Chapters in the History of the Insane in the British Isles Part 6

It was in 1733 that two wings were added for incurable patients, but this proved insufficient in the course of time; and in 1793 an adjoining plot of ground was obtained, and more accommodation provided. Only six years later, however, surveyors appointed to inspect the premises reported that the hospital was dreary, low, melancholy, and not well aired; and in 1804 the condition of the building was so dangerous that it was resolved to admit no more patients except those already pet.i.tioned for.[86] As the asylum had been built upon the ancient ditch of the city, a large portion of the foundation was insecure. Serious settlements had taken place, and rendered it necessary to underpin the walls.[87] When one looks at the palatial building represented in engravings, one feels some surprise to find it described as so low and dreary; but doubtless it was quite time to erect another asylum, and seek a better and more open site.

I do not propose to enter upon the revelations made as to the internal condition of Bethlem Hospital by the investigations of the Committee of the House of Commons in 1815;[88] many are familiar with the prints exhibited at this Committee, of poor Norris who was secured by chains as there represented, consisting of (1) a collar, encircling the neck, and confined by a chain to a pole fixed at the head of the patient's bed; (2) an iron frame, the lower part of which encircled the body, and the upper part of which pa.s.sed over the shoulders, having on either side apertures for the arms, which encircled them above the elbow; (3) a chain pa.s.sing from the ankle of the patient to the foot of the bed.

As to the treatment pursued at this time at Bethlem, the pith of it is expressed in one sentence by Dr. T. Monro in his evidence before the Committee. He had been visiting physician since 1783. "Patients," he says, "are ordered to be bled about the latter end of May, according to the weather; and after they have been bled, they take vomits, once a week for a certain number of weeks; after that we purge the patients.

That has been the practice invariably for years long before my time; it was handed down to me by my father, and I do not know any better practice." If in all this we are disposed to blame Bethlem, let us still more condemn the lamentable ignorance and miserable medical red-tapism which marked the practice of lunacy in former times.

I may here remark that, prior to the Monros, Dr. Thomas Allen[89] was, in 1679, visiting physician to Bethlem, and that, as I have observed already, Helkins Crooke (1632) was the first medical man who is known to have been at the head of this hospital. Dr. Tyson was physician from 1684 to 1703. Mr. Haslam was appointed resident apothecary in 1795, and in 1815 gave evidence before the Committee of the House of Commons. At that time he said there were a hundred and twenty-two patients; "not half the number," he stated, "which we used to have." For these there were three male and two female keepers: the former a.s.sisting the latter when the female patients were refractory. Ten patients, he said, were at that moment in chains, and we may be sure that the number was much larger before public feeling had been aroused to demand investigation.

"The ultimatum of our restraint," said Mr. Haslam, "is manacles, and a chain round the leg, or being chained by one arm; the strait waistcoat, for the best of reasons, is never employed by us." Mr. Haslam, when asked whether a violent patient could be safely trusted when his fist and wrists were chained, replied, "Then he would be an innoxious animal." Patients, however, were frequently chained to the wall in addition to being manacled.

A brief reference here to Dr. Allen and Dr. Tyson will not be out of place.

"To his [Dr. Allen's] credit let it be recorded," says Dr. Munk, "that he refused to accede to a proposition which had met with general approbation at the Royal Society (of which he was himself a Fellow), to make the first experiment of the transfusion of blood in this country 'upon some mad person in Bedlam.'" He died in 1684.

Dr. Edward Tyson, F.R.S., was the author of various works, but none on mental disease. His portrait is in the College. He died in 1708, aged 58, and was buried in St. Dionys Backchurch, where there is a monument to his memory. He is the Carus of Garth's Dispensary.[90]

"In his chill veins the sluggish puddle flows, And loads with lazy fogs his sable brows; Legions of lunaticks about him press, His province is lost Reason to redress."

Of the family whose hereditary connection with Bethlem is so remarkable, it should be chronicled that Dr. James Monro was elected physician to Bethlem, 1728; he died 1752. His son describes him as "a man of admirable discernment, who treated insanity with an address that will not soon be equalled." Dr. John Monro succeeded his father in this post.

"He limited his practice almost exclusively to insanity, and in the treatment of that disease is said to have attained to greater eminence and success than any of his contemporaries. In January, 1783, while still in full business, he was attacked with paralysis.... His vigour, both of body and mind, began from that time to decline. In 1787 his son, Dr. Thomas Monro, was appointed his a.s.sistant at Bethlem Hospital, and he then gradually withdrew from business."[91] He died in 1791, aged 77.

