Chapter Two: The Pennsylvania Hospital for the Insane, 1835 to 1919

1751 to 1830: Origins and Early Years of the Pennsylvania Hospital

The Pennsylvania Hospital, located at 8th and Spruce Streets in center city Philadelphia, was founded in 1751 by Dr. Thomas Bond, Benjamin Franklin and other civic-minded Philadelphians.53 They planned a hospital building in the shape of an "E," with east, center, and west wings.  The founders were successful in designing and constructing the first of the three wings, which opened in 1756, but thereafter, for forty years, their building plan languished.  Finally, in the mid-1790s, the Pennsylvania state legislature appropriated funds sufficient to complete the original plan.  The west wing was opened in 1796 and the center wing in 1805.  The Hospital also purchased vacant land on its perimeter: the entire city square on its east; most of the city square on its south; and half the city square on its west.  The result of these improvements, in the opinion of George B. Wood, the Hospital’s centennial historian, was a flourishing institution:54

Reference has already been made to the purchase of two lots east and west of the Hospital.  At various periods the [Board of] Managers were enabled to possess themselves also of one upon the south-west, and another opposite to the Hospital on the south; so that, with their buildings all completed, and surrounded on every side except on the north, with beautiful green fields, kept in the nicest order, they could boast an institution, if not the largest, assuredly in all points of beauty, healthfulness, and general prosperity, unsurpassed on this continent.

From its inception, the Hospital admitted both the physically ill and injured and the mentally ill.55 Eighteenth century medical practice was crude, even counter productive by modern day standards, but the treatment of the mentally ill was particularly harsh.  Solitary confinement and involuntary restraints were the order of the day.  Many of these patients did not improve, but then, neither did they die.  Over time, therefore, the proportion of the Hospital’s patients who were severely mentally ill increased in size, until it began to crowd out the sick and injured.  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,56 provides a view of the institution perhaps more objective than that of Dr. Wood:

The Pennsylvania hospital is celebrated through the universe, and is often referred to as a model in Europe and Asia; as it is too much the fashion of the world to think less of our intimates than of strangers; it is from a Kentucky paper we copy the following account of a hospital in this city  … 

From the Kentucky Gazette

An Account of the Pennsylvania Hospital

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.  … 

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.  … 

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 published report of 1817 brings a number of issues into focus.  Two-thirds of the Hospital’s patients were the mentally ill and the Board of Managers had 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.  There must have been calls for the expansion of the physical plant, but this report suggests that the Board was unwilling to consider the Hospital’s vacant land for 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.57 The 1820s, in particular, experienced an increase in the average number of resident patients from less than 150 to more than 200.58 By 1830 the average daily number of mentally ill patients was about 115.59 The demand for the services of the Pennsylvania Hospital must have been near, if not beyond the Hospital’s ability to provide them.

1830 to 1841: Pennsylvania Hospital and the Mentally Ill; Planning, Decision Making, and Building a Hospital in West Philadelphia

During these same years the medical profession was rethinking how best to care for the mentally ill.  Physicians increasingly held the opinion that the mentally ill should be treated in a setting of extensive open space, where physical exercise, productive activity, and general freedom of movement could be encouraged and practiced.  The Friends Asylum, established in 1813 and located in the rural township of Oxford, near Frankford, about five miles north of the City of Philadelphia, was the model.60 The Friends Asylum practiced what was known as "moral treatment,"61 that is, that the mentally ill be treated "as fellow men and brethren to be cared for with dignity, respect, kindness, and love within comfortable, pleasant surroundings."  Right away, in its first years of operation, the Friends Asylum reported a recovery rate of its mentally ill patients at levels well above what was then considered the norm.  The effect on the medical profession was profound and fundamental beliefs about the mentally ill began to change.

