The 'Sanatorium,' in the New Road, opened in 1842, is an especially interesting institution, and calculated to be of most essential service to a particular class, as governesses, clerks, and other persons of respectable station who are without friends in London; but we cannot here do more than refer to the interesting Annual Report.

Besides the institutions just enumerated, there are numerous lying-in hospitals in different parts of the metropolis: none of them are as yet a century old, the earliest (the British Lying-in Hospital in Brownlow Street) having been established in 1749. Comparing the first ten years of its existence with the first ten years of the present century, it appears that the deaths of mothers had fallen from 1 in 42 admitted to 1 in 288, and the deaths of children from 1 in 15 to 1 in 77. Dispensaries, for supplying the poor with medicine and advice gratis, are also found in every part of London. Some of them have been in existence about eighty years; but they originated at the close of the last century, and led to those medical squabbles which made the subject of Garth's poem. These insti tutions are often made use of by persons of a very different class from those whom they are more particularly intended to benefit.

The Lunatic Hospitals and Asylums, though widely differing in most respects from the medical and surgical hospitals, are still institutions of the same class. Above 3200 lunatics and idiots are in confinement within the limits of the metropolitan Lunacy Commissioners, above half of whom are confined in 34 licensed houses, about 300 at Bethlem, above 200 at St. Luke's, 24 at Guy's, and nearly 1000 at Hanwell. Bethlem and St. Luke's only come within our province on the present occasion.

Bethlem Hospital, or the House of Bethlem, as it was originally called, was founded as a convent by Simon Fitz-Mary, a citizen of London, in 1247. The founder directed, that in token of subjection and reverence, one mark sterling should be paid yearly at Easter to the Bishop of Bethlem or his nuncio. The date of this house being converted into an hospital is not known, but in 1330, less than a century after its foundation, it had acquired this designation. In 1346 the brethren of the house were dispersed abroad collecting alms, and an application on their behalf was made to the mayor and aldermen to be received into their protection. The earliest notice which can be found of lunatics having been received at Bethlem is 1403. There were then in the house six men deprived of reason, and three sick persons, as appears by an inquisition taken at the above date. The purchase of Bethlem by the city took place in 1546. In 1555-6 it was for a short time, along with the other hospitals, under the same government as Christ's Hospital; but in 1557 it was placed under the control of the governors of Bridewell, one treasurer being appointed for both houses. This union still subsists, and was confirmed by the act of 1782, for regulating the royal hospitals. The affairs of the two hospitals are transacted at the same courts, and the proceedings are recorded in the same books, as if the two houses were one foundation; but the accounts are kept in separate ledgers.

In 1555, it appears, by an account rendered to the Governors of Christ's Hospital, that the "yerely issues and proffittes" of Bethlem Hospital were 437. 8s. 4d., arising almost entirely from houses. A valuation of the real estates was made

in 1632, and it appears that, if then out of lease, they would have produced about 4701. per annum. For many years the funds were inadequate to the maintenance of the hospital; and in 1642 the preachers who were to preach at Easter at the Spittal were desired to make an appeal to the people in its behalf. In 1644, it appears there were 44 lunatics constantly maintained in Bethlem, and the revenues only defrayed two-thirds of the charges. The endowments of the hospital are now very ample, and the greater part of the property is applicable to the general purposes of the institution; but one portion (under the will of Mr. Barkham) has been given exclusively for incurable patients, and consists of 3736 acres of land in Lincolnshire, which, with the tithes, produce 57901. a-year, of which only one-fourth is realised, applicable to the purposes mentioned in the will. The total income of the real and personal estate of the hospital for the year ending Christmas, 1836, was 15,864l., of which above 12,000, was derived from houses and land, and 36007. from stock invested in the public funds. The gross income of the hospital from all sources (the profits made by the reception of criminal lunatics excepted) averaged 16,2631. for the ten years ending in 1836.

Stow says that the church and chapel of Fitz-Mary's Hospital were taken down in the reign of Queen Elizabeth, and houses built instead by the governors of Christ's Hospital. The Charity Commissioners give an extract, made in the muniment book in 1632, which is the earliest description of the hospital they could find. The old house contained "below stairs a parlour, a kitchen, two larders, a long entry throughout the house, and twenty-one rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in, and a long waste room now being contrived and in work, to make eight rooms more for poor people to lodge where there lacked room before." Besides this, there was "one messuage newly builded of brick, containing a cellar, a kitchen, a hall, four chambers and a garret, being newly added unto the old rooms." Ten years later the question of enlarging the hospital came under consideration, and a committee of view being appointed, it was reported that the ground on which two old ruinous tenements stood would allow of space for a new building to contain twelve rooms on the ground floor, and eight over them for lunatics, and garrets for servants, and another yard for lunatics. This addition to the hospital was effected, but it appears that altogether not more than fifty or sixty patients could be accommodated.

