Useful or useless architecture? A dimension of the relationship between the Georgian schizophrenic James Tilly Matthews and his doctor, John Haslam

James Tilly Matthews, a paranoid schizophrenic admitted to Bethlem on 28 January 1797, was to become the most colourful and controversial inmate of the hospital in the years up to his death in 1815. Influential relatives and friends campaigned for his release and attempted to demonstrate his sanity, on two occasions, in 1797 and 1809, having him examined before high court judges. The hospital medical staff, in particular John Haslam, the apothecary (in post 1795–1816), were obliged to demonstrate repeatedly Matthews' continued insanity, and to this end his case was published (Haslam, 1810). Bethlem was under political pressure to continue Matthews' detention. His admission followed an attempt to disrupt a sitting of the House of Commons in December 1796, which occurred as the climax of a campaign of deluded lobbying during which he had made threats against the safety of senior politicians, including Lord Liverpool, the Home Secretary (Matthews, 1796). Under in-patient care, Matthews continued to express threats against the lives of the Royal Family, politicians, and the staff of Bethlem (Matthews, 1804). Transferred to the incurable ward in 1798, his continued detention was at the specific request of the Home Secretary, a fact revealed by Haslam at the 1809 hearing (Haslam, 1809). In May 1813, Matthews, having developed a spinal abscess, was transferred to a private madhouse in Hoxton, where it was felt country air might improve his medical condition. He died there in January 1815.