Bethlem traces its origins back to a Catholic priory founded in 1247 and existed at four different locations over a period of more than 760 years. Well over 600 of those years have been spent providing some form of “asylum” for people with psychiatric illness. While “Bethlem”, “Bedlam” and “Bethlehem” were, and indeed still are, often used interchangeably, the most appropriate distinct name for each of the four sites the institution has occupied over those years are:
Bethlem (aka Bethlehem Priory/Bedlam)
Founded: October 23rd 1247; exact date of completion/opening unknown. Closed: July, 1676
Architect: Unknown, founded by Simon FitzMary.
Location: Situated on what later became Bishopsgate Street, London EC2, and around what is now Liverpool Street Station in London.
Current status: Completely demolished
New Bethlem (aka New Bedlam/New Bethlehem)
Opened: July, 1676 Closed: September, 1815
Architect: Robert Hooke.
Plan: Linear Corridor (with later perpendicular extensions).
Location: Situated at what is now Finsbury Circus, London EC2
Current status: Completely demolished
Opened: August, 1815 Closed: October, 1930
Architect: James Lewis; significant additions by Sidney Smirke.
Plan: Linear Corridor (with perpendicular and radial extensions).
Location: Lambeth Road, London SE11
Current status: Centre block and rear wings remain as The Imperial War Museum London; all wings, extensions, and other buildings (except lodge) demolished.
Opened: July, 1930 Closed: n/a
Architects: Charles E. Elcock & John Cheston
Plan: Colony (Parallel)
Location: Monks Orchard Road, Bromley (a London Borough, but geographically part of Kent)
Current status: Original buildings intact, much expanded, and still in use as an active psychiatric hospital.
Originally founded as a priory, the land “Bethlem” was built upon was donated by former Mayor of London Simon FitzMary, on the 13th October 1247. FitzMary belonged to the Bethlemites, a Catholic order who had dispersed across Europe from the middle-east at the end of the Crusades. Initially, there was no notion of offering care for the mentally ill, as the Priory was built to provide accommodation, care and shelter for traveling pilgrims, and to raise money to send back to the “mother” church in the city of Bethlehem, in what is now Israel.
Over the next 150yrs, a succession of corrupt Bishops and keepers gradually sold off the priory’s land, and the buildings were allowed to fall into disrepair. The priory and its surrounds became known by the popular truncation “Bethlem”, which in turn became something of a by-word for crime and mayhem, and was an area of London few would then visit or live in by choice. Over time, “Bethlem” would further mutate into “Bedlam” and pass into the English language forever.
By October 1346, the Mayor of London and his Aldermen agreed to take the hospital under their protection, and many of those involved also made provision for the building in their wills, securing its longer-term future, but this period also saw the end of its connections to to the mother-church in Bethlehem.
It is not known precisely when Bethlem admitted its first “mad” inmate, and it is likely that its early role as an asylum for such cases happened somewhat organically rather than as a result of any specific decision, but it was certainly beginning to admit a handful of such cases by the end of the 14th Century. We do know that in 1377, King Richard II closed down Stone House, a small hospital in Charing Cross which had until that point been picking up the majority of the most needy and/or problematic among London’s mad. This event is generally considered to mark the start of its evolution from priory-hospital to dedicated lunatic asylum.
A report of 1403 shows that among the various persons under their care, there were “sex viri menti capti” – or “six men whose minds had been seized” within its walls and that the instruments of restraint for use with them had definitely been there since at least 1398, most likely consisting of some or all of those brought in with the transfer of mad patients from Stone House. So 1403 stands as an alternate date from which to measure the beginning of Bethlem’s role as a lunatic “asylum”.
By 1437, William Atherton had taken the position of “Master” of Bethlem (which had replaced the previous role of “Keeper”). Due to decades of corruption and neglect, during which the patients’ needs were often totally disregarded, many of the buildings now lay in ruins, with priceless artefacts sold off, the churchyard covered in market stalls and the chapel stripped of its former splendour by a succession of corrupt workers. Atherton petitioned King Henry VI to order an inquiry into Bethlem’s affairs which resulted in some attempt to revitalise the hospital. King Henry would later succumb to madness himself, and was “treated” at home for his madness by his confessor, John Arundell, who prescribed the usual quackery of vomit-induction, cold baths and the like. It was felt that Arundell had demonstrated such skill in this role however, that he was appointed as the new master of Bethlem in 1457 – clearly a somewhat more prestigious title by that time.
In terms of the building itself, few detailed images exist of the original Bishopsgate Bethlem – the earliest street-map of reasonable detail dates from circa 1559 and offers an idea of the layout, which is primarily a series of stone and wooden buildings planned around a square courtyard, with a stone chapel in the centre. There would have been some degree of functionality to the layout which would have evolved through gradual conversion and modification over many decades, rather than anything purpose-built, and would have been very different from even the earliest “planned” asylum or hospital designs. We know that there were lodgings clustered around the gatehouses at either end of a large, central courtyard. The courtyard was used for receiving deliveries as well as for “airing” or exercising the patients during the day, just as at later purpose-built asylums. Some patients were allowed out unaccompanied, although they were believed to have been ordered to wear tin badges to identify them as coming from Bethlem, which might protect them from harm, as well as allow them to “officially” beg for alms without risk of violating vagrancy laws. There were rooms for those simply passing-through, but a specific ward believed to have been named “Abraham” existed for the mad inmates who did not require individual rooms, and which was likely only furnished with straw and blankets. Inside the isolated cells there would certainly have been manacles, chains and other devices for some. There would have been straw and perhaps sacks or cloth to provide the most meagre comfort from the cold stone floors – the stoves in the kitchens being the only real source of heat even in deepest winter.
