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

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ceration. I will proceed to discuss patients' geographical provenance, locating the hospital in the catchment areas that it served, and setting settlement information obtainable from the hospital archives in the context of vagrancy and lunacy laws, and in the broader context of parochial relief. This analysis shall underline the difficulties of authorities in establishing and enforcing obligations of settlement, and the extra difficulties entailed by the expense of maintaining the insane and by their particular tendency to wander. It shall, also, stress the general acceptance of a responsibility to cater for the poor insane, and the legal and administrative resources at the disposal of the hospital and other authorities to compel the meeting of these obligations. The ensuing section will examine more closely the gradual evolution of diagnostic criteria governing the reception of patients at Bethlem, focusing in particular on the ambiguities in the hospital's efforts to distinguish between suitable and unsuitable 'objects of Charity', and on the increasing discrimination exercised by the hospital board and medical officers in this respect. While medical certification was not introduced as a requirement for confinement in private madhouses until the Act of 1774, certification by the Bethlem Physician had been a condition of patients' admission and discharge at the hospital since the 1650s and 60s. While I shall go on to empha- sise how much Betlilem's provision for the insane was prioritised towards cases designated as 'dangerous', the intensity of the hospital's commitment to short-stay, 'curable' cases, shall also be demonstrated. The next section will analyse at some length what the 'danger' of the insane actually signified for contemporaries, delineating inier alia how the insane tended to come into the situations of conflict which precipitated their committal; how liable were contraventions of the hierarchical order, whether of families, localities or wider society, to be deemed as threaten- ing and irrational; and how profoundly the process of referral and incarceration was arbitrated by the prevailing social and political order. I shall also trace significant areas of tolerance for the 'unruliness' of the insane. There follows a brief discussion of religious dimensions in the committal and maintenance of patients at Bethlern; the gradual isolation of the insane from the more positive associations of divine intervention and inspiration, and the dynamics behind the mounting influx of religious 'enthusiasts' into the hospital's wards over the course of the eighteenth century. Consistently, during this period, the administrators and promoters of Bethlem claimed a cure-rate of over , and my final three sections assess more systematically the rather grim reality of the hospital's record behind the rhetoric of cure. An examination of the after-life of patients as derivable from parish records will evince just how limited a service Bethlem was performing, in therapeutic terms, for its pauper clients, and how rarely poor parishioners dis- charged or removed from the hospital can be said to have been fully recovered, or even, to have been capable of resuming their former lives. On the other hand, it will also be maintained that, given the inadequacies, paucity and expense, of alternative provision, Bethlem was performing no mean service to localities in offering affordable provision for difficult and alienated individu- 410
als. The final section, on the subject of mortality at Bethiem, while confirming the suggestions of previous chapters that the hospital was not one of the 'gateways to death' that early modern institutions have so often been characterised as; also argues that the apparently modest and de- clining mortality-rates it experienced were partially a cosmetic product of an increasingly rigid policy of exclusion and discharge of patients in a weak, debilitated or dying condition (although, not a policy by any means confined to Bethlem alone). 411
Page 1 and 2:
Queen Mary and Westfield College Lo
Page 3 and 4:
Abbreviations Contents Chapter 1 In
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Acknowledgments The list of those I
Page 7 and 8:
Chapter 1 Introduction: The Histori
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to 'be interesting' rather than ana
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paradigm of insanity' 9, and in ord
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that the development and practice o
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cure remained a vital object of the
Page 17 and 18:
Introduction Chapter 2 Visiting In
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accessibility' ?12 It is not enough
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would tend to verify the statements
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ernors concerning the conduct of st
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The Exhortatory Show And The Visito
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een worn by the apprentices of Brid
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more likely a patient was to receiv
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e compared to Isabella's role in Th
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egard the patients of Bethiem as th
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theorists and moralists were accord
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Lockean psychology on the Age of Re
Page 39 and 40:
of madness onto society more often
Page 41 and 42:
applied to visiting Bethiem. Thus,
Page 43 and 44:
always mischievous; and that 'if ev
Page 45 and 46:
a similar fashion, in The Changelin
Page 47 and 48:
Although the 8taff knew 'nothing ab
Page 49 and 50:
and the corners of her mouth raised
