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Page 279. " might very well be supposed to have escaped out of Bedlam "
The Interior of Bedlam (Bethlem Royal Hospital), from A Rake's Progress
Public DomainThe Interior of Bedlam (Bethlem Royal Hospital), from A Rake's Progress - Credit: William Hogarth, 1763

The Bethlem Royal Hospital in London specialises in the treatment of mental illness.  While it has changed locations and varied its name over the centuries, it has existed as a facility for the mentally ill since the 1300s, and is the world's oldest such institution.  The word bedlam, meaning uproar and confusion, derives from one variation of the hospital's name.

Bethlem originated in 1247 as a priory of the Order of the Star of Bethlehem. Its first site was in Bishopsgate, where Liverpool Street Station now stands.  In 1337 became a hospital. It admitted its first mentally ill patients in 1357, but did not become a dedicated psychiatric hospital until later.

For the first few hundred years, treatment amounted to little more than confinement.  Dangerous patients were manacled and chained, and conditions were appalling and inhumane. 

Things began to improve from 1700, when the hospital began referring to ‘patients’ rather than inmates.  From 1725, patients were separated into ‘curable’ and ‘incurable’ wards – suggesting that efforts at treatment were actually being made.