By 1509, King Henry VIII was on the throne, and Parliament ordered all religious houses worth less than £200 to be dissolved and sold off – Lord Mayor of London Sir Richard Gresham intervened on Bethlem’s behalf, convincing King Henry that its purpose had come to be solely for the benefit of the needy and rightly pointing out that it had not operated to serve the interests of the Catholic church for a great many years. Henry agreed to spare it, but only on condition that it was purchased from him. Bethlem, St Thomas’ and St. Bartholomew’s were the only pre-Reformation hospitals in England to survive Henry VIII’s reign, and with the later creation of Bridewell Hospital and Christ’s Hospital, formed the five “Royal Hospitals” of the City of London.
In 1557, under auspices of the City of London, Bethlem was now to be run by the same management responsible for overseeing the notorious Bridewell Prison-Hospital – a former residence of King Henry VIII which had been specially converted for this new purpose. Funding now came from the newly-formed Anglican Church to Bridewell who distributed it among the various buildings they oversaw, but Bethlem, whose mad inmates were not seen as any priority, would receive the most meagre share of all. Despite the promises made to the dying King Henry to maintain the buildings, Bethlem’s still stood neglected just as it had for years, with the chapel eventually having to be demolished in 1575.
By 1598 Bethlem officially had 20 mad inmates in total, whose places were paid for by the parishes from which they had lived before committal, or by their friends and relatives, or from Bridewell’s funds in cases where they had been declared mad while in prison. A report of 1598 shows that one female inmate at this time had already been in Bethlem for more than 25 years, although somewhat more encouragingly, 10 of the 21 names registered had been there for less than one year.
By 1610, people had begun to visit Bethlem purely for educational or “entertainment” purposes, lying as it did within walking distance of London’s theatre district and other “attractions”. Individuals or small groups came for guided tours, often braving the pickpockets and even knifepoint-robberies by the unsavoury Bishopsgate locals, simply to watch the inmates. At a time when the effects of scarring diseases, deformity, wounding and other medical problems were all considered valid forms of fee-paying entertainment, word of the wondrous cavorting of the inmates of Bethlem spread across London as promise of good, cheap entertainment – an image that the institution (or indeed asylums in general) would not really even try to shake off for more than 150 years to come, as such visitors tended to bring money with them. From here, “Bedlam” really begins to evolve into a concept as well as a physical location, and penetrates the public consciousness, cropping up ever more frequently in popular culture through plays, poems and songs, including the works of Shakespeare, whose “King Lear” (1606) tells of the “Bedlam beggars” and refers us to the popular name for such – their being known as “Tom O’Bedlam” in the city of London and its surrounds.
Professor Helkiah Crooke (1576-1648), had been King James I’s personal doctor from 1604 and was appointed by the King himself as the new Keeper of Bethlem in 1619, under the directive that Bethlem be raised to the levels of medical-led caring offered by St. Thomas’s and St. Bartholomew’s hospitals. But, living up to his name, money appears to have become Crooke’s main motivation and he quickly lost interest in most of Bethlem’s affairs beyond its finances. Under King James’ son King Charles I, investigators discovered the extent of Crooke’s embezzlement – he had sold off yet more of Bethlem’s land and left the inmates to starve while pilfering as much money for himself as he could. He was dismissed in 1634 and forced to resign from the Royal College of Physicians.
Crooke was the final “Keeper” or “Master” of Bethlem, and in 1638 King Charles handed complete control of Bethlem to the entity known as “The City of London”, extending Henry VIII’s decree that the site must remain in use as a hospital. The Keeper’s role subsequently evolved into that of “Steward”, who instead of simply placing all “housekeeping” duties at the feet of his wife, as had been the norm until then, would work with an officially-appointed Matron who fulfilled a more formal set of duties. The first Steward was a Richard Langley, who was assisted by the Porter’s wife Elizabeth Withers – the first Matron.
The spectre of Civil War was the next major national event to have an impact on Bethlem, with redemption and a new sense of importance for the hospital coming in the form of Puritanism, which spread across Britain with Oliver Cromwell’s rise to power. Along with a steely religious observance and strict code of abstinence, Puritanism also gave much greater import to caring for the poor and needy than had previously been seen on a nationally-implemented scale in Britain. With the war, there was a sudden marked increase in the number of mad amongst the soldiery, but now also a perceived need to provide some sort of specialised care for them. As a result, the City of London ordered that Bethlem be enlarged, building room for an additional 20 patients, taking Bethlem’s capacity up to around 50 by the end of 1644.
Amongst much of the rest of central London, The Great Fire of 1666 swept away Bridewell Prison, but the area around Bethlem was within the fire-breaks, and in the opposite direction to the wind so, with Bridewell destroyed, its Governors were temporarily forced to use the buildings of Bethlem to conduct their meetings and this situation, amongst the stench and ruin of its aged walls, unavoidably led to the realisation of just how out-of-date, dysfunctional and inadequate the ramshackle old hospital was, and indeed long had been. Under the climate of upheaval, reform and rebuilding forced upon London, in January 1674 the resolution was passed that Bethlem was “old, weak, ruinous and so small and strait for keeping the great number applying for admission that it ought to be removed and rebuilt elsewhere on some site grantable by the city.”
Liverpool Street Station covers the area where Bethlem once stood – and Liverpool Street itself was called “Bethlem Street” up until 1825 before being renamed for Lord Liverpool. There is now only a small plaque on the wall of the nearby Great Eastern Hotel, painted in gold and Bethlem’s trademark dark blue, as testament that the hospital which stood on the site for 429 years had ever existed.
In his role as Surveyor to the City of London and Chief Assistant to Sir Christopher Wren, the renowned scientist and polymath Robert Hooke was very much involved in the reconstruction and rehabilitation of the ravaged centre of the city. He devised the construction method by which St. Paul’s Cathedral’s iconic dome was completed and undertook more than half the official surveys commissioned to assess the damage to old London after the Great Fire, with a view to the city’s mass redesign. Among several civic architectural works, which include the original Royal College of Physicians on Warwick Lane, was the commission for the “New Bethlem” asylum, the first purpose-built lunatic asylum in Britain, and the first in the world on such a grand scale.
