The Abstract: Connecticut was the exception among the Northeastern and Middle Atlantic states in not founding a public institution for the insane until after the Civil War when it opened the Hospital for the Insane at Middletown in 1868, a facility previously neglected by scholars. The state had relied on the expedient of subsidizing the impoverished at the private Hartford Retreat for the Insane that overtaxed that institution and left hundreds untreated. Despite abundant evidence to the contrary, well meaning officials oversold the idea that the Middletown site would promote cures and be cost effective. A number of unanticipated consequences occurred that mirrored fundamental changes in nineteenth-century psychiatry. The new hospital swelled by 1900 to over 2,000 patients, the largest in New England. Custodianship at the monolithic hospital became the norm. The hegemony of monopoly capitalism legitimated the ruling idea that bigger institutions were better and was midwife to the birth of eugenic responses. Class based psychiatry—the few rich at the Retreat and the many poor at Middletown—was standard as it was in other aspects of the Gilded Age. Public policy toward the insane poor in Connecticut represents an outstanding example of the transition from antebellum romanticism to fin de siècle fatalism.