From City fringe to St George’s Fields
The dome of the Imperial War Museum, formerly Bethlem Hospital, photographed in January 2014
Visitors to the Imperial War Museum south London may easily be unaware that they are walking through the remains of a former mental hospital, in fact the former mental hospital that gave us the word Bedlam. Only the central block remains of this, the third home of that exceptional, long-lived institution that is now Royal Bethlem Hospital in the London borough of Bromley. 
The origins of Bethlem hospital were monastic, evolving from the priory of St Mary of Bethlehem. The copperplate map of London of the 1550s shows its original site at Bishopsgate near the large open ground of Moorfields.
The Moorfields section of the Copperplate map of London, 1559, Museum of London. Public Domain
By the early 1400s it was already specializing in the care of the insane. In time it came to be owned and governed by the City, which also acquired Christ’s Hospital ‘erected for the vertuous bringing up of the myserable youth’, St Thomas’s hospital ‘for the relevynge of the neadye and deseased’, and Bridewell for ‘thenfocinge of the lewde and naughtie sorte to labor and worke’. Bridewell and Bethlem were managed by a joint court of governors. 
Plan of Bethlem hospital reproduced in Daniel Hack Tuke, Chapters in the History of the Insane in the British Isles (London, 1882) – Project Gutenberg Ebook Edition
By the 1670s Bethlem had very much outgrown its site, the governors declaring their hospital to be ‘very old weake and ruinous’ and too small for the ‘great number of lunatics as are therein at present’.  The new building erected in 1674-6 just round the corner from the original hospital could not have contrasted more strongly with the old. It was designed by Robert Hooke with sufficient accommodation for 120 patients.
The Hospital of Bethlem (Bedlam) at Moorfields, London: seen from the north, with people walking in the foreground. Engraving by H. Fletcher, c. 1750 Wellcome Library, London
The engraving above shows the north elevation, viewed across the green expanse of Moorfields, and peeking above the roof ridge a regiment of City church towers and spires (and what appears to be Wren’s monument to the Fire on the left). Here is a hospital in the guise of a palace – its grandeur and French Renaissance style prompted the suggestion that it had been modelled on the Tuileries, and the apocryphal story that Louise XIV was so offended by the similarity that he ordered ‘a plan of St James’s Palace to be taken for offices of a very inferior nature’. 
The Hospital of Bethlem (Bedlam) at Moorfields, London, showing the additional wings at either end of the building. Coloured engraving by T. Bowles after J. Maurer. Wellcome Library, London. CC BY 4.0
A grand architectural statement was the wish of the governors. It was a quite deliberate piece of self-advertisement, intended to to attract visitors and funds. The policy of opening their doors to visitors to view the inmates was already well established at the old site. At the time the intention was to raise awareness of the plight of the insane, to awaken the pity of the spectator, and prompt charitable and generous donations towards their care and treatment.
Hooke’s selection as architect was a logical one. He had been City Surveyor since 1666 and was at that time supervising the rebuilding Bridewell, Bethlem’s sister institution, after the fire. There were no other hospitals for the insane in Britain at the time, or indeed many hospitals of any kind. The very term ‘hospital’ had not yet become so exclusively the property of a medical establishment and was still being used with its broader meaning of a place of hospitality – and ‘infirmary’ might more usually be expected to be applied to a place for the sick. The plan for Bethlem called for a building that could house a large number of individuals, who might at times be disturbed or violent. This introduced the need for containment or confinement. To modern eyes the plan seems most closely allied to that of prisons, and in particular the model prisons of the nineteenth century.
These statues, thought to depict raving and melancholy madness crowned the entrance gates, they have been preserved and can be seen at the Museum of the Mind at the present Bethlem Royal Hospital. Engraving by C. Warren, 1808, after C. Cibber, 1680. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
Although Hooke presented two ground plots and a model of his intended asylum to the governors before building work began, no plan has ever come to light. However, there are sufficient descriptions of the interior for key elements to be deduced. The central pavilion, with the main entrance, contained a hall, ornamented by tablets bearing the names of the hospital’s benefactors linked together by carved cherubs’ heads. Off the hall were the steward’s office and a room for the chief physician and apothecary where new admissions were examined and from which patients were discharged. To the rear of the hall the principal staircase rose to the committee room, probably the grandest internal space decorated with an ornamental plaster ceiling. This central block also gave access to the patients’ accommodation which was contained within the wings on either side. These were of two storeys over a raised basement, with the inmates on the raised ground and first floors where the plan comprised a row of single cells, lit by small high windows on the south side of the building, off a long gallery, lit by larger windows. In the basement were the kitchen, laundry and stores.