New Bethlem, or “New Bedlam”, was completed in 1676 at Moorfields, an impoverished area of London where throngs of Londoners displaced by the Great Fire had settled in makeshift hovels. They were “encouraged” to leave London to find work elsewhere, or pushed away into the city’s growing East End. Once the poorest and neediest of his people were safely out of the way, King Charles himself officially opened the New Bethlem asylum that July. A spectacular and grandiose façade, New Bethlem was considered by many to be one of the finest buildings in all of London. Commentators of the time were split on their interpretations of this massive edifice, then the third biggest civic building in the whole of Britain, with many applauding its emotional and symbolic contribution to Britain’s Phoenix-like rise from the ashes of the Civil War and the Great Fire, and others wondering why such expense and grandeur had been wasted on the mad.
In April 1674 Hooke had submitted sketches for an asylum of around 420 feet in length, intended for 100 patients and 20 “officers”. Although there are no absolutely conclusive records regarding the dimensions of the finished building, Bethlem Museum curator Patricia Allderidge believed the Bethlem Governors probably upsized Hooke’s plans and that when finished, the façade “seems to have been at least 550ft from east to west and probably much nearer 600ft.” Unsurprisingly, Hooke followed the standard hospital design of the time, later referred to as the “corridor plan”. This layout essentially consists of one long corridor, punctuated by a central “pavilion” or “administration block” in the centre, separating the corridor into “wings” on either side.
The admin block boasted a gilded ball, weather vane, and spectacular three-faced clock tower. The two gate statues, by Danish sculptor Caius Gabriel Cibber, are sometimes referred to as the “brainless brothers”, or “acute mania” and “dementia” respectively, and depict the two states of madness that were medically recognised at the time. Contentiously, many feel they served to act as an advert of sorts for the asylum as a public attraction, and indeed it did begin charging an entry fee as soon as it was up and running, with the statues acting in this capacity much like say, an effigy of a lion outside a zoo.
Now operating in such an official and deliberately visible capacity, “Bedlam” really became one of the great public attractions of London, with both Bedlam itself and the spectre of the madhouse penetrating deep into the nation’s collective consciousness. For the majority, Bethlem became less a place of cure and genuine asylum and more a place of captive entertainment, seen as a “walk on the wild side” comparable with a trip to the zoo or circus. The hapless inmates were indeed considered by many, including most medical men of the time, to be little better than animals, believed immune to heat or cold, hunger or the need for sleep, peace, comfort or love, and possessed with dangerously inhuman strength and endurance.
Visitors often appear to have behaved in a less restrained manner than many of the inmates, and both men and women would also visit Bethlem for a chance to ogle patients of the opposite gender, as many would be kept naked, remove their own clothes, or be presented naked before the crowds. Visitors would taunt the patients through the bars of their cells with long sticks (apparently provided to them by the keepers), or with food or cups of gin (bought from the stalls which were set up on each floor) to be exchanged only on the delivery of a song, dance, or some other performance or act of debasement. As much as history prefers to remember a place of perpetual torment however, there are also examples of patients who were said to gain something from the presence of the visitors, selling things that they had made, or being held in high regard and treated as minor celebrities, paid for their talent at oration, song recital or story-telling, although of course these were likely to have been the exception rather than the rule.
Besides the hoi-polloi, a great many of the most of the eminent writers, thinkers, scientists, politicians and social-movers of the day also visited New Bethlem at least once, it being “the thing to do” while in London. Jonathan Swift (author of “Gulliver’s Travels”, among other works), was suitably moved to later found his own asylum in Ireland. Dr Samuel Johnson visited with his associate and biographer James Boswell in 1774, and while Boswell was moved and quietly affected by the scenes he witnessed, Dr Johnson was unimpressed, although mildly amused by the sight of one patient beating the stuffing out of a pillow in the belief it was the Duke of Cumberland. He did feel however, that there was an important lesson to be learned about the dangers of an overactive imagination.
So it was at New Bethlem, and this attitude, along with the popular concept that the mad were undeserving of even the sympathy given to the layman, saw the shameful practice of fee-paying public visitation continue for nearly a century. Regardless of how we might see it through modern eyes, not to mention all the harm they undoubtedly did, the paying crowds certainly helped to fund the asylum and keep the patients fed, bringing in over £400 per year. It is probably safe to conclude that the fate the patients suffered at New Bethlem would still have been considerably better in most of cases, than that which they would have been subjected to on the streets outside its walls, and while many patients certainly professed their sanity and their desire to be released, many others are recorded as being quite vocal about their desire to stay in Bethlem, even after formal discharge.
In 1725 a new male ward was added onto the east wing, and the matching female ward added to the west in 1733, bringing the official capacity up to 150 inmates in total, and presumably widening the building to somewhere between 700-800ft. These new wards were intended for “incurable” patients – those who were never expected to recover. At New Bethlem, “incurable” was defined as any patient whom the asylum had not succeeded in curing after a year had passed, or whose violent and troublesome behaviour was felt to be impossible to deal with on the normal wards.
In 1728 a Dr. James Munro took the position of Physician and became the first in a nepotistic four-generation line of Bethlem’s Physicians spanning a 127 year period during which the medical understanding and methods of treatment for madness would make significant progress at other establishments across Britain, while New Bethlem itself seemed to disappear behind a veil of secrecy and speculation before being blown wide open to huge scandal nearly a century later.
