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Bethlem Royal Hospital, also known as St Mary Bethlehem, Bethlehem Hospital and Bedlam, is a psychiatric hospital in Bromley, London. Its famous history has inspired several horror books, films, and television series, most notably Bedlam, a 1946 film with Boris Karloff.
The hospital is part of the South London and Maudsley NHS Foundation Trust. It is closely associated with King's College London and, in partnership with the Institute of Psychiatry, Psychology and Neuroscience, is a major centre for psychiatric research. It is part of the King's Health Partners academic health science centre and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health.
Founded in 1247, the hospital was originally located just outside the city walls, in the Bishopsgate Without area of the City of London. It moved a short distance to Moorfields in 1676, and then to St George's Fields in Southwark in 1815, before moving to its current location in Monks Orchard in 1930.
The word "bedlam", meaning uproar and confusion, is derived from the hospital's nickname. Although it became a modern psychiatric hospital, historically it was representative of the worst excesses of asylums in the era of lunacy reform.
The hospital was founded in 1247 as the Priory of the New Order of our Lady of Bethlehem in the city of London during the reign of Henry III.
It was established by the Bishop-elect of Bethlehem, the Italian Goffredo de Prefetti, following a donation of personal property by the London alderman and former sheriff, Simon FitzMary. The original location was just beyond London's wall, in the parish of St Botolph-without-Bishopsgate, which for civil purposes was coterminous with the Bishopsgate Without area. The hospital was located where the south-east corner of Liverpool Street Station now stands. Bethlem was not initially intended as a hospital, in the clinical sense, much less as a specialist institution for the insane, but as a centre for the collection of alms to support the Crusader Church and to link England to the Holy Land.
De Prefetti's need to generate income for the Crusader Church and restore the financial fortunes of his see had been occasioned by two misfortunes: his bishopric had suffered significant losses following the destructive conquest of Bethlehem by the Khwarazmian Turks in 1244, and his immediate predecessor had further impoverished his cathedral chapter through the alienation of a considerable amount of its property. The priory, obedient to the Church of Bethlehem, also housed the poor and, if they visited, provided hospitality to the bishop, canons, and brothers of Bethlehem. Thus, Bethlem became a hospital, in medieval usage, "an institution supported by charity or taxes for the care of the needy". The subordination of the priory's religious order to the bishops of Bethlehem was further underlined in the foundational charter, which stipulated that the prior, canons, and inmates were to wear a star upon their cloaks and capes to symbolise their obedience to the church of Bethlehem.
During the thirteenth and fourteenth centuries, with its activities underwritten by episcopal and papal indulgences, the hospital's role as a centre for alms collection persisted, but its linkage to the Order of Bethlehem increasingly unravelled, putting its purpose and patronage in doubt. In 1346, the master of Bethlem, a position at that time granted to the most senior of London's Bethlemite brethren, applied to the city authorities seeking protection; thereafter metropolitan office-holders claimed power to oversee the appointment of masters and demanded in return an annual payment of 40 shillings. It is doubtful whether the city really provided substantial protection and much less that the mastership fell within their patronage but, dating from the 1346 petition, it played a role in the management of Bethlem's finances. By this time, the Bethlehemite bishops had relocated to Clamecy, France, under the surety of the Avignon papacy. This was significant as, throughout the reign of Edward III (1327–77), the English monarchy had extended its patronage over ecclesiastical positions through the seizure of priories under the control of non-English religious houses. As a dependent house of the Order of Saint Bethlehem in Clamecy, Bethlem was vulnerable to seizure by the crown and this occurred in the 1370s when Edward III took control. The purpose of this appropriation was, in the context of the Hundred Years' War between France and England, to prevent funds raised by the hospital from enriching the French monarchy via the papal court. After this event the masters of the hospital, semi-autonomous figures in charge of its day-to-day management, were normally crown appointees and it became an increasingly secularised institution. The memory of its foundation became muddied and muddled; in 1381, the royal candidate for the post of master claimed that from its beginnings it had been superintended by an order of knights and he confused its founder, Goffredo de Prefetti, with the Frankish crusader, Godfrey de Bouillon. The removal of the last symbolic link to the Bethlehemites was confirmed in 1403 when it was reported that master and inmates no longer wore the star of Bethlehem.
In 1546, the Lord Mayor of London, Sir John Gresham, petitioned the crown to grant Bethlem to the city. This petition was partially successful and Henry VIII reluctantly ceded to the City of London "the custody, order and governance" of the hospital and of its "occupants and revenues". This charter came into effect in 1547. The crown retained possession of the hospital while its administration fell to the city authorities. Following a brief interval when it was placed under the management of the governors of Christ's Hospital, from 1557 it was administered by the governors of Bridewell, a prototype house of correction at Blackfriars. Having been thus one of the few metropolitan hospitals to have survived the dissolution of the monasteries physically intact, this joint administration continued, not without interference by both the crown and city, until incorporation into the National Health Service in 1948.
