This book contributes to the growing scholarly interest in the history of disability by investigating the emergence of ‚idiot‘ asylums in Victorian England. Using the National Asylum for Idiots, Earlswood, as a case-study, it investigates the social history of institutionalization, privileging the relationship between the medical institution and the society whence its patients came. By concentrating on the importance of patient-centred admission documents, and utilizing the benefits of nominal record linkage to other, non-medical sources, David Wright extends research on the confinement of the ‚insane‘ to the networks of care and control that operated outside the walls of the asylum. He contends that institutional confinement of mentally disabled and mentally ill individuals in the nineteenth century cannot be understood independently of a detailed analysis of familial and community patterns of care. In this book, the family plays a significant role in the history of the asylum, initiating the identification of mental disability, participating in the certification process, mediating medical treatment, and facilitating discharge back into the community. By exploring the patterns of confinement to the Earlswood Asylum, Professor Wright reveals the diversity of the ‚insane‘ population in Victorian England and the complexities of institutional committal in the nineteenth century. Moreover, by investigating the evolution of the Earlswood Asylum, it examines the history of the institution where John Langdon Down made his now famous identification of ‚Mongolism‘, later renamed Down’s Syndrome. He thus places the formulation of this archetype of mental disability within its historical, cultural, and scientific contexts.