Bethlem Hospital is a royal foundation for the reception of lunatics, incorporated by Henry VIII., and erected in Moorfields in 1553. That building was pulled down in 1814, and the new hospital erected in St. George's Fields in 1815.

The old hospital was built on the plan of the royal palace of the Tuilleries at Paris ; and this fac-simile of his Palace, adopted for such a purpose, gave so much offence to Louis XIV., that he ordered a plan of St. James's Palace to be taken, for offices in his own capital of a very inferior description.

The present hospital is a noble and extensive building of brick. The foundation stone was laid in 1812, on the 20th of April, upon the site of the once celebrated Dog and Duck tavern and tea-gardens, which had been subsequently occupied by the School for the Indigent Blind. , The plan was designed by Mr. Lewis, and the building cost about £100,000.

The front is truly magnificent ; consisting of a centre and two wings, forming a range of build five hundred and eighty feet in length. The centre is surmounted by a dome, and adorned by an Ionic portico of six columns, supporting the arms of the United Kingdom. The interior is judiciously arranged, and is capable of accommodating two hundred patients of both sexes, independent of two criminal wings which are capable of containing about sixty patients, supported by Government. The asylum is supported by the Bridewell estates, consisting of property in London and Cornwall, as well as by voluntary contributions.

The following is a list of benefactions placed up in the hospital towards the erection of the building.

Minor Benefactions

In the hall are placed the two fine figures that represent raving and melancholy madness, for which Louis Xllth of France offered twelve thousand louis-d'or. They were executed by the celebrated Caius Gabriel Gibber, father of Colley Cibber, the dramatist and poet laureat; and they were repaired in 1820, by Mr. Bacon. They formerly decorated the pillars of the gateway entering to the Old Hospital in Moorfields. The building, and the grounds for exercising the patients, occupy an area of about twelve acres.

The following is a list of the new establishment.

President,
Sir Richard Carr Glynn, Bart.

Treasurer,
Richard Clarke, Esq., Chamberlain of London.

Physicians,
Sir George L. Tuthill, Knt., M.D.
Edw. Thomas Monro, M.D.

Surgeon,
William Lawrence, Esq.

Apothecary and Superintendent,
Edward Wright, M.D.

Steward,
Mr. Nathaniel Nicholls.

Matron,
Mrs. Elizabeth Forbes.

Keepers,

Minor Servants,

The Building

The two wings are appropriated for the patients, the centre for the resident officers, the physicians' parlour, apothecary's shop, and servants' hall, &c. &c.

Each of the wings has four galleries, and an infirmary for the aged, quiet, and helpless female patients. The galleries are about seventy-five yards long, with a wing of about twenty yards. In each gallery there are twenty-three bedrooms, a keeper's room, dining room, and a side room for confining refractory patients, which is but rarely used ; a pump, a washing place, and a water-closet.

The galleries, in cold weather, are warmed by Howden's patent air-stoves, one at each end, to the top of the house ; good fires are kept below, and the heat is said to be capable of increase to the temperature of sixty-six degrees, but this is never required.

The heat diminishes considerably in the top gallery, for which reason there is an additional fire in the dining-room and keeper's room of each gallery, to both of which the patients have access at pleasure. Around the stoves and fire-places are strong iron guards to prevent accidents; and the fire-irons are chained, to prevent the patients from using them for mischievous purposes. The gallery floors are of wood, and the cielings of plate iron, excepting the basement gallery, the floor of which is of stone pavement, and the covering an arch of brick work ; and in each gallery a lamp hangs in winter from dark till bed-time.

The patients are divided into the four galleries, thus. The basement, or No. 1, is appropriated for all noisy and dangerous patients, some of whom are very uncleanly. In this gallery there are two keepers, but in each of the upper galleries only one. The ground story, No. c2, receives the patients on their admission, and this gallery, as well as No. 3, is appropriated for curables.

The upper gallery, No. 4, is for the incurables, and contains patients of that description only. The male criminals' wing is a separate building in the rear of the west end of the hospital ; and the female criminals' wing is in the rear of the east end.

Each of these wings has four of the galleries floored and cieled in the same manner as the other galleries, and they are divided by iron partitions.

