CGC 4.0 While there are earlier issues that mention an unnamed insane asylum, this one is the first mention of the name Arkham hospital, although the actual first appearance of the hospital wouldn't come until issue 278 (it became Arkham Asylum in issue 326). Also,from the late golden age through the silver age, Joker had transformed from a mass murdering psychopath to a thieving prankster, and this issue returns him to his roots. Cover, Penciling,and Inking all by Neal Adams, story by Dennis O'Neil.