A Church of Our Lady that is named Bedlam. And in that place be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man
— William Gregory, Lord Mayor of London, c. 1450
It is unknown when Bethlem, or Bedlam, began to specialise in the care and control of the insane, but it has been frequently asserted that Bethlem was first used for the insane from 1377. This date is derived from the unsubstantiated conjecture of the Reverend Edward Geoffrey O'Donoghue, chaplain to the hospital, who published a monograph on its history in 1914. While it is possible that Bethlem was receiving the insane during the late fourteenth century, the first definitive record of their presence in the hospital is in the details of a visitation of the Charity Commissioners in 1403. This recorded that amongst other patients there were six male inmates who were "mente capti", a Latin term indicating insanity. The report of the visitation also noted the presence of four pairs of manacles, 11 chains, six locks and two pairs of stocks but it is not clear if any or all of these items were for the restraint of the inmates. While mechanical restraint and solitary confinement are likely to have been used for those regarded as dangerous, little else is known of the actual treatment of the insane for much of the medieval period. The presence of a small number of insane patients in 1403 marks Bethlem's gradual transition from a diminutive general hospital into a specialist institution for the confinement of the insane. This process was largely completed by 1460.
From the fourteenth century, Bethlem had been referred to colloquially as "Bedleheem", "Bedleem" or "Bedlam". Initially "Bedlam" was an informal name but from approximately the Jacobean era the word entered everyday speech to signify a state of madness, chaos, and the irrational nature of the world. This development was partly due to Bedlam's staging in several plays of the Jacobean and Caroline periods, including The Honest Whore, Part I (1604); Northward Ho (1607); The Duchess of Malfi (1612); The Pilgrim (c. 1621); and The Changeling (1622). This dramatic interest in Bedlam is also evident in references to it in early seventeenth-century plays such as Epicœne, or The Silent Woman (1609), Bartholomew Fair (1614), and A New Way to Pay Old Debts (c. 1625). The appropriation of Bedlam as a theatrical locale for the depiction of madness probably owes no little debt to the establishment in 1576 in nearby Moorfields of The Curtain and The Theatre, two of the main London playhouses; it may also have been coincident with that other theatricalisation of madness as charitable object, the commencement of public visiting at Bethlem.
The position of master was a sinecure largely regarded by its occupants as means of profiting at the expense of the poor in their charge. The appointment of the masters, later known as keepers, had lain within the patronage of the Crown until 1547. Thereafter the city, through the Court of Aldermen, took control and, as with the king's appointees, the office was used to reward loyal servants and friends. Compared to the masters placed by the monarch, those who gained the position through the city were of much more modest status. In 1561, the Lord Mayor succeeded in having his former porter, Richard Munnes, a draper by trade, appointed to the position. The sole qualification of his successor in 1565, a man by the name of Edward Rest, appears to have been his occupation as a grocer. Rest died in 1571, at which point the keepership passed on to John Mell in 1576, known for his abuse of "the governors, those who gave money to the poor, and the poor themselves." The Bridewell Governors largely interpreted the role of keeper as that of a house manager and this is clearly reflected in the occupations of most appointees as they tended to be inn-keepers, victualers, or brewers, and the like. When patients were sent to Bethlem by the Governors of the Bridewell the keeper was paid from hospital funds. For the remainder, keepers were paid either by the families and friends of inmates or by the parish authorities. It is possible that keepers negotiated their fees for these latter categories of patients.
John Mell's death in 1579 left the keepership open for the long-term keeper Roland Sleford, a London cloth-maker, who left his post in 1598, apparently of his own volition, after a 19-year tenure. Two months later, the Bridewell Governors, who had until then shown little interest in the management of Bethlem beyond the appointment of keepers, conducted an inspection of the hospital and a census of its inhabitants for the first time in over 40 years. Their purpose was "to view and p[er]use the defaultes and want of rep[ar]ac[i]ons". They found that during the period of Sleford's keepership the hospital buildings had fallen into a deplorable condition with the roof caving in and the kitchen sink blocked, and reported that "...it is not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fit for any man to come into the house".
The committee of inspection found 21 inmates with only two having been admitted during the previous 12 months. Of the remainder, at least six had been resident for a minimum of eight years and one inmate had been there for around 25 years. Three were from outside London, six were charitable cases paid for out of the hospital's resources, one was supported by a parochial authority, and the rest were provided for by family, friends, benefactors or, in one instance, out of their own funds. The reason for the Governors' new-found interest in Bethlem is unknown but it may have been connected to the increased scrutiny the hospital was coming under with the passing of poor law legislation in 1598 and to the decision by the Governors to increase hospital revenues by opening it up to general visitors as a spectacle. After this inspection, the Governors initiated some repairs and visited the hospital at more frequent intervals. During one such visit in 1607, they ordered the purchase of clothing and eating vessels for the inmates, presumably indicating the lack of such basic items.
Text from the Wikipedia article “Bethlem Royal Hospital”, available under CC BY-SA 4.0.