The whole expense of the criminal wings is defrayed by Government; and the provisions, medical treatment, and domestic arrangements, are precisely similar with the rest of the hospital.

The airing-grounds are large square areas in the rear of the building ; the males' side is divided from that of the females by a large garden, allotted for the use of the officers of the establishment, and separated from the criminals by a high wall, surmounted by a chevaux-de-jrise to prevent escape of the criminals. Into these airing-grounds the patients are brought daily, whenever the weather is fine ; and they have, by some means, obtained the appellation of " Green Yards."

Regulations 

The patients rise every morning in summer at six o'clock, and in winter at seven. They breakfast at eight in summer, and in winter at half past eight. They dine daily at one, sup at six, and retire to bed at eight, when they are locked up. Each patient has a separate room. The bedsteads are of iron, with common sacking bottoms ; the bedding a good flock mattrass, a pillow, three blankets, a pair of sheets, and a rug. The sheets are regularly changed every fortnight, or oftener if necessary.

In the basement gallery, where the disorderly patients are, there are no sheets, and they sleep on straw, which is changed every morning if requisite.

The night watch

This duty is performed by five keepers, two porters, and the cutter of provisions, who relieve each other every four hours. It begins at ten o'clock at night, and is continued until the bell rings for rising in the morning. This is a most necessary duty, for a patient may be taken ill, and without prompt assistance might die before morning, or he may commit suicide.

Cleanliness

The male patients are shaved regularly twice a week, and the whole of their linen is changed once a week. The cold, warm, and shower baths, are in constant use. The warm bath frequently, as well for purposes of cleanliness as of medical application. This is Howett's patent bath, heated by steam.

Treatment of patients

The grand principle of this establishment is mildness ; for it is now generally acknowledged, that this mode of treating the maniac is much better calculated to restore reason than harshness or severity.

No keeper has authority here to put a patient in confinement without first acquainting the superintendant, who inquires into the circumstances; and if it should appear to him necessary, the refractory person is put under restraint, which is invariably the mildest, and only kept so for a short time, unless it be absolutely necessary. Dr. Wright, whose vigilance is as unceasing as his mind is patient and humane, will allow no passionate confinement for trivial offences, being convinced that restraint, without urgent necessity, is injurious to the feelings and exciting to the initiation of patients, and considerably impedes their recovery. The good effects of this mild treatment have done wonders ; for a refractory patient is frequently silenced and becomes tranquil at the mere threat of restraint ; which if adopted for any trivial irregularity, he would become unhappy and mortified ; besides, it would give him a practical specimen of prison discipline, which perhaps he knows only by name. They are generally confined, when refractory, to their own rooms for an hour or two, until they become cool and orderly. The name of the person, the nature of his offence, the length of his confinement, and the date, are regularly entered in a book kept for the purpose, which is read by the clerk to the next sub-committee of governors, who meet every Thursday, upon which day also new patients are admitted to the hospital, leave of absence given or enlarged, and the cured discharged.

The laundry

Is fitted up with every appropriate conveniency, such as coppers for boiling, large wooden troughs for washing, with two pipes leading to each, one conveying hot, the other cold water. There is a large drying yard in front, with poles and lines to dry the linen in fine weather ; but in wet weather, the drying is conducted in a stove room, remarkably warm and commodiously fitted for the purpose. The immense piles of linen collected from all parts of the house are washed here : two laundry women conduct this business, and are assisted by such of the female patients as are able and willing, and can be safely trusted ; they also assist in getting it up. The whole is brought clean and regularly to each gallery on Saturday morning, when the patients' linen is entirely changed, and the foul returned to the laundry.

Diet

The general breakfast throughout the year is wholesome gruel mixed with milk, and two ounces of bread. The supper is seven ounces of bread and two of butter.

The dinner varies every day, and is as follows:
Sunday - Seven ounces of bread, corned beef half a pound, and vegetables in season.
Monday - Half allowance of bread and butter, rice pudding baked, and broth.
Tuesday - Seven ounces of bread, mutton roast and boiled alternately, or veal, in the season.
Wednesday - Excellent pease soup, and seven ounces of bread.
Thursday - Seven ounces of bread, with roast or boiled mutton, or veal, and vegetables.
Friday - Baked batter pudding, and half allowance of bread and butter.
Saturday - Rich rice milk, with seven ounces of bread and two ounces of butter.

