Bedlam - Paul Chambers - E-Book

Bedlam E-Book

Paul Chambers

0,0

Beschreibung

Bethlem Hospital is the oldest mental institution in the world, to many famously known as 'Bedlam': a chaotic madhouse that brutalised its patients. Paul Chambers explores the 800-year history of Bethlem and reveals fascinating details of its ambivalent relationship with London and its inhabitants, the life and times of the hospital's more famous patients, and the rise of a powerful reform movement to tackle the institution's notorious policies. Here the whole story of Bethlem Hospital is laid bare to a new audience, charting its well-intended beginnings to its final disgrace and reform.

Sie lesen das E-Book in den Legimi-Apps auf:

Android
iOS
von Legimi
zertifizierten E-Readern
Kindle™-E-Readern
(für ausgewählte Pakete)

Seitenzahl: 494

Veröffentlichungsjahr: 2019

Das E-Book (TTS) können Sie hören im Abo „Legimi Premium” in Legimi-Apps auf:

Android
iOS
Bewertungen
0,0
0
0
0
0
0
Mehr Informationen
Mehr Informationen
Legimi prüft nicht, ob Rezensionen von Nutzern stammen, die den betreffenden Titel tatsächlich gekauft oder gelesen/gehört haben. Wir entfernen aber gefälschte Rezensionen.



 

 

First published by Ian Allen Publishing 2009

The History Press

97 St George’s Place, Cheltenham,

Gloucestershire, GL50 3QB

www.thehistorypress.co.uk

© Paul Chambers, 2009, 2019

The right of Paul Chambers to be identified as the Author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without the permission in writing from the Publishers.

British Library Cataloguing in Publication Data.

A catalogue record for this book is available from the British Library.

ISBN 978 0 7509 9186 5

Typesetting and origination by The History Press

Printed and bound in Great Britain by TJ International Ltd.

eBook converted by Geethik Technologies

In Memoriam Matris

Contents

Acknowledgements

Author’s Note

Prologue

Part One: Bedlam in the Making

One: Humble Beginnings

Two: Crooke’s Revolution

Three: The New Bedlam

Four: Mad Doctors

Five: Dr Hale and Mrs Clerke

Part Two: The Monro Era

Six: The Start of a Dynasty

Seven: A Rival Across the Road

Eight: A Change in Attitude

Nine: Cash Crisis

Ten: Attempted Regicide

Part Three: The Madhouse Reformers

Eleven: Rules and Regulations

Twelve: Haslam, Crowther and Matthews

Thirteen: Relocation

Fourteen: Better by Design

Fifteen: The Criminal Department

Sixteen: The York Retreat

Seventeen: Wakefield Investigates

Eighteen: The Select Committee

Nineteen: St George’s Fields

Part Four: The Last Battle

Twenty: Sketches in Bedlam

Twenty-one: A Reformed Hospital?

Twenty-two: The Battle for Bethlem

 

Bibliography

Endnotes

Acknowledgements

Creating this book was a complicated and lengthy affair that was greatly facilitated by the assistance and support of a number of individuals. I am grateful to Ilona Jasiewicz and Ian Drury for drawing my attention to Bedlam, and to Nick Grant of Ian Allan Ltd for seeing the book’s potential. The staff at Ian Allan, especially Nick Grant and Mark Beynon, have offered much encouragement and have made the editing and production process run smoothly. My agents, Mandy Little, Sugra Zaman and Isabel Atherton (of Watson, Little Ltd), all had a hand in the sometimes protracted business of promoting this manuscript, and I am thankful that they were able to bear the strain with their usual good humour.

I am particularly grateful to the staff at the following institutions and companies who assisted me during the research phase and who, without exception, answered all my enquiries with diligence and patience: Bethlem Royal Hospital, Archives and Museum (Kent); Bodleian Library (Oxford); British Library (St Pancras); British Newspaper Library (Colindale); Cambridge University Library; Cruciform Library (University College Hospital); D. M. S. Watson Science Library (University College London); Family Records Centre (Islington); Hertfordshire Library Services; Institute for Historical Research (London); Society of Genealogists Library (London); The Welcome Library (London) and The National Archives: Public Record Office (Kew).

As ever, I received (apparently unlimited) moral support from my family and friends but especially my wife Rachel and daughter Eleanor. While I was writing this book my mother contracted a terminal illness and I shall remain forever in debt to the staff at Jersey Hospice Care (especially Margaret McGovern) for their help and assistance during what was a difficult time.

Author’s Note

When planning this book I was keen to understand why a centuries-old institution like Bedlam Hospital should continue to conjure up visions of chaos, disorder and abuse in the modern world. I wanted to discover when and how Bedlam had obtained its poor reputation and, above all, whether the many lurid stories of neglect, brutality and mismanagement had any basis in fact. As my research progressed it became clear that for an extended period of time during the eighteenth and nineteenth centuries most aspects of Bedlam’s dubious reputation were well-deserved. However, it was also evident that behind the examples of abuse that are often quoted in history books, there is a subtler, more intricate story that reveals the hospital to be as much a victim of the prejudice, ignorance and corruption of outsiders as of its own internal mismanagement. Beneath the lurid tales of violence, rape and murder is a compelling story in which Bedlam is placed at the centre of power struggles, political conspiracies and financial corruption. The hospital frequently found itself unable to control events; instead it was forced to react to the actions of others, and all too often it was the patients and inmates that suffered as a consequence. These public and private battles did not just affect Bedlam but rippled outwards into the wider ‘trade in madness’ that once thrived in Britain.

It is this turbulent part of Bedlam’s story that fascinates me, not least because it offers an insight into how British society transformed from the community-based treatments of the mentally ill in the seventeenth century to the routine institutionalising of the insane in Hanoverian and Victorian eras. At all times Bedlam was the centre of attention, it being the ascribed authority on the diagnosis and treatment of mental illness, and yet it was also in direct competition with other charitable and private ‘madhouses’ that were keen to exploit Bedlam’s reputation and its wealthier fee-paying patients. Thus, although this book covers the whole of Bedlam’s history, from its foundation in 1247 to the present day, the prime focus is on the period between about 1728 and 1855 when four generations of the Monro family had a controlling interest in the hospital. Not uncoincidentally, it was during this turbulent period that the allegations of abuse and corruption were at their peak and when society’s attitude towards madness in general was highly polarised.

