To Englishmen of the eighteenth and nineteenth centuries, few institutions inspired such horrified fascination as the Bedlam hospital, the principal London mad-house. Yet Bedlam, or to give it its proper title, the hospital of St Mary of New Bethlehem, had been in existence for several centuries before its principal charge became the care, or perhaps more correctly the confinement, of the insane. The origins of Bedlam lie in the 1240s, in the reign of King Henry III. To date, the circumstances which gave rise to the hospital's foundation have failed to attract the understanding and attention which they deserve. Bedlam's founders would no doubt have been surprised to learn of the subsequent fate of their institution, intended in origin not as a mad-house but as a link between England and the Holy Land, part of a wider movement in which the cathedral church of the Nativity at Bethlehem and its bishops sought land, alms and hospitality in western Europe. The purpose of this present essay is to investigate the links between England and the church of Bethlehem which gave rise to the foundation of Bedlam. In the process, it is hoped that new light will be shed upon English attitudes to the crusades, upon the reorganisation of the finances and administration of the bishops of Bethlehem exiled from the Holy Land after 1187, and in particular upon the career of one bishop, Goffredo de Prefetti. It was Goffredo who was to be personally responsible for the introduction of the Bethlehemites to England, and so it is with his career that we should commence.