And in summer rice milk on Wednesday instead of pease soup.

Excellent table-beer is served, without any stint of allowance ; some drink more, some less : but the average quantity does not exceed two pints each patient per day.

The knives and forks used here are of bone, just sharp enough to divide the meat. But a keeper attends the patients at their meals, and cuts for them what they cannot manage with the bone knives ; wooden trenchers and spoons, with bowls for their gruel and beer of the same material ; also night bowls. All dangerous articles used in cleansing about the establishment are always locked up, except at the time of using them.

Clothing is given regularly once a year to the incurable patients ; but oftener, if they stand in need. The curable patients are never supplied with clothing, unless their friends are unable to provide them : in that case, the securities pay the expense ; or, if paupers, the clothing is paid for by their parish.

When patients become bodily ill, they are placed on the sick list, and are allowed a different diet; such as batter-puddings, pies, fish, fowl, soups, jellies, tarts, or whatever they fancy, that is not improper for them.

To weakly patients, who are not too much excited, port wine or porter is allowed, according to their respective states of health : but no patient, whose health does not require it, is permitted to have wine or porter on any account.

Patients who, perhaps, have been accustomed all their lives to use tea, are permitted, when they cannot take gruel for breakfast, to have it with the keepers, for which they are allowed to receive from the patient's friends two shillings per week. Generally, however, they take the gruel with good appetite, the best proof of which is, that very little is left after breakfast.

The visitation of patients

The friends of patients who reside in London are permitted to see them once a week, namely, on Mondays from ten till twelve. Two persons are allowed to visit each patient ; but persons residing at a distance, or in the country, may see them any day at any hour.

When patients are sufficiently well, or in a fit state to see their friends, they are brought by the keepers who attend for that purpose : the male patients to the servants' hall ; the females to a room adjoining the committee room. The persons who thus visit, write their names, their addresses, and the names of the patients they come to visit, in a book kept for the purpose. They must not bring with them any eatables (the provisions of the house being amply sufficient). A little fruit, or a tart, may be allowed, but nothing else ; and, of course, no liquor of any description. They must not give money or presents to the keepers, on pain of the giver being refused in future permission to see their friends, and the receiver being discharged. This order, signed by the clerk, is conspicuously fixed up in the visiting room, that none may plead ignorance of the rule.

This liberty of visitation was not allowed under the old establishment, some twenty or thirty years ago; for at that time, when unfortunate persons became deranged, they were dreaded by their relatives, neglected, forgotten, and buried from the world, and the poor creatures became totally lost. But in this institution they come up cheerfully, receive with ecstacy the hopes their friends give them, and depart from the meeting generally gratified.

Divine service

Such patients as are thought sufficiently recovered, or who are otherwise well-behaved, attend divine service on Sundays and Fridays in the visiting room of the male patients (which is also the servants' hall). They are provided with prayerbooks, and generally conduct themselves well.

If any patient objects to the church service, or has any other objection to attendance, he is never obliged to appear. The male and female criminals attend on Sundays. The chaplain attends at the criminal wing on Wednesdays also. The service is performed by the Rev. Henry Budd, M.A., chaplain to the hospital. The keepers attend in turn with the other servants of the establishment.

Medical Department

The physicians attend their respective patients regularly twice a week each. Sir George L. Tuthill. M.D., on Mondays and Fridays ; Edward Thomas Monro, M.D., on Tuesdays and Saturdays. On those days they see all their patients throughout the hospital, and prescribe for them as the nature of their maladyA disease or ailment; or a serious problem. requires. Should a physician perceive that a patient is in an improving state, he particularly observes him from time to time, until after receiving a good account from Dr. Wright and the keepers, he thinks him sufficiently recovered for a trial at home with his friends. He then recommends him at the next meeting of the Committee of sub-Governors, and a month's leave of absence is obtained ; at the expiration of which time, should he be perfectly recovered, he attends at the hospital merely to shew himself to the committee, returns thanks, and is discharged. But if when the month's leave is expired, the patient should not be quite so well as is wished, another month's leave is granted and so on, until he is perfectly recovered ; when he attends to return thanks, and is finally discharged. If a patient should relapse during his leave of absence, he may be brought back to the hospital at any day or hour, free of expense. But it is considered that a month, at least, is necessary for him to continue well in the hospital, previous to the leave of absence.

