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Harlots: Bethlem on the TV?

Harlots season 2 poster cropped

Harlots season two poster

I love Harlots, that rarest of costume dramas that depicts a Georgian London I recognise from history books. Though it’s often very funny, it also kept me on the edge of my seat as its characters navigate the jagged edges of class, race and sex in a dangerous, almost lawless world. It’s great, and I thoroughly recommend it to anyone interested in history out there, or anyone who enjoys any sort of thriller. Full warning, it explores the full range of sexual mores and peccadilloes in Georgian London, and it is not for the squeamish.

I’ve recently caught up with the second series on BBC iplayer, and I was incredibly happy to see Bethlem play an important plot role! Or did it? Full disclosure, there will be spoilers. If you’ve never seen the show, I recommend watching it all first, then coming back here (with the important proviso above). The second series has been out there for a couple of years, but it’s only just come to the Iplayer.

What follows is something that deliberately over-analyses the last couple of episodes! But there is a serious point over how Bethlem operated during this time, and how it was thought of by contemporary Londoners.

On the Show...

In season two episode seven the dastardly Marquess of Blayne takes his sister, Lady Isabella Fitzwilliam, to an unnamed ‘madhouse’, which she later describes as ‘Bedlam’. Here he describes it as ‘a vision of your future’ and says ‘it would require more effort for me to purchase a new wig than to intern you in here’ in an effort to get his sister to reveal her secrets to him. In episode eight, Charles Quigley, in horror at his mother’s actions, is persuaded to commit his mother Lydia to ‘Bedlam’- he is told that ‘one male relative is all it takes’. Lydia is carried off by a group of burly men, and is seen a little later amidst the patients in the Bedlam we saw one episode before. She tries to reason with the attendants, but instead her wild accusations about the Marquess and her son seem delusional.

Bedlam is depicted as a dark gallery filled with unfortunate grotesques (Blayne describes one woman as ‘entertaining’ as ‘it believes it is an animal’), viewed from a sort of platform above when the Marquess and Lady Fitzwilliam visit. The attendants bring around food, but there is no sign of any medical care or intervention. Instead the devout Florence Scanwell preaches to the assembled patients, who are otherwise left to their own devices.

Harlots is set in 1763, so how accurately does its depiction stick with what we know about Bethlem at that time?

LDBTH8 129 A Rakes Progress Final Scene First Version 1735 c

Hogarth's A Rakes Progress final scene, in Bedlam

The Setting

The way the set looks is heavily influenced by two pictures of the interior of Bethlem, one from the Rakes Progress by Hogarth (left) and the other of male patients by an unknown engraver (below). Both of these are perhaps exaggerations, though they contain recognisable elements. In the Hogarth engraving fact and fiction blur, as the Bethlem statue of melancholy madness makes an appearance in one of the cells. We know that ‘raving’ and ‘melancholy’ madness were not only the statues outside Bethlem, but also the two main diagnoses given to patients by doctors. These patients were mostly kept in separate wards at Bethlem, not together as Hogarth explicitly shows.

Bethlem was at this time in its building in Moorfields. This was a single pile building, with the gallery adjacent to the windows at the front, and the patient’s cells at the back of the building. This means the galleries at least probably got quite a lot of light, certainly rather more than the darkness depicted in Harlots.

There was also probably not a kind of platform seen in the middle of the gallery, but we can all recognise a convenient plot worthy invention!

LDBTH8 14 Patients in Bethlem b

'Patients in Bethlem' by an unknown artist

Medical Care

The lack of doctors and the rather brusque appearance of the attendants may appear shocking to modern eyes, but this is probably entirely consistent with treatment at Bethlem. There was no resident physician in the Hospital, and the 1815 enquiry into the Hospital discovered that the head doctor visited once every fortnight. However, the junior doctor, known as the apothecary, was often onsite, and could have carried out treatment once the chief physician had made a diagnosis.

However, this may not have been good news for Mrs Quigley! Medical care at this time would have revolved around the Galenic conception of medicine, which involved balancing the four humours of the body- black bile, yellow bile, phlegm and blood. In practical terms this meant bleedings and purgings for the patients to reduce or top up the levels.

Other than three trained medical men (the other being the surgeon), who would all have had a medical degree, the attendants at Bethlem did not have any formal training at this point, though they were required to keep the patients fed, warm, safe and clean. It's hard to tell how good this care was, especially to modern eyes, but it seems as if the visitors to the Hospital (see below) thought it was of a suitable standard. It was only when visiting stopped in 1770 that the later inquiries into the Hospital identified serious problems occurring.


LDBTH2 10 1 Alms Box c 1760 a

An almsbox, which would have been used to collect donations from visitors like the Marquess to keep the Hospital running.

While it seems very strange to modern eyes, Bethlem was open to visitors. The Hospital in 1763 was a charity reliant on donations, and one of the ways it received donations was to charge visitors. The Marquess explicitly says the patients are entertaining, and there definitely seem to be an element of voyeurism and entertainment for some of the visitors- the ladies in Hogarth’s engraving (above right from the Rake) are clearly titillated by the experience. It’s entirely possible an historical equivalent of the Marquess could have visited with his sister for the payment of the fee.

However even when public visiting stopped in 1770, the doors would probably not have been closed to the Marquess. Visitors after this time would have had to have been accompanied by a Bethlem Governor, and as there were up to four hundred of these at any given point it seems unlikely the Marquess, with his connections, could not have found at least one who could have let him in.

