Posts Tagged 'victorian bethlem'

Location, Location 3

At the start of the nineteenth century, Bethlem’s Governors began actively seeking new premises for the Hospital. By then, as previously noted on this thread, all the perceived advantages of the Moorfields building had been irredeemably compromised (along with the healthful purity of the Moorfields air). In requiring asylums to be built in “an Airy and Healthy Situation, with a good supply of Water”,1 the 1808 County Asylums Act followed contemporary medical opinion in placing a high premium on the siting of residential psychiatric facilities. The Governors’ relocation plans were not constrained by the Act, Bethlem being a private hospital, but they were infused by the Zeitgeist. Their first preference was for seven acres of high ground in Islington; but it proved impossible to interest the vendors in the transaction, which (since the Governors were tenants on a 999-lease on the Moorfields site) would involve the direct exchange of land, rather than of cash. They eventually settled upon a site south of the river in Southwark, a suburb which laboured under the disadvantage of being “swampy, overcrowded and predominantly poor”, but had the fact of its being City-owned and available to recommend it.2

In August 1815, Bethlem’s 122 patients were brought from the old hospital to the new in a succession of hired Hackney cabs. In their first winter, they must have been exposed to rather too much air, since the building’s “system of warming by steam was installed only in the basement storey and the windows in the upper storeys were either exposed to the full blast of cold air or were completely darkened” by being shuttered.3 Moreover, this was, in all likelihood, air of the wrong sort, Southwark at that time sharing with Lambeth the highest number of smoke-consuming furnaces in London.4 Though at first a somewhat mealy-mouthed defence of this system of open ventilation (“for obviating the disagreeable effluvias to which, as Dr Latham has observed, is peculiar to all Madhouses”5) was offered, the windows were glazed, and amendments made to the heating system, in 1816.6

The Hospital’s maintenance of a convalescent department in rural Surrey (within the grounds of King Edward’s School Witley, which shared its governance with Bethlem, and had been recently moved there from central London) between 1870 and 1929 is evidence that its immediate environs in Southwark were not proving to be sufficiently therapeutic. There is little doubt that “beautiful Witley” exercised a beneficial effect on the minds of a good many of Bethlem’s patients over these years. However, Bethlem’s Governors had no intention of turning their backs on London, having stubbornly resisted pressure brought to bear on them throughout the 1860s to relocate to the countryside.7 When another move finally did take place, some sixty years later, it was to a suburban site no more than ten miles from Charing Cross. As is well known, the old hospital was then given over to the use of the Imperial War Museum. “It is perhaps appropriate”, wrote a London County Council surveyor of the 1950s, “that a building occupied for so many years by men and women of unsound mind should now be used to house exhibits of that major insanity of our own time”.8

1 Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services from the early 18th century to the 1990s (London, 1993), p. 37.

2 Jonathan Andrews et al, The History of Bethlem (London, 1997), p. 403.

3 Ida Darlington, The Survey of London: St George’s Fields, volume xxv (London, 1955), p. 78.

4 Jonathan Andrews et al, The History of Bethlem (London, 1997), p. 403.

5 Minutes of Evidence taken before the Committee on the State of the Madhouses, 1815-1816, p. 194.

6 Robert Howard, ‘A lesson from the history of psychiatry: competitive tendering for services and defective central heating systems in Georgian New Bethlem’, Psychiatric Bulletin (1991), pp. 566-568.

7 Jonathan Andrews et al, The History of Bethlem (London, 1997), pp. 498-502.

8 Ida Darlington, The Survey of London: St George’s Fields, volume xxv (London, 1955), p. 80.

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Life in a Victorian Asylum 3: Patient Rights

It’s easy to assume that, once inside in an asylum, Victorian patients had no rights whatsoever. Many were, however, well able to communicate with the outside world. Letters to the Commissioners in Lunacy or the Home Office – or, in the case of many private patients, their solicitors – were by law to be forwarded unopened. Other letters could be checked by the medical officers, but had to be shown subsequently to the Commissioners, to ensure that this had been done to protect the patient or prevent offence to others: a fine of £20 was payable if letters had been wrongly withheld. Although the decision to withhold letters does seem to have been made fairly often (given the numbers of letters addressed to outside parties pasted into patient records), there are also occasions when patients’ letters appear in the case books alongside a complaint from a relative who has returned them, urging the Hospital to be more strict in their censorship. There was, then, no hard and fast rule as to what was considered permissible.

In January 1895, a middle-aged gentleman by the name of Edward Peter King was admitted to Bethlem. King’s case well illustrates the lines of communication open to an asylum patient in the late nineteenth century. Diagnosed with mania, he was regarded as talkative and troublesome. He was constantly writing letters to the Home Office which, rather to his doctors’ annoyance, were often responded to, making him “more fixed in his idea about his importance & the interest taken in him by the State.” Several months after his admission, King ensured that he received a second medical opinion on his case after writing two letters to the eminent George Savage (a previous Bethlem superintendent) asking him to call, which he did, noting that “at all events I consider him insane as far as CONDUCT is concerned & if at large I believe he will always be getting into scrapes.”