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and to obtain most 'cause for laugh
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periods, the 'Sport' often became r
Page 55 and 56:
For Anne Digby, too, public visitin
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England and France went to consider
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alias Joseph Warton, in The Adventu
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a year of its opening, he 'was so c
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so contrary an effect' on him that
Page 65 and 66:
sympathy for 'those under such Dism
Page 67 and 68:
or woman 'of feeling'. From searchi
Page 69 and 70:
It was no mere coincidence that Tho
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themselves', three years before thi
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without the Direction of Reason and
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expostutated, after outlining the s
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e sad', indicates how little had ch
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may well have been confined by in l
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Tryon that visitors were allowed an
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Tryon had alleged that I3ethlern wa
Page 85 and 86:
cells, and only 'afforded' the usua
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Moorfields can have done little to
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to the amelioration of such conditi
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Sundays when visitors were barred 3
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acco began to come into better favo
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crusading endeavours to tighten lic
Page 97 and 98:
to have secreted nearly £12 in her
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in four public newspapers and poste
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adjustments had to be made to the b
Page 103 and 104:
carceral institutions447. If such d
Page 105 and 106:
Like Swift, Mackenzie, in his The M
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Governors what a provocation naked
Page 109 and 110:
observed a male patient leap on the
Page 111 and 112:
to mental and physical health, and
Page 113 and 114:
infirmaries, unless friends or rela
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The only question Carkesse records
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pots 'in the Spectators' Faces'522.
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y visiting 'the hospitals about thi
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Court dealt with both complaints in
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in excess of expenditure. By 1770,
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Hyde in 1781, and Jane Gibbs in 180
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whose immediate care they were573 D
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N N Uj I- LA 0 0 (n . 0 I U C CL I
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Fig. 2d Stone rigur.s o? '1s1ancho1
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Fig. 2g New Beth1en in Moorfields c
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- -,.----1 T 1fi' a - -4Ti L- I F1
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Pig. 2k View of Betbiern at Moorfie
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The fact of the matter is that hist
Page 143 and 144:
emoved the artificial obstacles sta
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edding permitted' at I3ethlem is il
Page 147 and 148:
semi-naked state. James Carkesse co
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when provided with them36. Benefact
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charged if their securities failed
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essaries were still 'wanting for th
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equired 'Sheeted Beds'. While 22% i
Page 157 and 158:
deemed capable of looking after the
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subject of considerable censure in
Page 161 and 162:
Indeed, there is very little direct
Page 163 and 164:
vaults at most 100 . Generally in t
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or lousy 'Kennels' was viewed by ma
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concern for matters of hygiene and
Page 169 and 170:
hospitals and prisons'. Moreover, t
Page 171 and 172:
one means of subjugating the signs
Page 173 and 174:
have supposed. Awareness of the nee
Page 175 and 176:
and that the Committee regularly we
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lunacy, as a means of enclosing the
Page 179 and 180:
of the darkness of Bethiem had as m
Page 181 and 182:
the sober splendour of the hospital
Page 183 and 184:
It would be erroneous to suggest, h
Page 185 and 186:
the weather in contemporary medical
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Diet: feeding and starving the poor
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to Bethiem until 1708, by which tim
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to mechanistic theories of diseased
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in, the eighteenth century hospital
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D inner: Supper: Dinner: Supper: DI
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which was an intermittent source of
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What was missing from the Governors
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aged the Matron and Cook to 'scum y
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'every indulgence, which oeconomy p
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Bethlem, in 1692, that the care of
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seems at least to have acted as a s
