With the author given simply as "A Constant Observer", this book gathers together glimpses into the personalities and stories of more than 140 mental patients confined to the Bethlem Hospital in the early part of the nineteenth century. In The History of Bethlem (1997), Dr Jonathan Andrews notes that “Bethlem is not simply Europe’s oldest psychiatric establishment; it is the most famous — or, what for long amounted to the same thing, the most notorious”. Founded in 1247, the hospital's infamy ultimately resulted in the name of Bedlam, a phonological corruption of Bethlem, becoming synonymous with a scene or state of uproar and confusion. The author of this volume would no doubt disagree with such an association, praising as he does the hospital's "regularity, cleanliness, humanity, and skill". (One has the impression that this "constant observer" was perhaps involved in the administration in some way, and so somewhat biased).

The full title of the work is Sketches in Bedlam; or Characteristic Traits of Insanity, as Displayed in the Cases of One Hundred and Forty Patients of Both Sexes, Now, or Recently, Confined in New Bethlem, including Margaret Nicholson, James Hatfield, Patrick Walsh, Bannister Truelock, and Many Other Extraordinary Maniacs, Who Have Been Transferred from Old Bethlem. Included among those patients listed by name are three individuals tied to assassination attempts on King George III (1738-1820) and one participant in the mutiny aboard the HMS Hermione (1797), the bloodiest in British naval history.

In addition to those famous entries, there are also fascinating accounts of other lesser-known patients. While the sketch of Thomas Dowle, for example, describes very little about his condition, it is a fascinating moralistic tale about the dangers of practical jokes that conveys a great deal about psychiatry in the early nineteenth century:

No taint of insanity ever before appeared in any of his family. Sudden fright was the immediate cause of his derangement, and he now presents a deplorable example of the mischievous consequences of those practical jokes, so frequently played off for the momentary diversion of inconsiderate young people, upon their unsuspecting companions, and but too often productive of lamentable, even fatal, consequences. Numerous are the instances wherein dementation, and even death, have followed the too sudden excitement of the stronger passions.(p. 182)

Seeing that each entry is attached to a name may evoke the feeling of walking among tombstones with only tragic epitaphs, but in this each patient named is also humanised, often in a way greater than their treatment in the text or, indeed, the hospital, and what’s more it makes Sketches in Bedlam an incredibly rich starting point for further historical research.