Above: the complex in a circa-1920s postcard view.

Above: the complex circa 1995.

Above: looming over Tilles Park, 1997.

The former St. Louis County Insane Asylum is an 1869 landmark, situated on a hilltop that was open country when it was constructed. The city grew up around it during the subsequent decades, but its site on Arsenal Street is the highest point in the city, and its cast iron dome is still visible for miles. Today the main building is handsomely restored, having outlived a host of other, younger buildings on the site.

The old hospital has gone through a succession of names and occupants:
- 1869: The main building, designed by William Rumbold, opened as the St. Louis County Insane Asylum, on land purchased from the short-lived Kemper College. The building is designed with capacity for about 250 patients. It featured marble columns on its front portico and a cast iron dome rising nearly 200 feet above the site. Rumbold also designed the dome that now graces downtown's Old Court House.
- 1876: St. Louis Insane Asylum
- 1910: City Sanitarium
- 1948: St. Louis (or Missouri) State Hospital, upon being turned over to the state of Missouri's control; the expanded complex could now deal with over 3,000 patients.
- Today: St. Louis Psychiatric Rehabilitation Center

A 1912 expansion campaign gave the original building two lengthy symetrical wing additions, transforming the stately building into a grandiose complex. The City Isolation Ward also erected a building on the site around this time, which has also been demolished.

By the 1990s, the complex was in use by the St. Louis Psychiatric Rehabilitation Center, the consolidated form of a number of institutions previously located on the site. The old St. Louis State Hospital building had been slowly deteriorating for years. Most visibly, the cast iron dome was badly in need of a cleaning, repairs, and painting. The main building also suffered from having a 1962 Modernist building placed directly in front of it, obscuring the intended entry vista.

In late 1998, a complete renovation of the grounds and buildings began to change all that.

Other pages on the State Hospital: