Data from archival sources were used to determine the kinds of patients treated at the St. Louis City (later St. Louis County) Insane Asylum, the treatments they received, activities of daily life in the asylum, and political factors affecting operation of the asylum in the late 19th and early 20th centuries. Data from patient records, journal and newspaper articles, and annual reports of asylum superintendents from the period were analyzed. The authors conclude that although much has changed in the operation of public psychiatric hospitals in the past 100 years, some themes, including inappropriate referrals of forensic cases to psychiatric hospitals, problems of discharging long-stay patients, and the media's tendency to sensationalize events and conditions in hospitals, remain the same.