Bethlem Royal Hospital was first built in 1247 as the Priory of the New Order of St Mary of Bethlem in Bishopsgate, London. It was not initially an asylum for the insane, but a centre for the collection of alms to aid the Crusader Church. The first record found of mentally ill patients in the hospital was in the early 15th century, when a group of six ‘mad folk’ were admitted. Since then, the hospital has moved location four times, had the term ‘Bedlam’ coined after its depravities, and remains Europe’s oldest extant psychiatric institution.
Bishopsgate – Liverpool Street Station currently stands in its place
The building was centred around a courtyard with a chapel in the middle. It had 12 cells for patients, staff accommodation, and a small exercise yard. The compact building covered two acres, and was built over a sewer, which served the hospital and the immediate buildings around it. The drain would often become blocked, resulting in overflows of waste invading the main entrance. The building was gradually expanded throughout the years, and by 1667 it was able to accommodate 59 patients.
The hospital was the property of the Church for the first hundred years of its existence, and was managed by monks who were dedicated to healing the paupers of London. Gradually, monks began taking in ‘mad folk’ of the city, who had no friends or family willing to look after them. Whilst many patients were mentally ill and had conditions which we now know as paranoid schizophrenia and manic depression, others suffered conditions such as ‘falling sickness’ (epilepsy), anxiety, and learning disabilities. Despite the clear differences in symptoms, the patients were mixed together and all given the same course of treatment, although some patients required more treatment than others.
The monks dealt out a strict regime of daily punishments and religious devotion for the patients, combined with a bland, vegetable free diet to ensure the spirit/ illness would not be fed. Inventories found dating back to this period show manacles, chains, locks and stocks, as it was believed that shock, punishment and isolation were the ultimate cure for madness and would help the patient ‘come to their senses.’
Edward III took control of the hospital in 1370, and replaced the monks in charge with semi-autonomous figures and crown appointees. The leaders of the hospital became known as ‘keepers’, and the vast majority of them had no experience of running a hospital or caring for the ‘mad folk.’ The reputation of the hospital was diminishing rapidly, and rumours of neglect and embezzlement began to circle among the general public. In 1403, the hospital treasurer, Peter Taverner was found guilty of embezzlement and theft of hospital property, proving that the new secularised institution was corrupt from within.
The hospital changed hands once again in 1546 when the Lord Mayor of London, Sir John Gresham, petitioned to have Bethlem granted to the city. The ruling monarch, Henry VIII declared that whilst the Crown would retain possession of the hospital, the City of London would be in charge of its administration. The running of the hospital was passed to the Governors of Bridewell, and they appointed keepers to take charge of the ‘mad folk.’
Roland Sleford resigned from his role of ‘keeper’ in 1598, after his two decade reign over the hospital. After his departure, the Governors of Bridewell performed an inspection of Bethlem to ensure it was ready for public visiting. However, they soon realised that it was in a serious state of disrepair: “It is not fit for any man to dwell in which was left by the keeper, for that it is so loathsomely filthily kept that it is not fit for any man to come into the sad house.” The committee found 21 resident inmates, the majority of whom had been locked up for over eight years. One inmate had been there for over twenty years, and was in a dire need of medical attention.
With support from the current ruling monarch, James I, Helkiah Crooke was brought in as the replacement keeper, to ensure the hospital was well managed and its patients cared for. Unfortunately, this keeper was no different to his predecessors, as he embezzled and stole from the hospital and the patients. Goods were sent to Bethlem as charitable donations for the ‘mad folk’ and consisted of food packages, clothing and bedding. Crooke’s Steward seized them for himself and sold what he did not want to the inmates. Those who had no resources to buy or trade from him were left to starve.
Crooke’s career ended when King James I died. The new monarch, Charles I demanded an inspection of the hospital in 1631, and after the findings that most patients were ‘likely to starve’ an investigation was launched. Crooke and his Steward were both fired in 1633 after they were found guilty of embezzlement, neglect and theft. Helkiah Crooke was the final keeper ever hired in Bethlem, as after his disastrous tenure, a new system was brought in. As opposed to one man ruling the hospital and his staff, a new three tiered medical regime stood in its place, consisting of a physician, a visiting surgeon and an apothecary (pharmacist.)
