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

'the poor creatures there [who] are not chained up in dark cellars', but allowed to 'exercise' in
'long airy corridors'342 . Describing Bethiem in the 1770s and 80s, William Black claimed that
'by far the great majority of Patients in Be'dlam...walk peaceably along the long wards' and that
'a very small number even of the Incurables' were 'constantly' chained. A very large proportion
of patients, nevertheless, seem to have been subjected to the temporary intimidation of irons,
strait-waistcoats and solitary confinement, and to have been securely restrained in their beds at
night343 . Moreover, the hospital's increasing prioritisation of 'dangerous' or 'mischievous' cases,
particularly after the establishment of the incurables' wards (to which only those deemed 'fit'-
i.e. 'incurably mad, mischievous...ungovernable' and 'outrageous', whose 'Enlargement would
be Dangerous' or who 'are likely to do mischief to themselves or others'—were admitted), had
also encouraged a higher degree of restraint at Bethlem than was maintained at other hospitals
and mad-houses344 . Indeed, it was on these grounds that, during the controversies of 1814-16,
the hospital's governors and medical staff attempted to justify the use of 'more restraint' at
Bethlem than elsewhere345.
By 1815, there were more than 120 patients at Bethlem, with only two female, and five male,
keepers, yet the staff:patient ratio was still considerably superior to that which had prevailed at
the hospital from 1728-85 (see chap. 5, table 5c). On this evidence alone, one would assume that,
for most of the eighteenth century, Bethlem was substantially more reliant upon manacles and
leg-locks than it was to be when the policy was denounced by the Madhouses Committee. (The
extent of restraint at the l3ethlem of the 1780s was something which the misty-eyed von Ia Roche
failed to notice). According to the same argument, one might also assume that staff dealing
with much smaller numbers of patients at the Bishopsgate building would have had far less
recourse to irons. Yet what information does exist, provides little support for such a supposition.
Conscious of declining staff:patient ratios during the course of the seventeenth century (and
seeking gratuities from the Court), staff not surprisingly took to complaining about 'the greate
342 Dr Londre. ci .e. environ., quoted in O'Donoghue, 282-3.
Black, Diaserialion, 13-14; Hunter & Macalpine, Paycktatrp, 646. In 1790, a maid servant was dismissed
'particularly' for 'omitting to secure the Patients in their Cell, at Night', reflecting the importance attached by
the governing board to matters of security, although this often simply seems to have entailed lodung their doore.
See BSCM, 2 Oct. 1790.
See e.g. chap. 6, 'Patients'; BCGM, 15 Nov. 1723, 12 July 1728, loIs 25, 153, 63; & Andrews, 'Incurably
insane'.
See Madhoi.e. Committee Repor1, 4th Report, 1815, appendix 3, 201. See also 1st Report, 1815, 102,
where Ilaslam defines incurables discharged from Bethiem as not fit' as those 'not of a mischievous disposition',
from whom 'society has nothing to dread'.
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