Today in the UK going to hospital when seriously ill or injured is a normal expected occurrence. However, did you know the hospital had its origins in the monastic religious houses?
The origin of the word hospital comes from the latin word – “hospes”, which stands for “a guest or visitor” – which is meant to provide shelter for travellers, pilgrims and those who suffered from illness. Not all monasteries and nunneries would have a hospital and in some locations the hospital would be a separate site to the monastery itself. One of the largest was at St Leonards, York, and its specific function was to provide shelter and treatment to the sick and poor. After all, one of the seven ‘spiritual works’ included counsel and comfort got sick. ‘Monasteries were founded on pirate initiative to interact for the souls of the living and the dead. The hospital were founded similarly but here the emphasis was on the practical relief of the suffering….’(Furniss p.244)
Monasteries and therefore hospitals to begin with were not publicly funded like ours are today but would rely on charity and revenue from various sources such as patrons, rent from owned land and houses, and for a few income generated from annual fairs and markets.
When the dissolution of the monasteries struck 1536 hospitals were lost. Those who were homeless and sought refuge in them went back to life on the street and living in poverty. Roads and towns would be “littered” with those who had nowhere to go. This would lead to a petition sent to King Henry VIII to reopen and establish hospitals to remove those from the streets. This however was not done out of care but because of ‘the miserable people lyeing in the streete, offending every clene person passing by the way’.
In London, two of the hospitals to reopen and be managed under public ownership rather than monastic were St Thomas’ and St Barts, both of which are around today, although not on their original sites. Over time hospitals, whether new or old, became a civic duty rather than a religious one.
The first Poor Law Acts were passed in the 15th century. These Acts started to bring about a change in how those that were physically and mentally ill were treated. Those deemed ‘impontent poor’ now had some assistance in their lives. Those considered ‘impotenet poor’ were those naturally disabled, either in wit or member, as an idiot, lunatic, blind, lame etc,. ‘Not being able to work…all those….are to be provided for by the overseers of necessary relief and are to have allowances…according to…their maladies and needs’.
As the world developed and societies changed, so too did the treatment of illnesses and maladies. With these changes came hospitals focused on certain illnesses and conditions such as leprosy, specialised children’s hospitals and the rise of mental asylums.
The word asylum comes from Middle english and greek asylon meaning refuge, fenced territory. It was an inviolable place – where criminals and debtors sought refuge from justice.
After the Great Fire of London in 1666 it allowed a new landscape of London to be developed and with this grand new hospitals were built, some for the physical, others for the mentally ill. These new asylums however were only for the wealthy as a result people began to feel that those less fortunate in life were entitled to help and care as well, and the voluntary asylum movement began. Smaller asylums were created across the country for those who could not afford to pay the fees of the luxurious ones.
The oldest and most infamous asylum in England was that of Bethlem Royal Hospital, more commonly known as Bedlam. Founded in Bishopsgate (it has relocated three times) in 1247 as the Priory of St Mary of Bethlem. It was first recorded as being a hospital in 1329, by 1403 it seemed to specialise in care for the ‘insane’. By the dissolution it came under the management of the governors of Bridewell and the care and treatment of the inmates was left to however their charge saw fit. This led to dreadful conditions for those who found themselves incarcerated at ‘bedlam’. Early treatment included being chained and manacled to walls and isolation.
In 1676 bedlam was rebuilt with its new design and architecture leading to it being considered the most grandiose mental asylum in the world, its design was almost palatial however the inside was rotten. Open for ‘tourists’ those inside who faced treatment did not fear much better than those inmates in the medieval era. Even though science was changing and our understanding of mental health, the patients at bedlam were subjected to treatments such as induced bouts of vomiting and diaorrhea to purge the body, ice cold baths and being spun in a chair suspended from the ceiling.
In 1750, St Luke’s hospital was set up nearby, unlike the views of those in charge at Bedlam those who managed St Lukes felt that each patient should have an individual diagnosis and care plan. That mental illness was in a wide variety of forms and providing a clean, calm environment was extremely beneficial towards their patients. Those in charge at Bedlam did not agree and felt their harsh form of treatment was best, even after investigations and research into the matter. Slowly however the methods at Bedlam began to change for the better, and those in charge were removed and the hospital was placed under a new form of management, bringing it more in line with the numerous other asylums in existence by this time.
More asylums led to more understanding of the mind and mental health. People began to realise that those disabled and mentally ill could thrive if in a healthy clean environment. And so the treatment began to change, albeit slowly. The first to lead the way was the York retreat. Set up in 1790 by Quaker William Tuke and others after a member of the congregation was admitted to York Lunatic Asylum and died there. Upon investigation of her death they found that she was treated in italy. They decided that no one should have to endure the horrible treatment that Hannah had suffered and set up their own ‘retreat’. “His aim was to provide Quakers with “suitable companionship and humane care and treatment”. His approach was to ensure that residents received nourishing food, outdoor exercise, had a purpose via the work they were encouraged to undertake and had the experience of gentle and kind social interactions in beautiful surroundings.’ It was such a success that 1800s other institutions from across the world were visiting and borrowing their ideas, including a visit by the Superintendent of Bedlam. Mental reforms were passed in parliament due to the York retreat which has impacted how those with mental health are treated today. The York retreat itself is still protected, although it does not have an inpatient hospital.
“The Retreat marks the beginning of the move away from chains and fetters to gentler restraint such as the straight jacket. The Quakers did not see the insane as animals, but believed the ‘inner light of God’ to be present in all. The patients were not to be beaten or chained up, but were considered as children and the Retreat as a loving family environment to bring patients back to reason, and recovery.”
Fortunately, a change was in place which has led to better practice and treatment for those suffering with mental disorders both within and outside the Asylums.
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