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History of Medicine Introduction Over the ages, philosophers, theologians, and physicians had accepted insanity disorders within their purview. By the late 18th century, however, the first two had largely withdrawn and physicians, social activists, and the state took responsibility for the care and treatment of the mentally ill. Psychiatry as a medical discipline came into being during the first years of the 19th century. The rapidly growing population of the United States during the 19th century, along with an ever increasing number of immigrants, gave rise to the need for provision for the poor, the sick, and the mentally ill. Publicly supported almshouses and hospitals were established and the special needs of the mentally ill led to the era of asylums.