er degree than would be suspected at the present
time, of these desirable qualities that modern science has come to
recognize as so indispensable for the rational care of the mentally
unbalanced. In saying this I do not wish to claim for the Middle Ages
accomplishments beyond their deserts. My idea is rather to write an
interpretation; to make clear from what we know of the details of the
care of the insane in the fourteenth and fifteenth centuries, that
unconsciously those generations, in their large-hearted charity,
anticipated what is best in our present system.

The first record in English medical literature of a home for the
insane is that of Bethlehem Royal Hospital, London, which has become
famous under the familiar shortened name of Bedlam, meaning a house or
place of confusion. Bethlehem was a general hospital into which during
the fourteenth century insane patients were admitted. There is a
historical record to the effect that at the beginning of the fifteenth
century a royal commission {373} investigated the methods of treating
the insane in vogue there, because there had been complaint of abuses
in the institution. Practically every century since there have been
written corresponding records of similar investigations. The trouble
seems always to have been that there were too few attendants properly
to take care of insane patients, and thus they had to be placed in
confinement in various ways, which inevitably led to abuses.

For a generation or longer after each exposure by a committee of
inspection, the evils of this system would be more or less tolerable;
then they would become unbearable once more and another investigation
would be demanded. I would like to feel that we have progressed in all
respects beyond these hit and miss methods, but any one familiar with
the present situation in the matter is quite well aware that there are
still many abuses that need correction, and inspection committees find
many suggestions to make and sometimes gross evils to stigmatize.

Bedlam seems, however, to have always been as well and as humanely
conducted as the spirit of the times demanded. It must not be
forgotten that according to well authenticated tradition, a very large
part of the hospital's income was obtained by the collection of fees
for the admittance of visitors who came to be amused by the vagaries
of the insane. The number visiting the asylum for this purpose must
have been enormous, for, though only a