Бетлема Королевская больница

Бетлема Королевская больница
Южный Лондон и Модсли Фонд Фонда
Shown in Bromley
Geography
Location	Monks Orchard Road, Beckenham, London, England
Organisation
Care system	National Health Service
Type	Specialist
Services
Emergency department	No
Beds	Approx 350
Speciality	Psychiatric hospital
History
Opened	1247 as priory 1330 as hospital
Links
Website	slam.nhs.uk/bethlem-royal-hospital
Lists	Hospitals in England

Королевская больница Вифлем , также известная как Святая Мария Вифлеем , Вифлеемская больница и Бедлам , является психиатрической больницей в Бромли, Лондон . Его знаменитая история вдохновила несколько книг ужасов, фильмов и сериалов, в первую очередь Bedlam , фильм 1946 года с Борисом Карлоффом .

Больница является частью фонда Фонда NHS в Южном Лондоне и Модсли . Он тесно связан с Королевским колледжем в Лондоне , и в партнерстве с Институтом психиатрии, психологии и нейробиологии является крупным центром психиатрических исследований. Он является частью King's Health Partners Академического центра здравоохранения и Национального института здравоохранения и ухода Центра биомедицинских исследований по психическому здоровью (NIHR).

Основанная в 1247 году, больница первоначально была расположена недалеко от городских стен , в епископсгейте без района Лондонского города . Он перешел на небольшое расстояние до Мурфилдса в 1676 году, а затем на поля Святого Георгия в Саутуорке в 1815 году, а затем переехал в свое нынешнее место в саду монахов в 1930 году.

The word "bedlam", meaning uproar and confusion, is derived from the hospital's nickname. Although the hospital became a modern psychiatric facility, historically it was representative of the worst excesses of asylums in the era of lunacy reform.

1247–1633

Foundation

Plan of the first Bethlem

Map of London in c. 1300. St Mary Spital is shown north of the city wall, outside Bishopgate.

The hospital was founded in 1247 as the Priory of the New Order of our Lady of Bethlehem in the city of London during the reign of Henry III.

It was established by the Bishop-elect of Bethlehem, the Italian Goffredo de Prefetti, following a donation of personal property by the London alderman and former sheriff, Simon FitzMary. The original location was just beyond London's wall, in the parish of St Botolph-without-Bishopsgate, which for civil purposes was coterminous with the Bishopsgate Without area. The hospital was located where the south-east corner of Liverpool Street Station now stands. Bethlem was not initially intended as a hospital, in the clinical sense, much less as a specialist institution for the insane, but as a centre for the collection of alms to support the Crusader Church and to link England to the Holy Land.

De Prefetti's need to generate income for the Crusader Church and restore the financial fortunes of his see had been occasioned by two misfortunes: his bishopric had suffered significant losses following the destructive conquest of Bethlehem by the Khwarazmian Turks in 1244, and his immediate predecessor had further impoverished his cathedral chapter through the alienation of a considerable amount of its property. The priory, obedient to the Church of Bethlehem, would also house the poor and, if they visited, provide hospitality to the bishop, canons, and brothers of Bethlehem. Thus, Bethlem became a hospital, in medieval usage, "an institution supported by charity or taxes for the care of the needy". The subordination of the priory's religious order to the bishops of Bethlehem was further underlined in the foundational charter, which stipulated that the prior, canons, and inmates were to wear a star upon their cloaks and capes to symbolise their obedience to the church of Bethlehem.

Politics and patronage

During the thirteenth and fourteenth centuries, with its activities underwritten by episcopal and papal indulgences, the hospital's role as a centre for alms collection persisted, but its linkage to the Order of Bethlehem increasingly unravelled, putting its purpose and patronage in doubt. In 1346, the master of Bethlem, a position at that time granted to the most senior of London's Bethlemite brethren, applied to the city authorities seeking protection; thereafter metropolitan office-holders claimed power to oversee the appointment of masters and demanded in return an annual payment of 40 shillings. It is doubtful whether the city really provided substantial protection and much less that the mastership fell within their patronage but, dating from the 1346 petition, it played a role in the management of Bethlem's finances. By this time, the Bethlehemite bishops had relocated to Clamecy, France, under the surety of the Avignon papacy. This was significant as, throughout the reign of Edward III (1327–77), the English monarchy had extended its patronage over ecclesiastical positions through the seizure of priories under the control of non-English religious houses. As a dependent house of the Order of Saint Bethlehem in Clamecy, Bethlem was vulnerable to seizure by the crown and this occurred in the 1370s when Edward III took control. The purpose of this appropriation was, in the context of the Hundred Years' War between France and England, to prevent funds raised by the hospital from enriching the French monarchy via the papal court. After this event the masters of the hospital, semi-autonomous figures in charge of its day-to-day management, were normally crown appointees and it became an increasingly secularised institution. The memory of its foundation became muddied and muddled; in 1381, the royal candidate for the post of master claimed that from its beginnings it had been superintended by an order of knights and he confused its founder, Goffredo de Prefetti, with the Frankish crusader, Godfrey de Bouillon. The removal of the last symbolic link to the Bethlehemites was confirmed in 1403 when it was reported that master and inmates no longer wore the star of Bethlehem.

"The Prospect of Bridewell" from John Strype's, An Accurate Edition of Stow's "A Survey of London" (1720). From 1557, Bethlem was administered by the Bridewell Governors.

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. The crown retained possession of the hospital while its administration fell to the city authorities. Following a brief interval when it was placed under the management of the governors of Christ's Hospital, from 1557 it was administered by the governors of 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 incorporation into the National Health Service in 1948.

From Bethlem to Bedlam

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

It is unknown when Bethlem, or Bedlam, began to specialise in the care and control of the insane, but it has been frequently asserted that Bethlem was first used for the insane from 1377. This 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 possible that Bethlem was receiving the insane during the late fourteenth century, the first definitive record of their presence in the hospital is in the details of a visitation of the Charity Commissioners in 1403. This recorded that amongst other patients there were six male inmates who were "mente capti", a Latin term indicating insanity. The report of the visitation also noted the presence of four pairs of manacles, 11 chains, six locks and two pairs of stocks but it is not clear if any or all of these items were for the restraint of the inmates. While mechanical restraint and solitary confinement are likely to have been used for those regarded as dangerous, little else is known of the actual treatment of the insane for much of the medieval period. The presence of a small number of insane patients in 1403 marks Bethlem's gradual transition from a diminutive general hospital into a specialist institution for the confinement of the insane. This process was largely completed by 1460.

Curtain Theatre circa 1600 (cylindrical building in the background). Some authorities believe this to be a depiction of The Theatre, the other Elizabethan theatre at Shoreditch in west Moorfields. Both playhouses were a stone's throw away from the original Bethlem site at Bishopsgate.

From the fourteenth century, Bethlem had been referred to colloquially as "Bedleheem", "Bedleem" or "Bedlam". Initially "Bedlam" was an informal name but from approximately the Jacobean era the word entered everyday speech to signify a state of madness, chaos, and the irrational nature of the world. This development was partly due to Bedlam's staging in several plays of the Jacobean and Caroline periods, including The Honest Whore, Part I (1604); Northward Ho (1607); The Duchess of Malfi (1612); The Pilgrim (c. 1621); and The Changeling (1622). This dramatic interest in Bedlam is also evident in references to it in early seventeenth-century plays such as Epicœne, or The Silent Woman (1609), Bartholomew Fair (1614), and A New Way to Pay Old Debts (c. 1625). The appropriation of Bedlam as a theatrical locale for the depiction of madness probably owes no little debt to the establishment in 1576 in nearby Moorfields of The Curtain and The Theatre, two of the main London playhouses; it may also have been coincident with that other theatricalisation of madness as charitable object, the commencement of public visiting at Bethlem.