It should be noted that while aspects of the story told here are appearing in print for the first time, this is a work of popular non-fiction and as such it cannot compete with the many fine textbooks that cover Bedlam’s history and that of mental illness in general (see the Bibliography). My aim is to keep the story flowing smoothly, so the main body of the text is largely devoid of complex explanations and overlong discussions. Those seeking further information on individual topics or events should consult the Endnotes, where individual entries list my sources, expand on certain points and provide suggestions for further reading.

Prologue

In the autumn of 1699 the diarist, raconteur and flamboyant wig-wearer Edward ‘Ned’ Ward adopted the guise of a London tourist and went in search of ‘the common vanities and follies of mankind’. Ward possessed a gigantic ego, a low boredom threshold and preferred always to be the centre of attention, all traits that made him somewhat tedious to be with. Those long-suffering friends on whom he imposed himself were forced to convey him about London in search of people and places that might whet his journalistic appetite. One particularly fraught day started with a visit to Gresham College, better known to Londoners as ‘Maggot-mongers Hall’ because of its display of stuffed and pickled bodies, both animal and human. Here there were rows and rows of dead birds, snakes, fish, monkeys and other horrors such as pickled foetuses and preserved human genitals. Most visitors found the sight compelling but it was not long before Ward grew bored and asked for a change of scene. ‘And so,’ wrote Ward, ‘glutted with the sight of those rusty relics and philosophical toys, we determin’d to steer our course towards Bedlam.’

At this time Bedlam, or Bethlem Hospital as it is more properly titled, was a large mental asylum located at Moorfields in the heart of London’s emerging business district. As well as being England’s oldest and only charitable madhouse, Bedlam was also a tourist attraction. Viewed from the street outside, the hospital’s imposing palatial architecture and landscaped gardens were a source of marvel, but for the cost of a single penny it was possible for the public to pass through Bedlam’s ornate gates and have free access both to its grounds and to its lunatic wards. A visit to the ‘madman’s college’ was high on the list of must-see London sights and Ned Ward, like so many of the capital’s other tourists, thrilled at the prospect. As their carriage drew nearer to Moorfields, Ward and his host debated the merit of London having so large and ornate a hospital reserved solely for ‘mad folks’.

Is it not surprising, asked Ward, that so much charitable money should have been spent on ‘so costly a college for such a crack-brained society’? His host agreed: ‘This ostentatious piece of vanity is but a monument of the City of London’s shame and dishonour, instead of its glory.’ This sentiment expressed, the two gentlemen paid their penny and walked through Bethlem’s gates to the courtyard within. To Ward the experience saw him cross a threshold from normality into a separate and far more terrifying world.

We heard such a rattling of chains, drumming of doors, ranting, holloaing, singing and rattling, that I could think of nothing but Don Quevedo’s vision where the damn’d broke loose, and put Hell in an uproar.

Ward was unnerved by this racket but nonetheless followed its origin to one of Bethlem’s ground-floor galleries, which housed the patients’ cells. It was here that the paying public could see and converse with Bethlem Hospital’s star attractions: its ‘crack-brained’ inmates or, as many preferred to call them, Bedlamites.

Ward initially found the Bedlamites to be amusing and he took delight in taunting and teasing them, safe in the knowledge that there was a locked cell door between him and the object of his bullying. One of the first Bedlamites encountered by Ward claimed to be in command of an army of eagles but complained bitterly that there was little wine to be had inside the hospital. Ward addressed the fellow, saying: ‘If you are a Prince of the Air, why don’t you command the Man in the Moon to give you some?’

‘The Man in the Moon’s a sorry rascal,’ replied the earnest Bedlamite. ‘I sent to him for a dozen bottles but t’other day, and he swore his cellar had been dry this six months.’

Getting a rise from Bethlem’s inmates was considered good sport and the practice was not discouraged by the hospital’s staff. They were, after all, ‘mad folks’ whose shame, emotional feelings and ability to rationalise had long since been rendered obsolete by their insanity. Even so, most Bedlamites did not enjoy being verbally assaulted and would try to dissuade people from approaching their cells. Ward, for example, had a mouthful of bread and cheese sprayed at him by a dishevelled man who objected to being stared at, while another woman, who could only be viewed via a small peephole in her cell door, delighted in embarrassing her onlookers. When a young girl asked her how old she was, the woman replied, ‘I am old enough to have hair where you have none!’ The young girl fled down the corridor in embarrassment.

Over the course of a couple of hours Ward was witness to a full variety of Bedlam’s inmates. At one end of the scale was a learned musician from St John’s College, Cambridge, whose chronic bouts of depression had led to his incarceration (‘a fiddling fellow with so many crotchets in his head that he crack’d his brains,’ observed Ward); at the other extreme was a raving man who smelled of urine and ran round his cell clapping his hands and shouting ‘halloo, halloo, halloo…’

Perhaps the most interesting Bedlamite he encountered was a man who claimed to have been sent to the hospital for being a vocal anti-monarchist. On hearing this Ward accused the man of treason, to which the inmate replied: ‘Truth is persecuted everywhere abroad, and flies hither for sanctuary, where she sits as safe as a knave in a church, or a whore in a nunnery. I can use her as I please and that’s more than you dare do. I can tell great men such bold truths as they don’t love to hear, without the danger of a whipping post.’ The man was quite correct. So long as he was classified as mad, he was free to express his anti-establishment views without fear of repercussion. Should he ever be declared sane and released then these same views would more than likely land him in prison or the pillory.

Lunchtime was approaching and, although Ward had derived much pleasure from the ‘frantic humours and rambling ejaculations of the mad folks’, his stomach was telling him it was time to move on. Ward asked his host to take him from the hospital and instead to escort him to the nearest pie shop.

All I can say of Bedlam is this,’ wrote Ward in his journal. ‘It is an alms-house for madmen, a showing-room for whores, a sure market for lechers, a dry walk for loiterers.