King certainly managed to get into a number of “scrapes” even at Bethlem, apparently irritating his fellow patients by constantly passing wind audibly (on one occasion this so aggravated a Mr Rowland that he threw a book at King, and tried to follow this up with a vase before being stopped by an attendant). On March 8 the Commissioners in Lunacy investigated King’s case, after the patient wrote to the Home Office saying he had not been allowed to visit two dying relatives: a request the Hospital claimed neither the patient nor his relatives had ever made.

With the medical officers checking his post, King made full use of his legitimate channels of communication: the Home Office, the Commissioners in Lunacy, and his solicitor. To the latter, he frequently sent bulky packages, containing letters to be passed on elsewhere (much to the despair of his doctors, who regularly lamented his ingenuity in bypassing their regulations), or advertisements to be placed in the press. In late March, for example, one of these appeared in the Morning Post, asking “parents and guardians” to provide “steady well-educated Young Gentlemen as ARTICLED PUPILS for five years” for a “high-class sixpenny illustrated paper” he wished to start up.

King’s frequent letter-writing was sometimes an embarrassment to the Hospital: in particular, when the patient received a letter from the Home Secretary asking him to give evidence in an enquiry into Holloway Sanatorium, but nothing official was sent to the Hospital. From the tone of the case book, it seems that the medical officers may have found some truth in King’s contention that “the Home Secretary looks upon us [i.e. the Hospital staff] with contempt”.

Edward King was discharged well, just four months after admission, although his life immediately following release does not seem to have been an easy one. It was later recorded that he had spent time in several prisons, and he returned to Bethlem at least once, to try and borrow £1 (which was refused). Although the level of correspondence King maintained while at Bethlem was unusual, his case is a particularly strong example of that way in which, even when certified, a late-nineteenth century patient might still interact to a considerable extent with the world beyond the asylum.

Just Visiting: Fukuzawa Yukichi

Fukuzawa Yukichi (1835-1901) is well-known within Japan as an author, political theorist, and moderniser, the founder of Keio University and, in a manner of speaking, one of the architects of the modern nation. He was an advocate of political and cultural engagement with the West, and some account of his travels to Europe and the United States is available in English translation in The Autobiography of Fukuzawa Yukichi, translated by Eiichi Kiyooka (Tokyo, 1981). His diaries, however, remain untranslated, and in them there is an account of a visit made to Bethlem Hospital in 1862 – a fact that may be verified from Bethlem’s visitors’ book, into which Fukuzawa wrote. Fukuzawa was by no means the only personage from abroad to visit the Hospital – nineteenth century psychiatrists maintained a lively cultural and intellectual exchange across national borders – but his Western hosts no doubt saw him as one of their more exotic guests. His own account of the visit, written on 20 May 1862, breathes a liberal, enquiring spirit, and provides another window onto mid-Victorian Hospital life.

“This lunatic asylum is a hospital that accommodates and treats lunatic people. It provides a single room for each patient. Patients are encouraged to come out of their rooms during the daytime. I saw patients who took walks through the hospital, went out into the garden to pick flowers, sang and danced on the rooftop, played ball, drew pictures, and enjoyed music. Patients can amuse themselves according to their inclination. The inside of the hospital is kept especially clean. Bird cages and pot plants are put in place so that patients can soothe their minds.”

Fukuzawa then turned his attention to Bethlem’s State Criminal Lunatic Asylum, within which those who (like Edward Oxford) had been tried for but acquitted of serious crimes ‘by reason of insanity’ were held until Her Majesty’s further Pleasure be known.

“The hospital not only treats patients who go mad but also detains for life people who have committed arson or attempted murder due to their madness. I saw three inmates today. One tried to kill the Queen, one killed his father, and another woman killed her three children.”

The would-be regicide was doubtless Edward Oxford himself, and the parricide Richard Dadd. A little over two years after Fukuzawa’s visit, both men – indeed all the male inhabitants of the State Criminal Lunatic Asylum – were relocated to the newly-built Broadmoor Hospital. Three years after that, Oxford proved an exception to the life detention rule, as related by Fukuzawa, by obtaining a Royal pardon. But that, as they say, is another story – one, incidentally, that is told by Paul Murphy in a book just published by Pegasus entitled Shooting Victoria.

Fukuzawa Yukichi

Fukuzawa Yukichi in Paris, 1862

Just Visiting: Henry Morley

If Charlotte Brontë did visit Bethlem, as she anticipated, in 1853, what would she have seen there? It is impossible to say for certain, since no account of her visit survives. But a sense of the Hospital’s environs is given in an account written just four years later by a lesser literary figure of the Victorian era, Henry Morley.

In 1857 Morley was commissioned by his friend Charles Dickens to write an account of a visit to Bethlem for Household Words, Dickens himself having reported on a visit to Bethlem’s rival St Luke’s Hospital in 1852. Morley’s account is of an institution transformed in the early 1850s by the appointment of Bethlem’s first Resident Physician.

