This book contributes to the growing scholarly interest in the history of disability by investigating the emergence of the so-called idiot asylums in England during the Victorian period. Using the National Asylum for Idiots, now known as the Earlswood Asylum, as a case study, it investigates the social history of institutionalisation, 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 utilising the benefits of nominal record linkage to other, non-medical sources, the book extends research on the confinement of the ‘insane’ to the networks of care and control that operated outside the walls of the asylum. The book contends that institutional confinement of mentally disabled and mentally ill individuals in the 19th 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, the book reveals the diversity of the insane population in Victorian England and the complexities of institutional committal in the 19th 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.