He was the author of "Remarks on Dr. Battie's Treatise on Madness, 1758." Dr. Thomas Monro was appointed physician to Bethlem in 1792, and held that office till 1816; he died 1833, aged 73. His son, Dr. Edward Thomas Monro, succeeded him.

We now arrive at the close of the second Act in the drama of the Royal Hospital of Bethlehem. The scene of Act the Third is laid in St.

George's Fields. The area of land covered about twelve acres. Provision was made for two hundred patients. In 1810 an Act of Parliament was obtained (50 Geo. III., c. 198), by which the City was authorized to grant the property to trustees for the governors of the hospital, for the purpose of erecting a new one on an enlarged scale--on lease for eight hundred and sixty-five years, at a yearly rent of 1s. The Corporation entered upon the spot occupied by the old hospital in Moorfields. The first stone was laid in St. George's Fields in April, 1812, and it was opened August, 1815, consisting of a centre and two wings, the frontage extending five hundred and ninety-four feet. "The former has a portico, raised on a flight of steps, and composed of six columns of the Ionic order, surmounted by their entablature, and a pediment in the tympanum on which is a relief of the Royal arms. The height to apex is sixty feet." There is the following inscription:

"HEN. VIII. REGE FUNDATUM. CIVIUM LARGITAS PERFECIT."

The funds were derived from the following sources:--

s. d.

Grant from Parliament 72,819 0 6

Benefactions from Public Bodies 5,405 0 0

Private Individuals 5,709 0 0

Amount of Interest upon Balances in hand 14,873 4 8

Contributed from funds of Hospital 23,766 2 3 -------------------- 122,572 7 5

Even in this new building, opened before the conclusion of the labours of the Select Committee of the House of Commons, 1815-16, the windows of the patients' bedrooms were not glazed, nor were the latter warmed; the bas.e.m.e.nt gallery was miserably damp and cold; there was no provision for lighting the galleries by night, and their windows were so high from the ground that the patients could not possibly see out, while the airing-courts were cheerless and much too small. Such was the description given by a keen observer, Sydney Smith, from personal inspection.[92]

Additional buildings were erected in 1838, the first stone being laid July 26th of that year, when a public breakfast was given at a cost of 464; and a narrative of the event at a cost of 140; a generous outlay of charitable funds! We may be quite sure that no one who breakfasted at Bethlem on this occasion had any reason to be reminded of Sir Walter Scott's observation in a letter dated March 16, 1831: "I am tied by a strict regimen to diet and hours, and, like the poor madman in Bedlam, most of my food tastes of oatmeal porridge."

Of the site of the third Bethlem Hospital a few words will suffice. The notorious tavern called "The Dog and Duck" was here, and there is still to be seen in the wall to the right of the entrance to the hospital a representation in stone of the dog, with the neck of a duck in its mouth. It bears the date of 1716. In Mr. Timbs' "London" it is misstated 1617. Doubtless in olden time there was a pond here, for a duck hunt was a common sport, and brought in much custom to the inn. After the Dog and Duck, this site was occupied by a blind school, pulled down in 1811.

Shakespeare makes the Duke of York say in "Henry VI.":--

"Soldiers, I thank you all; disperse yourselves; Meet me to-morrow in Saint George's Fields."

_2 Henry VI._, Act v. sc. 1.

The only other reference in Shakespeare to this locality indicates that in his time there was a Windmill Inn in St. George's Fields, for he makes Shallow say to Falstaff--

"O, Sir John, do you remember since we lay all night in the Windmill, in Saint George's Fields?"--_2 Henry IV._, Act iii.

sc. 2.

The subsequent history of Bethlem Royal Hospital; the considerable improvements which succeeded the investigation; the inquiry and admirable Report of the Charity Commissioners in 1837, from which it appears that at that time some of the patients were still chained, and that the funds of Bethlem had been to no slight extent appropriated to personal uses; its exemption from the official visitation of asylums required by the Act of Parliament pa.s.sed in 1845 (8 and 9 Vict., c.

100);[93] the unsatisfactory condition of the inst.i.tution as revealed by the investigations made in 1851 (June 28 to December 4); the placing of the hospital in 1853 in the same position as regards inspection as other inst.i.tutions for the insane (16 and 17 Vict., c. 96); the sweeping away of the old _regime_, and the introduction of a new order of things--the great lesson to be learned from this history being, as I think, the necessity of having lunatic asylums open to periodical visitation--and last, but not least, the establishment of a Convalescent Hospital at Witley within the last few years;--these important events I must content myself with merely enumerating, but I cannot close this chapter without expressing the satisfaction with which I regard the present management of the hospital, all the more striking when we recall some of the past pages of its history; nor can I avoid congratulating the resident physician and the other officers of the inst.i.tution upon this result.

