Statues of "raving" and "melancholy" madness, each reclining on one half of a broken segmental pediment, formerly crowning the gates at Bethlem [Bedlam] Hospital. Engraving by C. Warren, 1808, after C. Cibber, 1680. Image Credit: Wellcome Library, London.

Bethlem Bed Shortages in the Eighteenth Century

I just read an excellent post by Jennifer Evans (@historianjen) over at earlymodernmedicine on a sad case of madness from Hans Sloane’s correspondence. Go read the post in full, but to sum it up: over several months in 1714, the Earl of Derby was attempting to care for John Getting, who was in clearly declining mental health. The Earl wondered about the possibility of committing Getting to Bethlem, as the case had become too difficult to manage. Although the outcome can’t be traced, Evans wonders if Getting was admitted to Bethlem Hospital (also known as Bethlehem or Bedlam).

Maybe. Getting doesn’t appear in the letters again–but being admitted to Bethlem was not easy, nor did it provide long-term care.

We regularly complain about hospital bed shortages, but the situation was even more complicated in the eighteenth century! Mental health care primarily occurred in the home, although Bethlem Hospital and private care were an option for more difficult cases. There were few charitable hospitals overall and a chronic shortage of space. The early eighteenth-century Bethlem, for example, had only just over 100 places.[1] (The population of London in 1715 was around 630,000, but to make matters more complicated, Bethlem patients like Getting might come from outside of London.)

The Hospital of Bethlem [Bedlam] at Moorfields, London: seen from the south, with three people in the foreground. Etching by J. T. Smith after himself, 1814. Image Credit: Wellcome Library, London.
The Hospital of Bethlem [Bedlam] at Moorfields, London: seen from the south, with three people in the foreground. Etching by J. T. Smith after himself, 1814. Image Credit: Wellcome Library, London.
Bethlem was able to remain a charitable hospital largely through its fundraising: it doubled as a tourist attraction for rich and poor alike, with visitors expected to leave donations. Frenchman Cesar de Saussure, for example, described his tour of Bethlem. On the first floor, visitors could look in the little windows of cells at “these poor creatures” or, in the big gallery, pass by the “many inoffensive madmen” allowed to walk around. Cells on the second floor held “dangerous maniacs, most of them being chained and terrible to behold”. The building may have been grand, but it was a “melancholy abode”.

Patients being assessed could stay at Bethlem, but that did not always result in admission, as this fascinating case from Bethlem Blog suggests. Admission into most early eighteenth-century English hospitals was granted through patronage or—in the case of the Foundling Hospital (founded 1741)—by lottery. As a physician for Christ’s Hospital (1694-1730) and on the Board of Governors for St. Bartholomew’s, Sloane was frequently asked for assistance in obtaining admission for patients. But as the post on Getting reveals, admission to Bethlem could be helped by a charitable donation—and, perhaps, the assistance of important patrons like Sloane and Derby.

Another case from the Sloane correspondence, however, suggests the difficulty of finding long-term care for those in dire need. Ambrose Godfrey, a chemist well-known to Sloane for his analysis of the properties of stones and waters, wrote a distressed letter to Sloane in July 1724 on behalf of Mr. Steiger (an engraver).

Godfrey had known Mrs. Steiger and her brother well for nearly forty years, but the brother “had lost his understanding” and the family hoped to have him admitted to Bethlem. The Bethlem physician, however, “refuses it, alledging that there is no roome”. Godfrey hoped that a letter from Sloane might help. The situation was, indeed, dire.

He has been already been ones before in Bedlem & was sent out as cured. But being now as bad as ever & Threatning to stab them, haveing done already very dangerous things, it would be great charity good S’r if you could be instrumentall to get him in again, the dangerous prancks he has played will else be the ruin of my friend who has already the Burthen & care of 3 of this mad mans children upon his back.

It’s clear that in helping the Steiger family, Godfrey was asking Sloane for a very personal favour: “I am deeply concerned for them”, he wrote, and “it would be as much satisfaction to me see their request fulefilled, as if they ware relations of my own”. In the event that personal recommendation was insufficient, Godfrey also pointed out the brother’s good reputation. He had “ben a man of much credit & served all the offices in ye parish of Gracion’s street”.