The plan by Hooke is remarkable. It seems to be the first time that such an arrangement was devised, there being no obvious precedent in this country. This was also the first charitable building to be erected in London since the Reformation. In fact the first entirely new charitable foundation since the Savoy Hospital of 1505-17. It was one of the first public buildings completed after the Great Fire, pipped at the post by the rebuilt Royal Exchange designed by Edward Jarman and Wren’s Custom House, both of which were completed in 1671. 
Anonymous etching of the Royal Exchange from the British Museum
Although there may not have been any lunatic asylums in Britain to provide a model, there were other buildings where large numbers were housed under one roof. Schools, almshouses, prisons, and even royal palaces. Including palaces in this selection is not a mere frivolous reference to the Tuileries. The galleries at Bethlem may well have their origins in the long gallery and cloister walks of the great Tudor houses and palaces, where they were intended to serve the same function of a place for exercise, particularly in bad weather. Bridewell was built as a palace, to which a long gallery was added in the early sixteenth century. It was only turned into a workhouse some decades later.
The long gallery at Haddon Hall, Derbyshire, photographed in 2011 by Michael Beckwith. Galleries in Tudor houses provided exercise in wet weather, and are a possible model for the galleries in asylums. Image licensed under Creative Commons CC-BY 2.0
The galleries at Bethlem also served as corridors of communication, and were open to visitors. Hogarth’s final scene of the Rake’s Progress is set in Bethlem and shows one of the new men’s wards added at the east end of the asylum in 1725. This gives a glimpse of the cell/gallery arrangement, here the gallery is occupied by several patients, apart form Hogarth’s hero Tom Rakewell, and just two female visitors clinging to each other and keeping close to the wall in the background. It should be noted, however, that this wing, which was intended for incurable patients, had cells on both sides of the gallery. One of the key features of Hooke’s layout was therefore lost, that of creating a ‘permeable’ structure, with the cell doors opposite the gallery windows allowing light and air to pierce the building.
William Hogarth’s Rake’s Progress, Wellcome Library, London An insane man (Tom Rakewell) sits on the floor manically grasping at his head, his lover (Sarah Young) cries at the spectacle whilst two attendants attach chains to his legs; they are surrounded by other lunatics at Bethlem hospital, London. Engraving by W. Hogarth, 1763, after earlier engraving by himself, 1735. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
It may seem strange that the galleries were placed on the north rather than the sunnier and warmer south side of the building. This was no error, cool temperatures and even light were considered beneficial to a disturbed mind, having a ‘sedative power’. Some went so far as to argue that the insane were in fact insensible to cold, though at Bethlem, at least, there is evidence that measures were introduced to keep the patients warm.
The second of J. T. Smith’s 1814 views of Bethlem showing its humble back elevation. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
Two views published in 1814 show the north side of the hospital. They demonstrate how severe this elevation was in comparison to the front, with these small, high windows that lit the cells, as well as its proximity to the boundary and the road.
Bethlem Hospital from the south, showing the small high windows that lit the inmates’ cells. This view also shows part of London Wall in the foreground, and a muck-raker scraping at the cobblestones. Etching by J. T. Smith, 1814, after himself, June 1812. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
Christine Stevenson has pointed out the similarities between Hooke’s design for Bethlem with that of his nearby Aske’s Hospital an almshouse for the haberdashers’ Company designed in 1692. 
Aske’s Hospital, Shoreditch, London: a bird’s-eye view of the facade. Engraving, 1720. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
Like Bethlem the building is single pile, which, as Roger North noted later, was particularly suitable for a college or hospital, to be divided into cells, and chambers independent of each other. In asylum architecture this pattern of patient accommodation in single cells off a gallery remained set for almost two centuries, although it was some time before anything on a comparable scale was built in Britain. In fact, not until St Luke’s Hospital was built in 1750. And so, when Bethlem took the decision to move to a new location, the plan of the new hospital pretty much followed that of the old.
