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The "Old Main" was the original building at the Spring Grove site of the Maryland Hospital for the Insane.
Although construction was started in 1853, the Main Building was not substantially completed and ready for full occupancy until 1872. Work on the building stopped in 1862 and was not resumed until 1868. However, enough of the north wing was completed by the start of the Civil War (1861) to allow for that part of the building to serve as a military hospital during the War. The first psychiatric patients were transferred from the Baltimore City location of the Maryland Hospital to the newly completed facility at Spring Grove on October 7, 1872.