But does one really need to look back hundreds of years, to a time when Bethlem was a completely different institution - in fact, not really an 'institution' at all? The alternative might be to choose some other starting-point, and an argument could be made for the 1630S. It was from 1633, when the Hospital was first managed by an employee of the City of London instead of being granted to an individual who made what profits he could from it, and when the Physicians hip (medical management) and Keepership (administration) became distinct and separate offices, that Bethlem began to take a more modern form. But 1633 certainly did not represent a complete break with the past. Much of what happened afterwards was a consequence of previous attitudes of mind and ways of doing things. In 1633, Bethlem already had a 'corporate culture', and it is impossible to grasp why its Governors acted as they did in the seventeenth century and beyond without appreciating what that culture was.