ocial evils that were not challenged by some inspired St. George or well-meaning Don Quixote. The evils of drinking, pauperism, ignorance; the abuses of the penal system and the inhumanity meted out to the handicapped and mentally ill were exposed and remedies were vigorously advocated (Wiltse, 1961, p. 125).
Efforts to improve the lot of the mentally ill by means of transformed social policy persisted throughout the nineteenth century, not least for the reason that the mentally ill were often confined to jails, prisons, and poorhouses, where they received penal but no therapeutic care (Vourlekis, Edinburg, & Knee, 1998; "Mental," Funk & Wagnalls, 1975). Over the course of the century, it became a commonplace that the proper place for confinement of the insane was a state hospital. That view was most strongly promoted by the philanthropist, educator, and reformer Dorothea Lynde Dix, who in the 1840s began advocating humane treatment of the mentally ill, specifically by not confining them to institutions not designed for that purpose but rather by creating function-specific mental-health asylums. Dix was also an advocate of almshouse and prison reform per se ("Dix," Funk & Wagnalls, 1975). Dix personally helped found some 20 asylums, but by 1880, every state in the Union had at least one operating state hospital (Vourlekis, Edinburg, & Knee, 1998).
The creation of institutions designed to provide treatment to the mentally ill must be seen as the principal achievement of care delivery systems in the U.S. in the nineteenth century. Equally, the fact that the institutions were considered subject to public policy and public funding demonstrates a view that government agencies had a stake in maintaining mental health on one hand, or on the other protecting the public at large from the mentally ill or the mentally ill from abuse by themselves or others. This owes something to the editorial position adopted by the American Journal of Insa...