Ward had endured enough misery and madness for one day and desired a more enlivening experience; in consequence his host took him to the Royal Exchange, which, to Ward’s delight, was home to bands of European exhibitionists including a crowd of ‘mincing Italians’ with ‘effeminate waists and buttocks like a Flanders mare’. Being somewhat of a dandy himself, this gaiety suited Ward far better than the turmoil of Bethlem Hospital, whose inmates had been an uncomfortable reminder of the human persona’s fragility.1

PART ONE

Bedlam in the Making

1

Humble Beginnings

Bethlem Hospital is one of the world’s first infirmaries and is certainly the oldest mental institution in Britain. At the time of Ned Ward’s 1699 visitation, Bethlem had already been in existence for four and half centuries and was London’s second most famous landmark after St Paul’s Cathedral. The original Bethlem was founded in 1247 when a wealthy political figure named Simon FitzMary donated a piece of land to the Bishop of Bethlehem with the express aim of establishing a dependency house for paupers. FitzMary’s endowment was located on the northeastern fringe of the City of London in Bishopsgate Ward, an area that he thought was ideally suited to the needs of a charitable hospital. The Bishop of Bethlehem complied with FitzMary’s wishes and founded the Prior of St Mary of Bethlehem, a religious order devoted to healing sick paupers. The small establishment was soon being referred to as Bethlehem Hospital, a name which in time was itself abbreviated to just ‘Bethlem’.

Bethlem Hospital was continually short of money but somehow it always managed to scrape by and was, by the 1380s, being referred to by Londoners as ‘Bedelem’, a nickname that afterwards became a byword for all things chaotic.2 There are so many gaps in Bethlem’s early records that it is not known exactly when its monks began to accept patients whose symptoms stemmed from mental illness rather than physical injury or disease. One sixteenth-century rumour tells of how an unnamed medieval King of England had become so fed up with the distraught and lunatic people milling about outside his palace that he ‘caused them to be removed further off to Bethlem’. This tale is probably apocryphal but it is known that by 1403 lunatic patients formed a majority of Bethlem’s clients, making it London’s only dedicated mental hospital, a status that it would retain for several centuries afterwards.3

The hospital’s Bishopsgate plot was, at less than 2 acres, small and simply laid out. The site consisted of a rectangular walled courtyard in the middle of which sat a chapel. Opposite this, and pushed up against the courtyard’s north wall, were Bethlem’s main buildings. These were a compact affair and, even after some post-medieval rebuilding, the plain, single-storey edifice contained only a dozen or so cells for its patients; appended to these were a kitchen, staff accommodation and an exercise yard.

Bethlem may not have been the largest of London’s hospitals, but it was certainly the most famous. Londoners had a fascination with anything that was bizarre or unusual, so were quite aware of the City’s only mental hospital; they commonly referred to it in everyday language and used it as a backdrop in their plays and poetry. Jacobean playwrights, including Shakespeare, made regular reference to Bethlem and its inmates, usually to underline a character’s descent into madness or as a dramatic setting. In the 1605 play The Honest Whore (Part One), various characters at times find themselves despatched to Bedlam after being driven mad by their spouses. Fortunately the hospital always managed to effect a cure and all ends well, although the playwright’s final scene, set inside the hospital itself, reminds the audience that: ‘Wives with weak husbands that vex them long, in Bedlam they must dwell, else dwell them long.’

Aside from an amusing talking point and a threat for errant husbands and wives, the hospital was also a tourist attraction. In 1669, for example, the diarist Samuel Pepys glibly records that: ‘All the afternoon I at the Office while the young people went to see Bedlam.’ Pepys took Bedlam for granted and rarely troubled himself to visit; this was probably true of most Londoners who, like Ned Ward’s host, may only have visited the hospital when guests were in town. There were, however, some Londoners who took a very keen interest in Bethlem indeed, but not as a tourist attraction: they appreciated that the hospital was of great political significance and that those who exercised control over it had much to gain.4

Bethlem’s management structure was unusual and was the cause of many of its later problems, including the accusations of physical and sexual abuse, corruption and even murder. When founded, it had been administered as a religious hospital, but at around the time of the Black Death its management became the subject of dispute between the Church, the King and the Corporation of London (the political authority that governs the City of London). From 1504 the Corporation of London made periodic bids to control Bethlem, but it continued to operate in a quasi-independent fashion, treading a fine line between the desires of the Church and the King.

It was King Henry VIII who brought an abrupt end to Church control over Bethlem when, in 1536, he ended the monastic tradition in England and Wales by ordering the dissolution of all religious houses including their hospitals. Property that had belonged to the Church was taken by the Crown and afterwards administered by the State or parcelled up and sold off as private land. Bethlem was seized by the King but, instead of being decommissioned, the fate of some other London hospitals, it was allowed to retain its function as a charitable mental institution, possibly because it was the only such facility in England. With Bethlem no longer in Church hands, the Corporation of London renewed its campaign and pressed the King to give it overall control; the idea was resisted until January 1547 when the ‘custody, order and governance’ of Bethlem was transferred to the Court of Aldermen, an elected body within the Corporation of London. The King died two weeks later but he had not relinquished total authority and made it clear that, while the Court of Aldermen was in charge of Bethlem’s management, the Crown retained the right to intervene whenever it felt necessary.

For a time the Court of Aldermen tried running Bethlem single-handedly, but the results were far from satisfactory. By 1574 the Aldermen recognised that they had neither the time nor the experience to run a charitable mental hospital and consequently Bethlem’s management was handed over to nearby Bridewell Hospital, an institution that acted as a place of punishment for ‘lewd women’ and which, like Bedlam, had long been part of London’s urban folklore as a place to be both admired and feared.

Incorporating Bethlem into Bridewell’s management structure (which was also shared by Christ’s and St Thomas’s hospitals) was a logical and sensible move on the part of the Aldermen. Bridewell was run by a Court of forty-two Governors who oversaw the work of the hospital’s senior officers and administrative staff. Placing Bethlem under the control of these Governors was to be a pivotal moment in its history, the effect of which would be felt for centuries afterwards in both positive and negative terms.

