Bethlem Museum of the Mind records the lives and experience and celebrates the achievements of people with mental health problems. Situated within the current day site of Bethlem Royal Hospital, the oldest psychiatric hospital in Europe, the Museum seeks to explore and discuss issues around mental health, both in the past and the present day, using its collection of art, objects, and archives.
The Museum is a place of public deposit for the historic records of the South London and Maudsley NHS Foundation Trust and its predecessors. As part of this duty, the Museum of the Mind archivist cares for the archives of Bethlem Royal Hospital, the Maudsley Hospital, and Warlingham Park Hospital. Our goal is to make our collections more accessible, and to provide accurate information to help in their interpretation.
The Museum is open to the public 10.00 a.m. to 5.00 p.m. Wednesday to Friday, and also on the first and last Saturdays of every month. To find out how to get to the Museum please see our ‘Visit Us’ page. The archive is available to view by arrangement with the archivist.
History
Bethlem Royal Hospital was founded as the Priory of St Mary of Bethlehem in 1247, following a grant of land just outside of Bishopsgate to the Order by Simon FitzMary, a wealthy alderman of the City of London. At some point, possibly not long after its establishment, the Priory became a Hospital (which at this point literally meant a place of hospitality, like a hostel), probably housing alms-takers who would have raised funds for the Order of Our Lady of Bethlehem, a military order then fighting the crusades. Following the end of the crusades in the 1300s, ownership of the Hospital went to the Crown, which employed a master or keeper to supervise and manage the facility.
By 1400 Bethlem had become a hospital in the more modern sense of the word, housing some elderly and the sick in the many buildings that made up the Bethlem precinct, which also included a master’s house and a chapel. However, there are also indications that some of the buildings were rented out to provide income for the care of these people. In 1403 there is the first mention of the mentally unwell being housed there, as the City of London records note that there are ‘six insane men & three others who were sick’. It is possible that this links to the closure of Stone Hospital in Charing Cross, another royal building, a few years earlier.
Over the next 150 years Bethlem became synonymous with the care of the mentally unwell, and in doing so earned itself the sobriquet ‘Bedlam’ from the citizens of London. Its specialisation was probably complete by the 1460s, when the inhabitants were described as ‘poor, sick and distraught’, but it becomes clear in City documents that ‘insanity’ was an essential criterion for admission. While no records survive from the Hospital itself at this time, it appears that it was the only place providing this sort of care in England, and that it depended on donations in order to survive.
In 1547 the Hospital was granted to the Corporation of the City of London by Charter of Henry VIII, becoming one of the ‘Royal Hospitals’ in the process (though it only used that title from 1845 onward). In 1557 the City united Bethlem with the Hospital of Bridewell, which was a sort of remand home for women and children, as a single charity. The Court of Governors of Bridewell and Bethlem, whose President was usually either the Lord Mayor of London or a predecessor, and whose ranks were drawn from the Corporation, oversaw Bethlem until its entry to the NHS in 1948.
In 1676 the Hospital moved from the increasingly dilapidated site at Bishopsgate to its first purpose-built building in Moorfields, within the walls of the City of London. Designed by Robert Hooke with Gaius Cibber’s statues of Raving and Melancholy madness (the two main diagnoses then given to the mentally unwell) positioned on the gates outside, this palatial new building was designed to make an impression, and to increase donations from passers-by and visitors, through publicising the issues of those within. It also increased the capacity of the Hospital from around 60 to over 150. Our admission books, which begin at this time, show that patients were drawn not only from London but from across the whole of Britain.
Over the course of its time at Moorfields, the Hospital seems to have developed its rules of admission. It aimed to take in those that parish authorities could not look after but that it felt it could cure within a relatively short period of time; usually one to two years. The exception was the so-called ‘Incurable Wing’, which housed long term patients (at least some of whom were ‘cured’). Two wings to accommodate these patients were added to the Hospital in the early 1700s and by 1789 the Hospital had a maximum capacity of around 250.
Though the Hospital provided clothing, food, and bedding, it required that someone (a surety), either representing the family or the parish, put up a bond of £100 in case of additional expenses. The Hospital regularised its staff, which consisted of attendants and three trained medical men, a Physician (usually a respected MD), an apothecary (who usually acted as an onsite junior doctor), and a surgeon. By the early 1800s it had begun to take on the role of imprisoning those people that the State deemed to have committed crimes for reasons of insanity, most notoriously the two would-be assassins of George III, Mary Nicholson and James Hadfield.
Treatment at Bethlem during this time was based on Galenic theories of medicine, which required the balancing of the four humours, black bile, yellow bile, blood, and phlegm. This was achieved through purging (application of laxatives or diuretics), vomiting, bleeding, and blistering, all of which usually caused extreme discomfort to patients.
Initially the Hospital encouraged paying visitors, which led to Bethlem becoming one of the sights of London recommended to visitors by people like Samuel Pepys. In the final panel of ‘The Rakes Progress’, William Hogarth depicts a nightmarish scene of chaos within ‘Bedlam’, including two clearly titillated visitors. Though the Hogarth engraving exaggerates many elements (the Hospital separated those suffering from ‘mania’ from those with ‘melancholy’, as well as separating males and females), some parts of this have the ring of truth, and it certainly reflects how normal Londoners viewed the Hospital.
