 One of the earliest structures and the oldest extant hospital building in St. Louis is the St. Louis Insane Asylum (now the Metropolitan St. Louis Psychiatric Center).The asylum is built of brick in the Italianate style, complete with cast iron dome and cupola reminiscent of the Old Courthouse.As St. Louis expanded, the city hall was moved further west of downtown to its present location in 1904 (construction began in 1892).