Management

The position of master was a sinecure largely regarded by its occupants as means of profiting at the expense of the poor in their charge. The appointment of the masters, later known as keepers, had lain within the patronage of the Crown until 1547. Thereafter the City, through the Court of Aldermen, took control and, as with the king's appointees, the office was used to reward loyal servants and friends. Compared to the masters placed by the monarch, those who gained the position through the city were of much more modest status. In 1561, the Lord Mayor succeeded in having his former porter, Richard Munnes, a draper by trade, appointed to the position. The sole qualification of his successor in 1565, a man by the name of Edward Rest, appears to have been his occupation as a grocer. Rest died in 1571, at which point the keepership passed on to John Mell in 1576, known for his abuse of "the governors, those who gave money to the poor, and the poor themselves." The Bridewell Governors largely interpreted the role of keeper as that of a house manager and this is clearly reflected in the occupations of most appointees as they tended to be inn-keepers, victualers, or brewers, and the like. When patients were sent to Bethlem by the Governors of the Bridewell the keeper was paid from hospital funds. For the remainder, keepers were paid either by the families and friends of inmates or by the parish authorities. It is possible that keepers negotiated their fees for these latter categories of patients.

John Mell's death in 1579 left the keepership open for the long-term keeper Roland Sleford, a London cloth-maker, who left his post in 1598, apparently of his own volition, after a 19-year tenure. Two months later, the Bridewell Governors, who had until then shown little interest in the management of Bethlem beyond the appointment of keepers, conducted an inspection of the hospital and a census of its inhabitants for the first time in over 40 years. Their purpose was "to view and p[er]use the defaultes and want of rep[ar]ac[i]ons". They found that during the period of Sleford's keepership the hospital buildings had fallen into a deplorable condition with the roof caving in and the kitchen sink blocked, and reported that "...it is not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fit for any man to come into the house".

The committee of inspection found 21 inmates with only two having been admitted during the previous 12 months. Of the remainder, at least six had been resident for a minimum of eight years and one inmate had been there for around 25 years. Three were from outside London, six were charitable cases paid for out of the hospital's resources, one was supported by a parochial authority, and the rest were provided for by family, friends, benefactors or, in one instance, out of their own funds. The reason for the Governors' new-found interest in Bethlem is unknown but it may have been connected to the increased scrutiny the hospital was coming under with the passing of poor law legislation in 1598 and to the decision by the Governors to increase hospital revenues by opening it up to general visitors as a spectacle. After this inspection, the Governors initiated some repairs and visited the hospital at more frequent intervals. During one such visit in 1607, they ordered the purchase of clothing and eating vessels for the inmates, presumably indicating the lack of such basic items.

Helkiah Crooke

The title page of Helkiah Crooke's Microcosmographia (1615). Crooke was appointed keeper-physician to Bethlem Hospital in 1619.

At the bidding of James VI and I, Helkiah Crooke (1576–1648) was appointed keeper-physician in 1619. As a Cambridge graduate, the author of an enormously successful English language book of anatomy entitled Microcosmographia: a Description of the Body of Man (1615) and a member of the medical department of the royal household, he was clearly of higher social status than his city-appointed predecessors (his father was a noted preacher, and his elder brother Thomas was created a baronet). Crooke had successfully ousted the previous keeper, the layman Thomas Jenner, after a campaign in which he had castigated his rival for being "unskilful in the practice of medicine". While this may appear to provide evidence of the early recognition by the Governors that the inmates of Bethlem required medical care, the formal conditions of Crooke's appointment did not detail any required medical duties. Indeed, the Board of Governors continued to refer to the inmates as "the poore" or "prisoners" and their first designation as patients appears to have been by the Privy Council in 1630.

From 1619, Crooke unsuccessfully campaigned through petition to the king for Bethlem to become an independent institution from the Bridewell, a move that while likely meant to serve both monarchial and personal interest would bring him into conflict with the Bridewell Governors. Following a pattern of management laid down by early office-holders, his tenure as keeper was distinguished by his irregular attendance at the hospital and the avid appropriation of its funds as his own. Such were the depredations of his regime that an inspection by the Governors in 1631 reported that the patients were "likely to starve". Charges against his conduct were brought before the Governors in 1632. Crooke's royal favour having dissolved with the death of James I, Charles I instigated an investigation against him in the same year. This established his absenteeism and embezzlement of hospital resources and charged him with failing to pursue "any endeavour for the curing of the distracted persons". It also revealed that charitable goods and hospital-purchased foodstuffs intended for patients had been typically misappropriated by the hospital steward, either for his own use or to be sold to the inmates. If patients lacked resources to trade with the steward they often went hungry. These findings resulted in the dismissal in disgrace of Crooke, the last of the old-style keepers, along with his steward on 24 May 1633.

Conditions

In 1632 it was recorded that the old house of Bethlem had "below stairs a parlour, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in". It is likely that this arrangement was not significantly different in the sixteenth century. Although inmates, if deemed dangerous or disturbing, were chained or locked up, Bethlem was an otherwise open building with its inhabitants at liberty to roam around its confines and possibly the local neighbourhood. The neighbouring inhabitants would have been quite familiar with the condition of the hospital as in the 1560s, and probably for some considerable time before that, those who lacked a lavatory in their own homes had to walk through "the west end of the long house of Bethlem" to access the rear of the hospital and reach the "common Jacques". Typically the hospital appears to have been a receptacle for the very disturbed and troublesome and this fact lends some credence to accounts such as that provided by Donald Lupton in the 1630s who described the "cryings, screechings, roarings, brawlings, shaking of chaines, swearings, frettings, chaffings" that he observed.

Bethlem had been built over a sewer that served both the hospital and its precinct. This common drain regularly blocked, resulting in overflows of waste at the entrance of the hospital. The 1598 visitation by the Governors had observed that the hospital was "filthely kept", but the Governors rarely made any reference to the need for staff to clean the hospital. The level of hygiene reflected the inadequate water supply, which, until its replacement in 1657, consisted of a single wooden cistern in the back yard from which water had to be laboriously transported by bucket. In the same yard since at least the early seventeenth century there was a "washhouse" to clean patients' clothes and bedclothes and in 1669 a drying room for clothes was added. Patients, if capable, were permitted to use the "house of easement", of which there were two at most, but more frequently "piss-pots" were used in their cells. Unsurprisingly, inmates left to brood in their cells with their own excreta were, on occasion, liable to throw such "filth & Excrem[en]t" into the hospital yard or onto staff and visitors. Lack of facilities combined with patient incontinence and prevalent conceptions of the mad as animalistic and dirty, fit to be kept on a bed of straw, appear to have promoted an acceptance of hospital squalor. However, this was an age with very different standards of public and personal hygiene when people typically were quite willing to urinate or defecate in the street or even in their own fireplaces.

For much of the seventeenth century the dietary provision for patients appears to have been inadequate. This was especially so during Crooke's regime, when inspection found several patients suffering from starvation. Corrupt staff practices were evidently a significant factor in patient malnourishment and similar abuses were noted in the 1650s and 1670s. The Governors failed to manage the supply of victuals, relying on "gifts in kind" for basic provisions, and the resources available to the steward to purchase foodstuffs was dependent upon the goodwill of the keeper. Patients were fed twice a day on a "lowering diet" (an intentionally reduced and plain diet) consisting of bread, meat, oatmeal, butter, cheese, and generous amounts of beer. It is likely that daily meals alternated between meat and dairy products, almost entirely lacking in fruit or vegetables. That the portions appear to have been inadequate also likely reflected contemporary humoral theory that justified rationing the diet of the mad, the avoidance of rich foods, and a therapeutics of depletion and purgation to restore the body to balance and restrain the spirits.

1634–1791

Medical regime

James Monro was elected to the post of Bethlem physician in 1728, a position which he retained until his death in 1752. This marked the beginning of a 125-year Monro family dynasty of Bethlem physicians.