As well as notable work towards a cure for smallpox, Dr Munro undoubtedly had much experience of working with and around the mad, but like most Physicians of his day, whether working with the physically or mentally ill, spent most of his time among the rich and took a highly detached approach to treating his pauper patients. James’ son John would take over the same role in 1752, and although required to jump through a few hoops before Bethlem’s Committee, he would have very much been expecting his own, and particularly his father’s reputation and influence, to decide the matter over all other considerations. John continued the role of New Bethlem’s Physician in the same rather detached manner of his father, spending most of his time working with far more lucrative private clients, as well as the private madhouses he also inherited. While he did exhibit a kind public attitude toward his patients, believing they should always be “talked to kindly” and “used with the greatest tenderness and affection”, his toe rested firmly on the family line as far as the treatment of madness was concerned, saying: “very little of real use can be said concerning it, the immediate causes will forever disappoint our search, and the cure of that disorder depends as much on management as it does on medicine”.
Outside New Bethlem, an increased awareness that madness was certainly not restricted to the lower orders, and therefore the mad of any class might deserve better consideration and treatment in general, was very, very slowly beginning to take root. Change at New Bethlem was pushed with pressure from Dr Battie of St Luke’s Asylum, which had opened in London in 1751 as the second public asylum funded by charitable subscription after Bethlem. The other Bethlem Board members (reinforced by Battie’s refusal to allow “tourists” into his own asylum) and its Governors eventually conceded in 1766 that the public no longer be allowed to enter New Bethlem on a whim. While the decision to ban tourists can only have been a positive one, it did mean that access by the press or other parties interested in carrying out an investigation or exposé was now far more difficult too, and the relatively few reports of conditions at New Bethlem from the late 18th Century are contradictory. Some commentators paint a picture of a pleasant house of refuge populated by genial yet quirky fellows and ladies, only too happy to chat about how they arrived there through unrequited love or extreme religious passion. Others tell of patients chained to walls who cower in their dark basement cells as the wardens rattle their keys outside, filthy, tortured and neglected souls who continue to live in a state of physical and mental anguish often exacerbated by their degenerative surroundings and bullying keepers.
In 1791, Dr Thomas Monro became the third member of the family to saunter into the job of Physician at New Bethlem. Outside the asylum, factors such as the madness of King George III and the growing philanthropy around Quakerism had somewhat softened attitudes and practices towards insanity outside New Bethlem, while reports began to surface of conditions inside that were by then considered barbaric. Amongst a growing atmosphere of asylum reform, the Quaker Edward Wakefield and his associates William Hone MP and the architect James Bevans had made it their business to visit various asylums around England to determine for themselves the state of care (or lack thereof) at each. Wakefield and friends would visit New Bethlem in April 1814 and their evidence was collated in the “Report from the Select Committee of the House of Commons on the Madhouses of Britain” and presented to Parliament on the 11th July 1815.
One of the most damning stories of mistreatment which Wakefield uncovered was that relating to an inmate named James Norris, a former American Marine who had been in New Bethlem for 14 years. Norris had found his way to England via various seafaring jobs, and had been admitted to the Office for Sick and Wounded Seamen in 1800 after displaying some form of madness that went unrecorded. He was transferred to New Bethlem, where he was deemed a “dangerous and incurable lunatic” and was moved into the male incurable ward the following year. When Wakefield discovered Norris on his visit in 1814, he was in a poor state of physical health and chained to the wall of his cell by a bizarre contraption that involved a chain threaded through a hole in the wall by which the wardens could loosen or restrict his movement about the cell as they saw fit. This was in addition to an iron collar around his neck attached to a 6ft metal rod protruding from the floor, and other bars and chains securing his arms to his waist – essentially an iron straitjacket. Norris had apparently been kept in this contraption, in solitary confinement, for the last 10 years.
The period of the 1790’s through to the 1830’s saw the likes of Edward Wakefield, Samuel Tuke, Elizabeth Fry and Godfrey Higgins – powerful and lucid men and women determined to see reform in the treatment of lunatics – visit a great many asylums across England. The appalling stories they brought back from New Bethlem and so many other institutions led to the forming of the Select Committee on Lunacy in 1815, which undertook a nationwide assessment of the conditions within all asylums, public or private, as well as all workhouses that had pauper lunatic inmates. The vast majority did not bear up favourably to such scrutiny. With bitterly ironic timing, the death of James Norris on 26th February 1815 trumpeted the failings at New Bethlem more loudly than anything else, and the senior staff were quick to begin blaming each other for all that was wrong with their asylum. Although the Surgeon, Bryan Crowther, had recorded the death as tuberculosis, it later emerged that Norris had been kept in the same position for so long that his bowels became impacted, which in turn had caused his intestines to explode, leading to a slow and excruciatingly painful death.
Upon investigation, Dr Monro remained relaxed about the whole affair, however his arrogance saw him willingly reveal the very information that was to condemn him as so woefully unfit for the role. He happily admitted that he spent most of his time with his rich patients as he believed that chains and restraints were fit only for the pauper lunatics and that “if a gentleman were put in irons, he would not like it”. He also yet again expressed the firmly-held Monro belief that the practices used by his father and grandfather were still appropriate, and that madness could not be cured anyway, regardless of the methods used.
Damning evidence flowed in from New Bethlem’s own staff and many (including Wakefield and members of the Select Committee) who had visited the asylum themselves, as well as former inmates such as the magnificently-monikered Urbane Metcalf. Mr Metcalf attested to having had no choice but to sleep each night on cold, damp mattresses, the effects of which still ailed him years later, and that the most troublesome patients were often taken down and chained up cold and naked in the asylum’s cellars to be beaten or abused by sadistic keepers. He also revealed a system of perks for favoured inmates and how the frequently-drunk keepers would cruelly encourage bullying and extortion against the weaker patients for the keeper’s own profit and amusement, even going so far as to encourage an attack on one patient, a Mr Baccus, which led to his death.