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occupying patients after mid-centur
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of which Bethiem has been the great
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most other witnesses at the 1815/16
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Bethlem338 In the period before the
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number of Lunatikes' and of 'their
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with appropriate medicaments, and d
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Chains were imposed as a matter of
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against his physical or moral emanc
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a patient was restrained and of the
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ential, when viewed in the context
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unhealthy obstructions, and even at
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p[re]dudiciall to the said hospital
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cells throughout the period, and th
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apeutic/classificatory division of
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the Governors claimed (with an iron
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(agreeing to abate the entire sum o
Page 241 and 242:
access (with the complicity of staf
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of Bridewell and Bethlem 'proposed'
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Fig. 3a City Surveyor, George Dance
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Pig. 3c g160 I, G -t ? Detail from
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Robinson and Robert Whytt, amongst
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Appointments, patronage, sa1arie an
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and accounting of patients' fees an
Page 255 and 256:
independent right to govern the hos
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At the beginning of the eighteenth
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London for seven years when appoint
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sity, and had accompanied his fathe
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een well groomed for the Bethlem po
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despite his preparedness to serve w
Page 267 and 268:
not succeed his master directly to
Page 269 and 270:
attendance from that of other physi
Page 271 and 272:
the hospitals by checking the Apoth
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medical attention might occasionall
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predecessors to absenteeism. With t
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however, and the assessment of The
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with the Apothecary, the size of hi
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apprentices and staff of Bridewell,
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Nurse had a 'great practice in the
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Bride, where he was resident, in su
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estates to comfortably bring in an
Page 289 and 290:
his appointment'63. Therapy or negl
Page 291 and 292:
those admitted to the hospital, was
Page 293 and 294:
idiculed and censured by his enemie
Page 295 and 296:
give presentations upon numerous po
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the conduct of numerous demonstrati
Page 299 and 300:
can hardly have been expected to ab
Page 301 and 302:
Indeed, hunter and Macalpine did so
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(including the hire of 'a Midwife'
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Lunacy', but also for her 'sore leg
Page 307 and 308:
he had performed, his quantifying o
Page 309 and 310:
physical injury to patients. One mu
Page 311 and 312:
sertion of Teresia Constantia Phill
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part of the century, the Board cons
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a great deal of cause for practitio
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the patient', and claimed that, not
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assessment that 'very little of rea
Page 321 and 322:
negative in the extreme. Rather tha
Page 323 and 324:
The revolution represented by St. L
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introduction of the therapy of cold
Page 327 and 328:
LO N- F—I _C)
Page 329 and 330:
Table 4c: BETIILEM & BRIDEWELL APOT
Page 331 and 332:
Introduction Chapter 5 The Rule of
Page 333 and 334:
and most reviled of all, while 'Bed
Page 335 and 336:
however, this ruling was to be inst
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of the office, than with the profli
Page 339 and 340:
father's social standing; 'a grave
Page 341 and 342:
Nicholson, Jewson and others, have
Page 343 and 344:
and servants. During the seventeent
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Nixon had formerly been basketmen,
Page 347 and 348:
mittee of governors, prompted by a
Page 349 and 350:
than the rule at Bethlem. At St. Ba
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Male and female servants alike were
Page 353 and 354:
active governor, while Joseph Arnol
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of interest on the Governors' part,
Page 357 and 358:
discharge, without any sign of disa
Page 359 and 360:
Bridewell'31. Inferior officers far
Page 361 and 362:
instead of increasing staff salarie
Page 363 and 364:
While Bethlem servants' wages remai
Page 365 and 366: almost expected that Stewards would
Page 367 and 368: With Bethlem's resiting and expansi
Page 369 and 370: servants to care for them; at 1:17.
