Within the pages of Bethlem’s Victorian medical casebooks a large number of letters are preserved – letters to, from and about many of its patients. These letters offer multiple perspectives on the experiences of patients that would be inaccessible from a reading of the hospital’s casenotes alone. They bring the personal dimensions of clinical encounters to the fore. A good example of this is the letters which formed the basis for our recent thread entitled His Powers of Walking.
There is another layer of poignancy attaching to these letters, which arises from the very fact of their preservation in Bethlem’s casebooks. The presence of incoming letters from friends, family, doctors and employers within these pages is unremarkable. The books were simply being used as a filing system. But what of correspondence that was written by patients and addressed to friends and family? The presence of letters such as these in the casebooks testifies to the Hospital’s practice of reading all outgoing letters and deciding which could (and which could not) be sent. The only letters that were not vulnerable to interception were those addressed to the Commissioners in Lunacy (the regulator of the day, to whom all certified patients had a right of appeal against their detention). Put simply, we may presume from the presence of letters written by patients within their Bethlem medical records that in Victorian times an unknown proportion of patients’ letters – whether tender, hurt, confused or threatening in tone – never reached their intended destinations. Such letters may give the researchers of today a measure of access to patients’ voices, but they do so by virtue of a practice which consciously limited the range of their audience at the time of writing.
The piquancy of a recent chance discovery by a visiting researcher is so intense as to be tantalising. Sitting within one of Bethlem’s late Victorian casebooks is a sealed envelope marked ‘confidential’, around which coloured string has been delicately tied. This envelope appears to have been addressed by a female patient to a non-conformist minister of her acquaintance, to whom (it is reported in her medical record) she had previously sent letters of considerable length and amorous intent. In common with other letters written by patients contained in Bethlem’s Victorian casebooks, this envelope was never delivered; but unusually (uniquely, we think, within Bethlem’s holdings) it remains sealed. What confidences are locked inside it? Whatever motives the hospital authorities of the day had in stopping this letter, yet making an exception to their usual rule by not breaking its seal, our researcher did not think that opening the letter was any business of hers. Nor do we really consider it to be any part of ours. Readers familiar with A.S. Byatt’s Possession may recall the (contrived) set of circumstances in which a sealed envelope from a previous century was opened, supplying the novel with an appropriately dramatic conclusion; but only, it will be remembered, by a descendant of the correspondent with the closest and (as it turned out) the most legitimate of interests in its contents.