Statues of "raving" and "melancholy" madness, each reclining on one half of a broken segmental pediment, formerly crowning the gates at Bethlem [Bedlam] Hospital. Engraving by C. Warren, 1808, after C. Cibber, 1680. Image Credit: Wellcome Library, London.
Statues of “raving” and “melancholy” madness, each reclining on one half of a broken segmental pediment, formerly crowning the gates at Bethlem [Bedlam] Hospital. Engraving by C. Warren, 1808, after C. Cibber, 1680. Image Credit: Wellcome Library, London.
So why the stickiness over admissions and the insistence in discharging an obviously ill patient? A charitable hospital like Bethlem needed to show that it was successful in curing people in order to attract patronage. To that end, according to Bethlem Blog, those patients accepted into Bethlem were most likely to be easily treatable within a year or two. It was not until the late 1720s that Bethlem opened an “incurable” ward—and that was only available to patients already in the hospital. After a year of treatment and assessment, severely ill patients might be transferred to the ward.

Might. The waiting list to enter the ward was long.

It’s hard to say what happened to either Getting or Mrs. Steiger’s brother, but their sad cases predated the incurable ward. At best, if the men were admitted to Bethlem, the Steiger family and Earl of Derby might have had a couple years respite; in the brother’s case, this might even have coincided with the opening of the new ward. At worst? Well, the Earl had the inclination, money and assistance to continue helping Getting. As for the Steiger family, however, I dread to think. Mrs Steiger’s brother was a danger to the family: the costs of caregiving for a family could be high, indeed.

[1] Christine Stevenson, “Robert Hooke’s Bethlem”, Journal of the Society of Architectural Historians 55, 3 (1996): 254–275.

Looking after your family until the end: the cost of caregiving in historical perspective

A very old man, suffering from senility. Colour stipple engraving by W. Bromley, 1799, after T. Stothard. Image credit: Wellcome Library, London.
A very old man, suffering from senility. Colour stipple engraving by W. Bromley, 1799, after T. Stothard. Image credit: Wellcome Library, London.

Another day, another governmental exhortation that families just aren’t doing enough to keep society going… This time, it is Simon Hughes (the UK coalition’s justice minister) who suggested that British people had lost a sense of duty to care and were neglecting the elderly. Caregivers regularly bear the brunt of governmental disparagement, especially at a time when an ageing population puts increasing stress on limited resources. The solution, Hughes proposes, is that we look to immigrant cultures who understand the necessity of sacrifice for the good of elderly family members.

Gee, that’ll do the trick… (There’s a thorough dissection of Hughes’ statements  over at (Dementia Just Ain’t) Sexy.) But what I want to discuss here is the problematic view of the past underpinning Hughes’ assertions. He ignores the daily experience of modern caregivers and instead assumes that British family responsibility was much more important back in the halcyon olden days.

Let me introduce you to the Meure family in the early eighteenth century, whose case suggests the high costs of caregiving at a time when there were no other options. The Meures were naturalized Huguenot immigrants who had moved to London shortly after Louix XIV had revoked the Edict of Nantes in France. The family’s immigrant status is worth noting, given that the myth of dutiful families relies on the belief that they remained in one place.

The location of the French Academy, where a different sort of dancing now takes place. Image source: my own photograph.
The location of the French Academy, where a different sort of dancing now takes place. Image source: my own photograph.

Abraham Meure (senior, hereafter “Meure”) established a boarding school for French Protestants in Soho, but the school—which taught fencing, dancing, drawing and languages—quickly attracted of the English nobility. Times must have been good for the family, as Abraham Meure (junior, hereafter “Abraham”) styled himself as “Gent.” when he married Elizabeth Newdigate in 1707.

Somewhere around 1708, Meure’s son-in-law Moses Pujolas wrote to Hans Sloane. Sloane had previously acted as a legal witness on behalf of Meure who suffered from dementia and senility. The father’s need for care was not disputed within the family; rather, this was a matter of ensuring that Abraham could take over his father’s interests. Unsatisfied with the facts of the case, the jury at the Court of Chancery wanted Meure to attend court. Moses worried that ‘he isn’t in a fit state to conduct himself without embarrassment’ and hoped that Sloane would attest to treating Meure’s senility over time.[1] The family appears to have been protecting Meure by preserving his dignity. The Court treated the debility as temporary, but then removing Meure’s power irrevocably wasn’t the family’s goal, either. The Meures delayed three more years before seeking a permanent ruling.

Meure’s last will dates from 1703 and was proven in 1716.[2] Although it’s hard to know when exactly Meure’s dementia began, the will makes it clear that his daughter Magdalene Pujolas and her family were living with him. According to the will, Abraham received the bulk of his father’s estate, but was to pay Moses £500 as specified in the marriage articles and, within six months of Meure’s death, Magdalene would receive a further £500. Meure declared:

Further, I give my daughter Magdalen Pujolas her board for all the time she lived with me since her marriage, and for three months after my decease, as alsoe the Board of her Husband Moses Pujolas his Children, and servants, and I doe prohibite my Eldest son or his Executors ever to make any demand thereon upon any amount whatever.

