Since the establishment of Pennsylvania Hospital at 8th and Pine Streets “to care for the sick-poor of the Province and for the reception and care of lunaticks,” Philadelphia was a leading center of psychiatric care. The city is, after all, the birthplace of Declaration of Independence signer Benjamin Rush, widely regarded as the father of American psychiatry.
Rush’s belief that mental illness should “be freed from moral stigma, and be treated with medicine rather than moralizing” was reflected in his colleagues’ work at the nation’s first hospital. Founded by Dr. Thomas Bond and his close friend Benjamin Franklin, Pennsylvania Hospital was the first in America to treat insanity as a disease and the insane as potentially curable patients. While better-off, indigent and criminal mental patients were traditionally cared for – or, rather, stored – with relatives, in poorhouses or in prisons, respectively, those admitted to Franklin’s hospital at least had the potential to receive regular, professional medical care.
Yet as the number of insane patients grew to the point that the mentally ill made up the majority of the hospital’s population by the early 19th century, conditions worsened. Insane patients regarded as more violent or dangerous were kept restrained in cells in the hospitals basement, where most of their contact was not with medical staff but a ‘cell-keeper.’ Others were housed with sane patients, provoking complaints and putting pressure on the hospital to make new arrangements.
An expansion of the hospital’s west wing allowed the insane to be segregated from the physically ill for a time. But by 1832, the hospital administration had decided that an entirely separate satellite campus ought to “be provided for our Insane patients with ample space for their proper seclusion, classification and employment.” Pennsylvania Hospital duly acquired an 111 acre farm far from the main downtown location and began construction. On December 16th, 1841, the Pennsylvania Hospital for the Insane opened its doors. For hours and hours that day, a carriage traveled back and forth from 8th Street to the location on 44th between Market and Haverford Streets, transporting about 100 patients to their new West Philadelphia home.
According to many accounts, it wasn’t a bad place to live. The hospital grounds took up about 41 acres – surrounded by a ten and a half foot high wall – leaving the balance of the enormous campus to be used for “asylum pleasure grounds” and a small working farm. An engraving from Report of the Pennsylvania Hospital for the Insane for 1845 shows a sprawling 3 story complex with two massive wings extending from a dome-topped central building, as men in top hats and tails and women in long dresses wander the manicured grounds.
A typical day for an asylum patient would include at least one 20 minute walk in the morning, followed by a visit to the on-site museum, library or billiard room. There was also a “pleasure railroad” on the grounds, apparently an enormous model train patients could ride. Lunch was served at 12:30, follwed by afternoon activities until 6:00, a light evening meal, and entertainment in the hospital auditorium. Though “magic lantern shows” of illuminated slides projected onto a screen were especially popular, patients also enjoyed lectures and musical acts, including, on at least one occasion, a performance by trained singing canaries. The institution’s doctors then made evening rounds before lights-out at 10:00. Bible classes and religious services were held on Sundays and were reportedly very well-attended, possibly as patients were rewarded for their presence and good behavior with gingerbread.
There were no restraints or straitjackets; patients were merely expected to behave themselves and, when they did not, were corrected with “nonviolent but firm resistance.”
Patients committed to the hospital owed their treatment to the institution’s famous superintendent, Dr. Thomas Story Kirkbride. An expert in asylum design, Kirkbride was trained as a surgeon but refocused on the care of the mentally ill early on, being hired to run the brand-new Hospital for the Insane at the age of 31. Kirkbride’s impact was such that the hospital he ran, as well as many he designed, became known simply as “Kirkbride’s.”
While the gentle treatment patients received were in line with Kirkbride’s medical philosophy, their fairly lavish surroundings reflected his skills as an administrator and fund-raiser. Recognizing that wealthier patients paid in a disproportionate amount of the hospital’s revenues, Kirkbride had his institution cater to their desires. Those who could pay could have large private apartments, fine clothes and furniture and anything else their families might want to provide for them that Kirkbride’s staff agreed would not harm them. The hospital even built a private Italianate “cottage” on its grounds for one wealthy patient. Working-class patients, meanwhile, were encouraged to work. Male patients were directed to the asylum farm, while females were put to work in the kitchen. Though not unusual for its time, these internal class divisions between patients whose families could afford to pay extra for their care and those who couldn’t puts an interesting spin on the Biblical inscription on the Pennsylvania Hospital seal: “Take Care of Him and I will repay Thee.”
In any case, life at Kirkbride’s was not always calm, nor was the hospital entirely free of scandal. Shortly after it opened, the hospital proved to be infested with rodents and vermin – though Kirkbride’s expertise as an asylum-planner later became famous nationwide, he had not had the opportunity to have any part in the planning of his own hospital. Thus, an embarrassing incident in 1850 saw a recently deceased patient nibbled on before being brought to the morgue. As Kirkbride explained, “a portion of the cartilage of his nose had been destroyed, how they were unable to day, but it is supposed by a mouse or a rat.”
The superintendent was also periodically attacked in the press for knowingly committing sane people, a charge he vehemently denied. Occasionally his own patients had other ideas about their treatment as well. One escapee, a young man named Wiley Williams who had been committed by his family as a dangerous eccentric, managed to shoot Kirkbride in the head by lying in wait for him in a tree. Kirkbride survived with a scratch – the bullet was apparently deflected by his thick hat – while Williams spent the rest of his life classified as a criminal lunatic in Eastern State Penitentiary, from which he sent his former doctor long, apologetic letters.
Kirkbride died of pneumonia in 1883, after a lifetime of treating the mentally ill. His hospital lasted more than a century after his death. The city moved the campus moved a few blocks west to make room for the expanding Market Street subway line in late 1950’s, around which time the hospital changed its name to The Institute of Pennsylvania Hospital. The asylum closed its doors in 1997, sending its psychiatric care operation back across the river to the 8th Street campus after over 150 years in West Philadelphia. Today, some remaining hospital buildings are used as a social services center, while the rest of the original campus has been redeveloped. A housing project and the enormous office building built by the Provident Mutual Insurance Company now occupy the space where Kirkbride’s patients once strolled, rested and – in about half of their cases – healed.
- Board of Public Charities of Pennsylvania. To the Legislature: A Plea for the Insane in the Prisons and Poor-Houses of Pennsylvania. A.C. Bryson & Co., Steam-Power Printers, Philadelphia, 1873.
- Bond, Earl D. Dr. Kirkbride and his Mental Hospital. J.B. Lippincott Company, Philadelphia, 1947.
- Kirkbride, Thomas S. On the Construction, Organization and General Arrangements of Hospitals for the Insane with Some Remarks on Insanity and its Treatment. J.B. Lippincott & Co., Philadelphia 1880.
- Tomes, Nancy. A generous confidence: Thomas Story Kirkbride and the art of asylum-keeping, 1840-1883. Cambridge University Press, 1984.
- “Dr. Benjamin Rush: patriot and father of American psychiatry.” Medical Post January 14 1997.
- “Kirkbride’s Hospital Also Known as Institute of Pennsylvania Hospital Placed on the National Register of Historic Places July 24, 1975.” http://www.uchs.net/HistoricDistricts/kirkbride.html
- “History of Pennsylvania Hospital” http://www.uphs.upenn.edu/paharc/