The year 1634 is typically interpreted as denoting the divide between the medieval and early modern administration of Bethlem. It marked the end of the day-to-day management by an old-style keeper-physician and its replacement by a three-tiered medical regime composed of a non-resident physician, a visiting surgeon and an apothecary, a model adopted from the royal hospitals. The medical staff were elected by the Court of Governors and, in a bid to prevent profiteering at the expense of patients that had reached its apogee in Crooke's era, they were all eventually salaried with limited responsibility for the financial affairs of the hospital. Personal connections, interests and occasionally royal favour were pivotal factors in the appointment of physicians, but by the measure of the times appointees were well qualified as almost all were Oxford or Cambridge graduates and a significant number were candidates for or fellows of the Royal College of Physicians. Although the posts were strongly contested, nepotistic appointment practices played a significant role. The election of James Monro as physician in 1728 marked the beginning of a 125-year Monro family dynasty extending through four generations of fathers and sons. Family influence was also significant in the appointment of surgeons but absent in that of apothecaries.

The office of physician was largely an honorary and charitable one with only a nominal salary. As with most hospital posts, attendance was required only intermittently and the greater portion of the income was derived from private practice. Bethlem physicians, maximising their association with the hospital, typically earned their coin in the lucrative "trade in lunacy" with many acting as visiting physicians to, presiding over, or even, as with the Monros and their predecessor Thomas Allen, establishing their own mad-houses. Initially both surgeons and apothecaries were also without salary and their hospital income was solely dependent upon their presentation of bills for attendance to the Court of Governors. This system was frequently abused and the bills presented were often deemed exorbitant by the Board of Governors. The problem of financial exploitation was partly rectified in 1676, when surgeons received a salary, and from the mid-eighteenth century elected apothecaries were likewise salaried and normally resident within the hospital. Dating from this latter change, the vast majority of medical responsibilities within the institution were undertaken by the sole resident medical officer, the apothecary, owing to the relatively irregular attendance of the physician and surgeon.

But is there so great Merit and Dexterity in being a mad Doctor? The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit, and a Vomit and a Purge over again, and sometimes a Bleeding, which is no great mystery

Alexander Cruden, The London Citizen Exceedingly Injured, 1739.

The medical regime, being married to a depletive or antiphlogistic physic until the early nineteenth century, had a reputation for conservatism that was neither unearned nor, given the questionable benefit of some therapeutic innovations, necessarily ill-conceived in every instance. Bathing was introduced in the 1680s at a time when hydrotherapy was enjoying a recrudescence in popularity. "Cold bathing", opined John Monro, Bethlem physician for 40 years from 1751, "has in general an excellent effect"; and remained much in vogue as a treatment throughout the eighteenth century. By the early nineteenth century, bathing was routine for all patients of sufficient hardiness from summer "to the setting-in of the cold weather". Spring signalled recourse to the traditional armamentarium; from then until the end of summer Bethlem's "Mad Physick" reigned supreme as all patients, barring those deemed incurable, could expect to be bled and blistered and then dosed with emetics and purgatives. Indiscriminately applied, these curative measures were administered with the most cursory physical examination, if any, and with sufficient excess to risk not only health but also life. Such was the violence of the standard medical course, "involving voiding of the bowels, vomiting, scarification, sores and bruises," that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught.

The reigning medical ethos was the subject of public debate in the mid-eighteenth century when the Paper War of 1752–1753 erupted between John Monro and his rival William Battie, physician to the reformist St Luke's Asylum of London, founded in 1751. The Bethlem Governors, who had presided over the only public asylum in Britain until the early eighteenth century, looked upon St Luke's as an upstart institution and Battie, formerly a Governor at Bethlem, as traitorous. In 1758 Battie published his Treatise on Madness which castigated Bethlem as archaic and outmoded, uncaring of its patients and founded upon a despairing medical system whose therapeutic transactions were both injudicious and unnecessarily violent. In contrast, Battie presented St Luke's as a progressive and innovative hospital, oriented towards the possibility of cure and scientific in approach. Monro responded promptly, publishing Remarks on Dr. Battie's Treatise on Madness in the same year.

Bethlem rebuilt at Moorfields

The new Bethlem Hospital, designed by Robert Hooke, 1676, "primarily as a piece of fundraising rhetoric"

Most of Bethlehem Hospital by William Henry Toms for William Maitland's History of London, published 1739

Although Bethlem had been enlarged by 1667 to accommodate 59 patients, the Court of Governors of Bethlem and Bridewell observed at the start of 1674 that "the Hospitall House of Bethlem is very olde, weake & ruinous and to[o] small and streight for keepeing the greater numb[e]r of lunaticks therein att p[re]sent". With the increasing demand for admission and the inadequate and dilapidated state of the building it was decided to rebuild the hospital in Moorfields, just north of the city proper and one of the largest open spaces in London. The architect chosen for the new hospital, which was built rapidly and at great expense between 1675 and 1676, was the natural philosopher and City Surveyor Robert Hooke. He constructed an edifice that was monumental in scale at over 500 feet (150 m) wide and some 40 feet (12 m) deep. The surrounding walls were some 680 feet (210 m) long and 70 feet (21 m) deep while the south face at the rear was effectively screened by a 714-foot (218 m) stretch of London's ancient wall projecting westward from nearby Moorgate. At the rear and containing the courtyards where patients exercised and took the air, the walls rose to 14 feet (4.3 m) high. The front walls were only 8 feet (2.4 m) high but this was deemed sufficient as it was determined that "Lunatikes... are not to [be] permitted to walk in the yard to be situate[d] betweene the said intended new Building and the Wall aforesaid." It was also hoped that by keeping these walls relatively low the splendour of the new building would not be overly obscured. This concern to maximise the building's visibility led to the addition of six gated openings 10 feet (3.0 m) wide which punctuated the front wall at regular intervals, enabling views of the facade. Functioning as both advertisement and warning of what lay within, the stone pillars enclosing the entrance gates were capped by the figures of "Melancholy" and "Raving Madness" carved in Portland stone by the Danish-born sculptor Caius Gabriel Cibber.

Late seventeenth-century map showing the placement of the new Bethlem Hospital in Moorfields. It shows the large gardens of Moorfields to the north of the front face of the building. The hospital is shown as a very long and thin structure.

At the instigation of the Bridewell Governors and to make a grander architectural statement of "charitable munificence", the hospital was designed as a single- rather than double-pile building, accommodating initially 120 patients. Having cells and chambers on only one side of the building facilitated the dimensions of the great galleries, essentially long and capacious corridors, 13 feet (4.0 m) high and 16 feet (4.9 m) wide, which ran the length of both floors to a total span of 1,179 feet (359 m). Such was their scale that Roger L'Estrange remarked in a 1676 text eulogising the new Bethlem that their "Vast Length ... wearies the travelling eyes' of Strangers". The galleries were constructed more for public display than for the care of patients as, at least initially, inmates were prohibited from them lest "such persons that come to see the said Lunatickes may goe in Danger of their Lives".

Melancholia and Raving Madness (mania) carved by Caius Gabriel Cibber (1680), and which adorned the entrance portal of the new Bethlem Hospital at Moorfields

The architectural design of the new Bethlem was primarily intended to project an image of the hospital and its governors consonant with contemporary notions of charity and benevolence. In an era prior to the state funding of hospitals and with patient fees covering only a portion of costs, such self-advertisement was necessary to win the donations, subscriptions and patronage essential for the institution's survival. This was particularly the case in raising funds to pay for major projects of expansion such as the rebuilding project at Moorfields or the addition of the Incurables Division in 1725–39 with accommodation for more than 100 patients. These highly visible acts of civic commitment could also serve to advance the claims to social status or political advantage of its Governors and supporters. However, while consideration of patients' needs may have been distinctly secondary, they were not absent. For instance, both the placement of the hospital in the open space of Moorfields and the form of the building with its large cells and well-lit galleries had been chosen to provide "health and Aire" in accordance with the miasmatic theory of disease causation.