If the Friends Hospital provided the model, then the Philadelphia Almshouse certainly provided the motivation.  The Philadelphia Almshouse dated to 1729, when the colonial Pennsylvania legislature adopted a measure providing the City of Philadelphia with funds for "the purchase of ground and erection of an Almshouse or Hospice for the use of the poor of the city."62 The Almshouse originally occupied the city square bounded by Spruce, Third, Pine, and Fourth streets, but in 1767 moved to larger accommodations on the block bounded by Spruce, Tenth, Pine, and Eleventh streets.  This second home of the Almshouse was just two blocks west of the Pennsylvania Hospital.  The Philadelphia Almshouse was a much larger institution than the Pennsylvania Hospital and it had become overcrowded at an earlier date.  As early as 1811 the Almshouse directors, known as the "Guardians of the Poor,"63 had appealed to the Pennsylvania legislature, asking permission to sell the Philadelphia property and move the institution to a "farm."64 The legislature did not respond at that time, but in March 1828 it adopted a bill authorizing the Almshouse directors to build a new "hospital, almshouse, house of employment, and children’s asylum."65 The Guardians of the Poor proceeded, in January 1829, to purchase 187.375 acres of land on the west side of the Schuylkill River in Blockley Township.66 There they began building four structures, one for each of the institution’s four purposes.  In May 1833 they announced that two of the buildings would be ready for occupancy in October of that year and by July 1834 they had transferred the last of the patients from the old Almshouse buildings to the new.67

The innovation of the Friends Asylum and the move of the Philadelphia Almshouse from city square to an outlying, rural district68 together had a transformative effect on the Pennsylvania Hospital.  In the words of Dr. Wood:69

A new era now begins in the history of the Hospital.  A great question agitated the minds of the Board, the contributors, and the thinking men of the general community.  This question had reference to the insane.  Their numbers had increased beyond the means of accommodation.  New views in relation to the treatment of this class of patients had been developed which could not be carried out in the existing space and arrangements of the house.  The Pennsylvania Hospital, which had taken an acknowledged lead in this branch of practical medicine, was falling behind other establishments.  They who had the immediate charge of the insane, and I happened to be one of them, felt themselves cramped in their curative efforts, and, seeing their way clearly to better things, were troubled and grieved at the intervening obstacles.  There was no opportunity for proper classification, none for bringing duly to bear the vast remedial power of moral influences.  It is true that in our Institution, under the enlightened supervision of Rush and others, correct views of insanity and its management had prevailed and been carried into partial effect, at a very early period, and had undoubtedly been one cause of its wide reputation and popularity.  But in the march which we ourselves had been among the first to begin, circumstances were now compelling us to halt.  This state of things could be tolerated no longer.  Either the care of the insane must be abandoned, or we must conform with the improved views and methods of the day.

The Pennsylvania Hospital’s initial response to the move of the Philadelphia Almshouse was to try to purchase its center city land.70 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.  6½ acres of land were at stake.  The Pennsylvania Hospital saw long term opportunity in the move of the Almshouse.

On 3 May 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.71 The Board quickly made an offer of the full $50,000,72 but the Guardians of the Poor refused to sell.73 Instead, later that same year, they decided to put the land up for sale at auction.  The Board of Managers, meeting on 27 December, authorized a bid of $50,000 at the auction,74 but the minutes of the Board for 12 January 1831 note that the Board’s representatives attended the auction and bid $50,100, but that another bidder had offered more and had bought the property.  Both the Contributors and the Managers must have been very disappointed.  The winning bid was just $300 more: $50,400.75 The new owner planned to develop the site promptly.76 The possibility of the Hospital owning four contiguous city blocks was gone.

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 31 January 1831 included the following statement:77

The great increase of the number of insane patients78 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.

The Managers reflected on this minute and then, in April,79 decided to bring it before the next meeting of the Contributors, which was held on 2 May 1831.  The Contributors responded by adopting the following resolutions:80

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.

These resolutions confronted the Managers with two major challenges: where to locate a new hospital building and how to fund its design, construction, furnishings, and subsequent operations.  The Managers would struggle with these two questions for the next four years.  The Managers’ first choice was to build on the city square on the south side of Pine Street, bounded by Pine, Eighth, Lombard, and Ninth streets.  In November 1831, the Managers paid $10,000 for a property on the west side of Eighth Street, between Pine and Lombard.81 With this purchase they consolidated the Hospital’s ownership of the entire city block.  In March 1832, the Managers voted to recommend to the Contributors that the Hospital sell the "Eastern Lot," that is, the city block bounded by Spruce, Seventh, Pine, and Eighth streets.  The latter action, taken to raise funds for the new building, provoked opposition, as indicated by Dr. Wood in his 1851 history of the Hospital,82

But how was this to be accomplished? Whence were the funds to be obtained? The productive capital of the Hospital could not be touched. The income from this source was sacred. It did not belong to the "Contributors to the Pennsylvania Hospital;" it belonged under solemn pledges to the sick and destitute poor. There remained then but one alternative – an appeal to the public, or the sale of the beautiful but unproductive lots around the Hospital. The former, it was well known, would, under the circumstances and to the extent desirable, be unavailing. The answer to every hint of such a recourse was – you are rich; you are overburthened with unproductive real estate; make use of your own means, and then if necessary apply to us. It is true that many regretted the loss of those grassy squares; hoped that they might be reserved as breathing places for the crowded city; deprecated even the effect of their loss upon the probable health of the inmates of the Hospital; but they gave no money; they made no offers; they left the Hospital to its own resources. The sale of the grounds then became imperative. The Hospital had bought them with its own money, and had a full right to dispose of them.

It seems as though the Managers’ recommendation, though regretted, was agreed upon as the best option available to the Hospital.  At their regular annual meeting, held on 7 May 1832, the Contributors adopted the following resolution,83

Resolved, that the Managers be authorized to make sale of the Eastern Lot for the purpose of raising funds to erect buildings for the additional accommodation of the Hospital.

The disposition of the Eastern Lot, however, proved to be a very slow process.  More than a year passed before the Managers authorized the first sales of land84 and several years passed before the last of the building lots were sold.  In the interim a division took place among the Managers about how to proceed.

On 30 September 1833, the Managers voted, with eight yeas to four nays, to adopt the following resolution,85

The attention of the Managers being called to the building contemplated to be erected under the resolution of the Contributors of 5th mo. 2nd 1831, and it being the judgment of some of the members of this Board that a suitable structure for the accommodation of sick and surgical patients should be provided on the South Lot, it is resolved that Charles Watson, Alexr. W. Johnston, Wm. W. Fisher, John Paul and Thomas Morris be requested to submit a plan and estimate of an edifice adapted to the space embraced between Pine and Lombard and Eighth and Ninth Streets, and report thereon, as soon as practicable, in order that they may be laid before the Contributors for their consideration and conclusion thereupon.

At a meeting of the Board held 27 January 1834, "the committee on plans of a building reported progress,"86 but just a month later, on 24 February, "the committee on plans made a report on the several duties entrusted to it, which was received, laid on the table, and the Committee discharged."87 The minutes of the Board of Managers contain no further reference to plans for a new building on the South Lot.  The proposal must have met too much resistance.

Another year passed.88 Sales of building lots, carved out of the Eastern Lot, progressed, but only slowly.  Finally, on 8 May 1835, the Managers decided to call a meeting of the Contributors, in accordance with the following minute,89

The subject of the erection of buildings for the additional accommodation of the Hospital being brought under consideration, it was agreed to call a general meeting of the Contributors on 2nd day the 8th of next month at 3 o’clock p.m. to deliberate and determine the same both as regards the location and the means of effecting that object of which the Secretary is directed to give at least ten days notice in two newspapers stating the time, place of meeting, and object.

The meeting of the Contributors was held on 8 June 1835 and in the discussion which took place it was clear that the large majority of the Contributors did not want to build a new hospital on the South Lot.  Instead, they wished to follow the example of the Philadelphia Almshouse.  The Contributors concluded by adopting the following resolution,90

Resolved, that in the opinion of this meeting it is expedient that the Lunatic department of the Pennsylvania Hospital should be removed from the City of Philadelphia to the country in its vicinity, provided that the removal can be effected upon such a plan as will promote the comfort and improve the health of the patients and admit of the superintendence and control essential to a good administration of the institution.

Resolved, That the Managers of the Hospital be, and they are hereby requested to prepare and report to the Contributors at their next meeting a plan of removal agreeably to the preceding resolution; embracing in their report the location in point of distance from the City, the general structure of the buildings to be erected, the details of the organization for superintendence and control, the funds and resources of the Corporation available for this object, and the probable cost; with such facts and remarks as they may think it expedient to communicate for the information of the Contributors.

The Managers appointed an ad hoc committee to respond to these resolutions and to report to the Board.  On 4 August 1835 the committee reported back to the Board.91 The members of the committee reported their preference for a new hospital for the insane inside the city limits, but because "the popular opinion appears to be against a longer continuance of your insane department in the City, and your Contributors appear disposed to yield thereto, they [the members of the committee] confined themselves to such a view of the subject."  The long debate over the location of a new hospital seemed finally concluded, but the issue of funding was still outstanding.

