London, Volume 5

Knight, Charles
1843

CXXIV.-Medical and Surgical Hospitals and Lunatic Asylums.

CXXIV.-Medical and Surgical Hospitals and Lunatic Asylums.

 

It is perhaps, on the whole, a matter of congratulation that the London Hospitals are more eminent as schools of medicine and surgery than for their influence as social institutions. In Paris - of the deaths ( out of , in ) occur in the hospitals, but in London the proportion is only in ( out of ). The domestic feeling, or prejudice, if we like to call it so, of the English people is, generally speaking, believed to be adverse to that public association which is inevitable in an hospital. This is true to a great extent; but, on the other hand, it is also the limited capacity of the London hospitals which restricts the proportion of persons dying there to in . In general hospitals there does not exist accommodation for more than persons at time, and every

taking--in day

a large number of persons are unable to obtain admission.

There is scarcely a district of London which is without its hospital of kind or another; but we shall notice the great hospitals, of which are of ancient foundation, and are historically interesting. The most ancient of these is St. Bartholomew's Hospital. Rahere, the minstrel of King Henry I., not content with founding the priory of St. Bartholomew, annexed to it an hospital, about the year , for the relief of poor and sick persons. Alfune, who, among other charitable works, built the church of St. Giles-without-Cripplegate, and was the

hospitaller,

used daily to beg for the relief of the poor under

370

his care at the adjoining market and shambles of Smithfield. centuries after the foundation of the hospital, the mayor, aldermen, and commonalty of the city of London prayed the King to commit the order and governance of both this hospital and St. Thomas's to their hands. The hospital, however, was not transferred to the city until , years later, during which period the Crown continued to enjoy its revenues, which at the dissolution were of the gross annual value of , of which sum was from rents in London and the suburbs. In the hospital was newly incorporated, but its revenues were not re-granted; and it does not appear that the new constitution ever came into operation. At length, years afterwards, in , the king consented to re-found the hospital, for the reception of poor and sick persons, and to endow it with from its former possessions, on condition that the citizens raised yearly other for its support. This they agreed to do: but Stow says that the houses which formed the bulk of the property granted by the King were either in such a decayed state or leased out at such low rents, that great difficulty was experienced in obtaining the required income, and various expedients were adopted to raise this sum. In there were surgeons, with salaries of each, appointed to be in daily attendance on the sick; and in the expenditure, including the payment to the ministers of Christ's Church and St. Bartholomew's, and the diet of the poor at per day each, amounted to about per annum. In this hospital, with St. Thomas's, Christ's, , and Bethlem, were united for purposes of administration, and their affairs were managed by general board until , when an act was passed under which, with the exception of and Bethlem, each of them was placed on its present footing and under separate government.

The income of the hospital at present exceeds a-year. The bulk of the real estate is in London, and the London rents amount to a-year; landed estates in different parts of the country produce ; dividends on stock in the funds, ; rent-charges and annuities, ; and the benefactions and legacies for years averaged a-year. The pecuniary donations and bequests to the hospital, received up to , amounted to , including appropriated to building the wings between and .

St. Bartholomew's Hospital is situated on the south-east side of Smithfield Market. The principal entrance is through a large arch, ornamented with a statue of Henry VIII., and figures representing Lameness and Sickness. The main buildings consist of separate elevations of stories in height, faced with stone, standing detached on the sides of a quadrangle. They were completed from the produce of voluntary subscriptions raised between and . On the floor of the north wing there is a very handsome hall, feet by , and feet high, which is appropriated to general court meetings and the annual dinners of the governors. The grand staircase was painted gratuitously by Hogarth. The several stories of the south wing contain wards, and the west wing contains wards. The wards in the east and west wings are feet by ; and their height varies from to feet. In the south wing the wards are feet in length, and the heights are the same on each floor as in the east and west wings. To every ward an apartment for the sister in

371

attendance is annexed. In the roof of each wing is a tank for water, containing from to gallons, supplied by a steam-engine; and a continual supply from the Company is carried all through the hospital by force-pumps. Besides the quadrangle, the area of the hospital comprises buildings, almost as extensive, for the residences of the different officers, &c. There is also the church of St. Bartholomew the Less, rebuilt about years ago, at a cost of out of the hospital funds. At the back of the western wing is a range of buildings containing the Lecture-Room for Materia Medica, the Medical Theatre, Pathological Theatre, Chemical Theatre, the Anatomical Museum, Dissecting-Rooms, rooms for lecturers, professors, and curators, pupils' room and library, laboratory, apothecary's shop, surgeon's and physician's rooms. The treasurer's house and garden, the burial-ground of the church, and the vicarage-house, occupy the space north-east of the western wing; and between it and the southwestern gateway are houses for the steward, the matron, and the apothecary.

