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 penny was charged for admission, the resulting revenue is said to have amounted to four hundred pounds sterling a year, showing that nearly one hundred thousand persons had visited the institution. From generations that were pleased to derive morbid amusement out of the misfortunes of others, humanitarian {374} care of the insane could not be reasonably expected; but in view of this custom it is difficult to understand how there could have been at this period any great abuse of patients, in the matter of severe punishments or inhuman restraint.