The new system improved conditions at Bethlem, and by the 1650’s, the hospital was gaining in popularity. Due to severe over crowing in 1664, the Governors decided that a new hospital must be built: “The hospital house of Bethlem is very old, weak, ruinous and too small and straight for keeping the greater number of lunatics therein at present.” Robert Hooke, the city surveyor was hired to design the new hospital at a site in Moorfields, and the doors on the first Bethlem closed for the final time in 1667, just one year after it survived the Great Fire of London.
Moorfields, designed by Robert Hooke
Unlike the first building, the Bethlem hospital at Moorfields was lavishly designed. The people of London stood back and admired its luxurious size and attention to detail. It quickly became labelled as the ‘Palace for lunatics’ and after 13 years, it opened its doors to the general public as a tourist attraction. However, during these years, it became clear that despite its luxurious size and structure, the treatment of the patients was no better than the previous building. Patients were treated like prisoners and were subjected to a wide range of cruel and neglectful conditions. The majority of the patients were simply locked away and left to their own devices, being given the bare minimum of food and water.
When Bethlem opened its doors to the tourism industry, many patients were so starved of food and attention that they were grateful for any human interaction they were allowed to have. Visitors from all social classes came to stare and interact with the mad folk, offering them pennies to sing and dance for them. Opening up Bethlem to the general public also served as a warning to society: this is what will happen to you if you indulge in lust, greed or passion.
Visitors walked through the ‘Penny Gates’ upon entry, which consisted of two statue gypsies wearing the Bethlem uniform. It cost two pennies to pass through the gates, which were placed in the money pots held by the statues. The visitors were not given unlimited access, but they were allowed unsupervised access to the patients deemed suitable to be put on display. Whilst many patients did not object to the spectators, there were also patients who were forced on display against their own consent. For these patients, the sense of shame and embarrassment flooded their days at Bethlem, making their mental conditions even worse, and thus extending their stay at the mental asylum.
Visitors were allowed to drink alcohol and mingle freely with the permitted patients, making Bethlem more of a public house than a place for respite and care. The governors of Bethlem attempted to attract visitors from high social classes, but as the years passed, it became increasingly popular with the lower classes. Public holidays such as Easter became dreaded events which attracted thugs and hooligans, and inevitably turned into riots and chaos.
Bethlem fascinated many people, especially writers and artists who would visit the building for inspiration. Ned Ward, a writer for the ‘London Spy’, described Bethlem as “a dry wart for loiterers, a promenade of rogues.” Whilst interviewing a patient, Ward voiced his disdain for the language his interviewee was using. In response, the patient explained that it was only in asylums such as Bethlem where freedom of speech was actually applied. Within those walls, the patients could say what ever they wished, without facing consequences, unlike people on the outside, such as Ward. He went on to say that perhaps only true freedom lies behind bars, and this not only disturbed Ward, but the general public who read his published article. After 90 years on display, Bethlem finally closed its doors on the public and became one of the most isolated and secretive asylums in Europe.
In 1795, John Haslam took over the management of Bethlem, and brought in a new way of dealing with the mentally ill. He claimed that instead of simply locking them away, there was in fact a cure to madness, and he was on the path to finding it, but it would only occur once his will had been entirely imposed upon the patient. Using fear and intimidation, Haslam broke the will of his patients, often beating them into submission until they behaved in a manner which he deemed appropriate. He believed that the mentally ill were all cunning and violent, and a mastery needed to be set in place over the patient in order for them to become obedient.
Many techniques were used in Bethlem to install fear into the patients, including cold bathing (hydrotherapy) and rotation therapy (the swing). When patients misbehaved, they were threatened with the chair, and this usually silenced them. However, on the occasions where the threat did not work, patients were subjected to either one of the two therapies.
Haslam hired Bryan Crowther as chief surgeon, who was initially hired to attend to injuries and ailments of the patients. However, he expanded his job description somewhat when he began dissecting deceased patients brains in the mortuary. Whilst this was the beginning of legitimate pathology, Crowther’s experiments were at the time illegal and considered a heinous act. He was not caught until 1815, and spent two decades dissecting the brains of his patients at will.
A year after Haslam’s move to Bethlem, in 1796, a young businessman and father was admitted to the asylum. James Tilly Matthews was sent to Bethlem after interrupting a debate in the House of Commons, in which he accused the Home Secretary of treason. Britain had been at war with France for three years, and Matthews insisted that he had been sent to France as a double agent for the British government. Now that he had returned, the British government were denying all knowledge of his mission and were effectively ‘washing their hands of him.’ He was sent to Bethlem 10 days after his outburst, and was never released, despite numerous efforts by his family and their doctors.
