C.J. Sansom: Revelation

As for care for the mentally ill, this was rudimentary and only accessible to the rich, like all medicine. Foucault has seen the emergence of mental hospitals in the eighteenth century, when people working in industrial environments could no longer look after mentally ill relatives at home, as 'the great confinement'. This assumes, however, that pre-industrial societies looked after the mentally backward and mentally ill better. While this may be true to some extent of those with low intelligence, who might be cared for at home, there are too many accounts of those with severe mental illness being chained up at home or abandoned to live and frequently die in uninhabited regions ('the wild men of the woods') for us to believe that life for the mentally ill in early modern Europe was anything other than precarious and grim.

The Bedlam, originally founded in the fifteenth century as a hospital for London's mentally ill, was one of the very few hospitals for those with mental problems in Europe. It has earned a grim reputation, not least because of the image of people visiting the Bedlam to laugh at the antics of the chained-up lunatics as a weekend diversion. This did indeed happen, but not until Stuart times. Little is known about the Tudor institution except that it housed perhaps thirty inmates, that they were usually kept there for a year (though some stayed for much longer), at the end of which they were discharged whether cured or not, and that it was a paying institution, which meant that most of the inmates came from the wealthier classes. There may have been some serious attempts at treatment at this time in the hospital, but the fact that the wardenship was used as a source of profit, and the grim conditions prevailing at most such 'privatized' institutions at the time, argue in favour of a more neglectful regime. But we do not know, so I have had to invent.

For background research, I had to read a number of books on serial killers. What struck me forcibly was that while there are certain common patterns that appear in the lives of these people, few exhibit all of these features, and there is still no real understanding of what turns some people down this terrible path.

The case of Gilles de Rais is, unfortunately, historically true. Strodyr, however, is an invention — I have been unable to find any verifiable references to serial killers in medieval England. Of course, given the lack of any real detection process at the time, that does not rule out there being any. I am grateful to James Willoughby for helping me by looking at the records of one possible case, which however turned out to be a canard.

On a somewhat lighter note, John Woodward's The Strange Story of False Teeth (Routledge 1968) was very helpful, although I disagree with his view that this sixteenth-century French fashion did not gain any popularity in England.

As usual, where historical dates are known I have tried to adhere to them, but although Vesalius' book referred to in the text was published in 1543, its appearance in England was probably a little later.

All the London churches mentioned in the text are fictional.

Once again, I am very grateful to Mike Holmes, Jan King, Roz Brody and William Shaw for reading the book in manuscript form. Thanks to Frank Tallis for discussions on the history of mental illness and its treatment. My agent Antony Topping once again read and commented most perceptively on the draft, as did my editor at Macmillan, Maria Rejt. Thanks to Mari Roberts for her copy-editing, to Frankie Lawrence and Rebecca Smith for their typing, and to Will Stone for research into the history of the doctrine of squatters' rights.