By 1800, New Bethlem was rotten both inside and out, neglected and subsiding, with one wing demolished entirely in 1805 to pre-empt its expected collapse, new admissions were halted and the existing patients crammed into the remaining half of the building. By 1807, the decision had been made to rebuild, and a new location at St. George’s Fields in Southwark was settled upon. Elements of three “winning” submissions entered into a competition to design the new asylum were incorporated into a final plan by Bethlem’s Surveyor, James Lewis. The 3rd incarnation, dubbed “Royal Bethlem” was opened to patients on the 24th August 1815, with 122 persons conveyed by Hackney carriage to their new place of incarceration. It should be noted that Royal Bethlem was officially referred to as a “hospital” from this time onward, although “asylum” was still considered an acceptable term at the time, and the public and press generally continued to refer to it as such.
Nothing whatsoever of New Bethlem (now of course, the old Bethlem) was deemed worth saving, bar the two stone figures from the gates. The Governors decided against their external placement this time, and had them instead erected on pedestals inside the main entrance to greet visitors at eye-level. They were eventually removed altogether and transferred to London’s Victoria & Albert Museum, and later still, returned to the museum at the 4th incarnation of Bethlem, built in 1930. Robert Hooke’s once-spectacular New Bethlem was pulled down completely by the end of 1816. The site is now covered by Finsbury Circus.
The general layout of the new asylum’s main building was much the same as before, on a “corridor plan” and at 580ft in length before being later extended. A central admin block sported six plain Ionic columns and a central pediment which contained the Royal coat of arms above an erroneous memorial to Henry VIII, then thought to have been the founder of the original Bethlem. Above this, was a shallow golden dome which sat atop the asylum’s chapel, unusually placed in the roof space, and this gleaming exterior feature was the only significant allusion to the showy outer grandeur of the previous incarnation. The rest of the new asylum consisted of plain three-story wings holding 108 cells on each of the three floors, this time divided into male and female wings on either side of the central block, which again held all the administrative offices and meeting rooms, as well as an infirmary, the aforementioned chapel on the top floor, and the staff residences and kitchen in the basement. Inmates’ cells were 11ft by 7.5ft and had arched roofs with wooden groins to help reduce the noise made by those they contained. “Uncleanly” patients were kept on the ground floor so that the straw of their cells could be changed and washed-out more easily. There were also two “criminal lunatic” sections at the end of each wing, which were completed and opened a year later, in 1816.
With Dr Thomas Monro having been dismissed in shame, Bethlem now needed a brand new Physician, a man of sincerity, honesty, integrity and enthusiasm who would finally break with the shameful and regressive traditions of the past, embrace the emerging new thinking around mad-doctoring, get the asylum back at the forefront of caring for the mad, restore its tattered reputation and put the reign of the neglectful and exclusive Monro dynasty behind it forever. Who better for this job than….Thomas’ son, Dr Edward Monro. Astoundingly, Bethlem’s Governors chose to uphold the dynasty that had stretched back to 1728 by putting yet another Monro in charge of the asylum. There was some disagreement among members of the board regarding this decision, and as a concessionary nod, the role was made into one shared with a co-Physician, so that there would now always be two men responsible for running Bethlem. Dr George Leman Tuthill was the man chosen to work alongside Dr Edward Monro. The old role of Apothecary was renamed “Superintendent”, the first of whom was Edward Wright.
In 1838, Royal Bethlem already needed to be enlarged and the additions were made by Sidney Smirke to expand the accommodation for general patients, which saw Bethlem’s front aspect widen considerably as he extended the span of each wing further outwards on both sides, bringing the inmate population up to 364, more than twice that of New Bethlem. In the same year, he also added small detached radial wards behind the new extensions to separately house 45 male and 15 female “criminal lunatics”. Later, there were yet another two general wards built which extended out from behind the back of the admin block. A ballroom was also added for functions, performances and dances. In 1846, Smirke also replaced the shallow dome which originally adorned the asylum with a much larger and taller “pumpkin” shaped dome made of copper, which became a more visible and significant London landmark and also allowed the chapel below to be expanded in line with the growing inmate population. A small single-story gatehouse was added on the Lambeth Road entrance to improve security, and workshops in the rear grounds to teach and occupy male patients.
As heart-warming as it would be to report that Bethlem’s horrific past was now finally left behind, it is clear that conditions overall had really not kept pace with the leading institutions in the country, such as The Retreat at York or London’s own St. Luke’s and Hanwell asylums. In 1831, the first Superintendent, Edward Wright was dismissed after accusations of being habitually drunk within the building, sexually assaulting a female attendant and having been found in compromising positions with female inmates at night on more than one occasion. To help dampen any subsequent scandal, Wright was actually dismissed on the basis of his poor record-keeping, rather than his drunken fondling, to be replaced by Dr William Wood in late 1831.
Parliamentary Acts relating to asylums which were passed in 1828 and 1845 did not affect Bethlem. With 19 of its Board of Governors in the House of Commons and another 13 in the House of Lords during this period, they had seen to it that minor clauses in the various bills had kept their asylum free from outside interference. In 1848, they refused a direct request for an inspection from an increasingly active Metropolitan Lunacy Commission (MCL) – the Parliamentary Committee appointed to regulate public and private asylums. After the near death in 1850 of young girl named Ann Morley (saved only by her transferal to the Northampton Lunatic Asylum (now St Andrew’s Hospital), a formal investigation into Bethlem was finally forced by the MCL, but not before the death in April 1851 of another young girl, Hannah Hyson, which created a situation that even Bethlem’s powerful Governors were unable to worm their way out of.
Dr Edward Monro finally broke ranks from the Board of Governors, and blamed them for its poor management. He also painted a clear picture of his own attitudes which summarised precisely what had been wrong with the Monro dynasty for so many years. Describing how little time he had to work at Bethlem due to all his private fee-paying clients’ demands, he expressed his dismay and surprise at being expected to take an interest in issues such as the asylum’s general care and conditions, or the social background and culture of the inmates. He expressed utter bewilderment at the concept of getting to know individual cases and prescribing bespoke care for them. He admitted, probably quite genuinely, that he knew absolutely nothing of the fetid basement cells to which young Ann Morley had been committed, saying that it was a department “clearly as distinct from my sphere as that of the architect or the cook”. His statements were also condemned in the press, as well as medical journals including The Lancet and The Journal of Psychological Medicine – the mouthpieces of a medical and psychiatric profession that, while still having a very long way to go, had moved on significantly by that time and was now embarrassed by his antiquated, anachronistic attitude and lack of integrity and ideas, let alone ideals.
