In the United States the movement to build public asylums for the insane began in the early nineteenth century. Demographic changes, a growing sensitivity to social and medical problems, a surge of philanthropic giving by elite groups, and knowledge of significant medical and psychiatric developments in France and England all combined to give rise to a movement to establish both general and mental hospitals. Shocked by the conditions of insane persons in family attics, county poorhouses, and local jails, state after state assumed the burden of providing free or low-cost institutionalization for this afflicted class. Expensive large asylums began appearing in the rural heartlands of the more prosperous states before the Civil War, reflecting the popular view that insanity was a disease, requiring segregation from society and long-term medical care. Previously only deviants who had broken criminal or poor laws were likely to be deprived of their liberty. Under the new system the state reached out to a larger, less deviant and non-criminal population, whose boundaries were not well-defined. Given the increasing health and welfare needs of an industrializing society, and the lack of alternative solutions for the mentally disabled, it was inevitable that the asylum populations would continue to expand.