Bedlam Hospital

“ Crossing over to the opposite thoroughfare of Lambeth Road, the Rambler will find, at a short distance on the left, the entrance to Bethlehem Hospital, familiarly known as Bedlam. A reference to this asylum will be found in the pages of “The Uncommercial Traveller,” where our author implies the idea that the sane and insane are, at all events, equal in their dreams—
“Are not all of us outside this Hospital, who dream more or less, in the condition of those inside it, every night of our lives?” ”

“ Some of the developments of their care for the [Pg 201] insane in the Middle Ages are very interesting. Before this period closed, there was a custom established at Bedlam by which those who had been insane but had become much better were allowed to leave the institution. This was true, even though apparently there might be no friends to care for them particularly, or to guarantee their conduct or their return, in case of redevelopment of their symptoms. This amounted practically to the open-door system. The authorities of the hospital, however, made one requirement. ”

“ It is painful to add that this long-continued punishment had the recorded approbation of all the authorities of the hospital. Nothing can more forcibly illustrate the hardening effect of being habitual witnesses of cruelty, and the process which the heart of man undergoes when allowed to exercise irresponsible power.”
The medical men were poorly paid and proportionately neglectful. At the time of which we are speaking—the end of the eighteenth and the beginning of the nineteenth century—the physician at Bedlam got only £100 a year. ”

“ With the exception of one such asylum in Granada, Spain, the Bethlehem Hospital was the first in Europe. It became famous and afterwards infamous for the brutal ill-treatment meted out to the insane (see Insanity: Hospital Treatment) . In 1675 it was removed to new buildings in Moorfields and finally to its present site in St George’s Fields, Lambeth. The word “Bedlam” has long been used generically for all lunatic asylums. ”

“ Many other dialogues with the inmates of Bedlam are given, but they are evidently embellished, or altogether fictitious; true as I believe the description of the building and the uproar within to be.
Mr. Harvey, from his recollections of the hospital in Moorfields, in the early part of this century, thus writes in 1863: "When I remember Moorfields first, it was a large, open quadrangular space, shut in by the Pavement to the west, the hospital and its outbuildings to the south, and lines of shops with fronts, occupied chiefly by dealers in old furniture, to the east and north. ”

“ Crace Collection, 26/1.
3. On a scroll, "Hospitium mente captorum Londinense." New Bedlam in Moorefields. Soly fec. Sold by H. Overton, cir. 1730. 223⁄4 in. by 161⁄2 in. Gardner Collection; British Museum.
4. Painting of Bethlem Hospital (fresco) in one of the rooms of the Foundling Hospital, by Haytley. 1746.
5. The Hospital of Bethlem (L'Hospital de Fou) . A view showing also Moorgate. J. Maurer del.; T. Bowles sculp. 1747. 16 in. by 101⁄2 in. Gardner Collection; Crace Collection, 26/6; Guildhall Library.
6. Hospital of Bedlam. ”

“ Thomas' Hospitals, now in process of construction at the Surrey Side of the Thames, in Lambeth, opposite the Houses of Parliament, will combine a number of hospitals for Special Diseases, and will accommodate about 2,000 patients, with as many beds, and will have an income of £50,000 a year, or more.
It is impossible to think of any disease, complaint, deformity, or injury to any member or organ of the body, which has not its special hospital or institution for relief or cure, in the English metropolis. ”

“ It was believed that the one chance for an insane patient to recover lay in trusting him somewhat, allowing him even to go unattended outside the walls at times. Patients in Bedlam were permitted to go out alone after they improved in health, and if they were poor they were allowed to obtain their living by means of begging. ”

“ Such disadvantages might be entirely removed if parliament would decide to throw open every poor-law infirmary for clinical purposes, and to have connected with each such establishment a responsible visiting medical staff, consisting of the best qualified men to be found in the community which each hospital serves. The old prejudice against hospital treatment has disappeared, for the least intelligent members of the population now understand that, when a citizen is sick, there is no place so good as the wards of a well-administered hospital. ”

“ If the case be a common one, you get so much familiarity with a phenomenon that it will be continually presenting itself. If a rare one, you have seen what you may seldom see again. There is every reason for taking the practice of the hospital exactly as you find it. It represents the diseases of the largest class of mankind—the poor; and, although in some of the details there may be a difference, upon the whole the forms of disease that are the commonest in hospitals are the commonest in the world at large ”

“ And that the same is a false pretence to colour their wandering and begging, and to deceive the people, to the dishonour of the government of that Hospital." [74]
I will now pass on to the close of the chapter of this the first Bethlem Hospital, with the remark in passing that Charles I. confirmed the charter of Henry VIII. in [67] 1638, [75] and will direct attention to the year 1674, when the old premises having become totally unfit for the care—to say nothing of the treatment—of the inmates, it was decided to build another hospital. ”

“ The current system of large hospitals is abandoned, as being equivalent to 'warehousing diseases on the largest possible scale;' while special hospitals are deemed unnecessary—'as if the different organs could walk out of the body and present themselves for separate treatment.' Each hospital has an ambulance ready to be sent out to bring any injured persons to the institution; the ambulance drives straight into the hospital, where a bed of the same height on silent wheels receives the patient, and conveys him or her to a ward. ”

“ Our hospitals in London are always crowded, the waiting-lists mount up till it seems hopeless to attack them, and all the time it is because we have no base hospital down in the country to which our patients might be sent to recover. I wonder how long it will be before each of the great London hospitals has its own base down in the country, with its own motor ambulances and its own ambulance coaches to carry its patients in comfort by rail to surroundings where they could recover as can never be possible in the middle of the London slums? ”