was originally a religious establishment, founded by Richard, prior of , in . In its possessions were valued at ; and in the following year they were surrendered to the King. Before the middle of the century the suppressed hospital was purchased by the City of London; and a charter from the crown having been obtained in , and the building repaired and adapted for the reception of poor, lame, and diseased people, it was opened for their admission in . For some time the funds of the hospital were insufficient; and in the lands late belonging to the Savoy Hospital, and some other property, which had been granted to the hospitals united, were granted for the sole use of St. Thomas's, with a view, perhaps, of equalising the revenues of the several hospitals. Notwithstanding this assistance, in the treasurer was obliged to advance , and in a sum of was obtained by pawning a lease; but it soon afterwards emerged from its difficulties. The rents of property in London and the suburbs at present realise a-year; the rental of estates in the country ; and the dividends on stock From to the pecuniary gifts to the hospital amounted to The gross annual income applicable to the general purposes of the institution is nearly

is situated in the borough of , not far from the foot of . It consists of several courts or squares, in of which are statues; , in brass, of Edward VI. by Scheemakers, and the other , of stone, of Sir Robert Clayton, Lord Mayor in . A large part of the hospital buildings was rebuilt in , and additions were made to them in . A new north wing was completed in , at a cost of ; the south wing in ; and it is intended to rebuild the centre on an adopted plan, when the whole building will present a very imposing appearance. The site of the new north wing and a portion of ground north of the old north wing were purchased of the City for , which was at the rate of per acre! The Museum, Anatomical Theatre, Demonstrating Theatre, Lecturing Theatre, Dissecting-Room, and other appropriate offices attached, cost , and are built on a site formerly covered by slaughter-houses, brothels, and miserable tenements. The Museum and Dissecting-Room are feet by ; the Lecturing Theatre is circular and feet in diameter. The Museum contains about

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preparations. The parish church of St. Thomas stands within the area of the hospital, besides which there is a chapel. The whole parish is the property of the hospital. There are wards, of which are feet by , and vary in height from feet to feet. They are well ventilated, kept at a uniform and agreeable temperature by fires, and in cold weather by hot-water apparatus, and are generally quite free from offensive smells.

The founder of was neither minstrel nor priest, and though claimed by booksellers as of their body, his property was acquired by stock-jobbing rather than by literature. At any rate he was a man of great benevolence, and had long been a munificent supporter of when he determined himself to be the founder of a new hospital. At the age of he commenced the erection of the present building, on which during his lifetime he spent nearly He died on the , and on the following patients were received into the hospital. In the sum of was carried to the account of his executors, as the residue of Mr. Guy's estate. This magnificent bequest has been laid out at different times in the purchase of real estates in the counties of Essex, Hereford, and Lincoln. The hospital has also been benefited by the enormous bequest of Mr. Hunt, who in left it a sum amounting to , besides other property which made the total amount , on condition of enlarging the hospital and providing additional beds. This legacy has also been invested in estates. The other benefactions received from the foundation of the hospital to the present time amount to about The gross income is now above a-year, and about a-year is directly applicable to the purposes of the charity. The rental of the hospital estates is a-year, of which is derived from the estates, and the dividends from funded property average about a-year.

The entrance to is in , by an iron gate opening into a square, in the centre of which is a statue, in brass, of Mr. Guy, by Scheemakers, the pedestal on which it stands bearing on side an inscription recording Mr. Guy's benevolence, and on the other sides are relievos of Mr. Guy's arms, Christ healing the Impotent, and the Good Samaritan. The main building consists of a centre and wings, containing residences for the Treasurer, Chaplain, Steward, Apothecary, Butler, Porter, and the

Dressers;

a chapel, in which there is a statue, by Bacon, of Mr. Guy; the

taking--in

and examination rooms, surgery, and waiting-rooms for out-patients, apothecary's shop, medical store-room, laboratories, medical and operating theatres, the electrical room (containing apparatus necessary for electrical and galvanic operations), a room for examinations, and several wards for patients. Behind this is the Lunatic House, which is peculiar to this hospital. The number of lunatics is , the number provided for by Mr. Guy having been . They have a tolerably spacious airing-ground in the rear of the building appropriated to their use, and a garden for their recreation adjoins it. The south side of the hospital ground comprises a mass of buildings, some of which are sick wards; and here are also the museum, theatre, and dissecting-room, and the museum of comparative anatomy, the residences of servants of the hospital, and various offices and store-rooms. The anatomical theatre and the larger theatre

373

in the main building afford accommodation for about persons. The operating theatre is of smaller size. At the eastern extremity of the area, bounded on the north by , is the Botanic Garden, which is occasionally used by the students, but its chief value consists in the improved ventilation which it secures to the whole establishment. The wards are all spacious and airy, and are warmed by means of stoves.

The constitution of the London Hospitals is not uniform, though in all of them the ruling body consists of the governors; but the powers of the various officers to whom the immediate management and superintendence of the hospital is entrusted are exercised under less control in some cases than in others. Since there have been classes of governors at St. Bartholomew's, the chartered or corporation governors and the donation governors.

At St. Thomas's there are kinds of governors. The corporation of London is represented by the lord mayor and aldermen and common councilmen, as at St. Bartholomew's; and they do not derive their authority from the other governors, but from the charter of the hospital and the Act of . The special governors consist almost entirely of retired officers, and the executors of benefactors are occasionally appointed. This class of governors is not required to contribute towards the funds of the Hospital, and it is this only which distinguishes them from donation governors. It has invariably been the practice to admit as donation governors any person willing to pay who can procure governors to propose and them.

The government of was settled by the founder. The number of governors must be at least and not exceed , with a committee of , to whom the immediate management of its affairs is entrusted, and of this number - retire annually. The governors are chosen from a list presented at a general court by the president and treasurer, and no division has ever taken place on their admission: no donation is required, and the appointment is for life.

The next important department of the hospitals consists of the medical and surgical establishment, including the

sisters

and nurses. At St. Bartholomew's there are principal physicians and assistant physicians, principal surgeons and assistant surgeons, who are appointed by the General Court: they do not reside in the hospital, but there are in addition house-surgeons and an apothecary, for whom apartments are provided. or other of the physicians and surgeons visits the hospital every day in the week, and physician and surgeon attends the almoners in rotation on the weekly admission-days for the purpose of examining patients. The physicians receive a salary of , but their principal emolument is derived from the fees paid by the pupils attending the medical practice of the hospital, which are guineas for eighteen months and guineas for the perpetual right. These pupils, or of whom are in constant attendance on each principal physician, prescribe simple remedies in his absence. The physicians have also the opportunity of becoming lecturers to the students attending the hospital school. The salary of the assistant physicians is per annum, but they are not allowed to take pupils, though they may become lecturers to the medical classes. The stipend of the principal surgeons is , besides a gratuity of each voted to them by

374

the general court, and the fees paid by the hospital pupils are divided equally among them. Each of the principal surgeons has the privilege of nominating dressers, who, in addition to the ordinary fee of guineas for attending the surgical practice, pay a further fee of guineas each. Out of these is named as his house-surgeon for the year, for which a further fee of guineas is paid. In going through the wards the principal surgeon of the day is attended by the pupils, frequently from to in number, or even a . The assistant-surgeons only act for their respective principals, and have neither salary nor any participation in the fund arising from the pupils' fees; but they usually succeed to the office of principal surgeons. The house-surgeons superintend and direct the dressers in the absence of the surgeons, perform minor surgical operations, and receive a salary from the hospital of a-year. The services of the eighteen

dressers

are highly useful in extending the advantages of the hospital. They attend to casual injuries of minor importance in cases where there is no necessity for the patient either being received into of the wards or admitted as an out-patient, and they contribute to the comforts of the in-patients by watching the symptoms of their disease. On a patient being admitted into of the wards, the dresser writes on the paper hung up at the head of each bed the name and age of the patient, the name of the complaint, the date of admission, and his own name, with a minute of the diet, medicines, and local applications ordered by the surgeon. They are required to collect a history of each new case, to report the progress of old cases, and to take down a full history of such cases as may be pointed out to them. They dress fractures, wounds, ulcers, and all cases that require local applications. The

sisters

of the wards are in number, superintending each ward and attending upon the casualty patients. They have usually been persons who have received some education and have lived in a respectable rank of life. Recently they have been at times selected from some of the most active and trustworthy among the nurses. The majority of the sisters receive from to C a-week, the seniors from to , and on Sundays a dinner is provided for them at the cost of the hospital. The duties of a sister consist in a general superintendence of the ward to which she is attached, in carrying into effect the directions of the medical officers, taking charge of and administering the medicines, reporting to the cook the daily diet required for the patients, and giving information to the medical officers of any change of symptoms in the patients. The nurses, in number, act under the sisters, of them being attached to a single and to a double ward. They perform the usual duties of servants, in waiting on and cleaning the patients, the beds, furniture, wards, and stairs; and are paid a-week, and partly dieted at the expense of the hospital.