It was the quality of Bethlem’s Governors and the decisions that they took which helped to define the outside world’s view of the hospital; yet becoming a Governor for Bridewell and Bethlem (as they were jointly known) was not at all difficult. A would-be Governor needed only to make a donation (usually at least £50) into the coffers of either hospital, after which his application to join the Court of Governors would almost certainly be met with approval. The majority of Governors treated the job as an honorary position, leaving the hard work to a handful of keen individuals who, together with the hospitals’ senior officers, would manage the finances and take all necessary management decisions. Around four times a year the Court of Governors would meet to hear any reports and to vote on matters affecting the hospitals’ management. Once a year, usually in April, a Grand Court of all the Governors (although often fewer than half would attend) was convened to, among other things, confirm senior staff appointments. As we shall see later, a Grand Court could also be raised at any time during periods of emergency or crisis.

In the early days of Bethlem’s accession to Bridewell, most of the Governors had a connection with Bethlem’s controlling body, the Corporation of London. Many were Aldermen, former mayors or senior members of the various mercantile guilds and livery companies that operated within the City of London (these were associations that would license and control various crafts and trades). As time progressed, this narrow pool broadened to include MPs, members of the landed gentry and well-to-do professionals such as doctors, lawyers and artists. (Both the writer Jonathan Swift and the artist William Hogarth, who is responsible for the most famous graphical depiction of the hospital as part of his ‘Rake’s Progress’ series, were Bridewell and Bethlem Governors.) Being a Bridewell and Bethlem Governor was something out of the ordinary and the position brought with it a certain degree of influence, especially among the political and mercantile classes.

Even though the Court of Governors was drawn largely from the City of London’s governing body, it frequently proved itself to be independently minded; it often resisted the bullying tactics used by the Court of Aldermen and, more rarely, the King’s Privy Council. However, the tripartite split of power between the City, Crown and Governors was unsatisfactory and led to occasional but serious conflicts of interest, especially when it came to the question as to who had the right to admit lunatic patients into Bethlem.

The importance of Bethlem as a political prize was entirely related to it being the only dedicated mental hospital in England, yet its buildings, which were all located on the original 1247 site, could only hold around forty inmates. In comparison to the population of London, which was around 250,000 in 1600, this appears to be a startling under-provision of mental health care, but there were times when fewer than half of these cells were occupied.5

This is not to imply that there was a lack of potential mental health patients in the London area – far from it. Every residential street had people who were labelled as being ‘distracted’, ‘idiotic’, ‘mad’ or ‘lunatic’, but instead of institutionalising them it was traditional for families to treat their insane relations within the community. In practice this meant that those who were considered to be simple, insane or melancholic would be cared for using the family home. Even violent and irrational lunatics were kept within the home, but they were often manacled to prevent them causing trouble in neighbourhoods at large although some were allowed to run free. Around 1628 one doctor records treating one Goodwife Jackson, a woman who had spent twelve years running barefoot up and down the streets with her dress torn and her hair wildly loose; periodically she would ‘lye down and pull up her cloaths to everyone’, causing much disgust locally. Miss Jackson was only put forward for treatment after she became obsessed with a local man who was himself placed in prison, causing the madwoman to lash out at people in frustration and to destroy private and public property. Jackson was allowed to behave like this for eighteen months before a doctor was called in to help restore her mental faculties. Such treatment within the community was the norm and it was left to Jackson’s family to ensure that she was kept under control whether by restraint or medicine.6

Those who had no family to care for them often ended up as ‘vagrant lunatics’, a class of homeless people with mental health issues whose only means of support came from begging. In Shakespeare’s day vagrant lunatics were referred to as Tom O’Bedlams in the mistaken belief that they had once been inmates at the hospital. Much pity was shown towards the Tom O’Bedlams, most of whom were considered to be harmless or even entertaining. In time this class of ragged wanderers played up to their stereotype and developed a sort of costume that immediately set them apart from other beggars.

‘The Tom O’Bedlam’, wrote Randle Holme in the 1680s, ‘has a long staff and a cow or ox horn by his side. His cloathing [is] fantastic and ridiculous for, being a madman, he is madly decked and dressed all over in ribbons, feathers, cuttings of cloth and what not, to make him seem a mad man or one distracted.’

Dressed in this manner the Tom O’Bedlam would go from door to door begging money, food or drink (the latter being placed in the cow horn). Another account tells of how, on being cast from Bethlem Hospital, a Tom O’Bedlam would have an iron ring fastened round his arm, which he could not remove and was a symbol of his madness. In fact, most Tom O’Bedlams had been nowhere near a doctor, let alone a hospital, but they inspired affection and sympathy from many people and feature in a number of plays and poems, including Shakespeare’s King Lear. Their bizarre dress and mannerisms would occasionally be adopted by ‘Abram men’, who were sane beggars looking for a better source of income. 7

This reliance on domestic care and public charity lessened the need for specialist mental facilities and, as a consequence, only the severest cases would be considered for Bethlem Hospital, and even then admission was by no means guaranteed. The Governors’ strict policy held that they would admit to Bethlem only those people who were ‘raving and furious, and capable of cure, or if not, yet are likely to do mischief to themselves or others, and are poor, and cannot otherwise be provided for.’ Those who were adjudged to be ‘melancholic or idiots and judged not capable of cure’ were routinely turned away. However, although the Governors professed only to be interested in severe (but ultimately curable) charitable cases, there was more than one means by which a patient could be admitted to the hospital, and this is where trouble frequently arose between Bethlem’s three controlling bodies.8

The majority of Bedlam’s inmates were pauper lunatics whose behaviour had caused their parish authorities or, more rarely, a local magistrate to recommend them to the hospital. Once a week a meeting would be held during which the cases of potential new admissions would be presented to one of Bethlem’s senior officers and any attending Governors. If an individual was deemed to be sufficiently mad, but also potentially curable, a warrant would be issued and the person admitted. However, those who sponsored the patient (usually their relations or their local parish) had to agree to provide a sum of money for their bedding, food and upkeep and also agree to remove the person should they be cured or diagnosed as an ‘incurable lunatic’.