It was London's first major charitable building since the Savoy Hospital (1505–17) and one of only a handful of public buildings then constructed in the aftermath of the Great Fire of London (1666). It would be regarded, during this period at least, as one of the "Prime Ornaments of the City ... and a noble Monument to Charity". Not least due to the increase in visitor numbers that the new building allowed, the hospital's fame and latterly infamy grew and this magnificently expanded Bethlem shaped English and international depictions of madness and its treatment.

Public visiting

Eighteenth-century Bethlem was most notably portrayed in a scene from William Hogarth's A Rake's Progress (1735), the story of a rich merchant's son, Tom Rakewell, whose immoral living causes him to end up in Bethlem.

Visits by friends and relatives were allowed and it was expected that the family and friends of poor inmates would bring food and other essentials for their survival. Bethlem was and is best known for the fact that it also allowed public and casual visitors with no connection to the inmates. This display of madness as public show has often been considered the most scandalous feature of the historical Bedlam.

On the basis of circumstantial evidence, it is speculated that the Bridewell Governors may have decided as early as 1598 to allow public visitors as means of raising hospital income. The only other reference to visiting in the sixteenth-century is provided in a comment in Thomas More's 1522 treatise The Four Last Things, where he observed that "thou shalt in Bedleem see one laugh at the knocking of his head against a post". As More occupied a variety of official positions that might have occasioned his calling to the hospital and as he lived nearby, his visit provides no compelling evidence that public visitation was widespread during the sixteenth century. The first apparently definitive documentation of public visiting derives from a 1610 record which details Lord Percy's payment of 10 shillings for the privilege of rambling through the hospital to view its deranged denizens. It was also at this time, and perhaps not coincidentally, that Bedlam was first used as a stage setting with the publication of The Honest Whore, Part I, in 1604.

Evidence that the number of visitors rose following the move to Moorfields is provided in the observation by the Bridewell Governors in 1681 of "the greate quantity of persons that come daily to see the said Lunatickes". Eight years later the English merchant and author, Thomas Tryon, remarked disapprovingly of the "Swarms of People" that descended upon Bethlem during public holidays. In the mid-eighteenth-century a journalist of a topical periodical noted that at one time during Easter Week "one hundred people at least" were to be found visiting Bethlem's inmates. Evidently Bethlem was a popular attraction, yet there is no credible basis to calculate the annual number of visitors. The claim, still sometimes made, that Bethlem received 96,000 visitors annually is speculative in the extreme. Nevertheless, it has been established that the pattern of visiting was highly seasonal and concentrated around holiday periods. As Sunday visiting was severely curtailed in 1650 and banned seven years later, the peak periods became Christmas, Easter, and Whitsun.

... you find yourself in a long and wide gallery, on either side of which are a large number of little cells where lunatics of every description are shut up, and you can get a sight of these poor creatures, little windows being let into the doors. Many inoffensive madmen walk in the big gallery. On the second floor is a corridor and cells like those on the first floor, and this is the part reserved for dangerous maniacs, most of them being chained and terrible to behold. On holidays numerous persons of both sexes, but belonging generally to the lower classes, visit this hospital and amuse themselves watching these unfortunate wretches, who often give them cause for laughter. On leaving this melancholy abode, you are expected by the porter to give him a penny but if you happen to have no change and give him a silver coin, he will keep the whole sum and return you nothing

Inveterate letter-writer César de Saussure's account of Bethlem during his 1725 tour of London's sights.

The Governors actively sought out "people of note and quallitie" – the educated, wealthy and well-bred – as visitors. The limited evidence would suggest that the Governors enjoyed some success in attracting such visitors of "quality". In this elite and idealised model of charity and moral benevolence the necessity of spectacle, the showing of the mad so as to excite compassion, was a central component in the elicitation of donations, benefactions, and legacies. Nor was the practice of showing the poor and unfortunate to potential donators exclusive to Bethlem as similar spectacles of misfortune were performed for public visitors to the Foundling Hospital and Magdalen Hospital for Penitent Prostitutes. The donations expected of visitors to Bethlem – there never was an official fee – probably grew out of the monastic custom of almsgiving to the poor. While a substantial proportion of such monies undoubtedly found their way into the hands of staff rather than the hospital poors' box, Bethlem profited considerably from such charity, collecting on average between £300 and £350 annually from the 1720s until the curtailment of visiting in 1770. Thereafter the poors' box monies declined to about £20 or £30 per year.

Aside from its fund-raising function, the spectacle of Bethlem offered moral instruction for visiting strangers. For the "educated" observer Bedlam's theatre of the disturbed might operate as a cautionary tale providing a deterrent example of the dangers of immorality and vice. The mad on display functioned as a moral exemplum of what might happen if the passions and appetites were allowed to dethrone reason. As one mid-eighteenth-century correspondent commented: "[there is no] better lesson [to] be taught us in any part of the globe than in this school of misery. Here we may see the mighty reasoners of the earth, below even the insects that crawl upon it; and from so humbling a sight we may learn to moderate our pride, and to keep those passions within bounds, which if too much indulged, would drive reason from her seat, and level us with the wretches of this unhappy mansion".

Whether "persons of quality" or not, the primary allure for visiting strangers was neither moral edification nor the duty of charity but its entertainment value. In Roy Porter's memorable phrase, what drew them "was the frisson of the freakshow", where Bethlem was "a rare Diversion" to cheer and amuse. It became one of a series of destinations on the London tourist trail which included such sights as the Tower, the Zoo, Bartholomew Fair, London Bridge and Whitehall. Curiosity about Bethlem's attractions, its "remarkable characters", including figures such as Nathaniel Lee, the dramatist, and Oliver Cromwell's porter, Daniel, was, at least until the end of the eighteenth-century, quite a respectable motive for visiting.

From 1770 free public access ended with the introduction of a system whereby visitors required a ticket signed by a Governor. Visiting subjected Bethlem's patients to many abuses, including being poked with sticks by visitors or otherwise taunted, given drinks, and physically assaulted or sexually harassed, but its curtailment removed an important element of public oversight. In the period thereafter, with staff practices less open to public scrutiny, the worst patient abuses occurred.

1791–1900

Despite its palatial pretensions, by the end of the eighteenth century Bethlem was physically deteriorating with uneven floors, buckling walls, and a leaking roof. It resembled "a crazy carcass with no wall still vertical – a veritable Hogarthian auto-satire". The financial cost of maintaining the Moorfields building was onerous and the capacity of the Governors to meet these demands was stymied by shortfalls in Bethlem's income in the 1780s occasioned by the bankruptcy of its treasurer; further monetary strains were imposed in the following decade by inflationary wage and provision costs in the context of the Revolutionary wars with France. In 1791, Bethlem's Surveyor, Henry Holland, presented a report to the Governors detailing an extensive list of the building's deficiencies including structural defects and uncleanliness and estimated that repairs would take five years to complete at a cost of £8,660: only a fraction of this sum was allocated and by the end of the decade it was clear that the problem had been largely unaddressed. Holland's successor to the post of Surveyor, James Lewis, was charged in 1799 with compiling a new report on the building's condition. Presenting his findings to the Governors the following year, Lewis declared the building "incurable" and opined that further investment in anything other than essential repairs would be financially imprudent. He was, however, careful to insulate the Governors from any criticism concerning Bethlem's physical dilapidation as, rather than decrying either Hooke's design or the structural impact of additions, he castigated the slipshod nature of its rapid construction. Lewis observed that it had been partly built on land called "the Town Ditch", a receptacle for rubbish, and this provided little support for a building whose span extended to over 500 feet (150 m). He also noted that the brickwork was not on any foundation but laid "on the surface of the soil, a few inches below the present floor", while the walls, overburdened by the weight of the roofs, were "neither sound, upright nor level".