Haslam wrote a book entitled ‘Illustrations of Madness,’ which was the first complete psychiatric study of a patient in medical history. It focused on James Tilly Matthews in great detail, displaying all of his symptoms and delusions, including a device Matthews called The Air Loom. He claimed that it was a device created to control his mind through the use of powerful beams of magnetic rays, and was operated by a gang of French agents. Haslam displayed a detailed diagram of the Air Loom in his study, showing the imagination and artistic capabilities of his subject. Haslam gave Matthews certain privileges, such as giving him a pen and paper, and allowing him to work in the garden.
In 1814, philanthropist Edward Wakefield paid a visit to Bethlem asylum which uncovered the secrets kept by Haslam and his staff. Wakefield walked through the male wards and was shocked by the conditions in which they were kept. He saw men chained to the walls by their feet, completely naked and severely under fed. The worst case he described was a patient named James Norris, who had been a former marine.
He was wearing a metal harness with chains coming from it. The chains went through holes in his wall into another room which was operated by a member of staff. When they wanted to punish him, they would pull on the chains, which would slam his body into the wall. Wakefield demanded to know how long Norris had been wearing the harness, and Haslam replied with the answer of “between nine to twelve years.” Appalled, Wakefield brought in an artist to draw the conditions that Norris was kept in, and this was published in the newspaper the following day. The sensational findings outraged the public, forcing an official investigation into the treatments upheld at Bethlem.
A huge inquiry was held in the following months, and at that point it was the largest inquiry into ‘madhouses’ ever to have been created. Haslam was called to give evidence, and was questioned on his treatment of patients, particularly James Norris. Haslam pointed the finger of blame in the direction of his chief surgeon, who was performing autopsies at will, was an alcoholic and was, as labelled by Haslam ‘insane.’ Both men were relieved of their duties, and a drastic change in the treatment of the mentally ill began.
As the building had been slowly subsiding into the ground over the past decade, a new build was proposed. The governors of Bethlem held a public competition to find the best design to be used. Many people submitted their plans for the new asylum, including long-term resident, James Tilly Matthews. Although his design did not win, many of his ideas were implemented into the new building, including his long windows and circular lawn at the front entrance. He was awarded £50 for his efforts, but did not live long enough to see the new building completed. He died from tuberculosis just months before the move.
Lambeth, St George’s Fields. Bought by Lord Rothermere in 1930, and became Imperial War Museum.
The patients at Moorfields were transferred to St George’s Fields by a concession of Hackney coaches in the summer of 1815, but their new place of residence was not quite what they expected. The windows in the upper stories were unglazed, and the heating system did not function, which meant that the sleeping cells were exposed to the cold air and the basement galleries were damp. Although glass was placed in windows the following year, the Governors still agreed that leaving the unglazed was necessary to prevent “the disagreeable effluvias peculiar to all madhouses.” The new build attracted many new patients, and the hospital once again became quickly overcrowded. A series of new buildings were added, including a criminal wing, extensions on the east and west wings and the dome, creating space for an additional 196 patients in total.
In 1852, ‘mad doctor’ William Hood was hired as the first ever Resident Physician at Bethlem, and with him he brought a refreshingly new regime. As opposed to the heavy use of manacles and chains, Hood introduced methods of non restraint. He did not punish his patients for their illness, but rather gave them peace, tranquillity and games, including bowls and skittles. The women’s ward was filled with soothing paintings, magazines and craft activities, and the idealistic notion of pastoral care became a reality.
Rehabilitation was fundamental in Hood’s treatment of his patients, and among other methods, he held monthly balls or dances. It was during the ‘Bedlam balls’ that visitors were allowed in to mingle freely with the patients, creating a situation where the doctors, nurses, patients and visitors all looked alike, making it impossible to tell who was mad and who was sane. Throughout the years, Bethlem has often operated in secrecy, locking patients away for decades at a time without any form of care or compassion. Patients starved within the walls of Bethlem at the hands of their ‘keepers’, or physicians. Hood was somewhat different to his predecessors, and stated there will be no attempt “to hide either from the lay or medical mind, anything which was being done from within its walls.”
Broadmoor Hospital for the Criminally Insane opened in 1863, and the violent or aggressive patients of Bethlem were removed and sent to Broadmoor instead. This diverted attention away from Bethlem, and produced a quieter and safer environment for the patients who still resided there.
Patients remained at St George’s Fields until after the World War I, when the Governors decided to build a new hospital in a rural location. The removal to Monks Orchard at Addington in Surrey was sanctioned by Act of Parliament in 1926.
