‘Madness confined’ reviews the care of the mad from the 18th to the mid-20th century. Initially, treatment was based on a humoral approach, combined with the use of chains and other mechanical restraints. Increasing numbers of institutions devoted to the confinement of the mad in the 18th century experimented with differing approaches to their management. The belief arose that maniac's frenzied behaviour resulted from misguided methods. The 19th century saw extraordinary optimism about the therapeutic possibilities of asylums and many were built, creating opportunities for experts in the diagnosis and treatment of madness. Social Darwinism eventually fed into eugenics and ultimately the conclusion that the insane should be eliminated.