After the Fire of London the governors resolved to build the house on a larger scale, and the City granted them a lease of some ground, 740 feet long by 80 deep, adjacent to London Wall, for the site of their new building, which it was intended should be capable of accommodating 120 lunatics. The lease was granted for 999 years, subject to a rent of 1s. if demanded, with a provision that the lease should be void in case the building was devoted to any other purpose. The new hospital (as it was recorded on an inscription over the entrance) was commenced in April, 1675, and completed in July, 1676. This was the centre of Old Bethlem Hospital, and it was similar in design to the Tuileries. Its length was 540 feet, and breadth 40 feet, besides the wall which enclosed the gardens before it, "which were neatly ornamented with walks of freestone round about, and a grass-plot in the middle, beside which garden there was another at each

end for the lunatic people, when they were a little well of their distemper, to walk in for refreshment." Two wings were added to the hospital in 1733, for the reception of incurable patients under the provisions of Mr. Barkham's will. In an edition of Stow, published in 1754, the hospital is described as consisting "chiefly of two galleries one over the other, 193 yards long, 13 feet high, and 16 feet broad, not including the cells for the patients, which were 12 feet deep. These galleries were divided in the middle by two iron gates, so that all the men were placed in one end of the house, and all the women at the other, each having their proper conveniences, as likewise a stone room where, in the winter, they had a fire to warm them, and at each end of the lower gallery a larger grassplot to air and refresh themselves in the summer, and in each gallery servants lay to be ready at hand on all occasions; besides, below stairs there was made of late a bathing-place for the patients, so contrived as to be a hot or cold bath as occasion required." Towards the close of the last century the hospital had become insufficient for the number of patients requiring an asylum; and in 1793 the City granted a lease for an adjoining piece of ground which would have enabled the governors to enlarge the hospital; but the bad state of the old buildings seems to have prevented any use being made of the space thus acquired. In the Report of a committee, dated April, 1799, it is stated that the whole building was dreary, low, and melancholy, and that the interior arrangements were ill-contrived, and did not afford sufficient accommodation, and the close and confined situation precluded the advantages of air and exercise. In consequence of this Report it was resolved not only to rebuild the hospital, but to transfer it to a new site. Great and unexpected difficulties occurred to delay the erection of a new hospital, and as the eastern wing had been rather too hastily pulled down, a reduction in the number of patients became unavoidable. The discovery of the true bearing of the old lease (by which the lease granted by the City became void, if the site were not used for a lunatic asylum), again protracted the negotiations. Four different sites were fixed upon at Islington; the end of St. John's Street was thought of; and at one period it was in contemplation to improve the site of the Old Hospital and the approach through Old Bethlem to Moorfields. Finally the 2 acres on which the old hospital stood were exchanged for the present site, containing about 11 acres, the condition of the lease requiring that the new hospital should be capable of accommodating 200 patients, and that not less than eight acres of the land should be appropriated to their use, while the governors were to be at liberty to employ the rest for the general purposes of the hospital and in augmentation of its revenues. The Act for effecting the settlement of this affair was passed in 1810.

A site being thus provided, premiums were offered for designs for the intended building, and thirty-six plans were sent in. The surveyor of the hospital and two architects selected three from this number, and on the basis of these, but with such alterations as he might consider necessary, Mr. Lewis was directed to form a plan for a building to contain accommodation for 200 patients, but with offices on a scale sufficient for twice that number. Further steps were taken to obtain the necessary funds, for the governors had commenced, in 1804, to reserve a portion of their revenues for building purposes. Grants of public money were also obtained to the amount of 72,8197.; the benefactions of public bodies amounted

