Location, Location 1

"The actual site” upon which Bethlem Hospital was originally founded, “now buried beneath the concrete horrors of Liverpool Street railway station, was never a very large one”, according to the medieval historian Nicholas Vincent, and its founders “would no doubt have been surprised to learn of the subsequent fate of their institution, intended in origin not as a mad-house but as…part of a wider movement in which the cathedral church of the Nativity at Bethlehem and its bishops sought land, alms and hospitality in western Europe”.¹ Its location was not chosen with its later function as a hospital in mind, but instead was governed by the landholdings of Simon fitz Mary, sheriff of London. In 1247 he granted all the property which he held in the parish of St Botolph outside Bishopsgate to the visiting bishop of Bethlehem, “to found there a priory under the obedience of the church of Bethlehem, for the reception of the poor and of the bishop, canons, brothers and representatives of Bethlehem whenever they should choose to visit England”.² By 1403, however, this religious community (which had been small from the outset, and by then was so tiny as to be practically unrecognisable as such) was playing host not to paupers or visitors but rather to the unwell, specifically “six insane men and three others who were sick”, according to the Porter’s visitation report of that year. In short, Bethlem’s location - like its transition from monastic house to hospital (in the medieval sense of that word, to which ‘almshouse’ is probably the nearest equivalent in meaning) - was “the product of pure chance”.³

Nevertheless, it turned out to be a felicitous one, at least for the majority of the 400 plus years the hospital stayed there. “It was…well-placed…beside the highway which linked the City with the Great North Road and ran on southwards to London Bridge…for the original purpose of offering a base and accommodation for members of the Order of Bethlem”, according to the hospital’s published history, as well as being “a good site for a hospital, as alms could be sought from passers-by” and “quite substantial sums to the income of the Hospital” could be solicited from intending visitors.⁴ On the downside, the hospital was “built over a regularly blocked common sewer”, and by 1674 it had become, in the words of its own Governors, “very old weake and ruinous, and too small and streight for keeping the greater number of Lunatikes as are therein at present”.⁵ Eventually these drawbacks precipitated a move away from the land originally given to the bishop of Bethlehem by Simon fitz Mary in hopes of ensuring “prayers for the sake of his own soul” (as well as currying favour with the King, a friend of the bishop).⁶ Yet, as its subsequent history would show, with this relocation Bethlem did not move far from the centre of the English imagination.