Fruit of the struggle of the medical profession and the interests of the State in resolving a serious public health question, the Bahian São João de Deus asylum for the alienated was inaugurated in June 1874, surrounded by the optimism and confidence of everyone involved. Meanwhile, its history would soon take an unexpected direction when the pregnancy and birth of an internee involved the Santa Casa de Misericórdia, the State and the press in an entangled web of interests and conflicts, revealing that the reality of an asylum institution was far from that imagined by its creators. At a time when Bahian psychiatry was beginning to take its first steps, the case produced serious doubts regarding the capacity of this medicine to wholly assume responsibility for the treatment of insanity.