Gem From The Archive

Archivist David Luck explains how an annual report reveals a crucial turning-point in the history of Bethlem Hospital

Bethlem Hospital annual report, 1842

Bethlem Royal Hospital, once nicknamed ‘Bedlam’, was founded in London in 1247 and has been a working mental hospital since 1400, using changing ideas about psychiatry to treat its patients. Records of the hospital’s long history are kept by the Bethlem Museum of the Mind, whose archivist, David Luck, tells us how an 1842 report captures the hospital in a state of change.

Tell Me About The Document…

It’s an annual report that covers the year 1841. It was produced in 1842 by Dr Alexander Morrison for the Bethlem and Bridewell Board of Governors, who were in charge of Bethlem Hospital. At that point Bethlem was not obliged to come under the scrutiny of the Commissioners of Lunacy. But it was coming under increasing pressure to adopt a more scientific approach and to open itself up to scrutiny. So really the report kind of represents a halfway house. It’s a set of data Morrison produced in line with the standards of the time to try to give some sort of facts and figures for the people going into Bethlem. Because as far as the commissioners were concerned, they saw people going into Bethlem and they saw people coming out of Bethlem, but nobody had any idea what was actually going on at the hospital.

What Does It Tell Us About Mental Health Treatment At The Time?

The exciting thing is that it contains a breakdown of what’s happening to each individual patient. There are some pro formas on what they were suffering from. The language around mental health was starting to become more scientific, but, for instance, they still referred to people as lunatics. The view was that these were people who suffered from attacks – there’s not a conception yet of mental health being a long-term condition. The idea they had was that your mental health was all fine until the point when it suddenly wasn’t. So it’s very different from how we view mental health today.

There’s stuff on the patient’s life: what they were doing; what age they were;

and notes on whether they had hereditary inclinations to madness. The idea that there were hereditary factors in mental health was the big thing in Victorian thought, whereas today we think that environment and brain chemistry are more important. And then there is each patient’s treatment, which provides our first look inside the hospital. Treatment is not something that Bethlem talked about in the specific for its patients for quite a long time after this. But here we find out whether they were given cold baths, drugs, and leaches, blisters or bleeding – all three were thought to help.

Why Were The Patients Treated In This Way?

This was a time of upheaval at the hospital. Morrison was a very modern doctor – he believed in statistics, in trying to work out what was going on with people. He was joint physician in the hospital, however, and the other physician Edward Thomas Monro was a very old-school doctor who practised Galenic medicine: he believed that topping up and reducing the humours would create a balance and harmony in the body and mind. That’s a throwback to almost medieval medicine. There was definitely tension between the two men.

In the next 10 years the hospital moved more towards Morrison’s vision. Treatments became more therapeutic, so the wards were created to be more bright and lively. Pet dogs and birds were brought in, and patients were given occupations and things to do. There was a regular evening ball, and music recitals. The annual report is a snapshot capturing the hospital when it was caught between a form of treatment that we’d regard as quite brutal, and Morrison’s more scientific and caring approach.

What Other Documents Are In Your Collection?

Our records start in around 1557, when Bethlem was transferred to the governors of Bethlem and Bridewell. Our admission books begin in the mid-1600s for patients, and from 1850 onwards we have patient casebooks and case notes as well. It’s in 1852 that you start getting very thorough case notes. We have a run of about 200 casebooks, from the early 1800s to the 1930s. The useful sources for patient information are digitised and indexed on findmypast.co.uk. Your readers can search the collection ‘London, Bethlem Hospital Patient Admission Registers and Casebooks 1683–1932’.