In addition, Moses could take back everything in his two furnished chambers and any Pujolas possessions elsewhere in the household. There were bequests to other family members: Robert Pujolas (Magdalene’s son), £500; Andrew Meure (son), £450; and Magdalin Meure (Andrew’s daughter), £100. The particularly generous bequests to the Pujolas family hints that Meure expected them to remain with him indefinitely and that they may already have been providing him with domestic assistance. The Meure family was not wealthy, although the school provided a sufficiently comfortable living to remunerate the Pujolas family for their long-term assistance.

The evidence is, admittedly, patchy. No family records or other letters to Sloane refer to Meure’s deteriorating state, though Moses’ reference to Meure’s likely embarrassment in court suggests that he was in a bad state a mere five years after writing the will. It must have been agonizing for those closest to him who continued to care for him until his death circa 1714, which was when Abraham took over as ratepayer for the property.

Moses and Abraham for many years had a friendly relationship. For example, Moses was Abraham’s guarantor in his marriage settlement of 1707. Not long after Meure died, there were growing tensions within the family. And it is these letters that suggest what the real cost of long-term caregiving was for Magdalene.

In 1719, Abraham wrote to Sloane to question Moses’ treatment of his sister:

I beg the favour of you to lett me know when you saw my sister Pujolas last, and how you found her, her husband saith that he locked her up by your advice.

Sloane replied that he had not treated Mrs Pujolas for several years, but had looked into the matter for Abraham. Magdalene had, apparently, ruined her health, by ‘coveting and drinking large quantities of hott liquors’.

The case must have been severe. Sloane was concerned enough to advise Moses to consult a lawyer about locking Magdalene up in order to limit the quantities of alcohol that she consumed.

Coincidence?

[1] British Library, Sloane MS 4060, ff. 142-3. Pujolas thanked Sloane for an affidavit in BL MS 4060, f. 141,

[2] London Metropolitan Archives, PROB 11: Will Registers – 1713-1722 – piece 554: Fox, Quire Numbers 173-208 (1716), Will of Abraham Meure.

The Sir Hans Sloane Birthday Collection: Giants’ Shoulders #70

Sir Hans Sloane, collector and physician, was born on 16 April 1660. To celebrate his 354th birthday, I’m hosting the history of science carnival: Giants’ Shoulders #70. Sloane collected stuff of all kinds, from curiosities (natural and man-made) and botanical samples to manuscripts. He was very thorough… So what does one give the man who had (nearly) everything for his birthday? The gift of knowledge! Hosting Giants’ Shoulders follows–in a small way—in the footsteps of Sloane, who edited the Philosophical Transactions of the Royal Society for two decades.

Newspaper recipes pasted into a manuscript recipe book. Wellcome, WMS 7366, p. 78. Image Credit: Wellcome Library, London.
Newspaper recipes pasted into a manuscript recipe book.
Wellcome, WMS 7366, p. 78. Image Credit: Wellcome Library, London.

Being a physician was central to Sloane’s identity, so it’s fitting to start off with a round-up of history of medicine links. I must, of course, include a painful seventeenth-century medical case: that of “Samuel’s Stone-induced suffering”. Sloane, like many other eighteenth-century physicians, was no stranger to proprietary remedies; he even had his own special eye remedy. This month, we have “Proprietary Panaceas and Not-So-Secret Recipes”, “Newspaper Remedies and Commercial Medicine in Eighteenth-Century Recipe Books” and “The Business of Medicine”. Sloane was particularly interested in finding useful remedies and would, no doubt, have approved of our modern interest in reviving old treatments or exploring non-Western ones (“Under the Influence”). He was equally intrigued by indigenous knowledge (as was “A Pirate Surgeon in Panama) and older popular treatments (as was Thomas Scattergood in the early nineteenth century, here and here).

As President of the Royal College of Physicians from 1719, Sloane also would have been familiar with medical disputes and prosecutions against irregular practitioners, such as “Master Docturdo and Fartado: Libellous Doctors in Early Modern Britain”. A post on “The Return of Nicholas Culpeper” finds the traces of Culpeper’s career around London. I’ve often wondered whether Sloane would simply have seen Culpeper as an irregular practitioner, or appreciated what they had in common–botanical interests and willingness to treat the poor.

Photograph of a telescope that belonged to Caroline Herschel. Image Credit: Geni, 2008, Wikimedia Commons.
Photograph of a telescope that belonged to Caroline Herschel. Image Credit: Geni, 2008, Wikimedia Commons.