It was by this means that Bethlem received the majority of its inmates, but the hospital’s other political overseers, the Court of Aldermen, also had the power to admit patients, a privilege that was sometimes subject to abuse. It was, for example, not uncommon to find an Alderman trying to get his wife admitted as a lunatic so that he could conduct an affair with a lover or spend her inheritance. Periodic censuses frequently brought such unfortunate patients to light and saw them quickly released back onto the streets. Stories of false imprisonment in Bedlam were exploited and enhanced by playwrights and led to a widespread fear of being unjustly locked up in the hospital; it seems, however, that very few sane people ended up as patients.

Those falsely admitted were often released by the Governors, who had the power to overrule admissions made via the Aldermen. Unfortunately the same was not true for those patients sent to the hospital via the King’s Privy Council, the body that advised the monarch and retained a role in Bethlem’s management. Being unable to veto the Privy Council, the Governors were occasionally forced to watch as apparently sane people were admitted to Bedlam as lunatics on the grounds that they were vocal opponents of the monarchy. One such victim of the Privy Council’s displeasure was Richard Stafford, a zealous Jacobite who became one the first Bedlam patients to develop a celebrity status.

Stafford had been a young London lawyer when, in 1689, he witnessed the removal of the pro-Catholic James II from the British throne in favour of his Protestant daughter Mary. As an ardent Jacobite, Stafford reacted to this so-called ‘Glorious Revolution’ by publishing various short pamphlets that attacked Queen Mary and the House of Commons. This behaviour twice led to Stafford’s arrest and, finally, to his forced removal from London to Gloucestershire, but this did nothing to dampen his enthusiasm. In the autumn of 1691 Stafford was caught handing out defamatory leaflets outside the Queen’s Court in Kensington. He found himself in custody again but this time his enemies were determined to take him off the streets once and for all. On the evidence available, obtaining a lengthy gaol sentence for the Jacobite would have been problematic, so the Privy Council instead looked towards its power of admission to Bethlem Hospital.

In his published pamphlets Stafford frequently claimed that his Jacobite sympathies were not so much his own viewpoint but in fact belonged to the spirit of God who had chosen to speak to the world through him. ‘I speak nothing of myself,’ wrote Stafford, ‘but from His [ie God’s] Word only.’ On the strength of this apparent claim to be a prophet, the Privy Council were able to declare Stafford a madman even though he showed few other diagnostic signs of insanity. Despite protests from Stafford, the Privy Council despatched him to Bethlem on a warrant that declared him to be ‘distracted’, a contemporary description for someone considered to be ‘utterly mad’. For good measure they also noted that Stafford had proved ‘very troublesome to their Majesties at Kensington by dispersing books and pamphlets full of Enthusiasm and Sedition’.

The warrant sealed Stafford’s fate and ensured that he would remain in Bethlem until shortly before his death, aged just forty, in 1703. This is not to say that Stafford’s views were tempered by his imprisonment; in fact they became more vociferous and, because he was considered mad, he was free to express them to whoever chose to listen. As an eloquent and opinionated man, Stafford became one of Bethlem’s star attractions and was high on the tourists’ list of ‘must-see’ inmates. It is probable that the nameless polemic who told Ned Ward that Bethlem was the safest place to expound his anti-monarchist views was actually Stafford (see the Prologue). A couple of years before Ward’s visit, the Speaker at the House of Commons had requested that Stafford be denied access to a pen or paper to stop him writing politically charged letters to MPs, but incarceration had done nothing to diminish to his views.9

Blatant abuse of the admissions system caused Bethlem’s Governors to bristle with rage, and throughout the seventeenth century there were infrequent purges that saw those whom they regarded ‘as not to be kept’ discharged back into the community. Even so, many politically contentious cases, which included Stafford, had to remain within Bethlem awaiting ‘his majesty’s pleasure’ which, in most cases, meant spending the rest of their lives as a certified lunatic. Fortunately such patients were always a minority, and even genuinely afflicted inmates usually enjoyed a relatively brief stay with only a very few being incarcerated for a year or more. But it was not just the admissions procedure that led to tension between Bethlem’s three ruling bodies: there was also the matter of its hierarchy of officers and staff and, in particular, who was responsible for making individual staff appointments.10

On joining with Bridewell Hospital, Bethlem acquired not only its Court of Governors but also its three senior officers, namely the same President, Treasurer and Auditor-General. The Corporation of London usually sought to fill these positions from within its own ranks: the role of President, largely ceremonial, would be given to an ex-Lord Mayor, while the Treasurer and Auditor-General, who took care of the accounts and thus formed the real hub of power, were invariably members of the Court of Aldermen. In charge of the paperwork for both institutions was the Clerk, a responsible and well-paid job that required secretarial ability and long hours. The need for such skills meant that the post of Clerk was less subject to patronage and could be filled by outsiders; on falling vacant, the post would attract dozens of applications from people in all stations of life.

Below the level of Clerk, Bridewell and Bethlem had separate officers and staff who were charged with the day-to-day running of each institution. These positions were also subject to political wrangling, none more so than the Keeper, Bethlem’s most senior residential officer, who, following the merger with Bridewell, reported directly to the Clerk and the Court of Governors but whose sphere of influence did not extend beyond the hospital’s walls.

The Keeper was the man in charge of managing the hospital’s staff and ensuring that all ran smoothly with regard to cleanliness, food provision, maintenance, patient care, etc. He had no control over Bethlem’s budget (that was the task of the Treasurer) but did have the right to raise money by renting out certain properties of Bethlem’s and by charging the patients (or, more usually, their relations or parish of origin) for linen, bedding, food, medicines and other services. As with many aspects of Bethlem’s management, the boundaries between the responsibility of the Keeper, Governors and Treasurer were blurred. Some Keepers took advantage of this confusion by pocketing the money they collected and by appointing their friends and relations as members of staff. Perhaps most surprising of all was that the Keeper did not need to offer any form of routine medical care to his inmates, even though they were incarcerated within a building that described itself as a hospital. This is not to say that there was no medical care at all: if someone was deemed to be seriously ill or injured, a doctor would be brought in to deal with them, but for those who were judged to be in good health there was little or no treatment. Although Bethlem advertised itself to its benefactors as a place where the insane could be cured, those inside the system were offered few practical therapies that could coax them back to sanity. It was at this point that Bethlem’s generally well-organised hierarchy fell apart, for while there were rules and conventions dictating most aspects of the hospital’s management, there was no policy concerning the medical treatment of the inmates. Indeed, if the glimpsed descriptions we have of the hospital’s patients are generally indicative, then some people would have been lucky to come out in one piece, let alone cured.11