Bethlem rebuilt at St George's Fields

Bethlem Hospital at St George's Fields, 1828

showBethlem Hospital Act 1810
Act of Parliament
Parliament of the United Kingdom
Long title	An Act for vesting the Lease of the Governors of Bethlem Hospital in the Scite of the Hospital, in the Mayor and Commonalty and Citizens of the City of London by whom it was granted; and for authorizing the said Mayor and Commonalty and Citizens to grant certain Lands in Saint George's Fields, in lieu thereof, to Trustees for the Governors of the said Hospital for the like Term, for the Purpose of erecting a new Hospital thereon on an enlarged Scale.
Citation	50 Geo. 3. c. cxcviii
Dates
Royal assent	15 June 1810
Text of statute as originally enacted

showBethlem Hospital Act 1839
Act of Parliament
Parliament of the United Kingdom
Long title	An Act to enable the Mayor and Commonalty and Citizens of the City of London to let and sell Parcels of Ground in Saint George's Fields near Bethlem Hospital to the Governors of the said Hospital.
Citation	2 & 3 Vict. c. 20
Dates
Royal assent	1 July 1839
Text of statute as originally enacted

While the logic of Lewis's report was clear, the Court of Governors, facing continuing financial difficulties, only resolved in 1803 behind the project of rebuilding on a new site, and a fund-raising drive was initiated in 1804. In the interim, attempts were made to rehouse patients at local hospitals, and admissions to Bethlem, sections of which were deemed uninhabitable, were significantly curtailed such that the patient population fell from 266 in 1800 to 119 in 1814. Financial obstacles to the proposed move remained significant. A national press campaign to solicit donations from the public was launched in 1805. Parliament was successfully lobbied to provide £10,000 for the fund under an agreement whereby the Bethlem Governors would provide permanent accommodation for any lunatic soldiers or sailors of the French Wars. Early interest in relocating the hospital to a site at Gossey Fields had to be abandoned due to financial constraints and stipulations in the lease for Moorfields that precluded its resale. Instead, the Governors engaged in protracted negotiations with the City to swap the Moorfields site for another municipally-owned location at St George's Fields in Southwark, south of the Thames. The swap was concluded in 1810 and provided the Governors with a 12 acres (4.9 ha; 0.019 sq mi) site in a swamp-like, impoverished, highly populated, and industrialised area where the Dog and Duck tavern and St George's Spa had been.

A view of Bethlem Hospital, published in 1896

A competition was held to design the new hospital at Southwark in which the noted Bethlem patient James Tilly Matthews was an unsuccessful entrant. The Governors elected to give James Lewis the task. Incorporating the best elements from the three winning competition designs, he produced a building in the neoclassical style that, while drawing heavily on Hooke's original plan, eschewed the ornament of its predecessor. Completed after three years in 1815, it was constructed during the first wave of county asylum building in England under the County Asylum Act ("Wynn's Act") of 1808. Extending to 580 feet (180 m) in length, the new hospital, which ran alongside the Lambeth Road, consisted of a central block with two wings of three storeys on either side. Female patients occupied the west wing and males the east; as at Moorfields, the cells were located off galleries that traversed each wing. Each gallery contained only one toilet, a sink and cold baths. Incontinent patients were kept on beds of straw in cells in the basement gallery; this space also contained rooms with fireplaces for attendants. A wing for the criminally insane – a legal category newly minted in the wake of the trial of a delusional James Hadfield for attempted regicide – was completed in 1816. This addition, which housed 45 men and 15 women, was wholly financed by the state.

The first 122 patients arrived in August 1815 having been transported to their new residence by a convoy of Hackney coaches. Problems with the building were soon noted as the steam heating did not function properly, the basement galleries were damp and the windows of the upper storeys were unglazed "so that the sleeping cells were either exposed to the full blast of cold air or were completely darkened". Although glass was placed in the windows in 1816, the Governors initially supported their decision to leave them unglazed on the basis that it provided ventilation and so prevented the build-up of "the disagreable effluvias peculiar to all madhouses". Faced with increased admissions and overcrowding, new buildings, designed by the architect Sydney Smirke, were added from the 1830s. The wing for criminal lunatics was increased to accommodate a further 30 men while additions to the east and west wings, extending the building's façade, provided space for an additional 166 inmates and a dome was added to the hospital chapel. At the end of this period of expansion Bethlem had a capacity for 364 patients.

1815–16 Parliamentary Inquiry

James (William) Norris, Bethlem Patient, 1815

The late eighteenth and early nineteenth centuries are typically seen as decisive in the emergence of new attitudes towards the management and treatment of the insane. Increasingly, the emphasis shifted from the external control of the mad through physical restraint and coercion to their moral management whereby self-discipline would be inculcated through a system of reward and punishment. For proponents of lunacy reform, the Quaker-run York Retreat, founded in 1796, functioned as an exemplar of this new approach that would seek to re-socialise and re-educate the mad. Bethlem, embroiled in scandal from 1814 over its inmate conditions, would come to symbolise its antithesis.

Through newspaper reports initially and then evidence given to the 1815 Parliamentary Committee on Madhouses, the state of inmate care in Bethlem was chiefly publicised by Edward Wakefield, a Quaker land agent and leading advocate of lunacy reform. He visited Bethlem several times during the late spring and early summer of 1814. His inspections were of the old hospital at the Moorfields site, which was then in a state of disrepair; much of it was uninhabitable and the patient population had been significantly reduced. Contrary to the tenets of moral treatment, Wakefield found that the patients in the galleries were not classified in any logical manner as both highly disturbed and quiescent patients were mixed together indiscriminately. Later, when reporting on the chained and naked state of many patients, Wakefield sought to describe their conditions in such a way as to maximise the horror of the scene while decrying the apparently bestial treatment of inmates and the thuggish nature of the asylum keepers. Wakefield's account focused on one patient in particular, James Norris, an American marine reported to be 55 years of age who had been detained in Bethlem since 1 February 1800. Housed in the incurable wing of the hospital, Norris had been continuously restrained for about a decade in a harness apparatus which severely restricted his movement. Wakefield stated that:

... a stout iron ring was riveted about his neck, from which a short chain passed to a ring made to slide upwards and downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar about two inches wide was riveted; on each side of the bar was a circular projection, which being fashioned to and enclosing each of his arms, pinioned them close to his sides. This waist bar was secured by two similar iron bars which, passing over his shoulders, were riveted to the waist both before and behind. The iron ring about his neck was connected to the bars on his shoulders by a double link. From each of these bars another short chain passed to the ring on the upright bar ... He had remained thus encaged and chained more than twelve years.

Wakefield's revelations, combined with earlier reports about patient maltreatment at the York Asylum, helped to prompt a renewed campaign for national lunacy reform and the establishment of an 1815 House of Commons Select Committee on Madhouses, which examined the conditions under which the insane were confined in county asylums, private madhouses, charitable asylums and in the lunatic wards of Poor-Law workhouses.

In June 1816 Thomas Monro, Principal Physician, resigned as a result of scandal when he was accused of 'wanting in humanity' towards his patients. The Superintendent from 1852 to 1862 was William Charles Hood, who did much to reform and improve conditions for patients at the hospital.

Dr T. B. Hyslop came to the hospital in 1888 and rose to be physician in charge, bringing the hospital into the 20th century and retiring in 1911.

