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