Page 371 and 372: side the Porter, he was also suppos
Page 373 and 374: were paramount as never before. She
Page 375 and 376: Matron, three basketmen and a singl
Page 377 and 378: personall Attendance is required bo
Page 379 and 380: a result220. Indeed, there are indi
Page 381 and 382: Naturally, attendance was healthier
Page 383 and 384: careers. Basketmen were found guilt
Page 385 and 386: is unknown2as. Between 1700 and 177
Page 387 and 388: Thomas Willis, writing in 1672, cur
Page 389 and 390: punishment as counter-productive, b
Page 391 and 392: Katherine Goodfellow of 'abuses...d
Page 393 and 394: eminence as a place of cruelty towa
Page 395 and 396: abuse of patients by Bethlem staff
Page 397 and 398: instructed to 'locke her upp in one
Page 399 and 400: The period of Langley's Stewardship
Page 401 and 402: of supplementing staff's meagre wag
Page 403 and 404: forbidden repeatedly not 'upon any
Page 405 and 406: 0Ø 0) WI;:!, w CO 0' 1 IC) EC1)
Page 407 and 408: - cr I- Cl) LO+ C,) 0 N- 0000000 (0
Page 409 and 410: 0 co C C') 0 (0 (0 C C C (0 10 .o -
Page 411 and 412: Humphrey Withers Isaac Mount John H
Page 413 and 414: Table 5e: Bethlem Matrons (& Nurses
Page 415: Chapter 6 Patients, Obligors, and t
Page 419 and 420: weekly charge for patients, and the
Page 421 and 422: from 5/to 2/6 per week, a ceiling a
Page 423 and 424: insane, transferring or diverting m
Page 425 and 426: at the direction of Mr. Arnold, a g
Page 427 and 428: to Bethiem in 1654 at a weekly char
Page 429 and 430: compassion being eroded at the eigh
Page 431 and 432: Many obligors had, in fact, been mo
Page 433 and 434: (a friend of Tyson's and a writer o
Page 435 and 436: howse.. .[he] should have bene take
Page 437 and 438: in Figs 6d & 6e, which graph the se
Page 439 and 440: Prior to 1662, a year's residence h
Page 441 and 442: insane could be. The Bethlem Board
Page 443 and 444: acting on reports from persons unna
Page 445 and 446: abandonment of children described a
Page 447 and 448: handicapped105. It was the continue
Page 449 and 450: greater control over admissions aft
Page 451 and 452: ack home. When, for example, in 167
Page 453 and 454: Indeed, both Newell and Toote had b
Page 455 and 456: madhouses who complained bitterly o
Page 457 and 458: the appropriate action to be taken;
Page 459 and 460: other patients under severe threat
Page 461 and 462: to keep them at home or elsewhere w
Page 463 and 464: 22 (or 22%) record that patients we
Page 465 and 466: desire for the cure of the afflicte
Page 467 and 468:
the patient was provided for and 'r
Page 469 and 470:
examine in any depth what the threa
Page 471 and 472:
children & them Mischief'208. With
Page 473 and 474:
numerous accusations of this nature
Page 475 and 476:
one's own property was even less co
Page 477 and 478:
ill of today attempt (or gain) acce
Page 479 and 480:
1670-1762 after delivering letters,
Page 481 and 482:
the scales of justice in the prison
Page 483 and 484:
mirror on his accusers2 On the othe
Page 485 and 486:
fined at Bethlem or elsewhere witho
Page 487 and 488:
tunes earlier, such behaviour was l
Page 489 and 490:
to look after them, but, if orphane
Page 491 and 492:
members of the new Bethiem Committe
Page 493 and 494:
and Bridewell. From the notorious b
Page 495 and 496:
earthly, medical means. Moreover, w
Page 497 and 498:
ate of female patients over male, f
Page 499 and 500:
a similarly grim, if rather incompl
Page 501 and 502:
months before her admission to Beth
Page 503 and 504:
a temporary or exigency measure, un
Page 505 and 506:
at Bethnal Green madhouse, and one
Page 507 and 508:
hospital, over 22% of male admissio
Page 509 and 510:
insensibility, to a prolonged, vege
Page 511 and 512:
considered somewhat tautological. T
Page 513 and 514:
did more for its public and paying
Page 515 and 516:
0 '4— CI, C a) E I. a) (I) CI, C
Page 517 and 518:
N.. 1 m '0 a' In (U U- U IA 0 U. Ii
Page 519 and 520:
a' '0 (1) k4 '1 P'II 0 p 3' C X X C
Page 521 and 522:
'ic) so 40 34 1' (0 icg 6g (,motIr)
Page 523 and 524:
cc) 7ci 60 (0 - —2. Z-3 S-5 5-Jo
Page 525 and 526:
w (0 E a) -D CC m 0 4-. '4- 0 C 0 -
Page 527 and 528:
Table 6b: Occupations Iwhere record
Page 529 and 530:
Table 6c: Patients' Occupations (wh
Page 531 and 532:
Table 6d: Occupations (where record
Page 533 and 534:
0 Q) Oi co ' ,- . I -- aci) (0 0, 0
Page 535 and 536:
TABLE PE T ITI rs FOR A MISSION TO
Page 537 and 538:
TOTALS 345 101-150km Place km Numbe
Page 539 and 540:
ci) cci E ci) ccO ,T .r 'a) Ea Co 0
Page 541 and 542:
C 0 Co Co E 0 CO CO cO -a-Cf) 1 0 C
Page 543 and 544:
TABLEi(cQnt.l - DataOf Died' ______
Page 545 and 546:
7b1e O csrRc FO& '!NCUMPLE' PATIENT
Page 547 and 548:
TABLE PATIENTS' TOTAL JURATION OF S
Page 549 and 550:
0 C,) 0 aa- 'I- 0 Cl) C) SI 0 F- 0
Page 551 and 552:
4., '-4 El z 0p-I U) U) I-i ON
Page 553 and 554:
\0 0 U) z 0 HU) U) H rL4r-4 0 U) U)
Page 555 and 556:
ality of Bethlem's ancillary staff,
Page 557 and 558:
function of extirpation, or was the
Page 559 and 560:
• AppendiX 2a(ii) Grand Committee
Page 561 and 562:
Appendix 2a(ii) continued t1 é i12
Page 563 and 564:
H11RLRUIK METHODIST. To the Tune of
Page 565 and 566:
:.L Appendix 3a(i) George Dance 'B
Page 567 and 568:
Appendix 3b Prices & Composition of
Page 569 and 570:
, Ii_ 6?Jd'4 L nLJ;:. — i %, t 3f
Page 571 and 572:
KNOW all Men by ihefe Prefents, Tha
Page 573 and 574:
It is necefarj the following Partic
Page 575 and 576:
.!$ • 4,tJOy C4a14 — -- - T II
Page 577 and 578:
7 Appendix 61 Certificate of settle
Page 579 and 580:
Appendix 61(11 Letter from Sir Char
Page 581 and 582:
ppendix 6m Petition for the admissi
Page 583 and 584:
To the Right Worj7ipful the PR E S
Page 585 and 586:
Appendix 6p Petition for the admiss
Page 587 and 588:
6) Public Records Office:- PRO Kew
Page 589 and 590:
John Gilbert, A Sermon Preached bef
Page 591 and 592:
Thomas Arnold, Observations on the
Page 593 and 594:
Thomas Dekker and John Webster, Wes
Page 595 and 596:
the Real Art of Physick it self: an
Page 597 and 598:
______ Things Plain and Weighty, Re
Page 599 and 600:
James Yonge, The Journal of James Y
Page 601 and 602:
Michael V. Deporte, Nightmares and
Page 603 and 604:
W. L. Jones, Ministering to Minds D
Page 605 and 606:
______ Was there a moral therapy in
Page 607 and 608:
E. G. Thomas, 'The old poor law and
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