Too much praise cannot be conferred on Dr. Munro, for his humane attention and the kind feeling he at all times evinces for the unhappy persons under his care. At every visit, he orders all his patients to be brought regularly together, when he counts them, examines them one after another, and inquires of the keepers every par ticular relating to each, even to the most trivial circumstance.

Nor is less commendation due to the meritorious conduct of Sir George Tuthill, whose gentlemanly, kind, and humane attentions are ministered with unwearied diligence, and in some cases with the most invincible patience, or he could not bear the abusive insolence of many refractory subjects.

William Lawrence, Esq., surgeon, attends the hospital very frequently, and examines all cases that come within his professional department. A slate hangs up at the apothecary's shop door, on which Dr. Wright orders all surgical cases for inspection to be set down. This slate he examines as soon as he comes, and immediately goes round to visit such patients, but if any should require more prompt attendance, Mr. Lawrence is sent for. This gentleman is well known to the medical and philosophical world by his skill and science, and his published Lectures delivered at Surgeons' Hall.

Dr. Edward Wright is the superintendant and acting apothecary. He holds the situation formerly held by an apothecary only, Mr. Wallett : but on the resignation of that gentleman, Dr. Wright was elected superintendant of the hospital, over which he holds the chief controul and direction in the absence of the governors, to whom he is responsible, as well for its domestic economy and discipline, as for the preparation and application of medicines. He resides with his family constantly within the hospital, and performs all the duties of his situation, arduous as they are, with diligence and regularity, highly to his honour : ever attentive and humane towards the unhappy patients, and kind and considerate to all acting under his authority. He visits the whole once a day regularly, or oftener if occasion requires ; and, in the absence of the two visiting physicians, he prescribes for them as circumstances may render necessary. He is very rarely absent from the hospital, except upon its duties.

On Thursday he attends the committee, enters in his book the names of all patients admitted, discharged, or sent home on leave of absence ; reports to the physicians those patients who, from his own observation, he considers fit for a trial ; and also those for discharge, whose probationary twelve months in the hospital are expired, though they be still uncured. But it should be mentioned to his honour and benevolence, that when a poor patient is thus discharged, and by the rules of the establishment is not re-admissible, and Dr. Wright is informed that he is ill, he loses not a moment, but attends such patient at his own residence, without fee or reward, prescribes for him, and renders him every service in his power ; and, if such patient be able to attend the hospital, he cups, bleeds, or renders any other professional assistance.

Mr. Nathaniel Nicholls, steward, is in every respect perfectly well adapted to the duties of his situation : vigilant, careful, and correct ; a good accountant, and always on the alert for the interests of the establishment. He goes regularly once a day through the male side, to examine every thing which demands his inspection. He distributes blankets, bedding, soap, candles, household utensils, &c. &c. He rigidly examines the qualities and weights of all provisions, and other articles brought in from tradesmen, and sees at all times that none but the best shall be admitted.

Mrs. Elizabeth Forbes, the matron, superintends the whole of the female department. From her manner and demeanor she appears to have filled a situation in society far above that she now holds.

She feels most ardently for the interest of the establishment, and identifies herself with its prosperity as much as if she were one of its founders. She is humane and patient : yet, notwithstanding, she possesses more nerve than generally belongs to her sex ; for often, when a patient becomes so refractory as to intimidate the female keepers, Mrs. Forbes will undauntedly repair to the unruly maniac, and, by her firmness and discretion, reduce her to quietness and order.

The keepers, both male and female, are cleanly, intelligent, humane, and in all respects well adapted to their situations ; and they perform their various duties with alacrity and cheerfulness, to the satisfaction of the superior officers.