Perhaps the most unlikely visitor from the show is actually Florence Scanwell. Bethlem Governors and doctors, especially the Monro dynasty of doctors who were the Chief Physicians at the Hospital from 1728, were suspicious of ‘religious enthusiasm’, possibly because they were worried about provoking patients on a subject that would have been at the root of the delusions of some of them. The Hospital did not have its own chaplain in 1763, and the Bridewell Hospital chaplaincy visits had been discontinued in 1713. An unofficial preacher would almost certainly not have been a welcome speaker.


But Bedlam here serves as a plot point in a very important way in Harlots- it is a place that people can be locked up on the say-so of a single male relative, and it is understood and feared as that by the characters.

The reality of admission to Bethlem was not so simple. By the middle of the eighteenth century the Hospital was determined to take in people with genuine mental health issues and who could not afford expensive private care. Most referrals to the Hospital were made not by private patients, but instead from parish authorities who could not cope with those with such extreme mental health issues that they could not look after themselves. Many admissions from Bethlem had probably come from the parish workhouse, which was in itself an option of last resort. Bethlem also received petitions from the War Office regarding sailors and soldiers who became ‘distracted’. In the earliest admission registers we have a few patients described as 'gent', which implies a gentleman of independent means, or wife or widow of the same, but certainly no prestigious members of the nobility like Lady Isabella

Bethlem also set limits on the time the vast majority of patients that it treated stayed in the Hospital. By 1763 there were two long stay, ‘incurable’, wards onsite, but most of the c.250 patients in the Hospital would have ‘only’ stayed in the Hospital for a year or less before they were either sent back to their friends and families, or onto a private ‘madhouse’ (more on those later). Very few of these patients were seen by the Hospital’s staff as suitable for the long stay ward.

This means that Bethlem would have been a difficult place for Charles to have used to effectively imprison his mother forever! In addition to this, the Hospital by 1763 required the ‘surety’ of two men to put up a bond to guarantee that extra expenses of the patient could be paid- so there would have had to have been three people to get Lydia into the Hospital in the first place. Charles would also have had to have persuaded the Court of Governors by petition for an admission for his mother. It seems unlikely all this could be arranged over the course of a day, as is shown in Harlots.

You can find more on admissions here.

LDBTH2 17 51 The Hospital of Bethlehem L Hospital de Fou c 1747 b

Bethlem Hospital as it looked in 1751

Bethlem or Bedlam

However, the characters in Harlots make it clear that the institution is 'Bedlam', not Bethlem. Bedlam is a colloquialism, adopted by Londoners to describe the fears and horrors they had about Bethlem- and sometimes the image of Bethlem has been very close to Bedlam.

But in the eighteenth century a bedlam may have been a term used to describe any ‘madhouse’. While Bethlem and its near neighbour St Lukes were the two largest mental hospitals in London and the country, and probably the most visible and open to treating the public, there was also a large community of smaller, private mental healthcare providers. In the murky, unregulated world of Georgian London the standards of the houses run by these providers varied considerably, as did the qualifications and experience of the people running them. At worse they were run solely for profit, with little care for the patients, by non-licenced practitioners. One of these institutions, where a man’s money would potentially be enough to purchase ‘treatment’ close to imprisonment, would be closer to what is depicted in Harlots.

It is important to note that this was not always the case. William Parry-Jones’s study of the Trade in Lunacy presents quite a sympathetic view of the private care given at two Oxfordshire houses in the late 1700s. In Doctor John Monro’s casebook for 1766 we have evidence of him intervening at ‘Mr Miles' Madhouse’ to ensure a patient he thought to be sane was released in short order. However, importantly, this patient was a man. Harlots is quite correct in depicting a world where many women barely counted as legal entities, especially in regard to money and property ownership- even Lady Isabella is at the mercy of her brother and has no control of her finances. Whatever the likelihood of false imprisonment in a Georgian asylum or ‘madhouse’ was, it was far more likely to happen to women than men.

Trapped in the Asylum!

Harlots taps into the long standing trope of someone being wrongfully locked up in a ‘madhouse’, their sanity in extraordinary circumstances perversely looking to the rest of the world like madness. This is something that dates back at least to the Jacobean playwrights of the early 1600s, who often used ‘Bedlam’ as a setting or stage for their dramas.

While claims of wrongful imprisonment in private enterprises were starting to gain traction at the time Harlots is set, it was really the experiences and activism of Quakers in York, who publicised the deprivations one of their ley members went through at York Asylum in the late 1700s, that bought these concerns into mainstream consciousness. The 1815 Parliamentary Select Committee exposed many examples of poor care and treatment, including at Bethlem, though here the cases were arguable more relating to excessively poor treatment than wrongful incarceration (with the exception of James Tilly Matthews). The legislation of the 1800s which created a public system of mental health treatment also created an inspectorate for these private hospitals, the Commissioners of Lunacy, who ensured basic standards of care were raised and held to- and whose physical inspections sought to ensure no one would be held in one of these places without medically justifiable grounds.

It’s really in the Victorian period that the fear of wrongful incarceration started to grow, at least in part because the number of large asylums grew as well. Whereas the problems of mental health in Georgian London remained a relatively small and hidden issue, and people in ‘madhouses’ like Lydia Quigley remained shut away, the increase in large, visible and public hospitals meant the issues could not be dismissed so easily. However their foreboding appearance and closed grounds also created fears and worries of their own… but perhaps this is a blog for another time.

I hope this hasn’t ruined Harlots for anyone, but has perhaps explained some of the themes and topics raised in the series. If you haven’t seen it I hope it’s piqued your interest! You can find it on the BBC Iplayer here- https://www.bbc.co.uk/iplayer/...