The County Asylums at Hanwell (now St Bernard’s Hospital) and Colney Hatch (aka Friern Barnet Hospital) had opened in 1831 and 1851 respectively to provide, by that time, around 2,000 extra beds for the ever-growing numbers of paupers in London and its surrounds designated as lunatics. Dr William Charles Hood had been the first Superintendent of the male side of Colney Hatch at just 27 years of age, and was offered the position of Superintendent (now the title for the head role at most British asylums) at Royal Bethlem, which he took up in 1853. This marked a dramatic change both in the way Bethlem was run – at long last bringing it out from the shadow of the Monro years – as well as, eventually, to the types of patient it catered for.
Dr Hood, full of great enthusiasm for reform and the introduction of the “moral treatment” regimes developed at The Retreat (York), The Lawn (Lincoln) and Hanwell, insisted that the Governors must employ the “best class” of attendants. He also introduced the position of Head Male Nurse and Head Female Nurse who would henceforth be given much more authority and responsibility than comparable roles had previously bestowed. This hierarchical and accountable structure was by then the backbone to the system subsequently adopted within all public asylums across the country, and it meant that the roles and responsibilities of all those from the Superintendent through to the ward Attendants were now much more clear. Each person in each role now knew what was expected of them, so it also meant that the culture of blame and the claims of ignorance to particular problems, so prevalent in Bethlem’s own past, could not be avoided by anyone including the Superintendent.
By the time Hood began at Royal Bethlem, the agreements the Governors had entered into saw it catering for 100 of Britain’s then 436 certified criminal lunatics, housed in the grim wards at the rear of the asylum. Undoubtedly the most “celebrated”, if that is the appropriate word, of Bethlem’s criminal patients was the English painter and sketcher Richard Dadd (1817-1886), who was admitted in 1844, and is now probably considered to be the most important British artist to have suffered from a mental health condition and spent time in an asylum. On August 28th 1843, Dadd’s father asked him to “unburden his mind” to him, and took him out to Cobham, Surrey for a meal and a walk. At a local chalk pit later that night, Dadd stabbed his father to death with a knife and a razor he had hidden about his person. Tragically, he would later profess that he had planned the attack and did so because he believed his father was the devil in disguise.
After flight to France, eventual capture, trial and incarceration at Bethlem, Dr Hood encouraged Dadd to continue painting, and he produced many of his most celebrated works there, including “Contradiction: Oberon and Titania” (1858), “The Fairy-Feller’s Masterstroke” (1864), and “Portrait of a Young Man” (1853) – which was in fact a portrait of the young Dr Hood – one of the few people Dadd seemed to make any connection with during his years at the asylum. While never again at liberty to return to the artistic community, Dadd’s incarceration in Bethlem and later Broadmoor Asylum, meant that he is almost in a class of his own as far as any working Victorian painters are concerned. Having for the majority of his career neither the career-driven motivation nor financial necessity to paint “to order”, he was unusually free to create whatever he liked on whatever timescale he saw fit. Dadd continued to paint in Broadmoor until his death from “extensive disease of the lungs”, in January 1886. His works, now worth millions, can be seen in London at The National Gallery, the Tate Gallery and Bethlem Royal’s own museum gallery.
Within just 10 years of Dr Hood’s engagement, the need for a specialised establishment devoted solely to criminal cases had been addressed by the Lunacy Commission. The building of Broadmoor Criminal Lunatic Asylum in Berkshire in 1863 was intended to provide for criminal lunatics of all classes from across the whole of Britain, and saw all such cases at Royal Bethlem, including Richard Dadd, transferred there on the 23rd July 1864.
With London’s pauper lunatic cases now accommodated in the County Asylums at Hanwell and Colney Hatch and future criminal cases destined for Broadmoor, Dr Hood and the Governors decided that Bethlem’s overall role in Britain’s ever-growing network of asylums was due for a major change. The number of private asylums had greatly diminished in the wake of a succession of Lunacy Acts had rendered that once well-established and profitable business a risky, complicated and unattractive one, at least for those seeking to make money easily, or not well-ensconced within the right medical circles. A private madhouse could no longer be so easily opened-up by any doctor wishing to provide small-scale care for a limited number of patients, nor thankfully by any entrepreneur of dubious motive who could secure a large house with a few beds, manacles and some hired muscle.
Dr Hood felt that a gap had opened for a certain type of lunatic who was not being appropriately accommodated elsewhere – the lunatic among the “gentlefolk”. The typical patients he had in mind were middle-class men and women from educated backgrounds who were (or had recently been) of some means, but had fallen prey to madness brought on (as he saw it) by the pressures of their own industriousness and desire to succeed in the industrial age. Dr Hood’s program of reforms saw Royal Bethlem transformed from the dark, dingy monolith it had been, into a far more spruce, welcoming and homely establishment. Pet cats, birdcages, paintings, ornaments and potted plants appeared in the day rooms. Carpets, comfortable chairs and arranged flowers adorned the corridors, illuminated in the evening by the gas lighting installed in 1850. A well-stocked library was opened beneath the chapel, in which among many other things, the patients might read the asylum magazine “Under the Dome” which contained stories and articles written by staff and patients.