The majority of persons received as patients into the London Hospitals are mechanics, labourers, reduced tradesmen, or servants. There are, however, numerous admissions of individuals of both sexes, and particularly females, of the very lowest class of society and the worst character. The most common offences against the regulations are smoking, swearing, gambling, and fighting, and refusals to attend to the directions of the medical officers. Instances have occurred in which the lives of the sisters or nurses have been threatened by

375

patients of the lowest and most abandoned class. In all ordinary cases it is necessary that an applicant for admission should obtain the recommendation of a governor by his signature to a printed petition, of which forms are procured at the hospital. Many are admitted without any other recommendation than the urgency of their case. Cases of accident are admitted on all days, at any hour whatever; but at every hospital day in the week is set apart as the regular day of admission, when the applicants attend in the patients' waiting-room hour before the meeting of the board. Small-pox is the only disease against which the doors of the hospital are absolutely closed. The admissions average between and on the regular days, which is also the average number of the accident admissions and others which take place on other days. The outpatients consist of such as, being in want of medical aid, either do not apply for, or from the nature of the case or the want of room cannot obtain, admission into the hospital; or of convalescents, who, when partially cured in the hospital, are removed to make room for others. The casualty patients include all who apply on any day in the week between and for surgical assistance. They are seen by the dresser in attendance, and the case is treated and a record of it entered under the direction of the house-surgeon. The number of beds at St. Bartholomew's is , and the number of in-patients is between and a-year, of out-patients between and , and of casualty patients upwards of . The deaths amongst in-patients are about in eighteen, or about a-year.

At St. Thomas's and Guy's the general medical economy, arrangement, and regulations are of much the same nature as at St. Bartholomew's, and it is unnecessary to enter into a minute detail of them. At St. Thomas's there are wards, each of which is superintended by of the sisters, who were formerly selected from the nurses, but are so no longer. There is always candidate for the office in training. The nurses are divided into day-nurses and night-watchers, the latter of whom enter upon their duties at in the evening and remain until the next morning. It is found very difficult to get persons fitted for either of these offices, as the duties are onerous and disagreeable, and the stipend small. The total number of in and out-patients to whom relief was administered in was , classed as follows: Physicians' out-patients , surgeons' out-patients , midwifery out-patients , apothecary's out-patients ; and of in-patients there were discharged during the year and died. The remainder were under cure on the . When a patient dies, the body is laid out, and, after remaining in the bed about hours, is taken to the dead-house; the bed and bedding are thoroughly washed and cleansed; the bed is entered as a

dead bed,

and remains unoccupied about a week.

At Guy's the number of beds which can be made up on an emergency is . The average number of applications for admission on the regular day is , of whom on an average are admitted and rejected. The deaths are about per week. On the death of a patient, a screen is placed round the bed; but it is rarely possible to conceal the circumstance from the others in the ward, and within or hours the body is removed to the undertaker's room. The out-patients of this hospital amount, perhaps, to a-year. About

376

surgical tickets are issued per week; surgical casualties per day; eye-cases per week; physician's tickets per week; cases per day relieved at the apothecary's shop; obstetric cases per week, and ordinary lying--in cases; or taking weeks as the average of attendance of each class of cases, there is an average of above persons in the daily receipt of medicine or attendance, independently of slight casualties relieved.

The importance of the great London Hospitals as schools of medicine is well known. Nearly every medical and surgical practitioner has

walked the hospitals,

as the phrase goes; and though the recognition of provincial medical schools renders it no longer absolutely necessary that a medical student should have attended a , yet the number who

come up

for this purpose is but little diminished. The vicinity of the hospitals swarms with these incipient Galens; and they are so thick on the ground in some quarters, particularly in the neighbourhood of the Borough hospitals, as to give the district a distinctive character. Certainly the

medical students

are entitled as a class to figure amongst the social lights and shadows of this great metropolis.

There are schools of medicine in London, but the most important are those connected with the great hospitals, though it is chiefly within the last years that they have attained their pre-eminence over the private schools of medicine. The lectures of John Hunter, in , about , were the complete course ever delivered in the metropolis; and in all the dissections carried on in London--were confined to school, that over which John Hunter's brother presided. But even at St. Bartholomew's Hospital the introduction of lectures is of very recent date. Mr. Percival Pott, a distinguished surgeon of this hospital nearly years ago, was in the habit--of delivering occasional instruction in this manner; but the late Mr. Abernethy, about years ago, may be said to have been the father of the system as it at present exists. The institution of a medical school in connexion with an hospital adds to the emoluments of the medical officer; furnishes, through the medium of the pupils, additional and gratuitous attendance on the hospital patients; and, lastly, imparts a medical education to the pupils themselves by lectures, illustrated during their personal attendance on the patients, by observation of the progress and symptoms of disease, the mode of treatment adopted, and the results. The governors of this hospital have since expended above in buildings intended to facilitate the acquisition and communication of medical science. The museum was built so recently as .

