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General Historical Information
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Bethlem Royal Hospital is the original ‘Bedlam’, one of the world’s oldest hospitals for the treatment of mental illness.

It was founded in 1247 as the priory of St Mary of Bethlehem; the site now covered by Liverpool Street station. By the fourteenth century it was already treating the insane. In 1547 it came under the control of the City of London as one of the five ‘Royal’ hospitals refounded after the Reformation. Medical treatment for insanity was largely ineffective throughout this time, though patients did, in fact, recover. The violent and dangerous were restrained with iron manacles and chains.

In the sixteenth century the hospital came into the possession of the City of London. It was put under a joint administration with Bridewell Hospital which lasted until 1948. Bridewell was chiefly used as a prison, and became a school in the nineteenth century. It is now King Edward’s School at Witley, in Surrey.

By the late seventeenth century, the hospital needed new premises, partly to cater for increased numbers but also because the existing building was ‘very old, weak and ruinous’. In 1676 a magnificent baroque building, designed by Robert Hooke, was opened at Moorfields. On each of the two main floors, huge galleries ran the length of the building, with open work iron grilles across the centre to divide the male and female wings.

These galleries acted as the dayrooms for those who were fit enough to move about. They were also where patients saw their visitors and where sightseers were allowed to view the inmates until indiscriminate visiting was stopped in 1770. Individual cells or bedrooms opened off the gallery. High walled ‘airing courts’ were provided at either end of the building

At the time, Bethlem was the only public institution for those with mental disorders. The alternatives were the private madhouses which flourished up to the eighteenth century. These were not restricted to wealthy patients but often built their business on paupers sent by parish authorities. Throughout most of its history, Bethlem has been an acute hospital for short stay patients. Those who had not recovered at the end of a twelve-month period were generally discharged. From the 1730s however, an incurable wing was added for a small number of those discharged uncured from the main hospital and for whom no alternative existed. Admissions to this department ended in 1919.

bethleminteriorscene1.jpg The hospital moved to its third site in 1815, again due to increased numbers and a crumbling building. The new building was at St George’s Fields, Southwark, part of which still survives as the Imperial War Museum. It followed the same pattern as that of Moorfields but with a central administration block dividing the male and female quarters. The larger number of smaller wards allowed for a better system of classification, so that quieter patients and convalescents could be separated from the more seriously disturbed.

Restraint of patients had been used sparingly at Bethlem in the 1840s and was abandoned in the 1850s. There was more emphasis on the surroundings and opportunities for work and leisure as a means of facilitating recovery. The women, where possible, helped around the house making beds, washing up, cleaning, sewing and working in the laundry.

The men used capstans in the airing courts to pump water and were also employed in knitting, tailoring and mending clothes. The wards began to be much more comfortable, furnished with aviaries of birds, pictures, flowers and books. Recreation and entertainments were provided, as were regular excursions for those well enough to leave the hospital grounds.

At the back of the main building, a new State Criminal Lunatic asylum was housed in two detached wings. It was built and maintained at government expense, the Home Office controlling admissions and discharges, often at odds with hospital advice. Increasingly unpopular with Bethlem’s governors, these wings were always overcrowded and in 1864 replaced by a new institution at Broadmoor in Berkshire.

In 1857, the hospital decided to no longer admit pauper patients who were now provided for in the asylums counties had been obliged to build after 1845. Bethlem remained a charitable hospital but preference in future was to be given to the poor of the middle classes. In 1882 the Charity commissioners permitted, for the first time, the admission of a few paying patients. The numbers increased over time though there was a scale of graduated charges based on the ability to pay and free admission was never wholly abandoned.

Bethlem moved to its present site in 1930. The decision was taken not to replicate the monolithic buildings of Moorfields and St George’s Fields but to design the hospital on the ‘villa system’. Each ward occupied its own building with kitchen, dining room and garden. Other facilities were housed in separate units throughout the 250 acres of grounds.

The Maudsley Hospital in Denmark Hill, London SE5, was opened in 1923 as a London County Council (LCC) hospital devoted to the early treatment of acute mental illness. Henry Maudsley’s stipulation that the hospital should be within 3 to 4 miles of Trafalgar Square caused delay in finding a site, and was not quite met by this location. He lived to see the hospital which bears his name completed and used during the war, but died before it was finally opened for civilian purposes. It was largely built by 1914, but was requisitioned for military use as a Neurological Clearing Hospital during the First World War. It was united with Bethlem Hospital under the new National Health Service (NHS) in 1948.
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With the introduction of the National Health Service in 1948, Bethlem was split from its partner Bridewell and joined with the Maudsley Hospital Camberwell, to form a single postgraduate psychiatric teaching hospital.

In 1999 they were formed into the South London and Maudsley NHS Trust, which provides mental health services throughout Lambeth, Southwark, Lewisham and Croydon as well as specialist services across the UK. The Trust is now the South London and Maudsley NHS Foundation Trust. Its major hospitals are the Bethlem Royal, the Maudsley, Lambeth (Landor Road) and the York Clinic of Guy’s Hospital, the Adamson Centre of St Thomas’s Hospital and the Ladywell Unit of Lewisham Hospital.



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shimArchives and Museum Bethlem Royal Hospital | Monks Orchard Road | Beckenham| Kent BR3 3BX
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