Overcrowding and the selection of a new site:
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Pennsylvania Hospital for the Insane, as it would have appeared in the spring of 1860
| established = 1835
| established = 1835
| construction_began = Female Dept: 1836 / Male Dept: 1856
| construction_began = Female Dept: 1836 / Male Dept: 1856
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[[File:Map.png|400px|thumb|right|The original campus of Pennsylvania Hospital for the Insane as it would have appeared around the year 1900]]
[[File:Map.png|400px|thumb|right|The original campus of Pennsylvania Hospital for the Insane as it would have appeared around the year 1900]]
−
From its inception, [[Pennsylvania Hospital]] admitted both the physically ill and the mentally ill to their historic South Philadelphia campus. Eighteenth and early nineteenth century medical practice was crude, and frequently counter-productive by modern day standards, but the treatment of the mentally ill was particularly harsh. Solitary confinement, bloodletting and involuntary restraints were the order of the day by most physicians. Over time, the proportion of the Hospital’s patients who were severely mentally ill increased in size, until it began to become overcrowded, leaving little room for the physically ill. In response, the Board of Managers believed itself obligated to limit the admission of the mentally ill. The west wing of the Hospital had been designed and set aside for the mentally ill, but by 1817 it was filled near to capacity and additional space had been set aside for mentally ill patients elsewhere in the facility.
A contemporary description of the Pennsylvania Hospital, published in the Philadelphia newspapers in May of that year, provides a view of the institution perhaps more objectively:
+
From its inception, [[Pennsylvania Hospital]] admitted both the physically ill and the mentally ill to their historic South Philadelphia campus. Eighteenth and early nineteenth century medical practice was crude, and frequently counter-productive by modern day standards, but the treatment of the mentally ill was particularly harsh. Solitary confinement, bloodletting and involuntary restraints were the order of the day by most physicians. Over time, the proportion of the Hospital’s patients who were severely mentally ill increased in size, until it began to become overcrowded, leaving little room for the physically ill. In response, the Board of Managers believed itself obligated to limit the admission of the mentally ill. The west wing of the Hospital had been designed and set aside for the mentally ill, but by 1817 it was filled near to capacity and additional space had been set aside for mentally ill patients elsewhere in the facility.
−
''"From
the
Kentucky Gazette"'
'
+
In a published report by
the
Board of Manager in 1817, the number are brought into focus. Two-thirds of the Hospital’s patients were the mentally ill and the Board of Managers had previously set aside two-thirds of the Hospital’s rooms for their care. The west wing was entirely committed to the care of the mentally ill, and sixteen of the thirty-nine rooms available in the east wing were also devoted to the mentally ill. Though the completed Hospital building was just twelve years old, the Board of Managers had already adopted a policy which limited the number of mentally ill patients for this very reason. There may have been calls for the expansion of the physical site from other administrators, but the Board was unwilling to consider the Hospital’s vacant land for the construction of yet another new buildings. The U.S. census returns for the first decades of the 19th century show increasing pressure: the number of resident staff and patients at the Hospital increased significantly in each decade. The 1820
'
s, in particular, experienced an increase in the average number of resident patients, from less than 150 to more than 200 present at any one time. By 1830 the average daily number of mentally ill patients was somewhere around 115. The demand for the services of the [[Pennsylvania Hospital]] must have been near, if not beyond the Hospital’s ability to provide them.
−
''An Account
of the Pennsylvania Hospital
''
+
In 1829, [[Philadelphia Almshouse]] announced that intended to shut down their center city facility by the fall
of
1834, with
the
intention of transferring all of their services to a new site in the West Philadelphia neighborhood of Blockley. [[
Pennsylvania Hospital
]]’s initial response to the move of the [[Philadelphia Almshouse]] was to attempt to purchase its center city land holdings. The "Western Lot" of the Pennsylvania Hospital was open land on the west side of Ninth Street. The Hospital owned the land from Spruce Street on the north all the way south to Pine Street, but only half the distance to Tenth Street. The other half of the block was also open and it was owned by the Almshouse. On the other side of Tenth Street was the city square on which the Almshouse buildings stood. If the western half of the Ninth Street block could be purchased, the way would be clear to expand westward yet another city square.
−
''This humane and benevolent institution was founded by the contributors
,
in
the
year one thousand seven hundred
and
fifty two, for
the
relief
of the
lunatics and sick poor
of
Pennsylvania
,
and has been supported by them ever since with legacies and private contributions. Persons with infectious diseases are
not to
be admitted
,
nor incurable cases
,
lunatics excepted
..