1930–present

showBethlem Hospital Act 1926
Act of Parliament
Parliament of the United Kingdom
Long title	An Act to provide for the removal of the Bethlem Hospital to the Monks Orchard Estate at Addington in Surrey and Beckenham and West Wickham in Kent and for the disposal of the existing hospital premises and convalescent home and the vesting of the said hospital premises or part thereof in the London County Council as an open space and for other purposes.
Citation	16 & 17 Geo. 5. c. xlviii
Dates
Royal assent	15 July 1926
Text of statute as originally enacted

In 1930, the hospital moved to the suburbs of Croydon, on the site of Monks Orchard House between Eden Park, Beckenham, West Wickham and Shirley. The old hospital and its grounds were bought by Lord Rothermere and presented to the London County Council for use as a park; the central part of the building was retained and became home to the Imperial War Museum in 1936. The hospital was absorbed into the National Health Service in 1948.

750th anniversary and "Reclaim Bedlam" campaign

В 1997 году больница начала планировать празднование своего 750 -летия. Однако перспектива пользователей услуг не должна была быть включена, и члены движения психиатрических выживших не видели ничего, что могло бы праздновать ни в первоначальной Бедламе, ни в текущей практике специалистов по психическому здоровью к тем, кто нуждается в уходе. была запущена кампания под названием «Reclaim Bedlam» Пит Шоннесси , поддерживаемая сотнями пациентов и бывшими пациентами и широко сообщается в СМИ. Сидя, которая была проведена возле более раннего участка Бедлама в Имперском военном музее. Историк Рой Портер назвал Бетлемскую больницу «символом бесчеловечности человека к человеку, за бездушностью и жестокостью».

Последние события

Bethlem Royal Hospital в 2011 году

В 1997 году была создана Галерея Бетлема, чтобы продемонстрировать работу художников, которые испытали психические расстройства.

В 1999 году Королевская больница Бетлема стала частью Фонда Фонда Южного Лондона и Модсли («Слэм») вместе с больницей Модсли в Камбервелле и состоялось слияние служб охраны психического здоровья в Ламбете и Льюишаме.

В 2001 году Слэм обратился за разрешением на планирование для расширенного среднего безопасного подразделения и обширных работ по повышению безопасности, большая часть которых будет на столичной открытой земле . Группы местных жителей организовали массовые встречи, чтобы противостоять этому применению, с обвинениями в том, что было несправедливо, что большинство пациентов могут быть из внутренних лондонских районов и, следовательно, не местные жители, и что употребление наркотиков было распространено в больнице и его окрестностях. Совет Бромли отказался от заявления, а Совет Кройдона также возражал. Однако канцелярия заместителя премьер -министра отменила решение в 2003 году, и началось развитие. Подразделение на 89 коек, 33,5 млн фунтов стерлингов (River House) открылся в феврале 2008 года. Это самое значительное развитие на месте с момента открытия больницы в 1930 году.

Фатальные ограничения

Оласени Льюис (известный как Сени; в возрасте 23 лет) умер в 2010 году в Королевской больнице Вифлема После того, как полиция подвергла его длительному ограничению типа, известного как опасного. Ни полиция, ни медицинский персонал не вмешались, когда Льюис не отвечал. На следствии Коронера присяжные обнаружили много неудач как полиции, так и медицинского персонала, которые сыграли роль в смерти Льюиса. Они сказали, что «чрезмерная сила, методы соответствия боли и множественные механические ограничения были непропорциональными и необоснованными. На балансе вероятности это способствовало причине смерти». Аджибола Льюис, мать Оласени Льюиса, заявила медсестру в больнице Модсли , где Льюис был ранее предупрежден о том, чтобы допустить свой перевод в Вифлем. «Она сказала мне:« Послушай, не отпускай его в Вифлем, не отпускай его туда », - сказала его мать. Доктор позже убедил ее отвезти сына в Бетлемскую больницу. Она была обеспокоена условиями там. «Это был беспорядок», - сказала она суду. «Это было очень смущено, много активности, много криков. Я не был счастлив; я был смущен».

Полиция была обучена рассматривать поведение Льюиса как неотложную медицинскую ситуацию, но присяжные обнаружили, что полиция не действует по этому поводу. Присяжные установили, что «полиция не следовала их обучению, что требует от них поместить не отвечающего человека на должность восстановления и, если необходимо, администрировать жизнеобеспеченную поддержку. На балансе вероятности это также способствовало причине смерти». Врач не действовал, когда Льюис не отвечал, в то время как его сердечный снимок резко замедлился.

Независимая комиссия по жалобам на полицию впервые очистила офицеров по поводу смерти, но после давления со стороны семьи они отменили выводы и начали новое расследование. МГЭИК планировал дисциплинарные меры против некоторых из вовлеченных полицейских. Дебора Коулз из благотворительного расследования , которая поддерживала семью Льюиса на протяжении всей своей кампании, сказала, что присяжные пришли к самым тяжелым выводам о действиях полиции и медиков. "Это была самая ужасная смерть. Одиннадцать полицейских были вовлечены в удержание испуганного молодого человека до его полного краха, ноги и руки, не связанных с ограничениями конечностей, в то время как персонал психического здоровья стоял рядом. Офицеры знали об опасности этой сдержанности, но решили Идите против ясного, однозначного обучения.

Дисциплинарное слушание, проведенное столичной полицией, показало, что офицеры не совершили проступка. Слушание подверглась критике со стороны семьи, потому что она держалась за закрытыми дверями без прессы и не публичного контроля.

В 2014 году Крис Бреннан (15 лет) скончался от у асфиксии в больнице Вифлем после повторного самоповреждения. Коронер обнаружил, что отсутствие надлежащей оценки риска и отсутствие плана ухода способствовало его смерти. Больница претендовала на кадровые проблемы, а низкий моральный дух были факторами. Уроки были извлечены, и подростка, где умер Бреннан, оценивалось как хорошее в 2016 году.

обсуждался законопроект В ноябре 2017 года в Палате общин , который потребовал бы, чтобы психиатрические больницы предоставили более подробную информацию о том, как и когда используются ограничения. Этот законопроект называется «Закон Сени». В ноябре 2018 года законопроект получил Королевское согласие в качестве Закона о психиатрическом здоровье (применение силы) 2018 года.

Удобства

Вход в трудотерапии отдел

Больница включает в себя специализированные услуги, такие как Национальное отделение психоза .

Другие услуги включают подростковое подразделение Bethlem, которое обеспечивает уход и лечение молодым людям в возрасте 12–18 лет со всей Великобритании.

В больнице есть отдел трудотерапии , в которой есть собственная художественная галерея, Галерея Бетлема , демонстрирующая работу нынешних и бывших пациентов.

Музей ума Бетлемы показывает экспонаты об истории Королевской больницы Вифлема и истории психического здоровья и лечения. В нем представлена ​​постоянная коллекция искусства, созданную некоторыми из его пациентов, а также меняющиеся выставки.

Каждое субботнее утро паркун проводится на территории Королевской больницы Вифлем.

СМИ

В 2013 году Фонд Фонда Южного Лондона и Модсли Фонда NHS (Slam) принял участие в документальном фильме на канале 4, Бедлам . Сотрудники и пациенты провели два года, работая с телевизионной компанией The Garden Productions. Серия из четырех частей началась 31 октября.

Первая программа, тревожная , следовала за пациентами через жилой отдел. Этот национальный подразделение относится к самым тревожным людям в стране - максимально один процент - и претендует на уровень успеха трех у четырех пациентов.

Следующая программа называлась кризисом ; Камеры были допущены в отделение сортировки больницы Ламбет впервые. В почтовом индексе с самым высоким уровнем психоза в Европе это случайность и чрезвычайная ситуация в области психического здоровья, где пациенты находятся в самой плохого.

Третья программа «Психоз» снимает общественную команду по охране психического здоровья. Траст Фонда Южного Лондона и Модсли Фонда обеспечивает поддержку более 35 000 человек с проблемами психического здоровья.

Окончательная программа «Разрушение » фокусируется на пожилых людях, включая стационарное отделение для людей старше 65 лет с проблемами психического здоровья в больнице Модсли .

