Hogarth depicts stereotypical incurable lunatics, including the Rake himself, visitors and hospital employees, in a chaotic melée at Bethlem Hospital. In the forefront, Tom Rakewell, maddened by his debauched life, is represented hi a half-naked recumbent posture, holding his head in evident distress. This is reminiscent of the statue of 'melancholy madness' by Caius Gabriel Cibber, which [along with a statue of 'raving'] stood guard over the entrance gates to Bethlem at Moorsfields. Tom's shoes have been removed, he is being manacled by a keeper, while the bewigged physician in attendance gently attempts to intervene. A plaster beneath his right breat may suggest that he has been bled. The other lunatics depicted include a mad scientist/ (plotting longitudes on the hospital wall); a mad tailor obsessed with measurement, with tape in hand; a mad astronomer gazing at imaginary stars through his rolled-up paper telescope; a mad musician (with violin in hand and score atop his head); a crazy Papist with mitre and trinitarian staff; a lovesick moonfaced melancholic, sitting on the stairs while a dog barks at his feet (as dogs were proverbially said to do at the moon); and a mad king whose crowned head and regel aspect are contradicted by his nakedness and his act of urinating in the cell. In addition, a religious maniac [this time resembling Cibber's statue 'raving'] is shown taking the light from his cell window for a revelation. Two visitors--judging by their appearance,either ladies of fashion ( or a lady and her maid) or high-class corteseans-- stand by the cell of the crazed king. The epitome of idle unfeeling, and uncivilized curiosity, they gaze unsympathetically upon the lunatics, as one conceals her amusement behind her fan while the other whispers in her ear. These attitudes are contrasted with those of the physician and of the spurned Sarah Young, Rakewell's former sweetheart, who kneels forlornly by his side, wiping her tears with a handkerchief. Architectural details of the hospital seem accurately depicted, including the recently erected rails, which divided the 'incurables' wing from other portions of the hospital where 'curables' were lodged [Andrews & Scull, 2001, 22-3]

For a larger image click on the image on the image on the home page of this site and go to the Artchive site.
 

Bedlam

Patricia Allerage has pointed out that historians of psychiatry have done very little research on Bethlem Hospital. After exploring several possible reasons for this she concludes:

    that, on the whole historians of psychiatry actually do not want to know about Bethlem as a historical fact
    because Bethlem as a reach-me-down historical cliché is far more useful. It has, afterall, fulfilled this role in the
    popular imagination throughout much of its existence; and the instantly recognizable 'Bedlam' image can be
    used on most occasions to fill in odd gaps in the picture, and add a touch of verisimilitude to the whole. There
    are certain things 'everybody knows' about Bethlem, which are fortunately not so closely defined that
    variations cannot be worked on them to fit the required context; and they are all, of course, irredeemably bad.
    Bethlem as the ultimate symbol fo all that is evil is far too useful a space-filler to be risked in the refining fires of
    academic research: and it does not really matter too much what it symbolizes, so long as it is sufficiently
    discreditable to be credible. The reading public seems preconditions to accept that if it is bad enough, it is bound to
    to be true.

Patricia Alleridge, "Bedlam: fact or fantasy?," in Eds. W. F. Bynum, Roy Porter and Michael Shepherd, The Anatomy of Madness, volume 2, [Tavistock Publications] p. 18.

see also: A Brief history of Bethlam by Patricia Allderidge

Some Bare Facts about the early history of Bethlem Hospital

It was not originally intended for the mentally ill, but was founded as a Priory by Simon FitzMary, who, in 1247, gave his landed property in the parish of St. Botolph without Bishopsgate, London, to the Bishop and Church of Bethlem, in the Holy Land in order that a hospital or priory might be built for a prior, brethren and sisters of the Order or Star of Bethlem. In 1376 this hospital was so poor that the prior applied to the City of London to be received under its protection. As this application was agreed to, it was subsequently governed by two aldermen. It is impossible to say when the mentally ill were first received into Bethlem Hospital, but the earliest mention of insane patients being there was in 1403. In 1674 the building had become so dilapidated that it was necessary to build another. For this purpose the City of London granted land in Moorfields, and the second Bethlem hospital was opened there in 1676. In 1815 a Committe of the Hous of Commons obtained evidence which revealed disgraceful conditions at the hospital. Another asylum was opened at St. Georges's Fields, Lambeth in the same year. …

D. Hack Tuke, A Dictionary of Psychological Medicine, vol. 1, [Philadelphia,1892] p.134
 

Some literary uses of Bedlam
           Part of "A Digression on Madness"  from Jonathan Swift's Tale of a Tub;
          Ned Ward's description of Bedlam in  The London Spy ;
          Chapter twenty  of Henry Mackenzie's Man of Feeling;

          A larger image of the plate VI of the Rake's Progress from the National Library of Medicine Collection

Paintings by a famous Bedlamite

          Richard Dadd, while an inmate at Bedlam produced remarkable paintings.
           Richard Dadd's The Fairy Feller's Master Stroke