We take medical records for granted now but in the 18th century they were the exception rather than the rule. John Monro, then Bethlem physician superintendent, began in his journal of 1766 to record details of some of his private patients – including the case of Flora, a slave in a wealthy household who’d apparently been frightened out of her mind by what she’d witnessed.
Colin Gale, the archivist at Bethlem Hospital, describes Flora’s case – and its significance.
‘The journal is a pocket book size, about the size of a Kindle. It records the case of Flora, “an Indian girl, slave to Mrs Denny, sent to Mr Miles’s from Mr Dudley’s, Bloomsbury Square.” These would have been madhouses.
“Her mistress alleged that she had been frightened by the ill usage of some servants in the house where she had been.” ‘In other words, she’d seen other servants or slaves being mistreated and this has frightened her.
“As she had been guilty of several pieces of extravagance and had refused both physic and nourishment for fear of being poisoned, they, not knowing how to manage her, sent her to Mr Miles’s.”
“But as the girl had some remains of fever upon her, I think it better to await the event of that before I pronounce her mad.”
‘Flora is physically ill. Dr Monro is saying – let’s see how she recovers from that before we say what her mental state is.
‘There’s a later note that says: “She afterwards proved mad enough. But got well.”
‘Back then, hospitals were for the poor who could not afford to pay. Consultants didn’t bother to keep records on them. But some started keeping records in diaries of their paying patients. Dr John Munroe’s journal is a very early example of medical record keeping.
‘At this time – 1766, no hospitals were keeping records in Britain. What happened was that in due course hospitals saw this practice developing in private medicine and decided they’d like doctors to do this for hospital patients as well. They asked them to write a casebook. And the next stage was to make the casebook hospital property so that anybody who treats the person can contribute to that record.
‘This 1766 journal was the private possession of the doctor, and we have it at the archive on loan from one of his descendants.
‘It’s a remarkable record, but in some ways it’s much more significant that we have an unbroken series of records from 1815 going through to the 20th century, without any gaps. It’s that progression and that unbroken chain of consistency that is the most significant thing. No one individual item – but the whole of it taken in total, minutes and administrative records for hundreds of years.
‘If people can mine that and if they can get their minds around it they can get a sense of what is really significant, by understanding the rest of the context around it.’
Visit the Bethlem Blog for more material on the hospital’s past and present.