Concern for the care of the mentally ill extends far back into the Middle Ages. In 1246 the Hospital of St. Mary of Bethlem, commonly known as "Bedlam", was founded in London and until 1751 it was the only public institution devoted to caring for the mentally ill. In that year St. Luke's Hospital was founded, again in London, and in the second half of the eighteenth century other asylums were established in cities such as Bristol and York, as well as an increasing number of privately run hospitals.

Most of the population of Bedfordshire did not have access to such expensive specialist care. The well-to-do or their servants were occasionally sent to private asylums: for example James Stapleton of Maulden was sent by Mary Coleman of Cranfield to the establishment run by the Lord family at Drayton Parslow, Bucks. in 1779 (Ref: X125/13). Purges, vomiting and restraint were standard treatments in an age which considered "raving madness" and melancholia to be caused by physical malfunctions like any other disease. The mentally sick poor were looked after by their parishes, like Elizabeth Stodge who in 1799 became "so far Disordered in her senses" that she was "Dangerous to be permitted to go Abroad" and was ordered to be "safely locked up in her house at Arlesey" (Ref: P37/18/1).

By the early nineteenth century it had become clear that a local asylum was needed. Bedford General Infirmary had opened in 1803 (see Part One) and the next logical step was an asylum for mentally ill poor people. The 1808 Lunacy Act empowered counties to build asylums out of the rates, and Samuel Whitbread II, one of the leading lights behind the construction of the Infirmary, was determined that Bedfordshire should have one equipped to the best standards of the day. Bedford Asylum, built on a site in Ampthill Road, was designed by John Wing and opened in April 1812, the second of its kind in the country, Northampton (opened 1811) being the first.

The range of records relating to the care of the mentally ill increases dramatically from this period. Details of the sources are to be found in our online catalogue by inputting references quoted in this guide into the reference field, or inputting index terms such as 'mental health', 'mental illness' and 'lunacy' into the subject term field.  Bernard Cashman's book A Proper House, Bedford Lunatic Asylum: 1812-1860 is essential background reading and there are a number of other useful articles. Turning to the original sources, the Whitbread papers provide useful information on the construction and staffing of the asylum (especially Ref: W1/136-180). Comprehensive operational and medical records survive for the asylum itself (Ref: LB) including admission and discharge registers (Ref: LB3) , reports on patients and minutes of the asylum visitors and management committee (Ref: LB1). An inventory taken in 1834 (Ref: LB6/1) shows that restraint of the patients was still the primary task of the asylum. Locked up in the women's gallery were six new strait waistcoats, twelve old ones, twelve wrist locks and eleven pairs of police handcuffs.

The proposed Manual of Duties of Ward Attendants of 1851 (Ref: LB1A/4) sheds interesting light on the regime at the asylum. Rule 3 states: They [the attendants] must always bear in mind the insane are ill, and not responsible for what they say or do. That they are sent to their Asylum for their cure and to be taken care of. That they are afflicted, and deserve our pity and kind consideration". Life on the ward was hard for the attendant - up at 5.30 a.m., they had to wash and dress their patients and give them their daily exercise in the yard.

Unfortunately, adoption of the 1808 Act was not compulsory. Not all counties were as progressive as Bedfordshire and Northamptonshire and by 1828 only ten out of 52 had built their own asylums. Pressure on the limited facilities at Bedford Asylum were partly eased by the opening of Springfield House Private Asylum at Kempston in 1837. Reasonably comprehensive records survive for this hospital until its closure in August 1962 (classes: X611; LSL-LSV). The hospital buildings were demolished soon afterwards, but the superintendent's house and the lodge still stand today.

Matters came to a head in 1845 when a new Act of Parliament compelled counties to build local asylums or combine with other counties for the purpose. Hertfordshire and Huntingdonshire joined Bedfordshire in 1847 and consequently the number of inmates at Bedford nearly doubled. Eventually, it was decided to abandon the old site and in June 1860 the new Three Counties Hospital (later Fairfield Hospital) was opened on the borders of Stotfold and Arlesey.

For the full history of Fairfield Hospital see 'A Place in the Country- Three Counties Asylum 1860 - 1998'(Searchroom library shelves Book 150). All the raw materials for this history are in a very comprehensive archive which has been deposited at the Archive Service over 20 years (class: LF). The records include detailed building plans (Ref: LF78) and photographs taken by the architect George Fowler Jones when the dining room wing was added in 1870-1872 (Ref: Z50/2/6-18). Medical case papers exist from 1860, but obviously many of the more recent records (under 100 years old) are embargoed for reasons of confidentiality (See Access to Medical and Care Records). These records are often much more detailed than similar records for the general hospitals, for it was recognised that family background, upbringing and employment could influence the manifestation and cure of mental illness. There are also wage books for nurses, servants and workmen at the hospital (Ref: LF12-21).

Apart from the records of Bedford Asylum (1812-1860) and Fairfield (from 1860) there are statutory returns of the mentally ill in Quarter Sessions records (class: LR). These run from 1828 until 1930 and include parochial returns of pauper lunatics (1828-1841), similar returns by the Poor Law Unions (1842-1930), and other lists of patients at Bedford Asylum (1846-1859) and at Three Counties (1868-1921). There are also plans (Ref: PLH1-2) and papers (Ref: LH3) relating to an abortive attempt to found a private asylum at Hinwick House, Podington, in 1879-80.

In the nineteenth century a growing distinction was made between individuals with learning disabilities, known then as "mentally defective" and other mentally sick patients. This was embodied in the 1913 Mental Deficiency Act under which County Councils opened local homes, but the interruption caused by the First World War meant that it was years before any progress was made. In 1930 Bedfordshire County Council opened Bromham Hospital, administered by a Joint Board with Northamptonshire County Council (class: JB). The papers mostly consist of agreements for the purchase of Bromham Hall and associated minutes and correspondence - there are no patient files. The Board was superseded by the Health Committee under the National Health Services Act of 1946 and its records cease in 1948.

In 1994 the archives of the Bedfordshire Executive committee of the National Health Service (class: NHS) were deposited at the Archives Service. These contain some references to the care of the mentally ill over the last fifty years. At this time the opportunity was taken to produce a conspectus of records for the various Health Authorities and their predecessors, hospitals of all kinds, nursing associations, and archives relating to specific medical conditions and practice. This list (see Part Three) is a useful starting point for researching the history of hospitals and medicine. The variety of records shows just how radically medical care has changed over the last two hundred years. There are signs of further changes on the way, but at this stage we can only guess at the impact these will have on the creation of the medical archives of the future.