2

Crooke’s Revolution

As far back as 1403 Bethlem had a reputation for offering treatment that was deemed to be ‘wretched indeed’. An inventory from that year shows that there were six lunatics in residence (plus three sane patients) and that the hospital also owned six sets of chains and locks. This coincidence of numbers has led to the assumption that Bethlem’s medieval inmates were routinely chained up, a theory that is supported by the hospital also owning four sets of manacles and two pairs of stocks. Reports from this time forwards make scattered references to patients having been routinely restrained with chains and of their being regularly beaten. There is, for example, a reference to a sixteenth-century patient whose ‘leg is so ulcerated that it is thought it must be cut off’, and another who complained that ‘her foote was rotten’. It is little wonder that Londoners lived in dread at the prospect of being sent to Bedlam.12

The need for a more formalised system of health care did not go unnoticed, but the infighting between Bethlem’s Governors, the Aldermen and the Crown led to an impasse on the issue. At the heart of the problem was the refusal of successive Keepers to take an interest in the idea of employing a permanent visiting physician or doctor, perhaps because of the expense this would incur, or because it would erode some of the Keeper’s sphere of influence at the hospital. This problem was compounded by a near permanent battle between the Governors and the Court of Aldermen over who had the right to appoint the Keeper. The Aldermen saw the post as a political prize and would routinely offer it to merchants and tradesmen associated with the Corporation of London. Most of their appointees were drapers, cloth-workers or grocers with little or no relevant experience for the job. Richard Minnes, who was appointed Keeper in 1561, got the job for having been the Mayor’s porter. The Governors repeatedly tried to exert their own influence over the post, including at least one attempt to get a sitting Keeper sacked, but to little avail. It took a rather strange turn of events to effect a change in this status quo.

The man responsible for creating a minor revolution within Bethlem was Helkiah Crooke, an unusual and controversial character who had been a continual source of irritation and embarrassment to London’s medical community. Crooke was born in 1576 to a middling Suffolk family whose relative poverty meant that he had to enter Cambridge University as a pauper student on a scholarship. It is conceivable that Crooke’s embarrassment at his humble origins may account for some of his later behaviour, especially his obsession with money. Following seven years of study, Crooke emerged with an MD in 1604 and began to practise medicine in London, where he was regarded with caution by many.

In 1610 Crooke’s application to the Royal College of Physicians was rejected when, during his entry interview, he accused a colleague of malpractice. It seems that even at this early stage Crooke had a reputation for rudeness, bullying and slander. ‘After actions at law’, recorded the Royal College in its files, ‘and other charges against him, and not a few charges of unwarranted interference, [Crooke] was advised to behave himself and have more regard for authority.’ It was to be another two years before the College of Physicians begrudgingly accepted Crooke’s application, but his behaviour did not moderate. The College authorities received many complaints from Crooke’s patients and were embarrassed at the number of law suits enacted against him, but, perhaps most irritating of all, he was continually in arrears with his fees despite running an apparently prosperous business.13

Crooke’s reputation as a trouble-maker was sealed in 1615 following the publication of Microcosmographia, an illustrated collection of mostly European anatomical papers that he had translated from Latin into English. The book was much needed and sold well, but many surgeons felt that Crooke, being a physician, had no place writing about anatomy and, furthermore, that by writing in English he was popularising a topic that had hitherto been the preserve of an academic elite. There was further outrage from both academics and the Church when it was discovered that Microcosmographia included images depicting the human reproductive organs in all their glory. Crooke was threatened with damnation unless he withdrew the offending images, and the President of the College of Physicians even promised to burn every copy he could find, but the author was unapologetic and the work went through many editions both during his life and afterwards, helping to raise his profile. At some point during this turbulent career Crooke had become acquainted with the Royal Court of King James I, although probably not as one of the monarch’s personal physicians, as is claimed in Microcosmographia. This connection was to prove invaluable to Crooke during his next battle, which, in 1618, was launched against Thomas Jenner, the then Keeper of Bethlem Hospital.

What inspired Crooke to attack Jenner remains unknown; it may have been a genuine concern over conditions at Bethlem but, given his track record, it seems more likely that he had spotted an opportunity to further his own ambition. Jenner was accused by Crooke of being unfit for the job because he held no medical qualifications (although no previous Keepers had either) and because of alleged ‘irregularities’ committed while in office. Perhaps through his court connections, Crooke was able to get a Royal Commission into Jenner’s behaviour, which concluded that the position of Keeper should be handed to Helkiah Crooke who was a ‘faithful and skilful man’.

The King was in overall charge at Bethlem, so, in April 1619, the Court of Governors voted for Crooke to become Bethlem’s new Keeper. He was the first person in the post to hold a medical qualification, although, as one biographer noted, Crooke was ‘sadly lacking in certain other desirable qualifications’. The Governors were aware that they were employing somebody who possessed many flaws: Crooke was made to swear that he would be subservient to the Governors’ will and that he would hand over any donations, bequests and other charitable money directly to them.

Crooke’s time as Keeper was predictably controversial and within months the new Keeper was being investigated over a number of financial irregularities as well as an accusation of impropriety against a female patient. The Court of Aldermen, and even the Lord Mayor, were kept busy by continual complaints made both by Crooke and by the Governors. This state of tension continued for some years until, in 1628, Crooke began to campaign for Bethlem to be given financial independence from Bridewell. Following a threat by Crooke to petition Parliament on the matter, it was agreed that from 1630 onwards the two hospitals would keep separate accounts, a move that led him to demand increased funding for his pauper patients.