Monks Orchard Road, Beckenham
In 1930, Bethlem hospital moved for the fourth time to Beckenham, where it is still in operation today. The lush country settings and serene silence provided by the new location, it was thought, would appeal to the middle-class patients who could afford to pay for their care. The wards were designed to create a comfortable and homely environment, with fine furniture and thick, warm carpets. A ‘free list’ was created, which provided care to those who could not afford to pay for their own care.
The days of chaining patients to walls, or forcing them to sleep on straw in dungeon like cells, were over by the time of the fourth move, but by this point other ‘treatments’ were in practice. The ECT was first developed in 1935, and evidence shows that by the 1940’s, Bethlem had joined in with the rest of the world. Other common treatments, such as chemical seizures and the lobotomy were also used at Bethlem.
The NHS was developed shortly after the World War II, in 1948 to provide free health care to all, regardless of wealth or social status. It was the first time that health care had been made free anywhere in the world, and in July that year, all hospitals, doctors, pharmacists and dentists were brought together under the NHS band. This included Bethlem, and it paired up with Maudsley Hospital (another hospital for the mentally ill in South London) to provide a community-based service. Previously to this development, Bethlem Hospital received patients from different places around the UK, which meant that rehabilitation and after-care could not be followed up for any patient. When they were released from Bethlem, their health care ended, and this was not appropriate for many patients, who had still not recovered from their illness.
A small museum was opened in Bethlem Hospital in 1970, which contains artwork from former patients and other exhibits, such as documents from the archives and a pair of statues by Caius Gabriel Cibber called ‘Raving’ and ‘Melancholy Madness.’
These lifelike human statues were said to be modelled on two former Bethlem patients, one of whom was Oliver Cromwell’s porter, Daniel and were once situated on the gates of the second Bethlem building at Moorfields. This museum is open to the pubic on weekdays, but due to its small size, only a small portion of the Bethlem collections can be displayed at one time.
In 1999, South London and Maudsley NHS Trust (SLaM) was formed following the reconfiguration of community and mental health services in south east London. South London and Maudsley NHS Trust (SLaM) was formed from the merger of three main organisations: Bethlem and Maudsley, Lambeth Healthcare and Lewisham, and Guy’s NHS Trusts. The Trust was created to provide mental health services and substance misuse services in the London Boroughs of Croydon, Lambeth, Lewisham and Southwark, as well as specialist treatment to people from across the UK.
A new building was commissioned in 2003 to be erected at Bethelm Royal hospital, despite protests from local residents who claimed the hospital already attracted too many drug users. Named ‘River House,’ the new building opened in February 2008 and provided an extra 89 beds for new patients, allowing them to be treated in their home town as opposed to being sent up to 200 miles away.
Current psychiatric services at Bethlem:
Adolescent Unit; Affective Disorder Unit, Alex 2; Alcohol Unit, Alex 1; Alex Ground Ward; Anxiety Disorders Residential Unit: Behavioural Disorders Unit; Behavioural Genetics Clinic; Chelsham House Inpatient Unit; Children’s In-patient Service; Clinical Exercise and Physical Activity; Crisis Recovery Unit; Eating Disorder Unit; Eating Disorders Day Care; Gresham 1 and 2 Ward; Gresham ICU; Medication Review Clinic; Mental Impairment Evaluation & Treatment Services; Mother and Baby Unit; Outreach Services; Psychosis Unit; River House (Brook Ward, Chaffinch Ward, Norbury Ward, Spring Ward, Thames Ward, The Beck, Waddon Ward); Wickham Park House.
Notable Patients throughout History
Augustus Pugin – An English Architect best known for his pioneering role in the Gothic Revival style and his designs for the interior of the Palace of Westminster. In 1852 he suffered a complete breakdown, resulting in a four month stay at Bethlem Hospital. Located at St George’s fields, the hospital overlooked St George’s Cathedral, the building designed by Pugin himself, and where he married his wife in 1848.
Bannister Truelock – He was a shoemaker who prophesied the second coming of Christ. In 1800 he was sent to Bethlem after conspiring to assassinate George III alongside James Hadfield.
Daniel M’Naghten – The catalyst for the creation of the M’Naghten Rules (criteria for the defence of insanity in the British legal system.)
Edward Oxford – He was tried for high treason after he attempted the assassination of Queen Victoria and Prince Albert in 1840. He tried to shoot the pair just outside of Buckingham Palace, but missed and was apprehended immediately.