Daily routines were punctuated by more widely social forms of rehabilitation including games, singing, music and huge dances backed by bands and orchestras in the refurbished grand ballroom – it being the one place in the asylum where the genders were allowed to mix with each other. In 1870, a pretty convalescent building named Witley House was built at the town of the same name in Surrey (designed by Samuel Daukes who had also designed Colney Hatch Asylum), which offered patients a way to adapt to life outside the confines and routines of the main asylum before returning to everyday life. By the time the MCL visited in 1861, Dr Hood had transformed Royal Bethlem in so many ways as to be almost unrecognisable from its former squalor, and the Commission was finally able to produce a satisfactory report for the asylum. During his time, there had been no suicides or murders, no serious accidents or outbreaks of illness and none of the appalling scandals of abuse, neglect, debauchery or embezzlement that almost every other notable man charged with looking-after Bethlem before him had left behind.
A marked change in regime from 1878 onwards was not merely down to Hood’s eventual absence however, it was very much a reflection of the presence of the Superintendent Dr George Savage (1842-1921). Born in Brighton, Savage had worked at Guy’s Hospital in London as well as teaching at the University of London, and like the Monros, dedicated much of his time to his private clients while employed at Royal Bethlem. He believed that insanity was hereditary, as was the popular thinking of his day, and so was rarely to be cured. Although strongly arguing that sedative drugs should be only very sparingly used, he saw the Superintendent’s role as “the responsible guardian of the lunatic” and was a great believer in physical and mechanical restraint instead.
Under Dr Savage, Royal Bethlem lead the way in the use of mechanical restraints with statistics for use during June 1887 at Royal Bethlem showing 18 of their 264 patients being so restrained, compared with only 25 recorded uses across the rest of Britain combined. It is always worth noting with such statistics that the term “recorded” may be of not-inconsiderable significance however, and that ironically after its many years of impunity to outside inspection, Royal Bethlem was now under greater scrutiny and greater pressure to accurately record such things than any other British asylum – whose use of such restraints may not always have been accurately written down.
Dr Savage expressed his belief that the forms of restraint he employed were never unnecessarily heavy-handed, and that his methods had often kept patients from coming to greater harm. He described scenarios in which he believed his methods had directly saved lives, and appears to have genuinely believed that all was for the greater good of the patient, even if only to calm or subdue, rather than to cure. In great contrast to his enthusiasm for forms of restraint, Dr Savage was also the first Superintendent to actively encourage certain patients to engage themselves in life outside the asylum while still remaining resident within it. Hundreds of patients took authorised “leave” during his tenure, and some appear to have been permitted to come and go unsupervised, with advance permission of course. Only one male patient failed to return as agreed – instead enlisting himself in the army.
Most of the practices which existed under Dr Savage’s regime continued much the same following his retirement in 1888. By the early 20th Century, descriptions of Bethlem again varied wildly, usually depending upon which side of its cell doors the author had found themselves. The novelist Antonia White (b. Eirine Botting, 1899-1980) was a patient at Bethlem for 10 months during 1922 and in her autobiographical novel “Beyond The Glass” (1954) looked back on her time in Bethlem (re-imagined as “Nazareth” hospital). She sees the building with a less than complimentary eye: “she was frightened of the nurses. Sometimes they were rough and called her “naughty girl”. Sometimes they were friendly and said “good girl”. But she could not discover what it was that she did that mad them say “naughty” or “good”, though she was very anxious they should not be angry.”
In the 1920’s, the Southwark/Lambeth area was considered by many to be little more than a series of slums, and as the gap between the fortunes of this area in which Royal Bethlem stood and those of its comparatively wealthy patrons widened ever further, neither the patients nor their visitors wished to be accommodated in such an area. It became clear that in order to maintain preference among its choice clients, yet another relocation was required. A new site was found in the peaceful fields of Eden Park/Monks Orchard at Beckenham in what was then Kent, later Croydon, and now part of the London borough of Bromley. It was bought in 1924 and building work began in 1928. The last patients were to finally leave Royal Bethlem and the confines of central London for the comfortable new buildings in October 1930.
Royal Bethlem and its grounds were put up for sale, and were bought by Harold Harmsworth – Viscount Rothermere. Harmsworth had the grounds of Royal Bethlem dug up, re-landscaped and named “Geraldine Mary Harmsworth Park” after his mother, and dedicated it to “the splendid struggling mothers of Southwark” in her honour, donating the buildings and grounds of the former Royal Bethlem to the London County Council. The park is still open to the public, and in 1999 also became home to a Soviet war memorial and a peace garden, opened by the Dalai Lama. Thankfully, at least Royal Bethlem’s central admin block with its huge iconic dome, together with tiny stubs of the wings and the wards leading behind the admin block were preserved. Apart from the gatehouse, the rest of Royal Bethlem, including supplementary buildings were all demolished. What then remained was converted into the Imperial War Museum, opened by the Duke of York (soon to become King George VI) on the 7th July 1936, and having previously moved through several locations, has now become one of the collection’s permanent homes.
The new site at Beckenham – “Bethlem Royal”, was officially opened on 9th July 1930 by the President of the hospital Board, Queen Mary, who also visited to plant new trees on the 700th anniversary in 1947. It is situated in pleasant, leafy surrounds on the former country estate of a local banker, Lewis Loyd. Bethlem Royal retained a small charitable “free list” for patients who were unable to afford the usual fees. The new buildings themselves were designed by John Cheston and Charles E. Elcock, the former being the Surveyor to Bridewell and Bethlem. Elcock would later design Runwell Mental Hospital and Cell Barnes Colony. Indeed, Bethlem Royal was designed to a layout known as the “colony” or “villa” plan, first used in the U.S. in the 1870’s and first used in the U.K. by G.T. Hine at the Belfast City Asylum (now Purdysburn Hospital). The “colony” plan was the final stage in the evolution of large-scale asylum layouts and the main design type in use during the 1930’s, consisting of various buildings (usually no more than two storeys) spaced-out across the available land, and not connected by the usual covered-walkways or corridor systems that criss-cross between wards at most large asylums. Movement around the site was instead facilitated by walking or driving along the numerous leafy paths between areas, giving the appearance of a village rather than large institution.