In February 1631 a committee of Bridewell Governors made an inspection of Bethlem, possibly at the insistence of Crooke who was keen to drive home his message that the hospital was seriously underfunded. Among other things, the Governors discovered that the hospital was operating with almost no food in its kitchens, a situation that was causing starvation amongst those pauper inmates who could not afford to buy in supplies from outside. As Crooke had hoped, the inspection achieved an increase in funding, but the slovenly conditions drew the attention of the Privy Council who, after some years of inactivity, decided that it was time for the King to step in and settle the acrimonious dispute between the Aldermen, Governors and Crooke.

The Privy Council ordered an increase in the allowances given to the pauper lunatics and demanded that the King be provided with copies of all the accounts relating to Bethlem since 1547. For a short while matters looked to be moving in Crooke’s favour, especially when the Privy Council requested additional financial details from the Court of Aldermen, but the Keeper may have overestimated his influence within the Royal Court. Crooke had been a favourite of King James I but his successor, Charles I, was a very different monarch and did not much like the look of the way in which Bedlam was being run.

In 1632 the King announced that there would be a Royal Commission into Bethlem Hospital, which would include the various accusations and complaints that had been lodged by and about its Keeper. The findings were damning and highlighted some very odd bookkeeping practices, which suggested that Crooke had been creaming money from the accounts for himself. These were not small sums; it was estimated that the Keeper had been reaping annually roughly twice the amount it would have cost to fund the entire hospital in the days when his predecessor Thomas Jenner had held the post. In October 1632 a further Royal Commission was established, which uncovered evidence that the errant Keeper had been falsifying accounts and stealing charitable donations (including selling gifts made specifically for the upkeep of pauper lunatics), and had at one time or another managed to break every single one of the hospital’s rules.

The effect was visible for all to see. According to the Royal Commission, Crooke’s financial allowance was ‘double to that which other hospitals have, yet the poor are in none of them so ill ordered and provided for, as in this: and that he doth nothing at all towards their cure … how fit the said Doctor may be held to be further trusted with the government of the said Hospital, and how worthy to carry away the greatest part of the renew thereof besides what he otherwise exacteth, We most humbly submit to your Lordship’s grave wisdom and judgement.’14

Although Bethlem was receiving sizeable sums of money, conditions inside were filthy with little in the way of food, medical help or basic comforts for the majority of inmates. It was a situation that could not be allowed to continue and, on 24 May 1633, Crooke was dismissed from his post.

Crooke’s fourteen-year stint at Bethlem left the hospital in a worse state than he had found it, yet the self-serving and embezzling Keeper inadvertently managed to bring about some changes that would in time be of great benefit. Immediately following his dismissal his joint role as Keeper and Physician was separated, ensuring that, following centuries of ad hoc medical care, Bethlem would for ever afterwards have a non-residential Physician on the staff who would (in theory) make regular visits and attend to the inmates’ needs. Shortly afterwards the medical staff was enlarged to include a non-residential Surgeon (to tend to physical afflictions and wounds) and a residential Apothecary (to prepare and dispense drugs). Having a team of dedicated medical officers can be attributed to Crooke’s time as Keeper and it appears that Crooke may also have been the first person to employ a Steward and a Matron at Bethlem. This created a whole new hierarchy of staff at the hospital whose job it was to look after the building and its patients. From Crooke’s time onwards these were the ordinary workers who kept the hospital running on a daily basis and who acted as a bridge between the patients and the Governors.

The Steward was in general charge of routine administration and acted like a clerk, dealing with the paperwork, accounts, finances, admissions and discharges as well as staff management. Below the Steward came the Porter, another administrative post that included more hands-on duties such as keeping tabs on food stocks and the coming and going of staff and visitors. The Matron was usually the Porter’s wife and the person who was in charge of the domestic staff (cooks, cleaners, laundresses, etc) and also oversaw the female patients, ensuring that they were not taken advantage of by the staff or other inmates. Right at the bottom of the pile were the ‘basketmen’, a term coined in Crooke’s time, and maidservants, whose role was to do all the manual work such as the cooking and serving of food, cleaning the cells and washing clothes and patients, as well as helping move patients about or, on occasion, restraining them.

As well as reorganising the staff, Crooke’s other legacy to Bethlem came as a consequence of the amount of strife he had caused the City of London authorities. The Court of Aldermen had endured fourteen years of Crooke’s complaints and accusations and, perhaps prompted by the Privy Council, they agreed to relinquish their right to the appointment of Bethlem’s Keeper and to control its finances. These responsibilities were instead handed to the Bridewell Governors, giving them effective control of the hospital’s management, something that they had been requesting for decades. This was a significant step down the road to making Bethlem an independent institution.

Crooke did not accept his sacking with grace and for years afterwards complained of being unfairly dismissed and, of all things, being owed money by the Governors. With his reputation in tatters, the Royal College of Physicians paid Crooke £5 on condition that he renounced his Fellowship; he did so and afterwards withdrew from the medical trade, to the relief of many. He died in 1648 and was buried in Clerkenwell, London.15

The turbulence of Crooke’s reign saw Bethlem start to break away from its post-medieval roots, but the hospital was about to face a new challenge: after centuries as England’s only mental asylum, it was to find itself in competition with a new generation of commercial, often brutal, asylums.

3

The New Bedlam

During the mid-seventeenth century the flow of London society was disrupted by the English Civil War and afterwards by the uncertainty created by Oliver Cromwell’s Commonwealth era. By the time King Charles II was restored to the throne in 1660 the land over which he was to preside had undergone many changes. Great leaps had been made in the fields of commerce, law, science and technology, the effects of which were to drag English society inexorably away from the religion-dominated philosophy of the post-medieval era and towards what would afterwards be termed the ages of Reason and Enlightenment.

Nowhere were these changes more keenly felt than in London, a city that had suffered much during the Civil War but which had recovered to grow physically and economically, albeit with the occasional blip. In the decade following the Restoration of King Charles II, London was ravaged first by the Plague of 1665 and, a year later, by the Great Fire, which by some miracle did not touch Bethlem but did severely damage nearby Bridewell Hospital. In the years following the Fire, England’s population began to grow rapidly, but London was expanding faster still. The City had found wealth through England’s foreign colonies, which in turn attracted country folk who came to town in search of jobs and adventure. The influx of cash caused a property boom that saw residential London expand far beyond the City walls along the Thames into Westminster. Here there was space enough to construct the large houses and roads desired by the nouveau riche traders and brokers. The result was to create a second urban centre, the so-called ‘West End’, which was frequented by London’s new tier of wealthy elite and their servants. However, this new-found wealth and social mobility came at a price.