. From
the
time the hospital was founded there have been admitted into it about ten thousand patients
,
great number
of
whom have been lunatics
,
some
of
these have been twenty or thirty years in
the
house (which is not uncommon
for
lunatics) hence arose
the
disagreeable necessity of limiting their number
,
so as to take
more than
one half of
the
paupers of that class
,
who would occupy the whole house
to the
exclusion
of
other cases
,
which have an equal claim
, the
hospital being not only
for
maniacs
,
but all others, except infectious diseases.''
+
On May 3, 1830
, the
Contributors to the Pennsylvania Hospital met
and
adopted a resolution directing
the
Board of Managers
of the
Hospital to purchase the western half
of
the Ninth Street block from the Almshouse
,
but
not to
offer more than $50
,
000 for the land available. The Board quickly made an offer of the full $50
,
000, but the Guardians of the Poor refused to sell
.
Instead, later that same year, they decided to put the land up for sale at public auction
.
The Board of Managers, meeting on December 27, pf
the
same year
,
authorized a bid
of
$50
,
000 at the auction, but the minutes
of the
Board
for
January 12, 1831 note that
the
Board’s representatives attended the auction and bid $50
,
100, but that another bidder had offered more and had purchased the property outright. The winning bid was just $400
more than the
hospital had offered: $50
,
400.75. The new owner planned
to
develop
the
site promptly. The Hospital’s Board
of
Managers
,
frustrated in their efforts to expand westward
,
were now forced to consider other options. The Managers began by articulating
the
Hospital’s need. The minutes of the Board
for
January 31
,
1831 included the following statement:
−
''
At
the
present time, there are ninety three
patients
in
the
hospital,
of
whom sixty three are on pay,
and
thirty one on
the
poor list;
of
the whole number sixty three are lunatics
.
And adjoining the centre house on the west, are
a
ward and wing, similar
to
those
on
the east, with
this
exception,
that the
wards are about 34 feet deep – this extension was agree to, in order to admit double rows
of
rooms to accommodate a greater number of lunatics. Rooms in
the
hospital are appropriated
to
the following uses … [21 devoted to various uses]; Lunatics in the west wing and ward, 70; [Ditto] in the east, 16;
for
sick and wounded, 23; In all 130 Wards and rooms. The lunatic being separated from the sick by the centre house, the latter are not incommoded with their noise. The unproductive part
of
the state consists in lots of ground bought and paid for by the contributors
,
and in
the
museum and medical library. These lots were mostly purchased early, when land was low, but they are now
become
valuable, being within the improved parts of the city. The hospital stands on a square, three hundred and ninety-six feet in width, and four hundred and sixty-eight feet in length, containing about four acres
.''
+
<blockquote>
''
The great increase of
the
number of insane
patients
which claim
the
care
of
this Institution
and
for whose suitable accommodation and means of relief and restoration
the
Managers feel deeply concerned has been a subject
of
frequent consultation
.
The Board believes it to be
a
duty
to
record its sense
on this
interesting concern and to express its opinion
that
when sufficient funds can be procured by
the
contributions
of the
benevolent, it will be proper
to
afford adequate space
for
that description
of
patients
, the
present building having
become
crowded
.''
</blockquote>
−
''There is also a vacant square to the east
,
and one-half a square to the west – containing together more than six acres running
in
parallel lines with the ground on which the buildings are erected; the other half of this square is owned by the alms-house
,
who mean
to
keep
it
always open, so that
the
Pennsylvania hospital is situated in the middle
of
three great squares; which, beside
the
open streets
,
measure more than thirteen acres. The contributors have also bought three lots
on
the south side of the hospital
.
Their object in providing so much ground was to secure a current of air for the benefit of the sick patients. –
The
policy of this provision was never more conspicuous than during
the
late fevers, particularly in 1793, when not a person took it in the hospital, though upwards of four thousand died of it, in about four months, in the city, in that year. Knowing the inestimable value of open ground to the hospital, the contributors have a confident assurance, that avarice itself will never dare to propose the alienation of one foot of the ground, which they have provided at their own expense for such a benevolent use.''
+
The Managers reflected on these minute and then
, in
April
,
decided
to
bring
it
before
the
next meeting
of the
Contributors
,
which was held
on
May 2, 1831
. The
Contributors responded by adopting
the
following resolutions:
−
In a published report by the Board of Manager in 1817
, the
number are brought into focus. Two-thirds
of
the Hospital’s
patients
were
the
mentally ill and the Board
of
Managers had previously set aside two-thirds
of the
Hospital’s rooms for
their
care
.
The west wing was entirely committed to the care
of the
mentally ill,
and
sixteen of
the
thirty-nine rooms available
in
the east wing were also devoted to the mentally ill
.
