In 1810, a newspaper competition for the design of Bedlam, the ‘hospital’ for the insane, was announced in the city of London. Among the 33 competition entries was one submitted by James Tilly Matthews, a Bedlam inmate of 14 years, who was not to be released from the hospital until his death in 1815. This one-off competition is well documented; it provides a wealth of historical information as to the use of competitions at the beginning of the 19th century for an important public building in London, and offers a glimpse into the internal politics of competitions at that time, ie who could participate, and who could win.