By 1815, the increasing patient numbers and the crumbling
building on the Moorfields site meant that Bethlem Hospital moved
again, this time to St George's Fields, Southwark. A larger number
of smaller wards in the new building allowed for a better system of
classification, so that quieter patients and convalescents could be
separated from the more seriously disturbed. Following a
parliamentary inquiry into the treatment of patients, blocks for
the 'criminally insane' were built over 1815 to 1816.
Bethlem's impressive building at St George's Fields, which was
subsequently taken over by the Imperial War Museum, boasted a
chapel to accommodate 220 worshippers, well-kept lawns, a pigsty
and stables. Social outings were introduced, with patients being
escorted by nurses and attendants to Kew Gardens, the National
Gallery, Brighton Pavilion and the Smithfield Cattle Show.
Bethlem changed further in response to the findings of inquiries
into the hospital's management and treatment practices in both 1815
and 1851. The changes precipitated the appointment of a reforming
medical superintendent, Dr W Charles Hood, and included the
abolition of all forms of 'mechanical restraint' from Bethlem, and
the promise of treatments underpinned by 'humane and enlightened
The Lunacy Act 1845 required counties to provide asylums and
most of Britain's psychiatric hospitals were built over the next 25
years. Funding arrangements encouraged local parishes to move the
parish poor into asylums, as these were funded by the county
councils rather than the parishes.
In the mid-19th century there was more emphasis on
opportunities for work and leisure as a means of facilitating
recovery. For example, female patients helped around the house
making beds, washing up, cleaning, sewing and working in the
laundry. Male patients used capstans in the airing courts to pump
water and were also employed in knitting, tailoring and mending
The ward environment became much more comfortable and was
furnished with aviaries, pictures, flowers and books. Recreation
and entertainment was provided, as were regular excursions for
those well enough to leave the hospital grounds.
A new State Criminal Lunatic asylum was housed in two detached
wings at the back of the main building. It was built and maintained
at Government expense with the Home Office controlling admissions
and discharges - often at odds with hospital advice. Increasingly
unpopular with Bethlem's governors, these wings were always
overcrowded and in 1863 were replaced by a new institution at
Broadmoor in Berkshire.
During the course of the 19th century, a network of county
lunatic asylums gradually formed in Britain, prompted in part by
new mental healthcare legislation. Bethlem's response to this was
to change its profile from that of a hospital for 'pauper lunatics'
to one for the middle and skilled labouring classes.
In 1857, the hospital decided to no longer admit pauper patients
who were now provided for in the asylums counties had been obliged
to build after 1845. Bethlem remained a charitable hospital but
preference in future was to be given to the poor of the middle
classes. In 1882 the charity commissioners permitted, for the first
time, the admission of a few paying patients. The numbers increased
over time although there was a scale of graduated charges based on
the ability to pay and free admission was never wholly