchley's London in 1865 : A Handbook for Strangers, 1865

In 1799, the Hospital was reported by a committee to be in a very bad condition it had been built in sixteen months, upon part of the City ditch filled in with rubbish, so that it was requisite to shore-up and underpin the walls. At length it was resolved to rebuild the Hospital; and in 1810 its site, 2 acres, was exchanged for about 11 acres in St. George's Fields, including the gardens of the infamous Dog and Duck. The building fund was increased by grants of public money, and benefactions, from the Corporation, City companies, and private individuals. The first stone of the new edifice, for 200 patients, was laid in April 1812, and completed in August 1815, at a cost of 122,572l. 8s., the exact sum raised for the purpose. It was built from three prize designs, superintended by the late Mr. Lewis: it consists of a centre and two wings, the entrance being beneath a hexastyle Ionic portico of six columns, with the royal arms in the pediment, and underneath the motto :-HEN. VIII. REGE . FUNDATVM CIVIUM LARGITAS PERFECIT. Two wings, for which the Government advanced 25,144l., were appropriated to criminal lunatics. Other buildings have since been added, for 166 patients, by Sydney Smirke, A.R.A., the first stone of which was laid July 26, 1838, when a public breakfast was given at a cost of 464l. 8s. to the Hospital, and a narrative of the proceedings was printed at a charge to the charity of 1401. The entire building is three stories in height, and 897 feet in length. To the centre was added a large and lofty dome in 1815 the diameter is 37 feet, and it is about 150 feet in height from the ground. The hospital and grounds extend to eight acres; the adjoining three acres being devoted to the House of Occupation, a branch of Bridewell hospital.
    In the entrance-hall are placed Cibber's two statues, from the old Hospital: they are of Portland stone, and were restored by the younger Bacon in 1814; they are screened by curtains, which are only withdrawn upon public occasions: some of the irons formerly used are also shown as curiosities. The basement and three floors are divided into galleries. The improved management was introduced about 1816. The patients employ themselves in knitting and tailoring, in laundry-work, at the needle and in embroidery; the women have pianos and occasionally dance in the evening, the men have billiards and bagatelle tables, newspapers, and periodicals; and they play in the grounds at trap-ball, cricket, fives, leap-frog, &c. Others work at their trades, in which, though dangerous weapons have been entrusted to them, no mischief has ensued, and the employment often induces speedy cure. The railed-in fire-places and the bone knives are almost the only visible peculiarities; there are cells lined and floored with cork and india-rubber for refractory patients. The building is fire-proof throughout, and warmed by hot air and water.
    From the first reception of lunatics into Bethlem, their condition and treatment was wretched in the extreme. lit a visitation of 1403 are mentioned iron chains with locks and keys, and manacles and stocks. In 1598, the house was reported so loathsome and so filthily kept, as not fit to be entered; and the inmates were termed prisoners. In a record of 1619 are expenses of straw and fetters, Up to the year 1770, the public were admitted to see the lunatics at 1d. each, by which the Hospital derived a revenue of at least 4001. a year : hence Bethlem became one of "the sights of London;" and such was the mischief occasioned by this brutal and degrading practice, that, to prevent disturbances, the porter was annually sworn a constable, and attended with other servants to keep order. So late as 1814, the rooms resembled dog-kennels; the female patients chained by one arm or leg to the wall, were coveted by a blanket-gown only, the feet being naked ; and they lay upon straw. The male patients were chained, handcuffed, or locked to the avail; and chains were universally substituted for the strait-waistcoat. One Norris, stated to be refractory, was chained by a strong iron ring, riveted round his neck, his arms pinioned by an iron bar, and his waist similarly secured, so that he could only advance twelve inches from the wall, the length of his chain; and thus he had been "encaged and chained more than twelve years;" yet he read books of various kinds, the newspapers daily, and conversed rationally: a drawing was made of Norris in his irons, and he was visited by several members of Parliament, shortly after which he died, doubtless from the cruel treatment he had received. This case led to a Parliamentary inquiry, in 1815, which brought about the adoption of a new method of treatment in Bethlem; although, in two years, 660l. were expended from the Hospital funds in opposing the bill requisite for the beneficial change.
    The last female lunatic released from her fetters was a most violent patient, who had been chained to her bed eight years, her irons riveted, site being so dangerous that the matron feared being murdered if she released her; in May 1838, she was still in the New Hospital, and was the only patient permitted to sheep at night with her door unlocked; the slightest appearance of restraint exasperated her; but on her release she became tranquil, and happy in nursing two dolls given to her, which she imagined to be her children.
