Control by the City of London
In 1547 King Henry VIII granted the 'custody, order and government' of the hospital of Bethlem to the City of London, as one of the five 'Royal' hospitals re-founded after the Reformation. Later he was thought of as Bethlem's actual founder, or at least as having first established it as a hospital for the insane.
From 1557 Bethlem was administered jointly with Bridewell, a house of correction. Inspectors in 1598 found the buildings to be in a poor condition, while later, in 1624, a formal visit revealed that 31 patients were confined in a space that should have contained 25.
Medical treatment for insanity was largely ineffective throughout this time, though some patients did recover. Those patients who were violent and dangerous were restrained with iron manacles and chains.
Bethlem Hospital is recognised as one of the world's oldest hospitals for the treatment of mental illness. In The History of Bethlem, published in 1997 to coincide with the hospital's 750th anniversary, a group of eminent historians make the case for Bethlem Hospital having a "strong claim to be the oldest foundation in Europe with an unbroken history of sheltering and treating the mentally disturbed" (Andrews et al 1997).
The historians go further and suggest that Bethlem Hospital is not just the world's oldest psychiatric establishment - but the most notorious as well. From Shakespeare's time onwards the word 'Bedlam' has been widely used to conjure up images of "turmoil, confusion and cacophony". Unfounded myths about the hospital's early history include claims that exorcism was used to treat some patients and that up until the late 19th century as many as 96,000 people visited Bethlem each year and paid to see patients being 'exhibited' on Sundays.
Picture: This portrait, attributed to the school of Hans Holbein, was known to have been hung in the committee room of the second hospital, and now forms part of the the Archives and Museum at Bethlem Royal Hospital in Beckenham.
A hospital for the insane
It was in 1403 that Bethlem was first referred to as a hospital for 'insane' patients, and since then it has had a continuous history of caring for people with mental health issues. Records from 1403 show that, among others, the hospital housed six mentally disturbed men.
The evidence of witnesses examined during the 1403 enquiry provides much information about Bethlem and its management (or mismanagement) at this time, including the fact that there were insane men among the inmates and lodgers.
A refuge for the sick and infirm
By the mid-14th century the priory was being used as a refuge for the sick and infirm and possibly being used as a hospice for travellers. By the 1360s, conditions at the hospital began to improve, when a new church and other buildings were built.
Towards the end of the 14th century, people with mental illness were accommodated in the hospital for the first time. 'Instruments of restraint' are said to have been in use from around 1398.
South London and Maudsley NHS Foundation Trust (SLaM) can trace its roots back to 1247 when the Priory of St Mary of Bethlehem was established in Bishopsgate - on the site which is now home to Liverpool Street Station.
Alderman Simon FitzMary, a former sheriff of the City of London, provided both funding and land for the priory which was linked to a religious order. The priory is the earliest form of what eventually became Bethlem Hospital. The names 'Bethlem" and 'Bedlam', by which it became known, are variants of Bethlehem.