INSTRUCTIONS FOR PERSONS APPLYING FOR THE ADMISSION OF PATIENTS INTO BETHLEM HOSPITAL.

All lunatics who are not disqualified by the following regulations may be admitted into this hospital at all seasons of the year, and will be provided with every thing necessary for their complete recovery, provided the same can be effected within twelve months from the time of their admission, upon payment of £2, if the patient is sent by relatives or friends; and of £4 if such patient is a parish pauper, or has received alms or support from any public body or community; which sums of £2 and £4 are not returnable, unless the patient dies or is discharged within one month after admission, nor in any case where deception has been practised upon the hospital by a false statement.

The following cases are inadmissible:—

1. Those lunatics who are possessed of property sufficient for their decent support in a private asylum, and also those whose near relations are capable of affording such support.

2. Those who have been insane for more than twelve months.

3. Those who have been discharged uncured from any other hospital for the reception of lunatics.

4. Female lunatics who are with child, or who have before been discharged from this hospital in consequence of their pregnancy having been discovered.

5. Lunatics in a state of idiotcy, afflicted with palsy, or with epileptic or convulsive fits.

6. Lunatics having the venereal disease or the itch.

7. Those who are so weakened by age or by disease as to require the attendance of a nurse, or to threaten the speedy dissolution of life, or who are so lame as to require the assistance of a crutch.

Certificate to be signed by the Minister and Parish Officers, and also by some Relation or Friend of the Lunatic.

We, whose names are hereunder subscribed, the minister and churchwardens or overseers of the parish of ——, in the county of ——, and ——, of the parish of ——, in the county of ——, the [here insert the degree of relationship, if any], of ——, in whose behalf the present petition is presented, having carefully read over the above seven regulations, do hereby certify, to the best of our knowledge and belief, that the said ——, who has resided in this parish for —— or upwards, now last past, is a lunatic and has [here insert whether the lunatic has or has not received parochial support] received alms from such parish, is not in any of the states or conditions above-named, but is in every respect a proper object for Bethlem Hospital. Witness our hands, this —— day of —— 182-.

} Minister.

} Churchwardens.

} Overseers.

} Relation or

} Friend.

Certificate of Insanity.

I, the underwritten ——, of the parish of ——, in the county of ——, do certify, that I have examined ——, of the parish of ——, in the county of ——, and that such person is a lunatic, and is not within any of the foregoing seven regulations, which are declared to render patients inadmissible at Bethlem Hospital; and I further certify, that I have given to the friends of the said lunatic a letter addressed to the physicians of Bethlem Hospital, containing a statement of the particulars of such patient’s case, as far I am acquainted with it.

Witness my hand, the —— of ——.

*⁎* This certificate is to be signed by the physician, surgeon, or apothecary, who has visited the patient.

Affidavit.

A. B., maketh oath and saith, that he did see the above-named minister, parish officer, relative, or friend, and medical practitioner, severally sign their names to the above certificates.

Sworn the —— day of ——, 182-, before ——.

*⁎* The person making this affidavit must sign his name above this note.

When the person or persons in whose presence the foregoing certificates shall have been signed, has made oath before a magistrate pursuant to the foregoing forms, the petition at the end of these instructions may be filled up, and directed to the steward of Bethlem Hospital.

On the following Thursday they will be considered by the governors, when the petitioner, or some one who is acquainted with the facts, must attend at the hospital, at ten o’clock in the morning, to give any further information that may be required, and to learn whether the lunatic can be admitted; but such lunatic must not be brought to the hospital until directions are given for that purpose.

If the case be found to correspond with the petition and certificates, and there be a vacancy, the lunatic may be admitted on the following Thursday; and if no vacancy, the name will be placed on the list, and the patient will be admitted in turn.

On the day appointed for bringing up the lunatic, two respectable housekeepers, residing within the bills of mortality, must attend at the hospital at ten o’clock in the morning, and enter into a bond of £100, to take the lunatic away whenever the committee shall think proper to direct his or her discharge; as well as to pay the expense of burial if the lunatic should die in the hospital. And the names and places of abode of such securities must be left three days before, in writing, with the porter of Bridewell Hospital in New Bridge Street, Blackfriars.

N.B. No governor, officer, or servant of the hospital, can be security for any patient.

PETITION.

TO THE RIGHT WORSHIPFUL THE PRESIDENT AND TREASURER, AND THE WORSHIPFUL THE GOVERNORS OF BETHLEM HOSPITAL, LONDON.

The humble petition of ——, on behalf of ——, of the parish of ——, in the county of ——, a lunatic, aged —— years.

Sheweth:

That the said ——, having been disordered in —— senses about —— and no longer, and being in every respect a proper object of your charity, as by the foregoing certificates will more fully appear;

Your petitioner prays that the said lunatic may be admitted into your hospital for cure.

And your petitioner will ever pray, &c.

[Let the petitioner sign his name above.]

[*⁎* The petitioner must be as near a relation of the lunatic as possible; but in default of such relative, then some friend of the patient, or officer of the parish in which such patient resides.]

I, the undersigned, a Governor of Bethlem Hospital, desire the above lunatic may be admitted, if a proper object.

[*⁎* If the parties do not happen to know any governors, the signature of a governor will be supplied at the hospital, when the petition is read.]

BOND.

Whereas [here insert the name of the lunatic] a lunatic, hath been this day received as a patient into Bethlem Hospital, established for the reception of lunatics, on our having jointly and severally agreed to remove and take away the said lunatic in manner hereinafter mentioned: now we do hereby jointly and severally undertake, promise, and agree, that we, or one of us, will, within seven days next after we shall be thereto required, by notice in writing, to be signed by the steward for the time being of the said hospital, remove and take away the said lunatic from the said hospital, at our, or one of our costs and charges; and at the like costs and charges bury such lunatic, in the event of death; and also that we, or one of us, will pay to the said steward the costs and charges of clothing the said lunatic, during the term of such lunatic’s continuance in the said hospital. And in case of any default in the premises, we do hereby jointly undertake, promise, and agree to pay to the treasurer of the said hospital for the time being, the sum of one hundred pounds, on demand, together with all costs of suit to be incurred in respect thereof. As witness our hands this —— day of —— 18

[Signed by the Bondsmen.]

Witness {

MEMORANDUM UPON ADMISSION OF PATIENTS INTO BETHLEM HOSPITAL.

Name, age, married or not, and how many children?

When admitted.

Whether disordered before, and how often?

When this attack commenced?

Causes and previous appearances?

Remarkable symptoms: whether mischievous?

Whether hereditary?

State of health?

Lucid intervals?

Habits of life, business, education, &c.?

Diseased ideas?

Where confined before, and how treated?