The committee estimated that the cost of land, design, construction, and furnishings for a new hospital for the mentally ill would be $203,000; that the annual operating expenses of the hospital would be $25,000; that the annual revenues from paying patients would be $12,500; and that the interest on $200,000 in capital funds would be required to pay the remaining annual cost of $12,500.  The total estimated need would therefore be $403,000, a sum the committee termed "immense."  The committee’s proposed plan for funding the new hospital apparently had been anticipated and a group of the Managers was opposed.  A substitute report, which proposed a different method of raising the necessary funds, was submitted.  A lengthy discussion followed, with the Managers finally voting five to four to reject the substitute report.  At a subsequent meeting of the Board, held on 31 August,92 the committee’s final report was adopted and ordered placed before the Contributors at a special meeting to be held on 14 September.

The Contributors met on that day and heard the Managers’ report.  The report opened with one last statement of difference,93

[The Managers] are convinced from experience that a Hospital for the Insane can be best managed within the limits of the city, where easy and immediate access can be had to its Managers, its Physicians, and Markets, and where a plentiful supply of water, equal to every emergency is at hand; but as a large majority of the Contributors appear anxious for its removal to the country, they have confined themselves wholly to this view of the subject.

The majority of the Managers clearly believed that a matter of principle (and perhaps, also, one of power) was involved, but they had absorbed the blow to their leadership and moved forward.

The report of the Managers94 addressed all the points contained in the Contributors’ resolutions of 10 June.  The report recommended that the Hospital for the Insane be located within four miles of the City of Philadelphia; it included a description of the proposed new building; a description of the framework of management required by a remote department of the Hospital; and estimates of cost and funding sources.  There was one major difference between the Managers’ final report and the report made to them by the ad hoc committee a few weeks earlier.  The Managers estimated that the annual revenues from paying patients would leave a shortfall in operating expense of only $3,400, not $12,500.  This meant that the amount of capital funds necessary to make up the difference would be $70,000, not $200,000 and the total cost of the new hospital would therefore be $273,000, not $403,000.  The Managers also proposed to the Contributors that the full amount of $273,000 could be realized in proceeds from the sale of the Eastern Lot, which was estimated at $163,000 and the proceeds from the sale of the land west of Ninth Street (which was referred to as the "Western and the Southwestern lots"), which was estimated at $110,000.  The Managers’ proposal thereby avoided the necessity of any additional fundraising or any transfer from the existing capital funds.

The Contributors were generally satisfied.95 They adopted resolutions authorizing the Managers to sell the Western and Southwestern lots and to purchase "a proper site and adjacent grounds for the erection and accommodation" of a new hospital for the insane.  They objected, however, to the Managers’ plan for a new building that would house 228 patients.  They asked the Managers to reconsider its plan for the hospital building and to return to the Contributors with a plan limited to the accommodation of 160 patients.  They set the next meeting of the Contributors for 8 February 1836.

With the adoption of these resolutions, the Managers finally began to move expeditiously towards funding and building a hospital in "the country."  At the meeting of the Contributors held in February 1836 the Managers reported on four points:96 a) the sale of the West and Southwest lots had been concluded for $120,000; b) the purchase of a West Philadelphia "farm" had been completed,97 with possession of the premises to take place on 1 April 1836; c) the funds available for the new Hospital included the proceeds of the sale of the Eastern lot – $155,000; the proceeds of the sale of the West and Southwest lots – $120,000; and the interest accumulated on the balance before expenditure on construction – $17,000; a total of $292,000; and d) a total estimated cost which was now $222,000 (which left exactly $70,000 in capital to fund the operating expenses of the hospital).  The Contributors were pleased and adopted a resolution which approved the Managers’ report in its entirety.98

In March 1836 the Board selected an English architect, Isaac Holden, to design the new buildings in Blockley Township and in June of that year the Board conducted a cornerstone-laying ceremony.99 Construction commenced.  The design of the new Hospital for the Insane followed certain fundamental decisions.  First, the Board and its architect maintained the Haverford Avenue orientation of the country estate.  The entrance to the new hospital buildings remained on Haverford Avenue and the brick mansion at the top of the hill was not disturbed.  The new structures were sited behind the big house and towards the southeast end of the 101 acres.  Second, in order "to have control of all the springs in the neighborhood of the pump-house,"100 the Board made two purchases of land, which together added approximately ten acres to the east end of the grounds.101 Third, they enclosed forty-one acres of the land – including the two new purchases – by building a wall, 5,483 feet in length and 10½ feet high.102 In 1839, when the construction was only about half finished, Holden took ill and returned to England, but the Board’s Building Committee pressed forward with the work.103

