page_title: Bethlem Royal Hospital
section_title: Medical regime
hierarchical_section_title: Bethlem Royal Hospital / 1634–1791 / Medical regime
caption_attribution_description: English: Portrait of Dr James Monro (1680-1752), 8th of the distinguished Monro of Fyrish family
context_page_description: Bethlem Royal Hospital, also known as St Mary Bethlehem, Bethlehem Hospital and Bedlam, is a psychiatric hospital in London. Its famous history has inspired several horror books, films and TV series, most notably Bedlam, a 1946 film with Boris Karloff.
  The hospital is closely associated with King's College London and, in partnership with the Institute of Psychiatry, Psychology and Neuroscience, is a major centre for psychiatric research. It is part of the King's Health Partners academic health science centre and the NIHR Biomedical Research Centre for Mental Health.
  Originally the hospital was near Bishopsgate just outside the walls of the City of London. It moved a short distance to Moorfields in 1676, and then to St George's Fields in Southwark in 1815, before moving to its current location in Monks Orchard in 1930.
  The word "bedlam", meaning uproar and confusion, is derived from the hospital's nickname. Although the hospital became a modern psychiatric facility, historically it was representative of the worst excesses of asylums in the era of lunacy reform.
context_section_description: The year 1634 is typically interpreted as denoting the divide between the mediaeval and early modern administration of Bethlem. It marked the end of the day-to-day management by an old-style keeper-physician and its replacement by a three-tiered medical regime composed of a non-resident physician, a visiting surgeon and an apothecary, a model adopted from the royal hospitals. The medical staff were elected by the Court of Governors and, in a bid to prevent profiteering at the expense of patients that had reached its apogee in Crooke's era, they were all eventually salaried with limited responsibility for the financial affairs of the hospital. Personal connections, interests and occasionally royal favour were pivotal factors in the appointment of physicians, but by the measure of the times appointees were well qualified as almost all were Oxbridge graduates and a significant number were either candidates or fellows of the College of Physicians. Although the posts were strongly contested, nepotistic appointment practices played a significant role. The election of James Monro as physician in 1728 marked the beginning of a 125-year Monro family dynasty extending through four generations of fathers and sons. Family influence was also significant in the appointment of surgeons but absent in that of apothecaries.
  The office of physician was largely an honorary and charitable one with only a nominal salary. As with most hospital posts, attendance was required only intermittently and the greater portion of the income was derived from private practice. Bethlem physicians, maximising their association with the hospital, typically earned their coin in the lucrative "trade in lunacy" with many acting as visiting physicians to, presiding over, or even, as with the Monros and their predecessor Thomas Allen, establishing their own mad-houses. Initially both surgeons and apothecaries were also without salary and their hospital income was solely dependent upon their presentation of bills for attendance to the Court of Governors. This system was frequently abused and the bills presented were often deemed exorbitant by the Board of Governors. The problem of financial exploitation was partly rectified in 1676, when surgeons received a salary, and from the mid-eighteenth century elected apothecaries were likewise salaried and normally resident within the hospital. Dating from this latter change, the vast majority of medical responsibilities within the institution were undertaken by the sole resident medical officer, the apothecary, owing to the relatively irregular attendance of the physician and surgeon.
  The medical regime, being married to a depletive or antiphlogistic physic until the early nineteenth century, had a reputation for conservatism that was neither unearned nor, given the questionable benefit of some therapeutic innovations, necessarily ill-conceived in every instance. Bathing was introduced in the 1680s at a time when hydrotherapy was enjoying a recrudescence in popularity. "Cold bathing", opined John Monro, Bethlem physician for 40 years from 1751, "has in general an excellent effect"; and remained much in vogue as a treatment throughout the eighteenth century. By the early nineteenth century, bathing was routine for all patients of sufficient hardiness from summer "to the setting-in of the cold weather". Spring signalled recourse to the traditional armamentarium; from then until the end of summer Bethlem's "Mad Physick" reigned supreme as all patients, barring those deemed incurable, could expect to be bled and blistered and then dosed with emetics and purgatives. Indiscriminately applied, these curative measures were administered with the most cursory physical examination, if any, and with sufficient excess to risk not only health but also life. Such was the violence of the standard medical course, "involving voiding of the bowels, vomiting, scarification, sores and bruises," that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught.
  The reigning medical ethos w
caption: James Monro was elected to the post of Bethlem physician in 1728, a position which he retained until his death in 1752. This marked the beginning of a 125-year Monro family dynasty of Bethlem physicians.
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