From to the schools of surgery of St. Thomas's and Guy's Hospitals were united, and the fees paid by the surgical pupils of both hospitals were put into common fund, and divided equally amongst the surgeons and apothecaries of the establishments. Medical lectures only were delivered at , while surgery, together with anatomy, was taught at St. Thomas's. For many years the late Sir Astley Cooper, who was surgeon at Guy's, filled the office of anatomical lecturer at St. Thomas's. This union was dissolved in , in consequence of the governors of the institutions differing respecting the appointment of a lecturer on anatomy; though we believe there is still some traces of the old connexion to be found in existing regulations. In it was resolved that the means of surgical education should be provided within the

377

precincts of . Accordingly, the building which contains the anatomical schools, museum, &c. was erected at a cost of about Sir Astley Cooper was appointed principal lecturer in surgery, his nephew succeeding him as surgeon. On this occasion Sir Astley was desirous of presenting to his anatomical models and preparations, when the governors of St. Thomas's refused to surrender them, but ultimately gave him for his interest in them. A few years ago, in consequence of some offence given by them, the privileges of the students of Guy's, in being admitted to see the practice of St. Thomas's, was restricted to some extent by the authorities of the latter establishment, when a most serious riot took place. The refractory students were indicted for the offence, and a slight punishment was awarded by the court. The fees paid by pupils entering the medical and surgical practice of this hospital are about a-year, which is divided amongst the principal physicians, principal surgeons, and apothecary. The pupils admitted yearly to the house-practice vary from to , and an attendance of years is required by the Apothecaries' Society.

We can scarcely do more than mention the names of the other hospitals. The , opposite the Abbey, was established in , and was the institution of the kind supported by voluntary contributions. It contains accommodation for patients. Hospital was established in , by a dissentient party in the management of the , and Lanesborough House was at engaged for the purpose. The principal front of the present building is feet long, faces the , and is of rather imposing design. It contains a theatre for the delivery of lectures and an anatomical museum, and the number of beds is . The was established in , and in was removed to its present situation in Whitechapel

378

Road. The patients are chiefly watermen, and labourers employed in the docks and on the quays in the east parts of London. In this quarter we have also the Dreadnought, a large man of war which lies off Greenwich, and is fitted up as a hospital for sick and maimed seamen of every nation. This floating hospital is in every way a very admirable institution, and we regret that we have not space to notice it more fully. On the north side of London we have the , established in , and subsequently enlarged by additional wings. The number of beds is ; and, through the munificence of the late Mr. Whitbread, provision is made here for patients afflicted with cancer, who may remain in the hospital for life if they wish. The ordinary expenditure is nearly a-year. The Small-pox Hospital was originally established in by public subscription, and opened at a house in , ; but in was removed to its present situation at . Adjoining it is the London , established in , which contains beds for about patients. University College Hospital was founded in , and already ranks high as a medical school. The number of students attending the practice of the hospital is usually about , and nearly -half of the income of the institution consists of the fees paid by them. Proceeding to another part of the metropolis, we find the Charing-Cross Hospital, established in , and combining the plans of a dispensary and an hospital for in-patients. In , near , is Hospital, established in . It has an income of about a-year. There is also the Royal Free Hospital for the Destitute, established in , in , and removed to in , supported entirely by voluntary contributions. We subjoin the population of the principal general hospitals of the metropolis on the day when the census was taken:--
Name of Hospital. Number of Patients,June 7, 1841. Number of Persons, employed in the Establishment or Resident on June 7, 1841. Grand Total. Deaths in 1839.
 M.F.Total.M.F.Total.
St. George's178134312104656368250
Westminster68751436222817195
Middlesex10910321293645257156
Charing Cross43468961319108102
King's College5645101620261270
University College564510191524125194
Fever1415291101140161
Small-pox151025279328
London20510831311607138311
St. Bartholomew's19419238622125147533361
Guy's25119244349161210653219
St. Thomas's1251162412281103344214
Dreadnought168016817926194110
Total1482181256317060577533382231

New institutions of this nature are every year springing up, especially those intended for the reception of special classes of disease,--as consumption and the diseases of the chest, cutaneous diseases, diseases of the eye and ear, &c. &c.- though some of these new establishments are dispensaries rather than hospitals.

379

The

Sanatorium,

in the , opened in , is an especially interesting institution, and calculated to be of most essential service to a particular class, as governesses, clerks, and other persons of respectable station who are without friends in London; but we cannot here do more than refer to the interesting Annual Report.