In October 1840, as the new hospital buildings neared completion, the Board of Managers made an inspired decision.  It appointed a young physician, Thomas Story Kirkbride (1809-1883), to the twin posts of Physician-in-Chief and Superintendent of the new Department for the Insane.104 Kirkbride was an 1832 graduate of the School of Medicine at the University of Pennsylvania and had served three years as a resident physician at the Friends’ Asylum for the Insane in Oxford Township, near Frankford, a rural setting about five miles north of the City of Philadelphia.  In 1835 he returned to Philadelphia and opened a general practice.  In 1839 he married the daughter of one of the former Managers of the Pennsylvania Hospital.  He accepted the Board’s appointment and immediately took control of the new Department.  He held his positions for forty-three years, until the date of his death.  Kirkbride brought enlightened ideas – modern ideas really – to the treatment of the mentally ill.  He believed that their illness could be cured and he set about a lifelong commitment to that goal.  His work made him famous in his day – he was, for example, one of the founders, in 1844, of what is now the American Psychiatric Association – and his legacy continues to the present time.105

In January 1841 the Board opened the new hospital buildings and gradually, over the next few months, they transferred ninety-three mentally ill patients to West Philadelphia.106  A Philadelphia newspaper, the North American, reported on the progress of the move in its issue of 1 March:107

Removal of the Insane

During the past week, about sixty of the insane patients were removed from the Pennsylvania Hospital to the new building belonging to the institution, erected over the Schuylkill for patients of this description.  The removal of the remainder, some forty or fifty in number, will shortly be effected.

Another Philadelphia newspaper, the Public Ledger, on 29 May, also reported on the new hospital:108

Pennsylvania Hospital for the Insane

The contributors to the Pennsylvania Hospital lately finished the main buildings of their new Hospital for the insane.  This is situated about two miles west of the Permanent Bridge, between the Haverford and West Chester roads.  The number of patients which can be accommodated there is stated to be 200.  Poor patients are supported by the Hospital, other pay according to their ability.  The lowest rate of board for a Pennsylvanian being three dollars fifty cents per week, or $182 per annum – for an inhabitant of any other State, $5 per week, or $250 per annum.  The whole receipts go to the support of the Institution.  The arrangements are on a fine scale, board cheap, situation healthy, and treatment judicious.

At the regular, annual meeting of the Contributors to the Pennsylvania Hospital, held on 3 May 1841, the Managers reported that the main new building of the Hospital for the Insane was completed and occupied.109 They also provided the Contributors with a final accounting of the project’s revenues and expenditures.  The purchase of the 101-acre Arrison estate and two subsequent purchases of adjoining land totaling ten acres had together cost $33,058.81.  Design and construction had cost $265,000.  Total expenditures to date were therefore $298,058.81.  This sum was more than balanced by the proceeds from the sale of the city square to the east of the Eighth Street, $154,226.24; by the proceeds from the sale of the partial squares to the west of Ninth Street, $120,000.00; and by the accumulated interest on these proceeds, $48,883.08.  Total revenues to date were therefore $323,109.32, leaving $25,050.51 in the building fund.110

While the main building of the new Hospital was completed, Superintendent Thomas S. Kirkbride petitioned the Managers that it was not adequate for "the noisy, violent and habitually filthy patients."  He requested the Managers and Contributors to approve the construction of two detached buildings for this class of patients.  The Contributors, at their May 1841 meeting, did approve the construction of these additional structures.111

Construction, therefore, continued and the Board’s Building Committee did not issue its final report until October 1842.112 That report contained the following description of the new facilities:

The Principal [building] has a front of 435 ft. 6 in., a basement and two upper stories all of stone, and it is composed of a centre building 63 ft. on the Eastern front, 67 ft. on the Western, 96 ft. deep and 85 ft. from the basement floor to the top of the dome; arched corridors north and south 12 ft. wide and East and West 14 ft. wide and a cellar under the basement.  On the East front which is of cut stone is a handsome Doric portico with four columns and on the West side a portico of the same stone as the front with four square pillars.  This building contains a kitchen, store rooms, Managers’ room, parlor, lodging rooms for the Steward’s family, Apothecary shop and library, four large parlors for the use of the patients, a large iron staircase and two rooms in which patients may receive their friends without exposing those in the wards to the view of the visitors.