ST. LUKE'S HOSPITAL.

To the foregoing account of Bethlem Hospital it is necessary to add a brief reference to that of St. Luke's, which, in consequence of the insufficiency of Bethlem, was established in 1751, by voluntary subscription, and was situated on the north side of Upper Moorfields,[94] opposite Bethlem Hospital, in a locality called Windmill Hill, facing what is now Wors.h.i.+p Street. It is stated that pupils were allowed to attend the hospital in 1753. It appears that Dr. Battie, the physician to the hospital, who also had a private asylum, was the first in London to deliver lectures on mental diseases. He wrote "A Treatise on Madness," in 1758, and in this work censured the medical practice pursued at Bethlem. He was warmly replied to by Dr. John Monro, in a book ent.i.tled "Remarks on Dr. Battie's 'Treatise on Madness.'" His "Aphorismi de Cognoscendis et Curandis Morbis nonnullis ad Principia Animalia accommodati" appeared in 1762. In 1763 he was examined before the House of Commons as to the state of private mad-houses in England.

In April, 1764, he resigned, dying in 1776, from a paralytic stroke. His character was described by Judge Hardinge, as follows:--"Battius, faber fortunae suae, vir egregiae fort.i.tudinis et perseverantiae, medicus perspicax, doctus et eruditus integritatis castissimae, fideique in amicitiis perspectae."

Dr. Battie did not escape satire:--[95]

"First Battus came, deep read in worldly art, Whose tongue ne'er knew the secrets of his heart; In mischief mighty, tho' but mean of size, And like the Tempter, ever in disguise.

See him, with aspect grave and gentle tread, By slow degrees approach the sickly bed; Then at his Club behold him alter'd soon-- The solemn doctor turns a low Buffoon, And he, who lately in a learned freak Poach'd every Lexicon and publish'd Greek, Still madly emulous of vulgar praise, From Punch's forehead wrings the dirty bays."

Dr. Munk, to whose "Roll of the Royal College of Physicians" we are indebted for these particulars, adds, "Eccentricity was strongly marked throughout the whole of Dr. Battie's career; many strange and curious anecdotes concerning him are on record," and he quotes from Nichol's "Literary Anecdotes" (vol. i. p. 18, _et seq._) the following:--"He was of eccentric habits, singular in his dress, sometimes appearing like a labourer, and doing strange things. Notwithstanding his peculiarities, he is to be looked upon as a man of learning, of benevolent spirit, humour, inclination to satire, and considerable skill in his profession."

In 1782 a new building was erected on a site formerly known as "The Bowling Green," where St. Luke's now stands, in Old Street. It cost 50,000, extended four hundred and ninety-three feet, and, although built on the same plan as the former building, was a great improvement.

It was opened January 1, 1787; the patients, one hundred and ten in number, having been removed from the first hospital.

Elmes says, "There are few buildings in the metropolis, perhaps in Europe, that, considering the poverty of the material, common English clamp-bricks, possess such harmony of proportion, with unity and appropriateness of style, as this building. It is as characteristic of its uses as that of Newgate, by the same architect" (George Dance, jun.).[96]

"Immediately behind this hospital is Peerless Pool, in name altered from that of 'Perillous Pond,' so called, says old Stow, from the numbers of youths who had been drowned in it in swimming." So writes Pennant in his "London," and adds that "in our time [1790] it has, at great expense, been converted into the finest and most s.p.a.cious bathing-place now known; where persons may enjoy this manly and useful exercise with safety. Here is also an excellent covered bath, with a large pond stocked with fish, a small library, a bowling green, and every innocent and rational amus.e.m.e.nt; so that it is not without reason that the proprietor hath bestowed on it the present name."[97]