Besides the institutions just enumerated, there are numerous lying--in hospitals in different parts of the metropolis: none of them are as yet a century old, the earliest (the British Lying--in Hospital in ) having been established in . Comparing the years of its existence with the years of the present century, it appears that the deaths of mothers had fallen from in admitted to I in , and the deaths of children from I in to in . Dispensaries, for supplying the poor with medicine and advice gratis, are also found in every part of London. Some of them have been in existence about years; but they originated at the close of the last century, and led to those medical squabbles which made the subject of Garth's poem. These institutions are often made use of by persons of a very different class from those whom they are more particularly intended to benefit.

The Lunatic Hospitals and Asylums, though widely differing in most respects from the medical and surgical hospitals, are still institutions of the same class. Above lunatics and idiots are in confinement within the limits of the metropolitan Lunacy Commissioners, above half of whom are confined in licensed houses, about at Bethlem, above at , at Guy's, and nearly at Hanwell. Bethlem and only come within our province on the present occasion.

, or the House of Bethlem, as it was originally called, was founded as a convent by Simon Fitz-Mary, a citizen of London, in . The founder directed, that in token of subjection and reverence, sterling should be paid yearly at Easter to the Bishop of Bethlem or his nuncio. The date of this house being converted into an hospital is not known, but in , less than a century after its foundation, it had acquired this designation. In the brethren of the house were dispersed abroad collecting alms, and an application on their behalf was made to the mayor and aldermen to be received into their protection. The earliest notice which can be found of lunatics having been received at Bethlem is . There were then in the house men deprived of reason, and sick persons, as appears by an inquisition taken at the above date. The purchase of Bethlem by the city took place in . In - it was for a short time, along with the other hospitals, under the same government as ; but in it was placed under the control of the governors of , treasurer being appointed for both houses. This union still subsists, and was confirmed by the act of , for regulating the royal hospitals. The affairs of the hospitals are transacted at the same courts, and the proceedings are recorded in the same books, as if the houses were foundation; but the accounts are kept in separate ledgers.

In , it appears, by an account rendered to the Governors of , that the

yerely issues and proffittes

of were , arising almost entirely from houses. A valuation of the real estates wva made

380

in , and it appears that, if then out of lease, they would have produced about per annum. For many years the funds were inadequate to the maintenance of the hospital; and in the preachers who were to preach at Easter at the Spittal were desired to make an appeal to the people in its behalf. In , it appears there were lunatics constantly maintained in Bethlem, and the revenues only defrayed -thirds of the charges. The endowments of the hospital are now very ample, and the greater part of the property is applicable to the general purposes of the institution; but portion (under the will of Mr. Barkham) has been given exclusively for incurable patients, and consists of acres of land in Lincolnshire, which, with the tithes, produce a-year, of which only - is realised, applicable to the purposes mentioned in the will. The total income of the real and personal estate of the hospital for the year ending Christmas, , was , of which above , was derived from houses and land, and from stock invested in the public funds. The gross income of the hospital from all sources (the profits made by the reception of criminal lunatics excepted) averaged for the years ending in .

Stow says that the church and chapel of Fitz-Mary's Hospital were taken down in the reign of-Queen Elizabeth, and houses built instead by the governors of . The Charity Commissioners give an extract, made in the muniment book in , which is the earliest description of the hospital they could find. The old house contained

below stairs a parlour, a kitchen,

two

larders, a long entry throughout the house, and

twenty-one

rooms wherein the poor distracted people lie, and above the stairs

eight

rooms more for servants and the poor to lie in, and a long waste room now being contrived and in work, to make

eight

rooms more for poor people to lodge where there lacked room before.

Besides this, there was

one

messuage newly builded of brick, containing a cellar, a kitchen, a hall,

four

chambers and a garret, being newly added unto the old rooms.

years later the question of enlarging the hospital came under consideration, and a committee of view being appointed, it was reported that the ground on which old ruinous tenements stood would allow of space for a new building to contain rooms on the ground floor, and over them for lunatics, and garrets for servants, and another yard for lunatics. This addition to the hospital was effected, but it appears that altogether not more than or patients could be accommodated.