Hannah Snell – Dressed as a man and became a soldier in 1747. She revealed her gender and was discharged from the military, but was granted a pension in 1750, a rare occurrence for women of her era.
James Norris – A former marine who was found by Edward Wakefield chained to the walls by a harness. He had been kept in this condition for 9-12 years and was the trigger for the largest mental health inquiry of its time.
James Tilly Matthews – The subject for the first complete case study, compiled by John Haslam named ‘Illustrations of Madness.’ The case study contained detailed diagrams created by Matthews of the Air Loom, a device which he believed was controlling his mind. Much debate exists as to whether Matthews was insane, or if their actually was a conspiracy to keep him locked up. However, the symptoms described by Haslam indicate that Matthews was suffering from what is now known as paranoid schizophrenia.
John Frith – On 21 January 1790, Frith threw a stone at King George III’s coach as it travelled to the State Opening of Parliament. He was tried for treason, but sent to Bethlem on grounds of insanity as he believed his “Christ-like powers” had helped him to defeat the voices in his ear.
Jonathan Martin – Was an English arsonist who burned down the York Minster in 1829. Although he was found guilty, which would result in being hanged, the Judge declared him not guilty on grounds of insanity. He was sent to Bethlem where he lived until his death in 1838.
Louis Wain – Once an art journalist, Wain became famous for his own art work, primarily focussed on cats. From the 1880’s until WWI, the Louis Wain cat was extremely popular and appeared on greeting cards, and in books, magazines and annuals. In 1924, he was certified insane, and spent the rest of his life in mental hospitals, including Bethlem
Margaret Nicolson – A woman who (incorrectly) believed that she was the rightful heir to the throne and tried to assassinate King George III with a dessert knife. She became the star attraction at Bethlem, and rich members of the public paid high prices to see her. She became the subject to much gossip was was eventually deemed as Bedlam royalty.
Mary Frith – Also known as “The Roaring Girl”and Moll (or Mal) Cutpurse, she was a notorious pickpocket and thief in London who dressed in male attire throughout her long life. She once appeared on stage at the Fortune Theatre in male clothing and played the Lute. In a society such as the Early Modern era, Frith was considered both scandalous and insane.
Nathanial Lee – A playwright with a considerable reputation, Lee spent five years in Bedlam. He was released, but died in a drunken fit shortly afterwards in 1692. His most famous quote regarding Bedlam is still widely known today: “They called me mad, and I called them mad, and damn them, they outvoted me.”
Richard Dadd – Dadd resided in the criminal wing of Bethlem after he murdered his father. A talented painter, he was given materials and was allowed to develop his art. His paintings are today recognised as masterpieces, and he is recognised as an accomplished artist, despite his murderous tenancies. After spending 20 years at Bethlem, he was evenutally transferred to Broadmoor Hospital.
St Bethlehem Burial Ground. 1560-1750 (Rough approximations)
This summer, the construction of a new ticket hall at Liverpool Street Station has begun as part of the Cross-rail project in the country’s capital. During the digging process, constructors discovered a section of the St Bethlehem churchyard, exposing multitudes of skeletons. The museum of London Archaeology took over the site and have began the process of exhuming the bodies and identifying as much information from them as possible.
The churchyard was founded in the 1560’s in the former plot of the Bethlem Hospital vegetable patch. According to Current Archaeology editor, Matthew Symonds: “requisitioning St Bethlehem’s vegetable plot was an essential element of a scheme to relieve the city centre graveyards, and provide new space for London’s, not the asylum’s, dead. Once established, the extent to which patients were interred in the cemetery is still unclear.”
The patients at Bethlem Hospital came from all over the UK, not just from the capital. When they died, it was common practice for Bethlem to send the patient’s body back to their home town, not to bury them on site. It is possible that a small portion of the bodies do belong to the ‘tortured souls of bedlam inmates’, but archaeologists are still unable to confirm any such evidence.
The study of the St Bethlehem skeletons remains ongoing, but substantial findings have provided a wealth of information regarding London’s dead. The graveyard was founded to supply additional space for the already existing cemeteries in London. They were drastically overcrowded, and findings of the St Bethlehem churchyard indicate that this burial ground was no different. Bodies were found pressed on top of each other with approximately two meters of earth between each other in either cheap coffins or shrouds.
Illnesses and injuries common to the era in London have been found on the Bethlem bodies, such as rickets and syphilis. Further study will provide additional information, and we will update this article when necessary.