The Moorfields building around 1811, depicted in a state of decay. Etching after a drawing by G. Arnald for the Beauties of England and Wales. From the British Museum
A competition had been held to design the new building in 1810, judged by James Lewis, the hospital’s surveyor, George Dance the younger and S P Cockerell. Although Lewis’s pupil, William Lochner was awarded the first prize of £300, it was Lewis who was given the task of drawing up the final plans and elevations based on the three winning entries. (the second pirze was awarded to J. A. and G. S. Repton and the third to John Dotchen)
The new Bethlem Hospital in Southwark, engraving from Ackerman’s Repository 1817. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
The opening of the new asylum coincided with the publication of a Select Committee Report on Madhouses in England in which it was immediately censured. There was a long list of complaints from its excessive expense to the gloominess of some of the rooms, particularly those at the front overshadowed by the ‘immense portico’.
Bethlem Hospital elevation and plan, 1823. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
The classification of the patients was deemed inadequate due to an absence of separate staircases to each of the galleries. There were complaints about the lack of glass in the patients’ sleeping rooms (a complaint no doubt shared by the patients, whose misery was increased by the fact that the system of warming the asylum by steam was installed only in the basement). This absence of glazing was no oversight, but a deliberate omission to ensure the ventilation of the cells and, as the governors claimed, obviate ‘the disagreeable effluvias peculiar to all madhouses’. A year later, however, the windows were glazed. The Report also disapproved of the way in which the front windows were closed up, preventing the patients from looking out of them. 
Extract from the 25-inch OS map surveyed in 1872. Reproduced by permission of the National Library of Scotland
The new Bethlem was neither so very different nor so very much worse than most other asylums built both before and after. It had a central administration block from which sprouted the patients’ wings, most of which followed the ‘cells on one side gallery on the other’ arrangement. Also repeating the earlier arrangement of having the galleries on the north side of the building. At either end of the building, again repeating the arrangement of the old building after the early eighteenth-century additions, there were cells on both sides of a central corridor. A chapel was provided under the shallow dome; sniffily referred to as a ‘species of pumpkin-shaped cupola’ by the Government in 1812 when it was proposed to put a semaphore on top, as an early warning system in the event of an attack from France. The dome was rebuilt in 1844-6 as part of general additions and alterations carried out to designs by Sydney Smirke.
Bethlem Hospital with Smirke’s new dome. Wellcome Library, London. Reproduced under Creative Commons Attribution only licence CC BY 4.0
When Bethlem moved for the fourth time to Monks Orchard the freehold of the old site was bought by Viscount Rothermere in 1930 and vested in the LCC for the formation of a public open space named in memory of his mother, Gerladine Mary Harmsworth. Much of the hospital was demolished but the remainder was leased to the Commissioners of Works to house the Imperial War Museum. It opened to the public in 1936, was closed during the Second World War during which time it received bomb damage in 1940, 1941 and 1944. An account of its history was published in volume 25 of the Survey of London, published in 1955 less than ten years after the museum had reopened. The volume was edited by Ida Darlington, and it is perhaps her words which end the account thus: ‘It is perhaps appropriate that a building occupied for so many years by men and women of unsound mind should now be used to house exhibits of that major insanity of our own time, war.’ 
Imperial War Museum, photographed January 2014
- The main source used here is the definitive history by Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker and Keir Waddington, The History of Bethlem, Routledge, London and New York, 1997
- The History of Bethlem, p.76, quote from Christ’s Hospital minute books
- ibid, p.248 quote from Bethlem Court of Governors Minutes
- Thomas Bowen, An Historical Account of the Rise, Progress and Present State of Behtlem Hospital, London, 1783 p. 5n, see also Christine Stevenson’s article (below) p.256
- Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55, no.3 (1996), p.257
- Christine Stevenson ‘Robert Hooke’s Bethlem’ in Journal of the Society of Architectural Historians, vol.55 no.3 (1996), pp.254-275
- Survey of London, vol.25 St George the Martyr, Southwark and St Mary Newton, Ida Darlington ed. 1955, pp 78 (online version at British History Online)
- ibid, p.80