    The criminal lunatics were formerly maintained and clothed here at the expense of Government, and cost nearly 40001. a year. Most of the criminals were confined for murder, committed or attempted. Amongst them was Margaret Nicholson for attempting to stab George III.; she died here in 1828, having been confined forty-two years. In 1841, died James Hadfield, who had been confined here since 1802, for shooting at George III., at Drury Lane Theatre. He was a gallant dragoon, and his face was seamed with scars got in battle before his crime : he employed himself with writing verses on the death of his birds and cats, his only society in his long and wearying imprisonment. Many, including Edward Oxford, who so nearly assassinated the Queen, in 1840; Macnaughten, who murdered Sir Robert Peel's secretary, at Charing Cross; and the celebrated Captain Johnston, who under such terrible circumstances killed all the clew of his ship, the Tory; were kept at Bethlehem, but have been removed to the great Broadmoor Asylum, built by Government near the Wellington College Station of the South Eastern Railway.
    Bethlem stands in eleven acres of ground, which is judiciously laid out. It was placed under the jurisdiction of the Commissioners in Lunacy in 1853. In 1841 only 23.60 per cent. of the patients attended chapel on Sunday, and there was a weekly average of 2.64 per cent. under restraint; in 1862, 55 per cent. attended chapel, and restraint had been for several years unknown. Of the 115 curable patients in the hospital in 1862 only eight were unemployed, and of the 61 incurables 24. Time annual cost of maintenance, furniture, and clothing was about 36l. in 1862. The following cases are inadmissible lunatics: those who have been insane for more than twelve months; who have been discharged uncured from other hospitals; afflicted with idiotcy, palsy, or epileptic or convulsive fits, or any dangerous disease. The patients are not allowed to remain more than one year: preference is given to patients of the educated classes, to secure accommodation for whom no-one will be received who is a proper object for admission into a county lunatic asylum.
    Although Bethhem receives only those cases of madness which it deems most likely to terminate in recovery ; of these simple and select cases nearly 40 per cent. (including deaths) are eventually discharged from Bedlam unrelieved. "The annual rate of mortality in Bethlem is 7 per cent.; in other asylums, from 13 to 22 per cent. -(Registrar rGeneral's Report, 1850.)
    The income of Bethlem and Bridewell Hospitals amounts to about 33,000l. per annum, mostly the accumulation of private benevolence.
    From November 22, 1841, Bethlem Hospital, with its purlieus and approaches, was considered to be within time rules of the Queen's Bench, by an order of that Court, until their abolition.
    Patients are admitted by petition to the Governors from a near relation or friend; forms to be obtained at the Hospital. The visiting days are two Mondays in each month; for taking in and discharging patients, every Friday.
    Strangers are admitted, on Tuesdays, Wednesdays, Thursdays, and Fridays, to view the Hospital by Governors' orders; and foreigners and Members of Parliament by orders from the president, treasurer, or Secretary of State; but the average yearly number of visitors does not exceed 550. Still, few sights calm be more interesting than the present condition of the interior of Bethhem. The scrupulous cleanliness of the house, the decent attire of the patients, and the unexpectedly small number of those under restraint, (sometimes not one person throughout the building), lead the visitors, not unnaturally, to conclude that the management of lunatics has here attained perfection ; while the quiet and decent demeanour of time inmates might almost make him doubt that he is really in a madhouse. The arrangements, however, are comparatively, in some instances, defective : the building being partly on the plan of the old Hospital in Moorfields, in long galleries, with a view to the coercive system there pursued, is, consequently, ill adapted to the present improved treatment.

John Timbs, Curiosities of London, 1867

Victorian London - Publications - History - The Queen's London : a Pictorial and Descriptive Record of the Streets, Buildings, Parks and Scenery of the Great Metropolis, 1896 - Bethlehem Hospital

Bethlehem Hospital - photograph


Bethlehem Hospital, colloquially known as Bedlam, has been a madhouse since the time of Henry VIII. but the present building in St. Georges Fields, Lambeth, only dates from early in the present century, and has been more than once enlarged. The Hospital was first situated in Bishopsgate Street, and was superseded in 1675 by a building in Moorflelds, and this by the structure shown above. The front, 900 feet long, is rendered very imposing by its Ionic columns. Over the portico is inscribed, Henrico VIII. rege fundatum civitum largitas perfecit. Lewis was the architect of the building, but the dome was added later by Smirke. The Asylum has accommodation for four hundred patients of both sexes.