Bethlem Royal Hospital - Medieval Period

Medieval Period

Throughout the reign of Edward III (1327–77) the English monarchy had extended its patronage over ecclesiastical positions through the seizure of alien priories. These were religious institutions that were under the control of non-English religious houses. As a dependent house of the Order of Saint Bethlehem in Clamecy, France, Bethlem was vulnerable to seizure by the crown and this occurred in the 1370s when Edward III took control of the hospital. After this event the masters of the hospital, semi-autonomous figures in charge of day-to-day management, were normally crown appointees. Subsequently Bethlem became a more secularised institution.

It is unknown from what exact date it began to specialise in the care and control of the insane. Despite this fact it has been frequently asserted that Bethlem was first used for the insane from 1377. This rather precise date is derived from the unsubstantiated conjecture of the Reverend Edward Geoffrey O'Donoghue, chaplain to the hospital, who published a monograph on its history in 1914. While it is likely that Bethlem was receiving the insane during the fourteenth-century, the first definitive record of their presence in the hospital is provided from the details of a visitation of the Charity Commissioners in 1403. This recorded that amongst other patients then in the hospital there were six male inmates who were "mente capti", a Latin term indicating insanity. The report of the same visitation also recorded the presence of four pairs of manacles, eleven chains, six locks and two pairs of stocks although it is not clear if any or all of these items were for the restraint of the inmates. Thus, while mechanical restraint and solitary confinement are likely to have been used, little else is known of the actual treatment of the insane in Bethlem for much of the medieval period. However, William Gregory, the Lord Mayor of London, referred to the hospital in the mid-fifteenth century in the following terms:

A Church of Our Lady that is named Bedlam. And in that place be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man —William Gregory, Lord Mayor of London, c. 1450, quoted in Allderidge (1979a, p. 144)

In 1546 the Lord Mayor of London, Sir John Gresham, petitioned the crown to grant Bethlem to the city. This petition was partially successful and Henry VIII reluctantly ceded to the City of London "the custody, order and governance" of the hospital and of its "occupants and revenues". This charter came into effect in 1547. Under this formulation the crown retained possession of the hospital while its administration fell to the city authorities. Following a brief interval when Bethlem was placed under the management of the Governors of Christ's Hospital, from 1557 it was administered by the Governors of the city Bridewell, a prototype House of Correction at Blackfriars. Having been thus one of the few metropolitan hospitals to have survived the dissolution of the monasteries physically intact, this joint administration continued, not without interference by both the crown and city, until Bethlem's incorporation into the National Health Service in 1948.