Примечательные пациенты

• Ричард Падд - художник
• Джон Фрит -потенциальный нападавший короля Георга III
• Мэри Фрит - также известная как «Молл Катпурс» или «Ревущая девушка», выпущенная из Бедлама в 1644 году, согласно записям Bridewell
• Даниэль М'Нагтен - катализатор создания правил М'Нагтена (критерии защиты безумия в британской правовой системе) после стрельбы Эдварда Драммонда
• Джонатан Мартин - Пожигай Йорк Минстер
• Уильям Честер Минор - хирург, который был совершен за убийство; Наиболее известный как один из крупнейших участников в Оксфордском словаре английского языка
• Джеймс Хэдфилд -будущий убийца короля Георга III
• Маргарет Николсон -потенциальный убийца короля Георга III
• Эдвард Оксфорд - Пытался на высокую измену после попытки убийства королевы Виктории и принца Альберта
• Август Уэлби Нортмор Пугин (1812–1852) - английский архитектор, наиболее известный своими работами над домами парламента, а также многими церквями; В последний год его жизни у него была разбивка, возможно, из -за гипертиреоза , и на короткий период был ограничен в Бетлеме
• Ханна Снелл (1723–1792)-женщина, переодевшаясь как солдат мужского пола; провела последние шесть месяцев своей жизни в Вифлеме
• Bannister Treulock - заговорщик, который планировал убить Георга III
• Луи Уэйн - художник

Смотрите также

• Авраам-люди
• История психиатрических учреждений
• Джон Руть (психиатр)
• Списки больниц
• Том О 'Бедлам , анонимное стихотворение c. 1600, о Бедлалите.
• Список больниц в Англии
• Партнеры по здравоохранению Кинг
• Бетлемский музей ума

Сноски

Источники

Первичные источники

• Комитет по безумным . Первый отчет: протокол доказательств, представленных перед избранным комитетом, назначенным для рассмотрения положения о лучшем регулировании безумных в Англии . Лондон: Палата общин; 1815.
• Больше, Томас . Четыре последних вещах (1522) . Под редакцией Д. О'Коннора. Лондон: Art and Book Co.; 1903.
• Saussure, César de . Иностранный взгляд на Англию в царствование Джорджа I & II: письма месье Сезар де Соуссюр его семье . Отредактировано и переведено мадам ван Муйден. Лондон: Джон Мюррей; 1902.
• Уэйкфилд, Эдвард . План убежища для сумасшедших и т . Д. Филантроп . 1812; 2: 226–29.

Вторичные источники

Книги

• Эндрюс, Джонатан; Бриггс, Аса; Портер, Рой; Такер, Пенни; Уоддингтон, Кейр . История Вифлема . Лондон и Нью -Йорк: Routledge; 1997. ISBN   0415017734 .
• Эндрюс, Джонатан; Скулл, Эндрю . Гробовщик ума: Джон Монро и сумасшедшие доктора в Англии восемнадцатого века . Калифорния: издательство Калифорнийского университета; 2001. ISBN   9780520231511 .
• Эндрюс, Джонатан; Скулл, Эндрю . Клиенты и покровители сумасшедшей торговли: управление безумием в Лондоне восемнадцатого века: с полным текстом книги Джона Монро 1766 года . Беркли и Лос -Анджелес, Калифорния: издательство Калифорнийского университета; 2003. ISBN   9780520226609 .
• Кови, Герберт С. Социальное восприятие людей с ограниченными возможностями в истории . Чарльз С. Томас; 1998. ISBN   9780398068370 .
• Дарлингтон, Ида , изд. Опрос Лондона: Том 25. Поля Святого Георгия (приходы Святого Георгия Мученика, Саутуорк и Св. Мария, Ньюингтон) . Лондон: Лондонский совет графства; 1955. Глава 9: Бетлемская больница, ныне Императорская военная музей, на Ламбет -роуд.
• Доулинг, Уильям С. Оливер Уэнделл Холмс в Париже: медицина, богословие и автократ за столом для завтрака . Ливан Н.Х.: Университет Нью -Гемпшир Пресс; 2006. ISBN   97815846558800 .
• Фуко, Мишель . История безумия . Под редакцией Жана Халфа. Перевод Джонатана Мерфи и Джин Халфа. Лондон и Нью -Йорк: Routledge; 2006. ISBN   9780415277013 .
• Гилман, Сандер Л. Видя безумное . Линкольн Н.Е.: Университет Небраски Пресс; 1996. ISBN   9780803270640 .
• Харрисон, Джон Флетчер Клеус . Второе пришествие: популярный тысячелетний, 1780–1850 . Лондон: Тейлор и Фрэнсис; 1979. ISBN   9780710001917 .
• Хилл, Розмари . Божий архитектор: Пугин и строительство романтической Британии . Лондон: Аллен Лейн; 2007. ISBN   978-0-7139-9499-5 .
• Джексон, Кеннет С. Отдельные театры: Бетлем («Бедлам») больница и Шекспирская сцена . Ньюарк: Университет штата Делавэр; 2005. ISBN   9780874138900 .
• Джонс, Кэтлин . БЕЛОТЯЯ, Закон и Совесть, 1744–1845 . Нью -Йорк и Лондон: Routledge; 1955. (Социология психического здоровья). ISBN   9780415178020 .
• Катол, Роджер Г.; Гатто, Сюзанна . Исцеляющее тело и разум: критическая проблема для реформы здравоохранения . Westport CT: Praeger; 2007. ISBN   9780275992019 .
• Кент, Дебора . Змеиные ямы, разговоры и волшебные пули . Брукфилд CT: книги двадцать первого века; 2003. ISBN   9780761327042 .
• Макдональд, Майкл . Мистический Бедлам: безумие, беспокойство и исцеление в Англии семнадцатого века . Кембридж: издательство Кембриджского университета; 1981. ISBN   9780521273824 .
• Нили, Кэрол Томас . Отвлеченные предметы: безумие и пол в Шекспире и ранней современной культуре . Нью -Йорк: издательство Корнелльского университета; 2004. ISBN   9780801489242 .
• Нолл, Ричард . Энциклопедия шизофрении и других психотических расстройств . 3 -е изд. Нью -Йорк: факты в файле; 2007. ISBN   9780816075089 .
• Оберхельман, Дэвид Д. Диккенс в Бедламе: безумие и сдержанность в его художественной литературе . York Press; 1995. ISBN   9780919966963 .
• О'Донохью, Эдвард Джеффри . История Вифлема от его основания в 1247 году . Лондон: TF Unwin; 1914.
• Парри-Джонс, Уильям Лливелин . Торговля в безумие: исследование частных безумных в Англии в восемнадцатом и девятнадцатом веках . Лондон: Routledge & Kegan Paul; 1971. ISBN   9780802001559 .
• Филлипс, Боб . Преодоление беспокойства и депрессии . Евгений или: издательство Harvest House; 2007. ISBN   9780736919968 .
• Пул, Стив . Политика Регицида в Англии, 1760–1850 гг.: Проблемные предметы . Манчестер: издательство Манчестерского университета; 2000. ISBN   9780719050350 .
• Портер, Рой . Безумность: краткая история . Оксфорд: издательство Оксфордского университета; 2002. ISBN   9780192802675 .
• Портер, Рой . Безумцы: социальная история безумных, сумасшедших доконов и сумасшедших . Пересмотренное изд. Страуд: Темпус; 2006. ISBN   0752437305 .
• Рид, Роберт Р. Бедлам на Джейкобеанской сцене . Кембридж, штат Массачусетс: издательство Гарвардского университета; 1952.
• Скулл, Эндрю . Самые одинокие из страданий: безумие и общество в Британии, 1700–1900 . Нью -Хейвен и Лондон: издательство Йельского университета; 1993. ISBN   0300107544 .
• Скулл, Эндрю; Маккензи, Шарлотта; Херви, Николас . Мастера Бедлама: трансформация безумной торговли . Принстон, штат Нью -Джерси: издательство Принстонского университета; 1996. ISBN   0691034117 .
• Скултаны, Вида . Английское безумие: идеи о безумии, 1580–1890 . Лондон: Routledge; 1979. ISBN   9780710003294 .
• Смит, Леонард Д. Лечение, комфорт и безопасная опека: общественные сумасшедшие убежища в Англии начала девятнадцатого века . Лондон и Нью -Йорк: издательство Лестерского университета; 1999. ISBN   9780718500948 .
• Тук, Даниэль Хак . Главы в истории безумных на Британских островах . Лондон: Киган Пол, Тренч и Ко.; 1882.
• Уолфорд, Эдвард . Старый и новый Лондон: том 6 . Cassell Petter & Galpin; 1878. Глава XXVI, Поля Святого Георгия.

