Queen Mary and Westfield College London University PhD Thesis ...

that the development and practice of therapeutics at Bethiem presents a much more textured
picture than historians have recognised. H ghlighting the nature of medical appointments, pa-
tronage, salaries, conditions of service and attendance, there; the visiting, honorary capacity in
which medical officers were hired shall be emphasised and medical attendance at Bethlem placed
more squarely in the context of standards set at other contemporary hospitals. Rather than the
absentees that the medical staff of Bethlem have so often been portrayed as, I shall demonstrate
that they actually attended the hospital energetically, given the part-time basis on which they
served. On the other hand, their attendai}ce at Bridewell and the prosperous private practice
that the Physicians, in particular, enjoyed, meant that affairs at Bethiem received an inferior
attention to that many other general hospitals appear to have enjoyed, while the Governors set
theniselves stubbornly against moves to supplement staffing at the hospital. Turning to medical
practice at Bethiem, and focusing inter alia on the introduction of cold bathing; the conduct of
post-mortem examinations; the appointment of a nurse for the 'physically' sick; the embracing
of an innovative and extensive responsibility for the after-care of patients; and the establishment
of infirmaries, it shall be argued that Bethlem was in many ways at the forefront of advances
in the care of the sick prior to the mid-eighteenth century. While partially corroborating the
customary impression of an indiscriminate and unprogressive system of medication at Betlilem,
this chapter also reveals a significant degree of modification and adjustment in the 'physickirig'
of patients over the course of the period. Concluding with an account of the hide-bound reaction
of Bethlem and its medical regime to the challenges represented by the founding of St. Luke's,
and the publicised criticisms of the hospital's brand of therapeutics by the St. Luke's Physician,
William Battie, I shall also delineate substantial areas of continuity and agreement between the
two institutions. I shall indicate how much St Luke's owed to Betlilem, and shall maintain that
historical treatment of the Battie-Monro controversy has been selectively prejudiced in favour
of the former, and failed adequately to take into account the limited practical ramifications of
the differences between the two medical regimes.
The service tendered by Bethlem's ancillary staff is the subject of chapter 5. A good deal
of the explanation for the poor quality of the attendance of the hospital's inferior officers and
servants, shall emerge from my opening examination of their recruitment, status and wages
also
Yet tlis section shall Areveal how neglected a dimension of institutional life these areas
have remained, and how much they can tell us about the nature of hospital patronage and
management; and shall underline the gradations and evolution in the social composition of staff
and just what sort of a pecking order prevailed at the hospital. There will follow an analysis of the
grossly deficient staff:patient ratio at Bethlem, although mollified by setting it in relief of staffing
elsewhere. A sketch of the manifold and multiplying duties of staff, will be counterpointed by a
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