Though the completed Hospital building was just twelve years old
, the
Board
of
Managers had already adopted a policy which limited
the
number
of
mentally ill
patients for
this very reason
.
There may have been calls for the expansion of the physical site from other administrators
,
but
the Board
was unwilling
to
consider the Hospital’s vacant land for the construction
of
yet another new buildings. The U.S. census returns for
the
first decades of
the
19th century show increasing pressure: the number of resident staff and patients at the Hospital increased significantly in each decade. The 1820's
,
in particular, experienced
an
increase in
the
average number of resident patients, from less than 150 to more than 200 present at any one time. By 1830 the average daily number of mentally ill patients was somewhere around 115. The demand
for the
services of the [[Pennsylvania Hospital]] must have been near, if not beyond the Hospital’s ability to provide them
.
+
<blockquote>''Whereas
,
from
the
great increase
of
Insane
patients
under
the
care
of
this Institution, that portion
of the
Hospital appropriated to the reception of such cases is no longer adequate to
their
proper accommodation
.
And Whereas it is evident that an Assemblage
of
Lunatics and Sick patients under
the
Same Roof is inconvenient
and
unfavorable to
the
seclusion and mental discipline essential
in
cases of Insanity; therefore
.
Resolved
,
That we consider it necessary to
the
interests
of
this institution and
the
furtherance
of
its humane design that a separate Asylum be provided for our Insane
patients
with ample space
for
their proper seclusion, classification & employment
.
Resolved
,
That
the Board
of Managers be and they are hereby directed
to
propose at a future meeting
of the
Contributors to be called by
the
Managers when prepared
,
a suitable site for such
an
Asylum and
the
ways and means
for
carrying into effect
the
foregoing Resolutions
.
''</blockquote>
−
In
1832, the Board of Managers of the [[Pennsylvania Hospital]] relented, and recognized the necessity of opening a separate asylum with the sole purpose of caring for the chronically insane. This had been a mounting for a problem for several decades prior because of the reversal of hospital policy under Dr. [[Benjamin Rush]], stating that lunatic should be treated on the regular medical unit of the hospital. A resolution was passed shortly thereafter, as the mentally ill had at that time outnumbered the sick and injured patients with Pennsylvania Hospital itself. The hospital moved to purchase a 101-acre farm in West Philadelphia in 1835 from Matthew Arrison, a local merchant. The cornerstone for this new facility was laid on July 26, 1836 on the corner of 44th and Market Streets, which would later become the Female Department. The question of selecting an appropriate superintendent was complicated because of the absence of other large psychiatric facilities in the America at the time. Locally, only [[Friends Hospital]], then known at the Frankford Asylum, was operational in treating psychiatric disorders, and was only financially viable because of large donations offered from the Society of Friends. The Board of Manager voted on October 12, 1840 and elected to hire the thirty-one year old [[Alienist]], Dr. [[Thomas Story Kirkbride]], as the head of the new hospital, which would open the following January. Dr. Kirkbride was born in Morrisville, where his family resided, and graduated from the University of Pennsylvania Medical School only two years prior. He was at the time finishing his residency at the Frankford Asylum before his selection.
+
By
1832, the Board of Managers of the [[Pennsylvania Hospital]] relented, and recognized the necessity of opening a separate asylum with the sole purpose of caring for the chronically insane. This had been a mounting for a problem for several decades prior because of the reversal of hospital policy under Dr. [[Benjamin Rush]], stating that lunatic should be treated on the regular medical unit of the hospital. A resolution was passed shortly thereafter, as the mentally ill had at that time outnumbered the sick and injured patients with Pennsylvania Hospital itself.
Simultaneously,
+
+
The hospital moved to purchase a 101-acre farm in West Philadelphia in 1835 from Matthew Arrison, a local merchant. The cornerstone for this new facility was laid on July 26, 1836 on the corner of 44th and Market Streets, which would later become the Female Department. The question of selecting an appropriate superintendent was complicated because of the absence of other large psychiatric facilities in the America at the time. Locally, only [[Friends Hospital]], then known at the Frankford Asylum, was operational in treating psychiatric disorders, and was only financially viable because of large donations offered from the Society of Friends. The Board of Manager voted on October 12, 1840 and elected to hire the thirty-one year old [[Alienist]], Dr. [[Thomas Story Kirkbride]], as the head of the new hospital, which would open the following January. Dr. Kirkbride was born in Morrisville, where his family resided, and graduated from the University of Pennsylvania Medical School only two years prior. He was at the time finishing his residency at the Frankford Asylum before his selection.
=== Under Dr. Kirkbride: 1840-1883 ===
=== Under Dr. Kirkbride: 1840-1883 ===