This article analyzes the medicalisation strategies deployed by Peruvian alienists in the daily life of the Lima Asylum during the last third of the 19th century. Special attention is given to the process of hospitalisation of the insane in the psychiatric hospital, since this administrative procedure reveals the dialogue, confrontation, and negotiation between the asylum staff and the state and social bodies in the public management of insanity. Through the support of the civil authorities in charge of the psychiatric hospital administration, we argued that the local alienists sought to impose medical knowledge in the asylum space as the legitimate criterion for the confinement of the insane in Peru. This process was not without tensions, setbacks, and disputes, especially with the families and the state agencies of control and social defence seeking to preserve their former prerogatives over the fate of their insane.However, we propose that these medicalisation strategies promoted by the alienists in the daily space of the Lima Asylum managed to situate psychiatric care as a state problem and these actors as experts in the public management of insanity.