ABSTRACT
The argument made here is that substantial change came late, probably not much before 1400. Until then, Bethlem was a religious institution which continued to focus primarily on collecting and distributing alms, although by the fourteenth century the main beneficiaries, apart from the Hospital and its staff, were probably poor people who lived locally, rather than the Order of Bethlehem. As the social and political changes of the mid-fourteenth century onwards made alms-collecting more difficult, the Hospital started to concentrate ever more on the care of the sick, and in particular on the care of the mad. Typically, this happened at just the moment when other English hospitals were abandoning or cutting back this type of provision severely.