While not attempting to compete with the grandeur of its two direct predecessors, the admin block is a handsome brick building of 140ft in length, designed in a restrained Egyptian art deco style. The entrance is dressed with stone surrounds, and two stone Doric columns flank a large central arched stair-window sitting below a modest copper clock-tower, forming the most delicate of nods to the designs of Bethlem’s past. Initially, accommodation was built for 250 patients and consisted of four detached ward blocks named for people or places from Bethlem’s past – “Tyson”, “Gresham”, “FitzMary” and “Witley”. These are built in a similarly restrained art deco style, laid out at generous distances on a parallel “colony” plan among the park-lands. Each ward has covered verandas to allow patients to take in the fresh air and scenery regardless of the weather, and each had its own kitchen and dining room so the patients did not need to leave their block to eat. This was all in service of creating a welcoming and homely atmosphere, where patients could feel some sense of belonging to their own block, and less a part of some huge institution, although the chapel and the main hall (which supposedly once lay behind the admin block) brought them all together for social events and worship. During the 1960’s as the “therapeutic community” model gained popularity, patients were encouraged to dine at the canteen or other sites where they would come into contact with new people, rather than only those familiar from their wards.
An odd mystery surrounds the main hall (or recreation hall), as it appears in the original plans and is mentioned in various documents from the 1930’s. However no-one (including the dedicated archivists at the Bethlem Museum) has been able to find any evidence of its existence – not even photographs as yet. Bizarrely, an aerial photograph from 1947 which was commissioned to celebrate the 700th year of Bethlem’s history also does not show any recreation hall situated where the plans suggest it should have been (nor elsewhere), suggesting that either it was never located there or anywhere else within close proximity to the hospital, or if it was, it was demolished for an unrecorded reason within just 17 years of the building’s opening. The second explanation is highly unlikely within so short a time of construction, and the first explanation is at odds with references made to meetings or events held in a “recreation hall” that do indeed exist elsewhere. Two possible explanations might be that for some reason the planned hall was never built but a temporary structure erected somewhere on site – a more likely explanation for demolition, or that again, for reasons unknown, it was never built and some pre-existing local structure was hired or bought and used instead. Given the volume of documents held at the archives, and new ones that occasionally come to light elsewhere, it is possible that a satisfactory explanation may yet be found.
Just 18yrs after the move to the new locale, specific provision for the middle-classes was rendered redundant with the formation of the National Health Service (NHS), which endeavoured to bring standardised healthcare to all, regardless of income or supposed class. The historic links which had still existed with Bridewell were severed and Bethlem was officially amalgamated with The Maudsley in Camberwell to form a postgraduate teaching hospital. Policy was also changed to admit only voluntary patients who were not expected to remain for long periods of time, as these were the patients felt most-suited to Bethlem Royal’s particular provision. Where a patient was admitted to Bethlem Royal but later assessed as needing long-stay care, they would be transferred to Cane Hill Hospital (former 2nd Surrey County Asylum by then serving greater London). From 1948 onward, Bethlem Royal began to run mixed-gender wards (oddly and incorrectly referred to as “bisexual wards” for a time), with all wards becoming mixed by the late 1960’s, as was then happening across Britain. However, during the 1990’s small sections of some wards were reallocated for males or females only, as it became understood that the enforced mixing of genders was equally undesirable to some patients as the enforced segregation had been for others.
Over many years, additional wards were built and all began to take on roles as individual specialised units, which operated under the same Board of Governors. The Board eventually became a Special Health Authority and then a unique NHS Trust, “SLaM” (the South London & Maudsley NHS Foundation Trust) in 1994, responsible for Bethlem Royal and The Maudsley along with several smaller sites and the psychiatric departments of various South London general hospitals. In keeping with changes at most former asylums in the late 1960s and early 1970s, staff uniforms were abandoned altogether in 1973.
As the old County Asylums were being torn down across Britain, new buildings were added to Bethlem Royal in 2004, overturning local opposition to its expansion. As of 2011, there are 13 wards, which include medium and low-security buildings, as well as “open” wards and services for children and adolescents, a mothers and babies unit, provision for the elderly, substance misuse, eating disorders and so on. The most recent building is River House, a 400ft wide secure unit which opened in February 2008, dwarfing every other building on the site and welcoming, among others, the last of the patients from the former secure unit at Cane Hill – although Bethlem Royal had first returned to taking non-voluntary patients once more with the opening of the Dennis Hill Unit in 1985. Today, the wards are furnished to appear much like a normal modern flat, with plain walls, laminate flooring and functional pine furnishings.
Today of course, there are no pickpockets, prostitutes, pillories or crowds of prying eyes outside, and the only present nod toward the public fascination of old is the on-site museum, long tucked away behind the gatehouse, but now housed in the much larger and more appropriate admin block. Among reams of historical documents and many antiquated items of clothing and asylum artefacts, it also contains diaries and writings by former Governors, Superintendents, Apothecaries and Nurses as well as those by a great many former patients, such as Richard Dadd and James Tilley Matthews. Housed here also, are the only survivors of the two previous incarnations – Cibber’s now-priceless “brainless brothers”, the statues from the gates of New Bethlem, now well over 300 years old.
Bethlem Royal has a long-standing focus on art therapy, and the building used for this is vibrantly-coloured and somewhat psychedelically decorated by the patients themselves, featuring recreations of the famous cats painted by Louis Wain, another highly collectible artist who once resided at Bethlem (as well as Napsbury (the former Middlesex County Asylum) in later years). The site also hosts a significant gallery displaying works by its many artistically-gifted patients from the past, such as Richard Dadd, Louis Wain and Cynthia Pell, right through to the meritorious work of recent and current patients, as well as those by other artists who have at one time or another suffered from psychiatric illness. Bethlem currently has around 400 patients, making it the largest psychiatric institution in the UK, as well as the longest-running in the world.