An insane man (Tom Rakewell) sits on the floor manically grasping at his head, his lover (Sarah Young) cries at the spectacle whilst two attendants attach chains to his legs; they are surrounded by other lunatics at Bethlem hospital, London. Engraving by

Lettering: Madness, thou chaos of ye brain ... Invented & c by Wm. Hogarth. Lettering continues: "What art? That pleasure givst, and pain? Tyranny of fancy's reign! Mechanic fancy; that can build vast labyrynth's, & mazes wild, with rule disjointed, shapeless measure, fill'd with horror, fill'd with pleasure! Shapes of horror, that wou'd even cast doubt of mercy upon heaven. Shapes of pleasure, that but seen wou'd split the shaking sides of spleen. O vanity of age! here see the stamp of heaven effac'd by thee. The headstrong course of youth thus run, what comfort from this darling son! His rattling chains with terror hear, behold death grappling with despair; see him by thee to ruin sold, and curse thy self, & curse thy gold."