B ethlem is a unique institution. Now seven hundred and fifty years old, it has been continuously involved in the care of the mentally ill since at least the qoos - in

other words for nearly six hundred years. As such it has a strong claim to be the oldest foundation in Europe with an unbroken history of sheltering and treating the mentally disturbed. Facilities for the mad were set up in Spain from the early fifteenth century, beginning in Valencia in q09, but such establishments were not to enjoy a continuous thread. In most of Western Europe it was the sixteenth century which brought comparable developments, and some regions did not develop independent psychiatric facilities until the nineteenth century. Many medieval institutions housed mad people from time to time, but few specialized in their care and won a reputation for it.1