Bethlem Hospital

   / "Bedlam"

   (from 1247)

   Bethlem hospital was the only asylum in England until the foundation of Norwich asylum in 1724, then St. Luke’s Hospital in London in 1751. It therefore, as Richard Hunter and Ida Macalpine observe, "occupies a unique place in the history of the insane in the British Isles" (Three Hundred Years, p. 306). Founded in 1247 as the Hospital of St. Mary of Bethlem in the Bishopsgate district of London, the hospital served initially as a base for the Crusaders’ sallies into the Holy Land; only over time did it assume the role of hospice for the poor and asylum for the insane. The City of London acquired control over its administration in 1547 and put it under a board of governors; a little more than a century later, in 1676, the hospital opened new quarters in the Moorfields district. By the mid-sixteenth century, it had sufficiently acquired the role of a specialist hospital for the insane that the corruption of its name, "Bedlam," became a generic term for craziness. As recent British historians of psychiatry have pointed out, tales of abuse and neglect at Bethlem have vastly been overdrawn.

   In 1815, the hospital moved again, this time to St. George’s Fields in the district of Southwark, where it remained until its removal in 1930 to Monk’s Orchard in suburban Kent (at which time the Southwark building, minus the dormitory wings, became the Imperial War Museum). In the 1850s, under its first nonresident superintendent, Sir William Charles Hood (in office 1852–1862; life dates 1824–1870), it was transformed from a receptacle for the poor and mad to a mental hospital for private patients. Dating from 1823, when Scottish-born psychiatrist Alexander Morison (1779–1866) began lecturing there, Bethlem played a minor role in training medical students and postgraduate registrars (residents); yet, it was never really integrated into the University of London, and after a big reorganization of graduate education beginning in 1944, Bethlem was excluded from training to the benefit of the Maudsley Hospital. Under the threatened loss of prestige of this downgrade, in 1948 Bethlem and the Maudsley merged, and the hospital’s centuries-long distinctiveness came to an end.

   Some of the signal names in the history of British psychiatry have been associated with the Bethlem, notably the Monro dynasty of "physicians," or medical supervisors, who presided over Bethlem for four generations beginning with James Monro (dates, 1680–1752) in 1728; John Monro (life dates, 1715–1791) was in office in the period 1751–1791 and is remembered for a highly publicized controversy with William Battie; Thomas Monro (life dates, 1759–1833), in office 1787–1816, was dismissed after a scandal involving the longtime chaining of a patient named William Norris (c. 1760–1815); and Edward Thomas Monro (life dates, 1790–1856), in office 1816– 1855, who was the last of the "physicians" and who left under something of a cloud. Among the hospital’s "apothecaries," or medical officers, might be mentioned John Haslam (life dates, 1764–1844), author of Observations on Madness and Melancholy (1809)—the detailed cases of which are among the earliest reported in psychiatry*— who served from 1795 to 1816. (The last of the Monros involved with psychiatry was Henry Monro [1817–1891], who was not associated with Bethlem but rather was an early advocate of biological theories and a physician at St. Luke’s Hospital.)