The expansion of London brought with it a slow dissolution of the community spirit that had hitherto pervaded its parishes and boroughs. As work patterns, job titles and the availability of accommodation changed, so did the dynamics of family life. Work hours increased, as did the distance people had to travel to work, while, conversely, pressure of space led to the indiscriminate building of low-cost housing, which swallowed up what were once discrete villages into the urban sprawl of Greater London.

A noticeable effect from all this change was a breakdown in the cohesiveness of family life. A lack of housing space, pressure of work and an increased cost of living meant that many families became unable, or were unwilling, to play host to their lunatic and melancholic relations. This intolerance of lunatics was reflected in the wider community where concerns about beggars and vagabonds led to a succession of poor laws and settlement acts designed to curtail the activities of vagrants. These laws affected the Tom O’Bedlams, the colourful lunatic vagrants that had been a common sight in Shakespearean England. Many Tom O’Bedlams were rounded up by magistrates and either moved on or placed in correctional facilities or workhouses: by around 1660 the Tom O’Bedlams had entirely disappeared from the English landscape.16

This change in society’s attitude towards the insane was mirrored by the medical profession, whose view of the treatment of madness had also shifted. Instead of recommending community-based care, many doctors advised institutionalising insane patients. This attitude is highlighted by the esteemed physician and anatomist Thomas Willis who, in around 1669, recommended that the insane be not only locked up but also brutalised back to good health. The cure of madness, wrote Willis:

…requires threatenings, bonds, or strokes as well as physic [i.e. medication]. For the madmen being placed in [a] house convenient for the business, must be handled both by the physician, and also by the servants that are prudent, that he may in some manner be kept in, either by warnings, chidings, or punishments inflicted on him, to his duty, or his behaviour, or manners. And indeed for the curing of mad people, there is nothing more effectual or necessary than their reverence or standing in awe of such as they think their tormentors. For by this means, the corporeal soul being in some measure depressed and restrained, is compell’d to remit its pride and fierceness; and so afterwards by degrees grow more mild, and return in order; wherefore, furious madmen are sooner, and certainly cured by punishment and hard usage, in a strait room, than by physick or medicines.17

Willis’s belief that the mad should be thrashed back to health was even then controversial, but his view that the insane were better off inside purposeful establishments was a generally held idea. Consequently, there quickly arose the need for institutions that could house and take care of society’s ‘mad folks’, many of whom had been abandoned to their fate by their families. Bethlem remained the only charitable mental hospital in England, but it could accommodate only a couple of dozen patients and its admission procedure was so strict that it was of little use to most people. It was therefore left to an emerging class of English entrepreneurs to find a market-led solution to the problem of London’s lack of mental health accommodation; thus, from around 1660 onwards, the first ‘private madhouses’ opened their doors to the public.

As their name implies, private madhouses were commercially run mental asylums that would, for a fee, take in those who were considered to be ‘troubled in mind, melancholic, mopish or distracted’. In an age of emerging capitalist principle, the private madhouse was a natural solution to a situation where demand for asylum places was outstripping supply. It was not, however, necessarily the perfect solution; as we shall see later, the unregulated nature of private madhouses led to widespread abuse in both admissions procedures and the general environment within these asylums. Also, not everyone could afford the luxury of housing their mad relations in a private madhouse, and there were many types of lunatic that the private madhouses would not touch, such as those who were prone to violence or who were criminally minded. This left a sizeable number of unwanted lunatics whose home parishes and relations could not find accommodation.

The Governors at Bethlem found themselves swamped with applications for admission, but the hospital was impossibly small and its buildings were falling into disrepair. In January 1674 the matter of Bethlem’s unsuitability was discussed by its Court of Governors. They concluded that ‘the Hospitall House of Bethlem is very old weake and ruinous and too small and straight for keepeing the greater number of Lunatikes as are therein att present and more are often needful to be sent thither.’18

This pronouncement was swiftly followed with an application by the Governors to King Charles II (who remained Bethlem’s ultimate authority), which requested his approval for a new and much larger hospital to be built somewhere within the City of London. At the same time the President of the Governors, Sir William Turner, approached the eminent architect and scientist Robert Hooke, who, together with Sir Christopher Wren, had been responsible for reconstructing large parts of London following the Great Fire of 1666. Hooke and Turner were already well known to each other and had helped rebuild the fire-damaged Bridewell Hospital. Hooke was pleased to be approached about the Bethlem project and, after discussing the matter further with Turner, agreed to work on it.

By the time of Hooke’s appointment the Governors had already decided that the Bishopsgate site, on which Bethlem had stood since 1247, was unsuitable for their planned new building. At just over an acre, the plot was too small to house a sizeable hospital and its location, at the end of a narrow lane behind several blocks of residential housing, too inconvenient. Both Hooke and the Governors had ambitious plans for the new hospital that required a large plot of land in a highly visible part of London. Their scouts had identified a plot of several acres in the fashionable district of Moorfields, which had the advantage of being sizeable, accessible and yet also entirely within the confines of the City of London. Moorfields was at this time relatively undeveloped, and retained large tracts of open ground to the north of the proposed Bethlem site. This would give the Bedlamites a commanding view of London and, conversely, give Londoners a commanding view of the new hospital.

Hooke started work on planning a building to fit the rectangular dimensions of the plot and, in July 1674, he presented the Governors with two different designs. Both were for a ‘New House for Lunatikes intended to be erected betweene Moorgate and the Posterne next London Wall where there will be ground enough for One Hundred and Twenty Roomes for the Lunatikes and Officers being about Fower Hundred and Twenty foote long.’19 Within weeks the Governors had agreed on which design to use and had provided a draft budget of around £17,000. With the finances in place and the necessary permission having been obtained, work on the new hospital began in April 1675.20