Журналы статьи и главы книг

• Аллдридж, Патриция . Управление и неумелое управление в Бедламе, 1547–1633 . В: Вебстер, Чарльз. Здоровье, медицина и смертность в шестнадцатом веке . Кембридж: издательство Кембриджского университета; 1979а. ISBN   9780521226431 . п. 141–164.
• Аллдридж, Патриция . Больницы, безумные и убежища: циклы в уходе за безумным. Британский журнал психиатрии . 1979b; 134 (4): 321–34. два : 10.1192/bjp.134.4.321 .
• Аллдридж, Патриция . В: Bynum, WF; Портер, Рой; Шепард, Майкл. Анатомия безумия: очерки в истории психиатрии . Тол. 2. Лондон и Нью -Йорк: Тависток; 1985. ISBN   9780415008594 .
• Эндрюс, Джонатан . «Вряд ли больница, но благотворительная организация для безбоких сумасшедших»? Терапия в Вифлеме в семнадцатом и восемнадцатом веках. В: Барри, Джонатан; Джонс, Колин. Медицина и благотворительность перед государством всеобщего благосостояния . Лондон: Routledge; 1994. ISBN   9780415111362 . п. 63–81.
• Эндрюс, Джонатан . Политика совершения раннего современного Вифлема. В: Портер, Рой. Лекарство в Просвещении . Амстердам и Атланта Джордж: Родопи; 1995. ISBN   9789051835625 . п. 6–53.
• Эндрюс, Джонатан . Монро, Томас (1759–1833). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; Январь 2010. doi : 10.1093/ref: ODNB/18981 . (требуется подписка)
• Биркен, Уильям . Крук, Хелькия (1576–1648). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; 2004. doi : 10.1093/ref: ODNB/6775 . (требуется подписка)
• Гибсон, Кэтрин . CIBBER, CAIUS GABRIEL (1630–1700). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; 2008 doi : 10.1093/ref: ODNB/5415 . (требуется подписка)
• Гриффитс, Пол . Фрит, Мэри (1584x9–1659). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; 2008 doi : 10.1093/ref: ODNB/10189 . (требуется подписка)
• Хаттори, Нацу . «Удовольствие твоего Бедлама»: Театр безумия в Ренессансе. История психиатрии . 1995; 6 (23): 283–308. doi : 10.1177/0957154x9500602302 . PMID   11639849 .
• Джексон, Кеннет С. «Я не знаю / где я пошел вчера вечером?»: Кинг Лир и поиск больницы Вифлем (Бедлам). Английский литературный ренессанс . 2000; 30 (2): 213–40. doi : 10.1111/j.1475-6757.2000.tb01170.x .
• Моран, Ричард . Современный фонд защиты от безумия: дело Джеймса Хэдфилда (1800) и Даниэля МакНаутан (1843). Анналы Американской академии политических и социальных наук . 1985; 447: 31–42.
• Мосс, Дэвид Дж . Уэйкфилд, Эдвард (1774–1854). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; 2008 doi : 10.1093/ref: ODNB/28414 . (требуется подписка)
• Филлпоттс, Кристофер . Ричард II и монастыри Лондона. В: Ormrod, W. Mark. 14 -й век Англия . Тол. 7. Вудбридж: Бойделл Пресс; 2012 ISBN   9781843837213 . п. 197-224.
• Портер, Рой . История сегодня . 1997; 47 (10): 41–8.
• Скулл, Эндрю . История болезни . 1999; 43: 248–55. doi : 10.1017/s0025727300065133 .
• Скулл, Эндрю . Фикции стипендии Фуко. Времена литературная добавка . 21 марта 2007 г.
• Стивенсон, Кристина . Бетлем Роберта Гука. Журнал Общества архитектурных историков . 1996; 55 (3): 254–275. doi : 10.2307/991148 .
• Стивенсон, Кристина . Архитектура Бетлема в Мурфилдс. История Вифлема . Джонатан Эндрюс, Аса Бриггс, Рой Портер, Пенни Такер и Кейр Уоддингтон. Лондон и Нью -Йорк: Routledge; 1997. ISBN   0415017734 . п. 230–59.
• Винсент, Николас . Гофредо де Префетти и Вифлеемская церковь в Англии. Журнал церковной истории . 1998; 49 (2): 213–35. doi : 10.1017/s0022046998006319 .
• Wheelwright, Джули . Снелл, Ханна (1723–1792). Оксфордский словарь национальной биографии . Онлайн ред. Оксфорд: издательство Оксфордского университета; 2008 doi : 10.1093/ref: ODNB/25975 . (требуется подписка)
• Уиттакер, Дункан . 700 -летие Бетлема. Журнал умственной науки . 1947; 93 (393): 740–47. Два : 10.1192/bjp.93.393.740 .

Тезисы

• Эндрюс, Джонатан . Bedlam Revisited: история Бетлемской больницы c. 1634 - c. 1770 [докторская диссертация]. Лондон: Королева Мэри и Уэстфилд Колледж, Лондонский университет; 1991.

Газеты и агентства новостей

• Олден, Марк . Некролог: Питер Шонесси. Участник кампании, который снял стигму из -за безумия. Опекун . 23 января 2003: 22.
• Кук, Мэтью . 33 миллиона фунтов стерлингов идет в 760-летнюю больницу . 30 октября 2008 г. [Получено 30 октября 2012 года]. Би -би -си Лондон.
• Сегодня программа . Сумасшедший Лондон . 8 августа 2008 г. [Получено 30 октября 2012 года]. Би -би -си, радио 4.

Веб -страницы

• Архив и музей . О музее . Архив и музей, Бетлемская Королевская больница; 30 октября 2012 (а) [Получено 30 октября 2012 года].
• Архив и музей . Искусство . Архив и музей, Бетлемская Королевская больница; 30 октября 2012 г. (b) [Получено 30 октября 2012 года].
• Бетлемская галерея . О нас . Бетлемская галерея; 23 октября 2012 г. [Получено 30 октября 2012 года].
• Гейл, Колин С. Бетлемская больница . Лондон: «Потерянные больницы Лондона» в понедельник в одной серии, Грешамский колледж; 19 марта 2012 г. [Получено 4 ноября 2012 года]. [1] [ Архивировано 29 мая 2012 года].
• Шлем ​ Служба психоза . Южный Лондон и Модсли Фонд Траст; 30 октября 2012 г. (а) [Получено 30 октября 2012 г. (а)].
• Шлем ​ Интерактивный тур по подростковым подразделениям Бетлема . Южный Лондон и Модсли Фонд Траст; 30 октября 2012 г. (b) [Получено 30 октября 2012 года].

Внешние ссылки

• Официальный сайт
• Bethlem Royal Hospital на веб -сайте NHS
• Отчеты об инспекции по качеству ухода
• «Архивный материал, относящийся к Бетлема Королевской больнице» . Великобритания национальные архивы .
• Католическая энциклопедия: Бедлам
• Исторические изображения Вифлема в альбоме монахов сада