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

have supposed.
Awareness of the need for standards f cleanliness was actually being heightened over the
half century prior to 1815, and novel directives from the Bethlem Governors do seem (if only
marginally) to have bettered conditions at the hospital. While it was only in this period that
the Bethlem Board began to become very insistent about matters of hygiene and cleanliness, it
was not until then that these matters became an emphatic concern of contemporary (especially,
non-conformist) physicians, philanthropists and institutional administrators, as miasmatic con-
ceptions of disease began to reach the fore of medical treatises and reformist tracts. Dirt and
bad air were increasingly owned and denounced as the fount of hospital and jail fever, and of the
high mortality rates in these institutions'. This enhanced concern with hygiene is especially
apparent in the comprehensive additions made to the duties of Bethlem officers and servants in
1765. These additions were recommended after prolonged enquiries by Grand Committees of
between ten and sixteen governors and officers, during which the conspicuous presence of the
Bethlem Physician, John Monro, must have been influential' 49 . From this date, the Steward
was required by standing order to make thrice weekly, morning inspections of the cells, galleries
and chequers for cleanliness and neatness, while the Matron was to examine the women patients
every morning to ensure that they had been properly 'Shifted and Sheeted' by the maids. Every
Wednesday, the Matron was also 'to Observe the Washer Women' and make sure that patients'
linnen was being 'Boiled as it ought to be and Washed in proper Suds'. An assistant basketman
who was to be newly appointed and was to take charge of the beer cellar, had the additional
responsibility of 'keep[ing] the Cellar Sweet and Clean'. Cleaning began at Bethlkm first thing
in the morning, after fires had been lit and after those patients who were convalescent, sick
or in need of surgery, had been carried down to the stove rooms, infirmaries and surgery'50.
'Dirty patients' were to be moved 'from one Cell to another' in order to 'Wash their Dirty Cells',
although, in practice, they were often chained up in the stove rooms (where they were found in
1814 by Warburton and his colleagues), or in their beds. Officers and servants were enjoined
to take 'great care in removeing old Straw and providing Fresh', changing it whenever it was
'Damp or Dirty', and left over provisions were also to be removed every morning.
145 See John Woodward, To Do The Sick No Harm. A Strady of the British VoInnt.ry Hospital Spstem io 1875
(London, Routledge & Kegan Paul, 1974), 97-104; Ign.atieff, A Jn,t Meaanre of Pain; George, London Life, 62.
149 BCGM, 24 April & 20 June 1765, 126 & 132-7. Monro put his hand to both Grand Committee reports
(dated 17 May & 19 June 1765) which had originally been convened on the Court's instructions (in April), merely
to enquire into the duties of the Steward (flow the olTice had fallen vacant) and to suggest alterations'. It is
impossible to say, however, how much influence he exerted upon the final form of (he proposals made.
150 I.e. soon after 6a.m. in summer and 7a.m. in winter.
167