The cleanliness and good order of the whole establishment affords the best proof of their attention and industry. Their wages are liberal, and the male keepers in turn enjoy the privilege of going out two evenings in each week, from six o'clock to ten, and one whole Sunday every five weeks.

The female keepers, in their turn, have liberty to go out one Sunday in three weeks, and one evening, from six to ten, in every week.

The duties of the keepers, both male and female, are certainly very arduous. They have the violent to restrain, the low and melancholy to cheer, the deluded to undeceive, the filthy to cleanse, the helpless to dress, undress, and feed, the ill-tempers of all to bear ; and, in fact, their occupation is one of perpetual anxiety, watchfulness, and alarm. Many of the patients are ever contriving to obtain means for self-destruction, the prevention of which in itself is a most anxious task, and requires the utmost vigilance.

A keeper here, in fact, should possess vigilance, courage, strength, and patience, to be able to accommodate himself to all the tempers, whims, and occasions.

The writer has been thus minute in his description of this establishment in every part, as well for the satisfaction of his readers as for the admonition and example of those officers who may hereafter have the management of an institution, admitted to be unparalleled in any other part of the world.

A circumstance the most surprising is, that there should be a single vacancy at the present day, when insanity is so prevalent, not only in and about the metropolis, but in all parts of the United Kingdom, and when all the private* and public mad-houses are nearly filled with lunatics ; and this appears the more extraordinary, inasmuch as the only qualifications for admission here are insanity and poverty ; notwithstanding which, in the month of March in the present year, there were vacancies for no fewer than thirty-eight men and twelve women, about one-fourth the number the building is capable of accommodating.

* There are no less than forty licensed private mad-houses within the Bills of Mortality ; and of these, two establishments at Hoxton and Bethnal Green, alone, contain upwards of thirteen hundred patients!!

Instructions for persons applying for the admission of patients into Bethlem Hospital

All lunatics who are not disqualified by the following regulations may be admitted into this hospital at all seasons of the year, and will be provided with every thing necessary for their complete recovery, provided the same can be effected within twelve months from the time of their admission, upon payment of £2, if the patient is sent by relatives or friends ; and of £4 if such patient is a parish pauper, or has received alms or support from any public body or community ; which sums of £2 and £4 are not returnable, unless the patient dies or is discharged within one month after admission, nor in any case where deception has been practised upon the hospital by a false statement.

The following cases are inadmissible:

1. Those lunatics who are possessed of property sufficient for their decent support in a private asylum, and also those whose near relations are capable of affording such support.
2. Those who have been insane for more than twelve months.
3. Those who have been discharged uncured from any other hospital for the reception of lunatics.
4. Female lunatics who are with child, or who have before been discharged from this hospital in consecpience of their pregnancy having been discovered.
5. Lunatics in a state of idiotcy, afflicted with palsy, or with epileptic or convulsive fits.
6. Lunatics having the venereal disease or the itch.
7. Those who are so weakened by age or by disease as to require the attendance of a nurse, or to threaten the speedy dissolution of life, or who are so lame as to require the assistance of a crutch.

Certificate to be signed by the Minister and Parish Officers, and also by some Relation or Friend of the Lunatic.
We, whose names are hereunder subscribed, the minister and churchwardens or overseers of the parish of ______, in the county of ______, and , of the parish of ______, in the county of ______, the [here insert the degree of relationship, if any], of ______, in whose behalf the present petition is presented, having carefully read over the above seven regulations, do hereby certify, to the best of our knowledge and belief, that the said ______, who has resided in this parish for ______ or upwards, now last past, is a lunatic and has [here insert whether the lunatic has or has not received parochial support] received alms from such parish, is not in any of the states or conditions above-named, but is in every respect a proper object for Bethlem Hospital. Witness our hands, this ______ day of ______ 182 .

} Minister.

} Churchwardens.

} Overseers.

} Relation or Friend.

Certificate of Insanity.
I, the underwritten ______, of the parish of ______, in the county of ______, do certify, that I have examined ______, of the parish of ______, in the county of ______, and that such person is a lunatic, and is not within any of the foregoing seven regulations, which are declared to render patients inadmissible at Bethlem Hospital ; and I further certify, that I have given to the friends of the said lunatic a letter addressed to the physicians of Bethlem Hospital, containing a statement of the particulars of such patient's case, as far I am acquainted with it.