A driving factor in Sloane’s career was his insatiable curiosity. A teacher tells us why the history of science “is essential to engage students”, while “Hydra meets Handel” shows children participating in early modern science by gathering “duck pond detritus”. Sloane also encouraged curiosity in others, including women; for only two examples, he exchanged letters and botanical samples with the Duchess of Beaufort and Cassandra Willughby. There were lots of early modern women who practiced science—and this month, there were posts on Margaret Cavendish, Emilie du Chatelet and Caroline Herschel. Women could also be important patrons of science, such as Angela Burdett-Coutts. (Sloane certainly benefited from the patronage of women early in his medical career, particularly that of the Duchess of Albemarle.)

In his botanical research, Sloane catalogued and classified his specimens. Language was increasingly important in describing experiments and specimens, and was being developed and refined out of necessity. Robert Hooke, for example, coined sixty-eight words including (my favourites) “splatch” and “punk”. Over at Evolving Thoughts, a series on speciation outlines the origins of “speciation”, Linneaus’ contribution and late eighteenth-century developments. There are lots of posts this month about curiosities that might have appealed to Sloane, which I’ve divided into man-made and beautiful objects. Under man-made (and sometimes horrifying) objects, we have Holler’s copper plate, Dead Men’s Teeth (a.k.a. dentures), a Time-Traveling, Vote-Gathering Miraculous Acousticon, Brunel’s Atmospheric Railway and the plutonium box. Under beautiful objects, we have the Salagrama Stones, the Vessels of Hermes, a triangular book about alchemy, Nathaniel Wallich’s specimens, and a colourful atlas.

T. Rowlandson, 1787. A fashionable dentist's practice: healthy teeth are being extracted from poor children to create dentures for the wealthy. Image Credit: Wellcome Library, London.
T. Rowlandson, 1787. A fashionable dentist’s practice: healthy teeth are being extracted from poor children to create dentures for the wealthy. Image Credit: Wellcome Library, London.

One of the reasons that Sloane was so well-known for his botanical expertise is that he had actually travelled to Jamaica early in his career, gathered local knowledge and tried out local remedies. On behalf of the Royal Society, he also requested that some explorers bring back specific items or look into particular issues. In 1700, Edmond Halley returned to St. Helena and reported on the area. Halley’s travel descriptions weren’t intended for the Royal Society, but his travels would certainly have been of interest. Explorers have also been the mappers of new and old areas. There is a series of posts on “A Concise History of Geological Maps”, which highlights the many uses of mapping beyond the geographical (2, 3 and 4). The newest areas are sometimes very far away, such as Martian canals or the centre of the Earth. Getting to some places might have been impossible in the nineteenth and early twentieth centuries, though astronomical photography might help to span the distance. But in the end, the question remains: we can take humans out of their usual lands, but can we take the terrestriality out of the humans?

Experimentation, itself a way of exploring the universe, became increasingly important from the early eighteenth century. This month, I read about Isaac Newton’s experiments as instances of special power, the most famous failed science experiment, the lack of religious barriers to the practice of early modern science, experimental self-asphyxiation and experimental embryology in China. The secrets of the universe, however, are often invisible to the naked eye—perhaps more so than early eighteenth-century people even would have guessed. What about trying to study “the unfashionable ether”, magnetism and light rays, quantum physics… or medieval multiverses and modern cosmic conundrums? And that’s before we even get to time! Sloane would have been familiar with the attempts to measure time and longitude, but less so the pervasiveness of modern standardised time, the ancient methods of measuring the movements of the sun or a twentieth-century physicist’s obsession with time and existence.

Sloane would have been no stranger to scientific disputes (especially since he sometimes played mediator). Recently, there has been much lively discussion among historians of scientists about the T.V. series Cosmos. By and large, historians of science have been highly critical of the choices made: the focus on Giordano Bruno, the inaccuracies in the story of Bruno, frustrating omissions and outright misrepresentations. Other historians were a bit more sympathetic, with suggestions that historians of science need to tell more compelling stories and that we need to provide better alternatives to the Cosmos style of history.

Pieter Bruegel the Elder, Hunters in the Snow (Winter), 1565. Source: Wikimedia Commons, from Kunsthistoriches Museum.
Pieter Bruegel the Elder, Hunters in the Snow (Winter), 1565. Source: Wikimedia Commons, from Kunsthistoriches Museum.

To end the Sloane birthday edition, I offer some book reviews. Sloane, of course, was constantly adding to his library, as do most historians. You might be interested in acquiring Everyday Renaissance Astrology, The Book of Trees, Ice Time (especially for those of us suffering from this never-ending winter in North America), or Books and Readers at the Dawn of the Victorian Age.

Happy reading! See you next month over at The Renaissance Mathematicus, where Thony Christie will be hosting Giants’ Shoulders #71. His contact details are here, if you want to start sending in nominations for May.