The Middle Ages to the Eighteenth Century 311disease, but only when the usual theories were not adequate to
explain a particular illness (see Clark, 1984).
Hospitals
The London hospital of St. Mary of Bethlehem (later known
as Bethlem, or Bedlam) was founded in 1247. Originally
intended to provide accommodations for visiting clergy, it
later became a hospital, which, like most other hospitals,
cared for a certain number of mental patients. John Stow’s
1890 Survey of Londonstated that “... it was an Hospitall for
distracted people.... In this place people that bee distraight
in wits, are by the smite of their friends receyved and kept
as afore, but not without charges... .” (Clay, 1909, p. 31).
By the fourteenth century, the church had established
hospitals throughout Western Europe, some with limited ac-
commodation for the mentally ill. By the fifteenth century,
asylums for the mentally ill were founded. In the sixteenth
century, hospitals established by religious groups began to be
replaced by hospitals under secular management with the ob-
jective of providing for the sick and needy at public expense.
Affluent lunatics were boarded out with clergymen or physi-
cians, thus giving rise to the first private “madhouses.” In
England and Germany, insane persons considered not dan-
gerous wore badges that signified they were entitled to seek
alms. In England, at least as early as the sixteenth century, in-
mates confined in Bethlehem Hospital were released to beg
when they were considered no longer likely to harm them-
selves or others (Aubrey, 1813/1972).
Certain shrines became noted as centers for mental
healing. In Belgium, during the eleventh and twelfth cen-
turies, the shrine of St. Dymphna, which had been erected on
the site of Dymphna’s martyrdom at Geel, became particu-
larly known for miraculous cures of epileptics and other
“lunatics.” From the second half of the fourteenth century, the
shrine gradually became a place of pilgrimage specifically for
mental patients.
Europe’s population approximately doubled during the
sixteenth and seventeenth centuries. Poverty conditions wors-
ened and begging reached unprecedented levels, with large
numbers organized into gangs. This exacerbated a growing
resentment on the part of citizens expected to give charity to
those who asked for it. Almsgiving came to be considered the
promotion of a social evil and therefore immoral. Resources
were unified under the governance of local or national au-
thorities with the aim of eliminating begging by organizing
public assistance. In France, a royal edict issued in 1656 by
King Louis XIV ordained the confinement of beggars,
tramps, vagabonds, freethinkers, prostitutes, and the insane.
The Hôpital General of Paris was established to segregate
socially dependent or disruptive individuals from society.
La Bicêtre, for men, and the Salpêtrière, for women, often
described as asylums for the insane, were both large general
hospitals for the poor with only a few wards for the insane.
There were many paths into institutions other than that of
mental illness. A 1690 regulation decreed that children (up to
age 25) of artisans and other poor inhabitants of Paris who
“used their parents badly,” refused to work because of lazi-
ness, or, in the case of girls, were debauched, were to be
confined—the boys in the Bicêtre, the girls in the Salpêtrière
(Rosen, 1968).
The first European institutions specifically for lunatics
were established during the eighteenth century. The methods
of treatment were those traditional from the classical
period—bloodletting, emetics, purgatives, and blisters raised
on the patients’ bodies in order to draw off corrupted hu-
mors. St. Patrick’s Hospital was founded in 1746 in Dublin
with the legacy left by Jonathan Swift (1667–1745), dean of
St. Patrick’s. Swift, known for his satire Gulliver’s Travels,
was deeply concerned about the problems of mental illness.
He willed most of his estate for the foundation of a “House
for Fools and Mad.” Lunatic asylums were founded some-
what later in other large cities.The Anatomy of MelancholyRobert Burton (1577–1640), an English clergyman, wrote
The Anatomy of Melancholy, first published in 1621. Burton
undertook the task of “anatomizing” melancholy, a term that
embraced all kinds of madness. He compiled all the descrip-
tive and conjectural writings on the nature, causes, and cures
of melancholy, accumulated from the classical period to his
own time. His book, which went through numerous editions,
was highly regarded as a medical treaties into the eighteenth
century and is an invaluable source for information regard-
ing the history of ideas about mental illness and its treat-
ment. Largely derived from Galen and modified by Christian
theology, his work testifies to the longevity of the humoral/
pneumatic theory.
Burton, as had Galen, stated that the passions may be
called diseases, and are a frequent cause of melancholy.
Other causes include defective heredity; bad nursing in
infancy; too rigorous, severe, remiss, or indulgent education
by bad parents, step-mothers, and teachers; and loss of lib-
erty, servitude, poverty, and death of friends. He wrote that
although melancholy is difficult to treat, it may be cured or at
least mitigated if it is not hereditary, if it is treated early, and
if the patient is willing to be helped. The physician should