Visiting on the whole ceased in 1770 as the Hospital Governors began using rent from donations of land to fund the Hospital. However, this may not have helped conditions in the Hospital. Free of the necessity to keep good order for appearances, evidence to an 1815 Parliamentary Select Committee reveals an institution that had not kept up with modern practices, and an attitude to treatment that seemed especially cruel compared to the new ideas of ‘moral treatment’ being advocated by other medical men in the field.
The Moorfields building itself was no longer suitable either. While it had fulfilled its role as a distinctive building, it had been constructed quickly and cheaply, and its lack of foundations meant it was slowly sinking. In 1815 the Hospital moved to a new site in Southwark (the central block still stands and is now the Imperial War Museum), this time with a specially constructed wing for ‘Criminal Lunatics': those people who had committed violent offenses because of their mental health issues. The ‘M’Naghton rules’, a set of guidelines for the legal defence of ‘insanity’, was bought into place in 1843 following the trial of a man who had killed Prime Minister Robert Peel’s secretary. Daniel M’Naghton would subsequently be imprisoned in Bethlem.
There followed a long period where the Hospital slowly moved toward adopting a more modern sensibility, under pressure from the enquiry of 1815 and the psychiatric profession’s adoption of humane methods of treatment, reflecting a general shift in the wider understanding of mental health. A greater focus on patients can be seen by the way the hospital begins to keep casebook records after the move to Southwark, a move which bought it into line with the developing County Asylum network.
With the appointment of William Charles Hood as the first Resident Superintendent in 1853, the Southwark Bethlem became a modern psychiatric hospital. It was not part of the asylum system, but a ‘registered hospital’ inspected by the national inspectors ‘The Commissioners of Lunacy’, and increasingly housing deserving cases from ‘the middling sort’, as the very poorest in society began to be treated at the gigantic county asylums.
This Bethlem sought to treat patients using occupational and environmental treatments, providing calming activities in a quiet environment. Though mechanical restraint was frowned upon, the Hospital regularly used sedatives and strong clothing to control its patients.
The distinctive dome was built in the 1830s, and in 1863 the Hospital’s criminal patients began to be transferred to Broadmoor: the newly built secure Hospital in Berkshire. In 1890 the Hospital appointed Geoffrey O’Donoghue as chaplain, and he went on to become the first historian of Bethlem, playing a large role in the preservation of the Hospital’s history.
In 1930 Bethlem moved to its current site in Monks Orchard, Beckenham, at the very edge of the London suburbs. Rather than have one monolithic building, the Hospital site was designed on the villa basis, with a number of smaller buildings set in bucolic parkland, emphasising the therapeutic benefits of the large green spaces. Bethlem entered the NHS with the Maudsley Hospital in 1948, and the joint hospital that was formed then became the basis for the South London and Maudsley NHS Foundation Trust (SLaM) that runs the site today.
Access
Museum of the Mind holds the records of Bethlem Royal Hospital dating from 1557 (when it came into the control of the City of London), the Maudsley Hospital from 1923 (when it opened to the public), and Croydon Mental/Warlingham Park Hospital, which opened in 1903 and came into the possession of SLaM in the 1990s.
The first records are the minute books of the Courts of Governors of Bridewell and Bethlem dating from 1557. In the first 150 years these books record details of patients, staff matters, property, and general administration, though they are generally more focussed on Bridewell than Bethlem. After 1700 the different functions of the Court start to be taken up by various sub-committees, and other records begin to be kept that hold some of the information previously only found in these records. You can find these records in this collection in the Management of Bethlem Royal Hospital, 1559-1932 volume. Find out more via the Museum of the Mind series catalogue.
The first patient records are the admission registers, which begin in 1683. These usually contain a patient name, date of admission and discharge, and details of the two securities the Hospital required to cover costs. You can find these records in this collection in the Admission, Discharge, and Death Registers, 1683-1919 and Criminal and Incurable Patient Admission Registers and Casebooks, 1778-1864 volumes.
More detailed patient records start with our casebook series in 1815. There are different series for ‘Incurable’ (long stay) and 'Criminal' patients as well. Sometimes the information within these books goes back further than 1815, especially if the patient was in Bethlem for a long time. After 1852 the casebooks become more standardised and include much more information. There is a small, digitised run of Croydon Mental Hospital casebooks from 1903 to 1914. See the following volumes in this collection for further details: Voluntary and Curable Patient Casebooks, 1816-1913; Criminal and Incurable Patient Admission Registers and Casebooks, 1778-1864; Female Patient Casebooks, 1778-1913; Male Patient Casebooks, 1793-1913; and Patient Casebooks from the First World War, 1914-1919.
For items that are not digitised, refer to the Museum of the Mind’s full catalogue listing.
For more information, or to contact the Archivist, please go to Museum of the Mind’s ‘Contact’ page and select ‘Archives’ in the ‘Recipient’ field.