State Hospitals and County Asylums

State hospitals and county asylums were central institutions in many communities during the 19th and early 20th centuries. Families often turned to these facilities during times of medical crisis, financial hardship, or legal intervention. For genealogists, records created by these institutions can provide important clues about an ancestor’s health, family relationships, residence, and social circumstances. Understanding how these institutions operated — and what types of records they produced — is essential for locating and interpreting those records accurately.

Understanding the Terminology

The terms state hospital, county asylum, insane asylum, lunatic asylum, mental hospital, state institution, and poorhouse hospital ward were not always interchangeable. The terminology used depended on time period, jurisdiction, and administrative structure.

In the 19th and early 20th centuries:

• State hospitals were typically large, state-funded institutions intended for long-term care of individuals diagnosed as insane, feeble-minded, epileptic, or otherwise mentally ill.
• County asylums were locally operated facilities, often smaller, and frequently connected to county poor farms or almshouses.
• The word asylum originally meant “refuge,” not confinement — but over time it acquired a custodial connotation.

Researchers must not assume the institution name reflects the level of care provided.

Why Individuals Were Admitted

Admission reasons were often broad and medically imprecise by modern standards.

Common recorded causes included:

• Melancholia
• Mania
• Dementia
• Epilepsy
• Alcoholism
• “Moral insanity”
• Postpartum conditions
• Senility
• Syphilis-related disorders

In some cases, admissions were triggered by:

• Family petitions
• Poverty
• Criminal proceedings
• Guardianship actions
• Public safety concerns

Not all admissions indicate chronic mental illness.

The Admission Process

Procedures varied by state and era, but typically involved:

• A petition filed by a family member, physician, or local official
• Examination by one or more physicians
• Court approval (in many jurisdictions)
• Commitment order issued by a judge

This means records may exist in:

• County court files
• Probate court files
• Circuit court minutes
• Guardianship records

Institution records are often only one part of the documentary trail.

Types of Records Created

Depending on time and jurisdiction, records may include:

• Admission registers
• Patient case files
• Commitment papers
• Physician certificates
• Superintendent reports
• Discharge registers
• Death registers
• Burial records (institution cemetery)
• Annual reports to the legislature

Early records may be brief entries in bound ledgers.
Later records can include detailed medical histories and correspondence.

Access restrictions often apply to patient case files.

Transfers and Movement

Patients were sometimes:

• Transferred from county asylum to state hospital
• Moved between state institutions
• Returned to family custody
• Paroled or released
• Sent to specialized institutions (epileptic colonies, tuberculosis sanatoria)

A paper trail may cross multiple institutions.

Institutional Cemeteries

Many state hospitals maintained their own cemeteries.

Burials were often:

• Marked with numbered stakes
• Recorded in burial registers
• Later re-interred or memorialized

Modern efforts to identify unnamed graves may exist through:

• State archive projects
• University research initiatives
• Nonprofit cemetery restoration groups

Administrative Oversight

State hospitals were typically overseen by:

• State Boards of Charities
• Boards of Control
• State Departments of Public Welfare

Annual reports often contain:

• Patient statistics
• Admission numbers
• Causes of insanity (as categorized at the time)
• Mortality rates
• Institutional budgets

These reports can provide valuable context even if individual case files are restricted.

Research Challenges

Researchers may encounter:

• Restricted access due to privacy laws
• Destroyed or missing patient files
• Name misspellings in registers
• Transfers without clear documentation
• Records held at multiple repositories

In some states, case files were routinely destroyed after a retention period.

Related Record Clues

Clues to asylum or hospital placement may appear in:

• Census records (listed as “inmate” or “patient”)
• Death certificates
• Probate files
• Newspaper notices
• Guardianship proceedings
• Institutional burial registers

An ancestor may not appear under the institution’s name but instead under a generic description such as “State Hospital” or “County Farm.”

Final Considerations

State hospitals and county asylums were complex institutions operating under evolving medical, legal, and social standards. Records reflect the terminology and diagnostic practices of their time and should be interpreted within historical context.

Not every admission indicates lifelong confinement, and not every discharge indicates recovery.

Understanding the structure of these institutions helps genealogists locate records across court systems, state archives, and institutional repositories.