After the Fire of London the governors resolved to build the house on a larger scale, and the City granted them a lease of some ground, feet long by deep, adjacent to , for the site of their new building, which it was intended should be capable of accommodating lunatics. The lease was granted for years, subject to a rent of Is. if demanded, with a provision that the lease should be void in case the building was devoted to any other purpose. The new hospital (as it was recorded on an inscription over the entrance) was commenced in , and completed in . This was the centre of Old Bethlemn Hospital, and it was similar in design to the Tuileries. Its length was feet, and breadth feet, besides the wall which enclosed the gardens before it,

which were neatly ornamented with walks of freestone round about, and a grass-plot in the middle, beside which garden there was another at each

end for the lunatic people, when they were a little well of their distemper, to walk in for refreshment.

wings were added to the hospital in , for the reception of incurable patients under the provisions of Mr. Barkham's will. In an edition of Stow, published in , the hospital is described as consisting

chiefly of

two

galleries

one

over the other,

193

yards long,

13

feet high, and

16

feet broad, not including the cells for the patients, which were

12

feet deep. These galleries were divided in the middle by

two

iron gates, so that all the men were placed in

one

end of the house, and all the women at the other, each having their proper conveniences, as likewise a stone room where, in the winter, they had a fire to warm them, and at each end of the lower gallery a larger grassplot to air and refresh themselves in the summer, and in each gallery servants lay to be ready at hand on all occasions; besides, below stairs there was made of late a bathing-place for the patients, so contrived as to be a hot or cold bath as occasion required.

Towards the close of the last century the hospital had become insufficient for the number of patients requiring an asylum; and in the City granted a lease for an adjoining piece of ground which would have enabled the governors to enlarge the hospital; but the bad state of the old buildings seems to have prevented any use being made of the space thus acquired. In the Report of a committee, dated , it is stated that the whole building was dreary, low, and melancholy, and that the interior arrangements were ill-contrived, and did not afford sufficient accommodation, and the close and confined situation precluded the advantages of air and exercise. In consequence of this Report it was resolved not only to rebuild the hospital, but to transfer it to a new site. Great and unexpected difficulties occurred to delay the erection of a new hospital, and as the eastern wing had been rather too hastily pulled down, a reduction in the number of patients became unavoidable. The discovery of the true bearing of the old lease (by which the lease granted by the City became void, if the site were not used for a lunatic asylum), again protracted the negotiations. different sites were fixed upon at ; the end of Street was thought of; and at period it was in contemplation to improve the site of the Old Hospital and the approach through Old Bethlem to . Finally the - acres on which the old hospital stood were exchanged for the present site, containing about acres, the condition of the lease requiring that the new hospital should be capable of accommodating patients, and that not less than acres of the land should be appropriated to their use, while the governors were to be at liberty to employ the rest for the general purposes of the hospital and in augmentation of its revenues. The Act for effecting the settlement of this affair was passed in .

A site being thus provided, premiums were offered for designs for the intended building, and plans were sent in. The surveyor of the hospital and architects selected from this number, and on the basis of these, but with such alterations as he might consider necessary, Mr. Lewis was directed to form a plan for a building to contain accommodation for patients, but with offices on a scale sufficient for twice that number. Further steps were taken to obtain the necessary funds, for the governors had commenced, in , to reserve a portion of their revenues for building purposes. Grants of public money were also obtained to the amount of ,; the benefactions of public bodies amounted

382

to , including from the corporation; from the ; and various sums from several of the city companies; the amount contributed by private individuals was ; were contributed from the funds of the hospital; and a sum of accumulated as interest during the progress of the work. The stone of the new building was laid in , and in , it was completed and ready for the reception of patients. The total cost was It consists of a centre and wings; the centre is surmounted by a dome, and the entrance is by an Ionic portico of columns, supporting the royal arms. In the hall are the figures of Raving and Melancholy Madness, executed by Cibber for the old hospital, and repaired in by Bacon. The wings, for which the government advanced , are appropriated to criminal lunatics, who are supported at the public expense at a cost of each. In the male criminal wing was enlarged, and there have been considerable additions made to the hospital since that time. The stone of some additional new buildings was laid , on which occasion a public breakfast was given, at a cost of to the hospital; and a narrative of the proceedings was drawn up and printed with several documents, at a cost to the charity of The length of the building as it now stands is feet. There are galleries, feet inches long, for male and female patients, both in the basement, on the ground-floor, and on the and floors. There is a gallery, on the floor of the central building, which is appropriated to incurable patients, and differs considerably from the other galleries. The sleeping-rooms are partitions divided from each other, and from a passage in front, by bulk-heads about feet high, which do not reach to the ceiling. The passage faces the south, and is more lively and cheerful than any of the others. The patients are divided into classes: the furious and mischievous, and those who have no regard to cleanliness, being placed in the basement; ordinary patients, on their admission, and those who are promoted from the basement, are on the floor; and the floor is appropriated to patients who are most advanced towards recovery: and there are other galleries for the incurable patients.

