ABSTRACT
The insane asylums suffered the most dramatic decline from a reform to a custodial operation. Both the reality of institutional care and the rhetoric of psychiatrists made clear that the optimism of reformers had been unfounded, that the expectation of eradicating insanity from the new world had been illusory. Once again an institution survived long after its original promise had dissolved. Visitors to state and municipal institutions told of seeing beds strewn about the hallways, because the space in the dormitories had long since been exhausted. Some institutions herded the most violent into special rooms, but without great discrimination or thoroughness. One crude index of survival can be found in the number of patients annually institutionalized: there were two thousand in 1840 and four times as many in 1860. Other private institutions were also unwilling to exclude the chronic from among their patients.