Two wings each 142 ft. by 38 ft., a basement and two upper stories containing together 120 rooms 8 x 10 ft. for patients and attendants disposed on both sides of corridors 12 ft. wide, an iron staircase in each and also communicating with each story a tunnel by which soiled clothes are discharged into closets for their reception in the basement.

Two end-buildings or return wings, a basement and two upper stories each 116 ft. by 44 ft., an iron staircase in each and having together 32 rooms 8 by 11 ft. and 12 rooms 13 by 17 ft. for patients, four bathing rooms, four water closets and four large parlors for the patients.  On each is a neat belvidere ranging with the dome on the centre Building.  In the basement of the four last described buildings are the furnaces for warming the house, bath, boiler, coal room, servants’ lodging rooms, laundry, two bakers’ ovens, flour and bread rooms and four refectories.  The whole is warmed by 26 warm air furnaces which draw their supply of fresh air from the outside of the house, 8 grates and 6 stoves and is considered nearly fireproof  …

[There are also] two detached Buildings which are hollow squares 95 x 73 ft. one story high, three sides of each contains 20 dormitories, dining and bathing rooms, water-closets and passages

8 ft. wide, the fourth sides are open walls the interstices guarded by iron rods, enclosing the yard for the use of the patients, they are warmed by four furnaces each, the cellars are arched, the roofs covered with slate and each room is well ventilated. 

[There is also] one workshop 20 x 40 ft., for the employment of the patients, with a handsome plastered room in the 2nd story to be used as an infirmary in the event of an epidemic in the main buildings.

By October 1842, then, the 112-acre "Blockley Retreat" was a gentleman’s farm no longer; it had been transformed into Pennsylvania Hospital’s "Department for the Insane."  The Pennsylvania Hospital would care for the mentally ill in West Philadelphia for the next 155 years, through good economic times and bad, until finally, in 1997, the changing nature of mental health treatment forced the Hospital to return to its original practice of admitting all patients – the sick, the injured, and the mentally ill – to its Eighth and Spruce Street facilities.  In the interim, however, the Hospital built up and then gradually reduced the scope of its work in the Department for the Insane (and its successors, the Department for Mental and Nervous Diseases and the Institute of Pennsylvania Hospital).  The use and re-use of the Hospital’s land, first by private, but later and primarily by public owners, tell a significant story in the history of West Philadelphia.

1841 to 1919: The Pennsylvania Hospital for the Insane

For seventy years the Department for the Insane steadily increased in size and complexity.  As early as February 1844 the trend had been established.  The Public Ledger took note of the statistics in Kirkbride’s annual report and published the following brief article:113

Report of the Pennsylvania Hospital for the Insane

We have received a copy of the Report of the Managers of the Pennsylvania Hospital for the Insane for 1843.  There were 140 patients admitted during the year, 126 have been discharged or died, and there remain 132 under care.  There were cured 68, much improved 7, improved 14, stationary 20, died 17 – total 126.  The Report contains a number of statistical tables, showing the number and sex of the persons admitted since the opening: their ages, occupations, condition, nativity, country, and the causes which produced insanity in them, with the duration and number of the attacks.  Since the opening of this Hospital, three years since, there has been a steady increase in the number of patients admitted, and the number under care at one time has constantly been augmenting.  The total number under care in 1841, was 176; in 1842, 238; in 1843, 258.

The trend continued and by 1851, just ten years after its opening, "the Hospital was inconveniently crowded, though the [Annual] Report states that 'the general good health which then prevailed, enabled us to receive all the cases that were brought to the Hospital, although much difficulty was often experienced in accommodating them.'"114 Two years later, the annual report for 1853 stated:115

…  during the entire year, the institution has been rather more than comfortably filled, the average number for the whole period, as shown above, being 229, while 220 is regarded as the capacity of the building.  Anxious to receive all who desired admission, we have at no previous time refused any suitable applicant; but during a part of the year just closed, we were for a time compelled, although with great reluctance, to decline receiving patients, except under the most urgent circumstances.