Under the Act of the united establishments of and Bethlem are governed by a president and treasurer elected by the general courts; the court of aldermen and councilmen; and an unlimited number of nomination governors. The number of governors at present is . Bethlem is exempt from the visitations of the Commissioners of Lunacy, a privilege which has not been of much advantage to it, for it has the demerit of having carried into operation, to a period of less than years ago, the unenlightened and brutal system of treatment which distinguished the century. In the inquisition of the iron chains with locks and keys, and the manacles and stocks there spoken of as belonging to , indicate but too plainly the system of that day. There are several passages in Shakspere which show that bonds, darkness, and flagellation were the remedies adopted for the recovery of the lost reason! A passage in

Lear

alludes to the custom of allowing lunatics whose malady was found to be unattended with danger to leave the hospital with an iron ring soldered about their left arm, and a permission to beg. In a committee appointed to view Bethlem reported that the place

383

was so loathsome that it was not fit for any man to enter. It contained only inmates, who were termed prisoners, and of these only were maintained at the expense of the charity. Coming down to a later period, we find that the Hospital used to derive an income of

at least

400l.

a-year from the indiscriminate admission of visitants, whom very often an idle and wanton curiosity drew to these regions of distress.

[n.383.1]  Ned Ward's

London Spy

shows, indeed, that the lunatics were visited just in the same way as the lions at the Tower. In the practice was put a stop to. In it appears that strangers, as well as the friends of the lunatics, paid on admission. The exposure of the wretched system pursued at Bethlem, which took place in , in consequence of the investigation of a parliamentary committee, is probably still fresh in the recollection of most readers. The visitors thus describe of the women's galleries:--

One

of the side-rooms contained about

ten

patients, each chained by

one

arm or leg to the wall, the chain allowing them merely to stand up by the bench or form fixed to the wall or to sit down again. The nakedness of each patient was covered by a blanket-gown only. The blanket-gown is a blanket formed something like a dressing-gown, with nothing to fasten it in front: this constitutes the whole covering. The feet even were naked.

female in this room was found, who in lucid intervals talked most reasonably, and on being treated like a human being became an entirely different creature. Many women were locked up in cells naked and chained, on straw, with only blanket for a covering, and the windows being unglazed, the light in winter was shut out for the sake of warmth. In the men's rooms,

their nakedness and their mode of confinement gave this room the complete appearance of a dogkennel.

The patients not being classified, some were objects of resentment to the others. The shocking case of William Norris, a lunatic confined here, excited a deep sensation, and by its exposure led eventually to improvement. At this period, for months together, the committee made no inspection of the inmates! The house-surgeon was often in an insane state himself, and still oftener drunk; and of the keepers who was frequently in the latter state remained undischarged. Just at this time also the governors spent in opposing a Bill for regulating madhouses I The improvements in the system of management at Bethlem began about . Patients of both sexes are now set to do such little offices as they are capable of. They assist in household occupations ; some employ themselves in knitting, tailoring, and mending the clothes of the other patients. Females find occupation in the laundry and in making up linen, all the ordinary needlework of the house being performed by them; and some are engaged in embroidery. In the airinggrounds many of the men play at ball, trap-ball, leap-frog, cricket, and other games; and the women are encouraged to dance in the evenings. Every case of restraint is now noted down, and must be at once reported to the medical officers, and brought under the notice of the committee.

for lunatics, in , was opened in , and was intended for the reception of those who could not obtain admission into old . It has always been favourably distinguished for its

384

management. The average number of inmates for was , and were discharged during the year. The Hospital is a very substantial brick edifice, but it is to be regretted that it is not situated at least in the suburbs. The income (above a-year) is derived from legacies and donations amounting to invested in the funds, and receipts on account of uncured patients.

The great for the county of Middlesex, situated at Hanwell, a short distance to the left of the Great Western Railway, and about miles from London, is of the most remarkable establishments in the country: and though it is somewhat out of our limits, we cannot pass it by without a brief general notice.[n.384.1]  The Asylum is intended for inmates, and accommodation will probably be eventually provided for . The present number of servants and officers exceeds . The grounds contain acres, of which are cultivated as a farm, as a garden, as an orchard, and nearly are shrubberies. The airing-grounds and courts occupy a space of eighteen acres, and the asylum buildings cover above and a half acres. The ancient bodily restraints, on which entire reliance was formerly placed, have been disused, and even severity of tone has almost ceased to be employe.d. We can here only say of the system, that it is in every respect precisely opposite to that which, until within a comparatively short period, was acted upon at Bethlem.

 
 
Footnotes:

[n.383.1] Rev. Mr. Bowen's Account of the Hospital, 1783.

[n.384.1] We take the opportunity (as we have not space for details) to recommend all who are interested in the subject to the admirable Reports of Dr. Conolly, the physician at Hanwell, and also the Reports of the Visiting Justices, by whom his enlightened efforts have been supported in a most excellent spirit. Bethlem Hospital.