Insane asylums began to decline around the turn of the 20th century. As patients with incurable illnesses filled them, asylums became warehouses for people who could not be maintained elsewhere. The St. Louis Insane Asylum exemplifies this trend of decline. Overcrowding and lack of funding led to placement of patients in the St. Louis Poorhouse and to unhealthy conditions at the asylum. Dr. Edward Runge, the superintendent, tried to counteract this trend of decline, but the asylum was able to offer little more than custodial care.
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