By May 1854, Kirkbride had convinced the Hospital’s Board of Managers of the need to build a second, large hospital building on the West Philadelphia grounds and to separate the patients by gender.  The Managers authorized a $250,000 fundraising campaign and published an "Appeal to the Citizens of Pennsylvania for Means to Provide Additional Accommodations for the Insane."  By the spring of 1856 the campaign had raised $209,000 in gifts and pledges.116 In March of that year the Managers authorized the design and construction of a separate building to house the "Department for Males" and it appointed a building committee to oversee the work.  The committee selected Samuel Sloan as architect.  Construction began in July and in October the Managers conducted a ceremony in West Philadelphia in which the Mayor of Philadelphia, Richard Vaux, laid the cornerstone.  The new building opened three years later, in October 1859, with a separate entrance on 49th Street, midway between Haverford Avenue and the West Chester Road (Market Street).  The new building’s total cost was $322,542.86, but additional expenses – for a boundary wall, carriage house, carpenter shop, etc. – brought the total expenditure to approximately $350,000.117

The new Department for Males was magnificent, with "a handsome Doric portico of granite in front, and is surmounted by a dome of good proportions  …  The lantern on the dome is 119 feet from the pavement, and from it is a beautiful panoramic view of the fertile and highly improved surrounding country, the Delaware and Schuylkill Rivers, and the city of Philadelphia, with its many prominent objects of interest."118 In 1860, the original building, now the "Department for Females," was renovated and placed in the same condition as the new building.119 The capacity of the Department for the Insane was thereby doubled, from 220 patients to 470.  It was now an extraordinary institution – one of the first to be designed and organized in accordance with the 1851 guidelines of the American Psychiatric Association (guidelines which had been authored by Kirkbride) – but it also was one with critics.  Dr. Meigs, in his 1876 history of the Pennsylvania Hospital, acknowledged the problem, but defended the Hospital:120

Occasionally, an outcry has been raised against what the objectors have been pleased to call ‘palaces for the insane.’  What would these critics have?  A building to contain from 200 to 250 patients, with officers, attendants, cooks, bakers; with offices, sitting-rooms, bed-rooms, bath-rooms, water-closets, ironing-rooms, and kitchens; can such a building be other than large and imposing?  Is it a palace, simply because it is vast?  This element of size cannot be avoided, and the question reduces itself to the simple alternative, shall the so-called palace be imposing by the hugeness of its deformity, or by fitness for its purposes, and by the beauty of its outlines?

But such cavils against insane hospitals come only from the thoughtless.  I have always felt, and shall always feel, grateful to the Managers of this Hospital, for the fine taste they have shown in the style and architecture of these buildings.  Amongst the pious uses of money is the embellishment of cities.  … 

We cannot be too thankful that the buildings for the insane were made handsome, striking, and picturesque.  Some one of these cavillers, or any one of us, may yet have to place in an insane asylum some one near and dear to us.  Who knows what the morrow shall bring forth?  If it were to be so, should we choose a building with the air of a prison, penitentiary, or great uncouth and rambling hotel, or a well-proportioned, attractive, and imposing house for the poor afflicted one to dwell in?  No, for one, I rejoice in these handsome and attractive buildings for the insane.  I think it must be only a weak, pitiful mind, and a cruel soul, that would refuse to these afflicted ones such sweet pleasures of the senses as we may be able to give them.

Despite the critics, expensive improvements in the physical plant continued.  In 1868, 1873, 1880, 1888, and 1893, five new buildings were constructed for women patients and called the South Fisher Ward, the North Fisher Ward, the Mary Shields Wards, the Cottage House or Villa, and the I.V. Williamson Wards, respectively.  In 1864 the women’s "Gymnastic Hall" was funded and constructed and in 1890 a gymnasium was also constructed for the men.  At the close of the 19th century the facilities of the Hospital for the Insane must have rivaled those of any similar institution in the nation.

