Unfortunately, much of Anna Agnew’s hospital treatment did not reflect "moral therapy." Frequently the attendants, and occasionally nurses and physicians, were demanding, harsh, uncaring, and even sadistic. Some of this may have been due to the overcrowding that was occurring in many state institutions as a result of increasing immigration and the growth of urban centers. King points out that at the time of Agnew’s admission the census of the hospital was 614 and that 7 years later, when she was discharged, the census had swelled to 1,454. Another major problem was the lack of adequate training for the attendants. King quotes Agnew that there would continue to be abuse "until state laws require that none but those who are fitted for the sacred duties of attendants upon the insane be employed." A third factor identified by King was the discrimination against women that existed in society at large and was clearly reflected in all of medical care. This last issue is a main theme of Women of the Asylum(1), which includes 26 first-person accounts of women placed in mental institutions from 1840 to 1945, one of which is Anna Agnew’s.