Following investigation and subsequent reform in the early half of the nineteenth century (1815 and 1852), Bethlem Hospital increasingly became a very domestic environment, as pictured in the Illustrated London News in 1860. The accompanying article attributed the changes in the Hospital entirely to Bethlem’s new “skilful and benevolent” resident-physician, W. Charles Hood, appointed in 1853; however, the published annual reports show that a large number of changes had already been made under the previous charge of Sir Alexander Morison and Edward T. Monro, the visiting physicians. In 1845, they reported that “much attention has been paid to the amusements of the patients during the past year. The library, billiard and bagatelle rooms are very generally occupied on the male side by the better classes, and much interest excited by books, cards and games.”
These additions to activities in the Hospital, and improvements in the therapeutic environment, were continued by Hood, who adhered strongly to the twin ideals of moral treatment (cure through re-education, with a clear emphasis on environmental and occupational, rather than strictly medical, therapies) and non-restraint (complete abandonment of any type of mechanical restraint, including straps, straight-waistcoats etc. Seclusion, however, was permitted).