Posts Tagged 'Getting into Georgian Bethlem'

Getting into Georgian Bethlem 3

In previous posts we described the restrictions placed on admissions to Bethlem Hospital, and to its ‘incurable’ ward, in the eighteenth century, and told the first of two stories of attempts made to gain admission for a patient. The second concerns Sarah Lufkin of Little Bentley near Manningtree, Essex, who came into the Hospital on 16 February 1782, and was discharged uncured on 15 February of the following year, in strict accordance with the previously-described rules governing admission and discharge. Mrs Lufkin was considered a ‘fit Object’ for transfer to Bethlem’s ‘incurable’ ward, but had to go on the waiting list for a vacancy. It took seven years for her to be offered a place, and a letter written to the Hospital by Sarah’s son John Lufkin is preserved in the archives.

‘My Brothers, Sisters and myself have Deliberated on the matter,’ John wrote, ‘and although her who has been one of the tenderest Mothers still continue in a state of Insanity, I leve [sic] you to judge from your own feelings if it would not be a heard, very heard work for us to part from her and perhaps never to see her more.’ This was no exaggeration on John’s part. Little Bentley was at least two days’ coach journey away from London in the eighteenth century, and the fare was not cheap.

By 1790 Sarah Lufkin’s children had been seven years without Bethlem’s assistance in caring for her. ‘Ever since she left London she has been in a very Creditable Famaly [sic] where she is treated with the greatest kindness and has every Indulgence a person in her Situation can have, and where we can see her as often as we please as the Distance is only half a mile from our own Famaly.’ What would they do, then, with Bethlem’s renewed offer of help?

‘Although it is a very heavy Expence’, John Lufkin continued, ‘we hope with the Blessing of God to be able to support her till it shall please the Lord to release her from her heavy affliction, for can we do two [sic] much for a good Parent’? That John Lufkin’s filial devotion was shot through with practicality is evidenced by the next (and effectively last) line of his letter: ‘Sir, if we omit this opportunity and if at a futer [sic] time any thing unforeseen should happen so that we find the Expence more than we are able to support, could she then at a Vacancy be admitted’? No record survives of the answer given by the Hospital, but we may surmise that, if that it stuck by its rules, the answer would probably have been ‘No’.

Getting into Georgian Bethlem 2

Correspondence between two eighteenth century solicitors, currently being edited for publication by the Sussex Record Society, provides an unexpected insight into how the rules of admission to Bethlem Hospital (described in an earlier post) functioned in practice at that time. We are grateful to the editor of these letters for drawing our attention to this example, and for permission to cite it here.

On 12 November 1745, James Collier of Hastings wrote to John Collier ‘in relation to the unhappy affair of Mary Cousens, whom my uncle and I though a proper person’ for admission to Bethlem.

‘I shall be able I beleive [sic] to have some respite in regard to her removal, and when the committee are known, shall endeavour to get her minuted down for the ward of the incurables which depends principally upon the report of Dr Monro; and I am glad to find that our case, viz. a raving madness, is a circumstance that particularly induces the committee to send such poor people there.’

In seeking a place for Mary Cousens at Bethlem, Mr Collier was acting as a professional agent of the Hastings authorities legally and financially responsible for the care of all ‘pauper lunatics’ resident within their parish boundaries. His communications with Bethlem’s Physician, Dr Monro, seem to have been conducted via a third party. At any rate, he had been poorly advised. As noted in the previous post in this series, in the ordinary course of events patients were not admitted directly to the ‘incurable’ department, and people judged ‘incurable’ would not be admitted to the Hospital in the first place.

While he hoped for a Bethlem admission for Mary, James Collier did not put all his eggs in one basket. ‘By next post, I shall be able to acquaint you with certainty what will be done as to Guy’s hospital,’ his letter to John continues. ‘They never suffer anybody to enter there, who has once been in bedlam, and I am afraid private madhouses will be attended with great expence.’

How did matters turn out? From a second letter, written by James Collier to John nine days later, it appears that Mary lived under Bethlem’s roof while being assessed for admission, but was not in the event admitted. ‘Mary Cousens is not as yet removed out of Bethlem hospitall [sic], but it is impossible to get her continued there’, he writes. ‘Mr Alnright of Lambeth marsh will take her for one month upon trial for 8sh per week, but if her distemper is such as to require a more than ordinary attendance, he will have more.’ With an eye to parish finances, Mr Collier would have preferred Bethlem to relent, an outcome for which he continued to hope against hope. ‘I don’t despair at present of getting her minuted down in the list of persons who are to supply the vacancys in the ward of incurables.’ In the event, however, Mary Cousens’ name does not appear in any of the Hospital’s admission registers, incurable or otherwise. Where she went, we cannot say.

Getting into Georgian Bethlem 1

The restrictions on admission to and discharge from Bethlem Hospital in the eighteenth century often come as a surprise to first-time researchers. (So, incidentally, does the language in which these restrictions were expressed). ‘Mopes, Persons afflicted with the Palsy, or subject to Convulsive or Epileptic Fits, or such as are become weak through Age or long Illness are not proper Objects of this Charity,’ according to the Hospital’s printed admission regulations.

In other words, the Georgian Hospital wished to focus its therapeutic efforts on those patients it regarded as most amenable to recovery, and commonly discharged uncured those who had not recovered within a year of admission. For example, 60% of patients admitted between 1694 and 1718 stayed no longer than twelve months, and a further 16% stayed no longer than twenty-four.

To ameliorate the hardship sometimes caused by discharging patients uncured, the Hospital opened a new ward in the 1720s in which ‘incurable’ patients could remain. Those still unwell twelve months after admission were assessed as to whether they were ‘fit’ and ‘proper Objects’ for this ‘Charity’. Space in this ward was at a premium, however. The majority of uncured patients were judged ‘unfit’ upon discharge, and even the patients considered ‘fit Objects’ for transfer had to wait until a vacancy became available on the ‘incurable’ ward.

But here’s the thing: patients could not be admitted to the ‘incurable’ department directly; they arrived there only by internal transfer. So those considered incurable at the outset were not admitted at all. Here we see Georgian Bethlem striving hard to avoid becoming in reality what it was in uninformed popular imagination: a warehouse of human misery. Its primary strategy was to enforce its published strictures on entry. Admission petitions ‘will be laid before the Committee… who…will make an Order as soon as there is a Vacancy, for the Patient to be brought to be Viewed as Examined by them and the Physician, and to be then admitted, if [and only if] a proper Object’.

The published histories of the Hospital often turn attention to its famous (or infamous) patients. But in blog posts to follow, the Archivist will describe attempts to find places in Bethlem’s ‘incurable’ ward for two ‘ordinary’ people of the eighteenth century…attempts which, as we will see, soon ran into difficulty.

'New Bedlam in Moorfields' in newbed

Georgian Bethlem, in Moorfields