to 54057., including 30001. from the corporation; 500l. from the Bank of England; and various sums from several of the city companies; the amount contributed by private individuals was 57091.; 23,7661. were contributed from the funds of the hospital; and a sum of 14,8731. accumulated as interest during the progress of the work. The first stone of the new building was laid in April, 1812, and in August, 1815, it was completed and ready for the reception of patients. The total cost was 122,572/. It consists of a centre and two wings; the centre is surmounted by a dome, and the entrance is by an Ionic portico of six columns, supporting the royal arms. In the hall are the two figures of Raving and Melancholy Madness, executed by Cibber for the old hospital, and repaired in 1820 by Bacon. The wings, for which the government advanced 25,144/., are appropriated to criminal lunatics, who are supported at the public expense at a cost of 381. 6s. 8d. each. In 1837 the male criminal wing was enlarged, and there have been considerable additions made to the hospital since that time. The first stone of some additional new buildings was laid July 26th, 1838, on which occasion a public breakfast was given, at a cost of 4647. to the hospital; and a narrative of the proceedings was drawn up and printed with several documents, at a cost to the charity of 1401. The length of the building as it now stands is 569 feet. There are galleries, 219 feet 8 inches long, for male and female patients, both in the basement, on the ground-floor, and on the first and second floors. There is a fifth gallery, on the third floor of the central building, which is appropriated to incurable patients, and differs considerably from the other galleries. The sleepingrooms are partitions divided from each other, and from a passage in front, by bulk-heads about seven feet high, which do not reach to the ceiling. The passage faces the south, and is more lively and cheerful than any of the others. The patients are divided into three classes: the furious and mischievous, and those who have no regard to cleanliness, being placed in the basement; ordinary patients, on their admission, and those who are promoted from the basement, are on the first floor; and the second floor is appropriated to patients who are most advanced towards recovery and there are two other galleries for the incurable patients.

Under the Act of 1782 the united establishments of Bridewell and Bethlem are governed by a president and treasurer elected by the general courts; the court of aldermen and twelve councilmen; and an unlimited number of nomination governors. The number of governors at present is 343. Bethlem is exempt from the visitations of the Commissioners of Lunacy, a privilege which has not been of much advantage to it, for it has the demerit of having carried into operation, to a period of less than thirty years ago, the unenlightened and brutal system of treatment which distinguished the fifteenth century. In the inquisition of 1403 the iron chains with locks and keys, and the manacles and stocks there spoken of as belonging to Bethlem Hospital, indicate but too plainly the system of that day. There are several passages in Shakspere which show that bonds, darkness, and flagellation were the remedies adopted for the recovery of the lost reason! A passage in Lear' alludes to the custom of allowing lunatics whose malady was found to be unattended with danger to leave the hospital with an iron ring soldered about their left arm, and a permission to beg. In 1598 a committee appointed to view Bethlem reported that the place

The ex

was so loathsome that it was not fit for any man to enter. It contained only twenty inmates, who were termed prisoners, and of these six only were main tained at the expense of the charity. Coming down to a later period, we find that the Hospital used to derive an income of "at least 4007. a-year from the indiscriminate admission of visitants, whom very often an idle and wanton curiosity drew to these regions of distress."* Ned Ward's London Spy' shows, indeed, that the lunatics were visited just in the same way as the lions at the Tower. In 1770 the practice was put a stop to. In 1740 it appears that strangers, as well as the friends of the lunatics, paid 1d. on admission. posure of the wretched system pursued at Bethlem, which took place in 1814, in consequence of the investigation of a parliamentary committee, is probably still fresh in the recollection of most readers. The visitors thus describe one of the women's galleries:-" One of the side-rooms contained about ten patients, each chained by one arm or leg to the wall, the chain allowing them merely to stand up by the bench or form fixed to the wall or to sit down again. The nakedness of each patient was covered by a blanket-gown only. The blanket-gown is a blanket formed something like a dressing-gown, with nothing to fasten it in front this constitutes the whole covering. The feet even were naked." One female in this room was found, who in lucid intervals talked most reasonably, and on being treated like a human being became an entirely different creature. Many women were locked up in cells naked and chained, on straw, with only one blanket for a covering, and the windows being unglazed, the light in winter was shut out for the sake of warmth. In the men's rooms, "their nakedness and their mode of confinement gave this room the complete appearance of a dogkennel." The patients not being classified, some were objects of resentment to the others. The shocking case of William Norris, a lunatic confined here, excited a deep sensation, and by its exposure led eventually to improvement. At this period, for months together, the committee made no inspection of the inmates! The house-surgeon was often in an insane state himself, and still. oftener drunk; and one of the keepers who was frequently in the latter state remained undischarged. Just at this time also the governors spent 600/. in opposing a Bill for regulating madhouses!

The improvements in the system of management at Bethlem began about 1816. Patients of both sexes are now set to do such little offices as they are capable of. They assist in household occupations; some employ themselves in knitting, tailoring, and mending the clothes of the other patients. Females find occupation in the laundry and in making up linen, all the ordinary needlework of the house being performed by them; and some are engaged in embroidery. In the airinggrounds many of the men play at ball, trap-ball, leap-frog, cricket, and other games; and the women are encouraged to dance in the evenings. Every case of restraint is now noted down, and must be at once reported to the medical officers, and brought under the notice of the committee.

St. Luke's Hospital for lunatics, in Old Street, was opened in 1751, and was intended for the reception of those who could not obtain admission into old Bethlem Hospital. It has always been favourably distinguished for its manage

* Rev. Mr. Bowen's Account of the Hospital, 1783.