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

weekly charge for patients, and the actual bond requiring their obligors to fulfil certain condi-
tions for their maintenance and removal, was agreed. (Each patient, with the exception of those
for whom an institution, public society or government body, stood as guarantor, was required
to have two 'sufficient' sureties resident within, or in the suburbs of, London, who signed the
bond and acted as insurance for the hospital). In the event of doubts as to the ability of obligors
to afford a patient's maintenance in Bethiem, governors were often asked to investigate their
financial condition, and the results of these enquiries produced in the Court Minutes also em-
phasise the poverty of the hospital's clients 3. Fees set by the Court of Governors for patients'
support were spoken of as payments 'towards the charge of keeping', signifying that they would
not suffice to defray all the expenses of maintenance, but were a charitable concession and that
the charity of Bethiem would supply the 'residue' 4 . These charges might be anything from 0-8/
per week, during the seventeenth century. The standard charge, however, was 5/, while the
hospital's policies of initial reductions, in view of hardship, and of abatements, in view (For
example) of circumstantial alterations, or prolonged lunacies, made 5/, throughout the period,
the highest most families, individuals, parishes and public societies, were required to pay. This
endowed patient admissions with a strong element of bargaining, whereby sureties were able to
negotiate with the Court for pat ents' support by outlining their conditions of poverty. In this
sense, then, admission was viewed as the positive relief of material distress, economic decay was
viewed substantially as a concomitant of mental decay, and the Governors saw themselves as
benevolent benefactors of the poor, relieving both the 'very poore' families and friends, and the
'overburthened' parishes, of the insane, and also succouring 'poore decayed...distracted' indi-
viduals themselves 5 . Those lunatics or relations who had means of their own were, natura1ly,
required to contribute by the Court, and if those means were deemed sufficient for a patient to
be maintained elsewhere, patients were, ordinarily, barred from admission or discharged from
the hospital 6 . Incurables, too, were discharged if 'intitled to any Estate or money sufficient to
see e.g. the case of Robert Ingram whose claim that he could not afford 5/ p/w for the support of his wile
was confirmed on a govel-nor's finding that he 'is a very poore man and not able to hold his house but dwelkth
in one Roome'; BCGM, 6 & 20 Nov. 1674, lola 62 & 67.
Between 8/ & 10/ was normally the Governors' estimate of what it cost to maintain a single patient. See
e.g. BCGM, 8 July 1653, 2 March 1659, 20 Oct. 1670, 3 Oct. 1673, loIs 616, 113, 235-6 & 567.
BGGM, e.g. 16 Nov. 1653, 3 Feb. 1654, 16 Jan. 1656, loIs 629, 641 & 729.
6 Martha Thornton, e g., an orphan of 20 years, with £40 'to her porcon', w initially charged only 3/
p1w, but the hospital also approached the Court of Aldermen to get 'the residue of the charge towards hesS
keeping...paid unto her out of the Chamber of London'. For moneyed patients discharged from Rethlem, see e g.
BSCM, 22 Sept. 1759, 14, Nov. 1761, 17 Sept. 1763, 5 May 1770, 18 May 1776, 13 April 1782, 8 Nov. 1783,
fols 235, 358, 52 & nm, cases of Joseph Belaham, John Godbolt, William McLacklar,, James Brewster, William
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