“ The Bloomingdale Asylum for the Insane, is a branch of the New York Hospital. It is situated on One-hundred-and-seventeenth street, between Tenth and Eleventh avenues. It is one of the most complete establishments in the world, and is admirably conducted.
Bellevue Hospital, on the East River, at the foot of Twenty-sixth street, is one of the largest in the city. It will accommodate 1200 patients, and is conducted by the Commissioners of Charities and Corrections. There is no charge for treatment and attendance, everything being free. ”

“ When a patient is cured, he is called before a Committee of the Governors and Physicians, who examine him, and being found fit to be discharged, the Physician gives a certificate to that purpose, and then the steward of the house takes care to have him delivered to his friends.
The hospitals of Bethlem and Bridewell being made one corporation, they have the same President, Treasurer, Governors, Clerk, Physician, Surgeon, and Apothecary; yet each hospital has its proper steward and inferior officers, and a particular committee is chosen out of the Governors for each. ”

“ It is a curious reflection that whilst in the present war the base hospital has been given, if anything, an undue importance, in the other war it has been practically neglected. Our great hospitals are almost entirely field hospitals, planted right in the middle of the battle, and there we keep our patients till such time as they are to all intents and purposes cured. A very few convalescent homes will admit cases which still require treatment, but only a very few. ”

“ They were very amused to find that “the doctor” they had been expecting was a woman!
‘Our main hospital was at Medgidia, and our field hospital at Bulbulmic, only about seven miles from the front. They gave us a very nice building, a barrack, at Medgidia for the hospital, and the personnel were in tents on the opposite hill. We arrived on the day of the offensive, and were ready for patients within forty-eight hours. We were there less than three weeks, and during that time we unpacked the equipment and repacked it. We made really a rather nice hospital at Medgidia, and the field hospital. ”

“ Complaints, too, have frequently been made of the alleged extravagance of the administration and of the architectural embellishment of Paris hospitals, to the detriment of the patients upon whom in a direct manner the funds should, it was held, have been spent. Another defect which has been much commented upon is the inability of the surgeons to assign beds, on their own authority, to sick applicants whom they have pronounced to be in need of clinical treatment. Every morning, it should be explained, gratuitous advice is given at each hospital. ”

“ Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, dreaded the very name of hospital, and the most skilful surgeons distrusted their own craft. New hospitals or new wards were built, yet after a very short time the new became as pestiferous as the old; and even scrupulous care in ventilation and housemaids’ cleanliness failed to prevent the devastation. Surgery had enlarged its freedom, but only to find the weight of its new responsibilities more than it could bear. ”

“ Another problem is the question of creating, in connection with General hospitals, wards where patients of this sort may receive at the beginning of their treatment, their preliminary examination, where they may be evacuated home with compensation or without compensation, or evacuated to a prolonged treatment hospital for further care.
It has sometimes been difficult to get enough men, trained personnel, to man these wards. ”

“ If they were in a strait waistcoat they could not assist themselves the least in the world." When, in the following year, the head-keeper of Bethlem Hospital was asked, "Was it not the practice in old Bethlem—not in the late gallery, but in the gallery pulled down—for eight, ten, or more patients to be fastened to the tables, almost in a state of perfect nakedness?" ”

“ Pending such a discovery the experience of the cancer department connected with the Middlesex Hospital in London proves to demonstration that the provision of adequate and special accommodation for the exclusive treatment of cases of cancer is not only desirable but necessary on humanitarian grounds alone. ”

“ Most people assume that the older generations did not know how to build good hospitals. They did as well as they could, but until the development of modern knowledge of hygiene and sanitation, as well as the demand made on hospital administration by modern surgery, hospitals could scarcely be expected to be anything but the sordid piles of buildings they usually were, thought proper if they but furnished a protection from the weather and sustenance for the sick poor. ”

“ What an Augean stable for a weak woman to cleanse! Then again nothing annoys the public more than to open the doors of its whited sepulchres. Of course, it was no use to condemn the present system without putting something better in its place. The workhouse infirmary was far better in one sense; there, the object was to help the patient to get well as speedily as possible, and take himself off the books; but there attaches a stigma to the infirmary from which the hospital is free, yet the hospital must be reformed on the model, in some respects, of the infirmaries. ”

“ Before the move was made to Spearman's Farm the Hospital was enlarged, and the staff was increased by the addition of eight civil surgeons. It is sad to report that of these two died in the camp and others were invalided. No men could have worked better together than did the army surgeons and their civilian colleagues.
The greatest capacity of the Hospital was reached after the battle of Spion Kop, when we had in our tents about 800 wounded.
Some account of the nurses who accompanied the Hospital is given in a section which follows. ”

“ The glorious halls and corridors, the massive marble pillars, the splendid marble staircases, indicate wealth, but the perfection of the sanitary and scientific arrangements tells of long years of anxious thought and study and research. So perfectly is this marvellous hospital built that, in the event of plague or cholera breaking out to such an extent as to infect the building, the whole of the inside of the hospital can be removed and another hospital will still be left standing as complete as the other. ”

“ During its two years of work for the sick and wounded, no military hospital has succeeded in establishing a finer record. To see it is a wonderful experience. The hospital consists of 17 wards, with 578 beds, and is entirely staffed by women—surgeons, doctors, pathologists, oculists, dental surgeons, anæsthetists, dispensers, nurses, orderlies. The only men are the patients.
Sir Alfred Keogh, the Director-General of the Army Medical Service, said, when speaking of it: “The hospital is in every respect a military hospital, differing in no way from any other military hospital in the country. ”