Witness my hand, the ______ of ______.
*** This certificate is to be signed by the physician, surgeon, or apothecary, who has visited the patient.

Affidavit.
A. B., maketh oath and saith, that he did see the above-named minister, parish officer, relative, or friend, and medical practitioner, severally sign their names to the above certificates.

Sworn the ______ day of ______, 182 , before ______.
*** The person making this affidavit must sign his name above this note.

When the person or persons in whose presence the foregoing certificates shall have been signed, has made oath before a magistrate pursuant to the foregoing forms the petition at the end of these instructions may be filled up, and directed to the steward of Bethlem Hospital.

On the following Thursday they will be considered by the governors, when the petitioner, or some one who is acquainted with the facts, must attend at the hospital, at ten o'clock in the morning, to give any further information that may be required, and to learn whether the lunatic can be admitted ; but such lunatic must not be brought to the hospital until directions are given for that purpose.

If the case be found to correspond with the petition and certificates, and there be a vacancy, the lunatic may be admitted on the following Thursday; and if no vacancy, the name will be placed on the list, and the patient will be admitted in turn.

On the day appointed for bringing up the lunatic, two respectable housekeepers, residing within the bills of mortality, must attend at the hospital at ten o'clock in the morning, and enter into a bond of £100, to take the lunatic away whenever the committee shall think proper to direct his or her discharge; as well as to pay the expense of burial if the lunatic should die in the hospital. And the names and places of abode of such securities must be left three days before, in writing, with the porter of Bridewell Hospital in New Bridge Street, Blackfriars.

N.B No governor, officer, or servant of the hospital, can be security for any patient.

Petition

To the right worshipful the president and treasurer, and the worshipful the governers of Bethlem Hospital, London.

The humble petition of ______, on behalf of ______, of the parish of ______, in the county of ______, a lunatic, aged ______ years.
Sheweth :
That the said ______, having been disordered in ______ senses about ______ and no longer, and being in every respect a proper object of your charity, as by the foregoing certificates will more fully appear ;
Your petitioner prays that the said lunatic may be admitted into your hospital for cure.
And your petitioner will ever pray, &c.

[Let the petitioner sign his name above.]
[*** The petitioner must be as near a relation of the lunatic as possible ; but in default of such relative, then some friend of the patient, or officer of the parish in which such patient resides.]

I, the undersigned, a Governor of Bethlem Hospital, desire the above lunatic may be admitted, if a proper object.

[*** If the parties do not happen to know any governors, the signature of a governor will be supplied at the hospital, when the petition is read.]

Bond

Whereas [here insert the name of the lunatic] a lunatic, hath been this- day received as a patient into Bethlem Hospital, established for the reception of lunatics, on our having jointly and severally agreed to remove and take away the said lunatic in manner hereinafter mentioned : now we do hereby jointly and severally undertake, promise, and agree, that we, or one of us, will, within seven days next after we shall be thereto required, by notice in writing, to be signed by the steward for the time being of the said hospital, remove and take away the said lunatic from the said hospital, at our, or one of our costs and charges ; and at the like costs and charges bury such lunatic, in the event of death ; and also that we, or one of us, will pay to the said steward the costs and charges of clothing the said lunatic, during the term of such lunatic's continuance in the said hospital. And in case of any default in the premises, we do hereby jointly undertake, promise, and agree to pay to the treasurer of the said hospital for the time being, the sum of one hundred pounds, on demand, together with all costs of suit to be incurred in respect thereof. As witness our hands this ______ day of ______ 18

[Signed by the Bondsmen.]

Witness {

Memorandum upon admission of patients into Bethlem Hospital

Name, age, married or not, and how many children ?
When admitted. Whether disordered before, and how often ?
When this attack commenced ?
Causes and previous appearances ?
Remarkable symptoms : whether mischievous ?
Whether hereditary ?
State of health ?
Lucid intervals ?
Habits of life, business, education, &c. ?
Diseased ideas ?
Where confined before, and how treated ?