“We went over the hospital a week or two ago,” he wrote. “Within the entrance gates, as we went round the lawn towards the building, glancing aside, we saw several groups of patients quietly sunning themselves in the garden, some playing on a grass-plot with two or three happy little children. We found afterwards that these were the children of the Resident Physician and Superintendent, Dr. Hood. They are trusted freely among the patients, and the patients take great pleasure in their presence among them. The sufferers feel that surely they are not cut off from fellowship with man, not objects of a harsh distrust, when even little children come to play with them, and prattle confidently in their ears. There are no chains nor strait waistcoats now in Bethlehem; yet, upon the staircase of a ward occupied by men the greater number of whom would, in the old time, have been beheld by strong-nerved adults with a shudder, there stood a noble little boy, another fragment of the Resident Physician’s family, with a bright smile upon his face, who looked like an embodiment of the good spirit that had found its way into the hospital, and chased out all the gloom.”

Morley’s conclusion, after a review of Bethlem’s chequered history? That “thousands of middle class homes contain nothing so pretty as a ward in Bedlam” and that “as to all the small comforts of life, patients in Bethlehem are as much at liberty to make provision for themselves as they would be at home”.1

1 H Morley, ‘The Star of Bethlehem’, Household Words, 15 August 1857.

Henry Morley

Henry Morley, c. 1888

The Unbroken Seal

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.

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In the Frame for September 2012

This striking image was partly chosen by the Education Officer because the sitter appears so relaxed in, or indifferent to, our presence. Many in the Hering series show the subject either sitting or standing quite formally but his pose is a nonchalant one, legs crossed, head propped up by the elbow resting on the highly polished table. The other hand rests on his hip, the fingers turned back. The body language gives a relaxed and unruffled impression; this is a pose adopted of his own volition. Though seated at a table, there are no additional objects or surroundings to distract us; we in turn are forced to make contact.

For many sitters, clothing would have chosen carefully to reflect taste, wealth and status but here it is unlikely that much choice would have been available. That said, there has been some attempt at style and individuality in the way the clothes are worn. The shirt does not appear to have a collar but this has been mitigated by the neckerchief tied neatly around the neck. The waistcoat is buttoned to accentuate the fit and give an indication of the body within. In contrast, the jacket might be too big, we note the sleeves are turned up, but this is disguised by the way in which it is being worn. The pose allows the jacket to fall open so that any deficiency in fit is not obvious and, taken together with the rest of the image, we might believe the sleeves had been turned back for reasons of style rather than necessity. His hat set at jaunty angle, pushed back from his face, giving us a clear view of his rather impertinent gaze, calmly assessing us.

Unusually for photographic portraits of the time, he is looking to camera, making a direct connection with the viewer as recommended in a treatise on painting by the Renaissance polymath Alberti. It’s a challenging look, as compelling as it is disturbing. The eyes are focused on the viewer under slightly lowered brows. Although set in a young face, they give the impression that they have seen rather more than their years might suggest and have not flinched from the dangerous or unpleasant. If the eyes are indeed a ‘window on the soul’ then we might wonder at its quality; there is coldness, ruthlessness, even cruelty here. The mouth is closed with no hint of a smile, though arguably there is something sensual about it.

It is a photograph which is as intriguing as it is disturbing.

The photograph of JP will feature in a new thread ‘Hospital Snapshots’ beginning next month.

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His Powers of Walking I

Regular readers will know that this year we have been blogging about patients of the past who have had their moment In the Spotlight of ‘fame’; and that from time to time we have drawn attention to others, such as Walter Abraham Haigh, whose names are unknown to posterity but whose stories are exceptional. Our recent blog thread of First Person Narratives provides evidence that this is an ongoing phenomenon. One of our aims in highlighting stories like these is to pay homage to the individual quiddity of all Bethlem’s patients, even though not every story can be told.

The Canadian author and researcher Aislinn Hunter has just drawn our attention to another such story, that of Robert Cowtan, a librarian at the British Museum admitted to Bethlem at the age of 60 in 1877 in a manic state brought on, as recorded in the admission register, by overwork. In Hospital Cowtan proved a prodigious letter-writer, addressing himself to the Lunacy Commissioners (who had the duty of inspecting asylums and hearing patient appeals), fellow patients (one of whom appeared to have become the object of his unrequited affection) and outside friends alike.

Like a great number of patients admitted between 1870 and 1929 who showed signs of improvement, Cowtan was temporarily transferred to Bethlem’s convalescent unit in Witley near Godalming, Surrey. The daily regime of this unit was mild and its environs pleasant, affording opportunities for escorted rural walks, for example, but the chief attraction of transfer to Witley was the associated prospect of departure from Bethlem after a month in the country.

Unusually, however, Cowtan stayed only eleven days at Witley, and rather than being discharged recovered upon his return to the Bethlem’s main site in Southwark, he was transferred to the ward in the Hospital reserved for those with the most challenging behaviour. All that appears in his medical record between the note of his transfer to Witley and his return is the cryptic line ‘Has great belief of his powers of walking’. In the event, Cowtan left the hospital in what the hospital considered to be a fit mental state a full eleven months after his abortive stay at Witley.

What, if anything, took place while Cowtan was at Witley? We are delighted to say that Aislinn Hunter has agreed to take up the story from here.

[to be continued]