St. Luke's never got into ill repute like Bethlem. The investigation of the House of Commons' Committee of 1815 did not reveal many abuses. If, however, its condition at that period were compared with the well-managed inst.i.tution of to-day, the result would be a very gratifying one. Thus, seventy years ago, the author of the "Description of the Retreat," while preparing it, visited St. Luke's and discussed the humane system of treatment of the insane with Mr. Dunstan, the superintendent, whom he considered desirous to do his duty to them, though he thought that, having made some steps on the road to improvement, he had become too much satisfied with himself, and that, having obtained a good character, he had become less solicitous about the treatment, and inclined to suspect those who had gone a step beyond him. "He was for many years a valuable attendant at Bethlem, but it would be very easy to advance many degrees from the practice of that establishment, and yet be at an inconceivable distance from perfection."[98] Mr. Dunstan observed, "You carry kind treatment too far at the Retreat--beyond safety. If you had many of our patients they would turn you topsy-turvy presently." Mr. Tuke replied, "It is certainly possible to carry a good general principle too far, but we have very few accidents or escapes, and we have many patients who come to us in a very violent state." Mr. Dunstan would not allow his visitor to see some of the rooms, and insisted that he could not have seen the worst cases at the Retreat when he visited it--"for I have men in this place who would tear to pieces every means of precaution or security which I saw there." The remainder of this ma.n.u.script of 1812 is worth reading by any one who knows the St. Luke's of 1882. "There are three hundred patients, s.e.xes about equal; number of women formerly much greater than men; incurables about half the number. The superintendent has never seen much advantage from the use of medicine, and relies chiefly on management. Thinks chains a preferable mode of restraint to straps or the waistcoat in some violent cases. Says they have some patients who do not generally wear clothes. Thinks confinement or restraint may be imposed as a _punishment_ with some advantage, and, on the whole, thinks fear the most effectual principle by which to reduce the insane to orderly conduct. _Instance:_ I observed a young woman chained by the arm to the wall in a small room with a large fire and several other patients, _for having run downstairs to the committee-room door_. The building has entirely the appearance of a place of confinement, enclosed by high walls, and there are strong iron grates to the windows. Many of the windows are not glazed, but have inner shutters, which are closed at night. On the whole, I think St. Luke's stands in need of a radical reform."

In 1841 the infirmaries at each end of St. Luke's were fitted up for the reception of male and female patients. In 1842 a chaplain was appointed, and the present chapel set apart for wors.h.i.+p. Open fireplaces were placed in each of the galleries. The old method of coercion was abolished; padded rooms were made available for the treatment of the paroxysm; additional attendants were hired; and an airing-ground was laid out and set apart for the use of the noisy and refractory patients.

Wooden doors were subst.i.tuted for the iron gates of the galleries, and the removal of the wire guards from the windows inside of the galleries added much to their cheerfulness. The bars on the doors of the bedrooms, and the screens outside the windows of the galleries were also ordered to be removed. In 1843 the reading-rooms for the male and female patients were completed, and a library containing two hundred volumes was supplied by the kindness of the treasurer; an amus.e.m.e.nt fund was established for the purchase of bagatelle and backgammon boards, and other games for the use of the patients. In 1845 the hospital came under the provisions of the Lunacy Act (8 and 9 Vict., c. 100). Since the Lunacy Act of that year, the affairs of the hospital have been subjected to the control of the Commissioners, in addition to that of the House Committee and Board of Governors. Gas was introduced in 1848 into the hospital. In 1849 the pauper burial-ground at the back of the hospital was closed.[99] Numerous improvements have been made in recent years, especially in regard to the appearance of the galleries. The next improvement will be, I hope, to build a third St. Luke's, in the country.

FOOTNOTES:

[57] Dugdale's "Monasticon," vol. vi. pt. ii. pp. 621, 622. Rot. Claus.

de ann. 4 Hen. IV. Videsis bundell. de beneficii Alienig. de anno 48 Edw. III. Et. Pat. 11 Edw. II. p. 2, m. 24. The Hospital or Priory of Bethlem must not be confounded with the Priory of St. Mary Spital, or New Hospital of our Lady without Bishopsgate, founded 1197.

The following were Masters or Priors of the Hospital: Robert Lincoln, 12 Rich. II.; Robert Dale, 1 Hen. IV.; Edw. Atherton, 15 Hen. VI. He was clerk of the closet to the King. John Arundel, 35 Hen. VI.; Thomas Hervy, 37 Hen. VI.; John Browne, later in the same year; John Smeathe or Sneethe, 49 Hen. VI. John Davyson was removed 19 Edw. IV., when Walter Bate and William Hobbes were made custodes, with benefit of survivors.h.i.+p as Master to either (Dugdale, _op. cit._, p. 622).

[58] French, _creche_, a manger.

[59] Argent, two bars sable, a labell of five points, throughout gules, on a chief azure, an estoile of sixteen points, or, charged with a plate thereon, a cross of the third between a human skull, in a cup on the dexter side, and a basket of bread, _i.e._ wastell cakes, all of the fifth, on the sinister.

[60] Stow, edit. 1603, p. 452. On Bethlem, see p. 166.