700 YEARS OF BETHLEM
By DR. J. G. HAMILTON
WE have in Britain many old and famous institutions, and this year the oldest mental hospital in the world celebrates the 700th anniversary of its foundation. In 1247 Simon Fitz/Viary, an alderman and sheriff of the City of London, gave property in Bishopsgate Without for the foundation of a priory dedicated to St. Mary of Bethlehem. Perhaps his charity received its inspiration from Godfrey de Prefetti, who in 1247, as Bishop Elect of Bethlehem, had arrived in England, where he held the living of Long Ilchington, near Rugby, with a message to the faithful from Pope Innocent IV. The original deed transfers the property completely to "the Lord Godfrey of the family of Prefetti of the City of Rome, at this time bishop-elect of Bethlehem." There is evidence that in A.D. 330 Constantine had endowed the Basilica of the Nativity in Bethlehem, and that in the thirteenth century, although the parent church had fallen into Moslem hands, the order had daughter churches in Italy and elsewhere. Soon, however, the poverty of the Brethren of tha Priory forced them to appeal for help to the City of London, and an agreement was reached with the Mayor and City of London in 1346.
In 1375 the hospital was seized by Edward III as an alien priory, and it was two years after this that the first reference is traced of its use for mental patients. Again, in the report of the Royal Com- mission of 1403, there is reference to six mental patients who were confined there and also to the use of some instruments of restraint. The next important date in the history of the hospital is 1546, at the end of which year Henry VIII, having suppressed the monasteries, granted to the City of London the control of the five Royal hospitals of Bart's, Thomas's, Christ's, Bethlem and Bridewell. Eleven years later the last two joined together, and to this day are controlled by the same board of governors.
The hospital was not destroyed in the Great Fire of 1666, but already there were plans for a new hospital, and in 1676 the second institution—in Moorgate—was completed. This was a fine building of impressive appearance of which many prints now exist ; it was said to have been designed to resemble the Palace of the Tuileries so as to insult the French, who were unpopular at the time. It was in the early eighteenth century that the hospital became widely known and the name " Bedlam " first came into popular use. Hogarth in his well-known series The Rake's Progress shows the final degradation of his subject in Bedlam, and engravings of his famous picture dated 1735 depict types of psychosis recognisable nowadays. It is also evident that at this time the hospital was a recognised show for visitors, much as the Zoo is nowadays. In 1782 an Act of Parliament ratified the union of Bethlem and Bridewell and settled the dispute between the Court of Common Council of the City of London and other governors.
By the year 1800 the architect had reported the building to be unsafe, but it was not until 1815 that the third hospital—in Lam- beth—was completed. This building remained in use until 1930, when the hospital was transferred to Monk's Orchard, Beckenham, Kent. Here the present modern buildings on the villa plan are to be found. Part of the Lambeth building is now used as the Imperial War Museum, and its copper dome is still a landmark of London. Early in the life of the third hospital there was much dissatisfaction with the way it was conducted, and in 18i5 and i8i6 there were Parliamentary enquiries into the treatment of patients. It seems that the hospital weathered this storm without mending its ways, and in 1851 the visiting Lunacy Commissioners enquired into alle- gations concerning the treatment of patients, and arrangements were then made for periodical inspections by the Lunacy Commissioners— a reform which had been so far resisted by the hospital. Ten years later the hundred or so criminal patients were transferred to the newly built Broadmoor, and their wing was made available for other purposes.
The first physician to be connected with the hospital was John Arundell, who was its master in 1457-8. He was also physician, chaplain and confessor to Henry VI, who in 1453 had temporarily lost his reason, memory, powers of speech and movement. The Privy Council authorised John Arundell and other physicians to administer to the King "head purges and to shalt. his head and to give him baths." Perhaps k was for his treatment of the King that Arundell was made Master of Bethlem and later Bishop of Chichester. The amount of accommodation provided throughout the centuries has varied little. The second hospital in Moorfields had 200 beds ; about this number was to be found in the Lambeth hospital, and the new Bethlem has only a few more. _During the last century other outhorities built asylums, usually for very Jarge numbers of patients, but their design in no way resembled that of Bethlem, which always provided single-room as distinct from dormitory accommodation.
In the 186o's considerable improvements were made in the internal arrangements of the hospital, which was now able to discriminate in the patients it accepted. It was about this time that a regulation was made restricting admission to early and presumably curable cases and making epileptics, paralytics and senile patients not eligible for treatment. Although these changes elevating the standing of the hospital took place nearly a century ago, so slowly do popular beliefs change that there are still to be found people to whom the name Bethlem signifies incurable insanity. It was not until fairly recent years that much treatment has been possible in any mental hospitals. but Bethlem is in the forefront in active treatment of early cases as distinct from custodial treatment of those who cannot live except under care.
It is only to be expected that in a matter so important as health there should be popular misconceptions and superstitions, and indeed it is probably because of these that certain novels and films are so much sought after today. There are signs that education is growing in matters of physical health, but a great deal remains to be done in regard to mental health. There is still an unreasonable prejudice against the person who suffers from a mental breakdown. A man with a past history of mental illness is often looked upon by ignorant people as likely to do the most unpredictable things. In the past such psychoses as schizophrenia and depression were incurable, but insulin treatment, electropexy and cranial surgery have changed the whole outlook. It will, however, probably be a long time before the public is enlightened. Thanks to these treatments the outlook for cure in the serious psychoses in their early forms varies from so per cent. to 90 per cent. ; before these methods were avail- able spontaneous recoveries covered probably less than 5 per cent. of cases.
A large number of the patients admitted to modern mental hospitals are sufferers from various types of neurosis whose condition ' so handicaps them in living that they seek treatment. Therapeutic methods include investigation into their environmental conditions both at home and at work, into their intelligence and personality qualities, and sometimes specialised forms of examination are re- quired. Many men and women with inferiority feelings, obsessional difficulties, anxiety conditions and other disabilities, who cannot adjust themselves without assistance, now get treatment so that their life takes on a new interest and happiness. The next few years are to see great expansion in the health services of the country to supply the public need ; in -no branch is this more required than in psychiatry.
The International Conference of Physicians, who meet in London in September this year, have appointed a section of psychiatry, and in August next year, also in London, there is to be an International Congress on Mental Health. Both these congresses are likely to attract large numbers of foreign physicians, and much will be gained from the interchange of ideas. All authorities are agreed that the amount of disability from neurosis today is undoubtedly very great, and all the psychiatric out-patients' departments of our hospitals have long waiting lists. Large numbers of specialists are required for this leeway to be made up, and Bethlem Royal Hospital will no doubt continue to make its contribution to their training.
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