Likewise the staffing of the Hospital for the Insane steadily expanded through the 19th century and into the early 20th.  A broadly useful view of the Hospital may be obtained from the decennial U.S. census returns.  In 1850 the Department housed 251 resident patients and 85 resident staff;121 in 1860, 276 patients and 119 staff;122 in 1870, 327 patients and 167 staff;123 in 1880, 376 patients and 218 staff;124 in 1900, 437 patients and 267 staff;125 and in 1910, 446 patients and 291 staff.126 A community that totaled 336 persons in 1850 more than doubled in size to one that totaled 737 in 1910.127 In addition, it was a self-contained community.  There were the officers – the superintendent, the stewards, the matrons, the physicians – and those who cared directly for the patients – the attendants (later called nurses) – but even as early as 1850 there were also farm laborers, cooks, men to attend to the fireplaces which heated each room, carpenters, coachmen, and gate keepers, all of them resident staff.  The number of work specializations increased with each decade, until, in 1910, there were also gardeners, waitresses, laundresses, cleaners, seamstresses, even a masseur, a pharmacist, a buyer of clothing, a bookkeeper, a storekeeper, an engineer, and two messengers.  The Department was a neighborhood unto itself.  It should also be noted that throughout this period, while the patients were almost all native born, the majority of the staff were natives of Ireland.  Finally, the Department’s community was almost entirely white.  If these arrangements seemed acceptable in the 19th century, they certainly were challenged by the changing demographics of West Philadelphia in the 20th.

The growth of the facilities and of the number of staff could only have been possible with a strong and regularly increasing stream of revenue.  Dr. Meigs, writing in 1876, acknowledged this and also revealed considerable sensitivity to critics who argued that the Hospital – contrary to its charter – was not concerned with the poor.  He wrote:128

…  Indeed, in the last year, 1875, [the Hospital for the Insane] appears to have been more than self-supporting, since the total expenditures were $201,366.53, and the net receipts $205,532.70.

This branch supports, on these means, a good many poor patients who pay nothing, and a number of others who are received at a rate of board so moderate, that it does not pay the cost of their support.  …  Since its opening in 1841, it has received 7,167 patients in all, of which number 1,532 were taken without charge, and about as many more paid less than the cost of their support.

So that this department is now, and has been, doing all that it can afford to do for the poor.  To extend its care to a yet larger number, it must have an increase of its funds.

Meigs’ figures, reduced to percentages, show that 78.6% of the patients admitted to the Hospital for the Insane between 1841 and 1875 were paying patients.  Over the twenty years that followed, the elaboration of the physical plant and the steady reduction in the ratio of patients to staff (from three to one in 1850 to 1.5 to one in 1910) strongly suggested that the Hospital’s work was increasingly profitable.  Nevertheless, when writing for publication in 1894, Kirkbride’s successor as Superintendent of the Department, Dr. John B. Chapin, took the position that the Department’s finances were just breaking even:129

…  Its affairs have been so conducted that no impairment of its capital has occurred.  The Department has been nearly self-sustaining from receipts for board of patients.  It has been demonstrated that, the plant being furnished, the larger proportion of patients have been able to pay the cost of their maintenance.  In computing the charge to be made for board and treatment, the interest on the cost of the plant, which would be a considerable sum, has not entered into the account.  That the plan has been practicable and has met an actual necessity in this community, appears by the fact that neither the state, nor any other charitable organization, has undertaken to do exactly the line of work carried out by the Pennsylvania Hospital.  … 

In the great work of the Hospital at every stage of its progress much careful consideration was devoted to obtain the most desirable site and plans for building.  The plans were the best expression of the medical thought and experience of their day.  The sum of $650,000 was expended in the purchase of land, buildings, and furniture, and at a time when the cost of construction was much less than at the present time.  As other figures may be of interest in this connection, it may be stated that from the year 1841 to 1893, the aggregate sum received for board and treatment of patients amounted to $6,025,148.61 and the amount expended for the same purposes (exclusive of building) was $6,112,349.47 – exceeding the receipts by $87,200.86.  As has been stated, the Managers have not been unmindful of the claims of the indigent insane.  Since 1841, this Department has received free patients admitted in accordance with its rules, and other patients at reduced charges, who gave promise of relief or recovery – the books of the department show that the sum of $911,300 has been expended in the care and treatment of these classes.

Chapin’s next paragraph, however, suggests that the Department’s finances were flourishing:130

At the present date the property and plant of the Pennsylvania Hospital Departments for the Insane consist of one hundred and thirteen acres of land; a building for the accommodation of two hundred and forty men and buildings for two hundred and fifty women; a gymnastic building for each on their respective grounds; two museum buildings on the grounds of the department for women.  Also a building for the residence of the physician and superintendent; barns, stables, carriage-houses, carpenter and repair shops, and green houses at each department, together with the furniture necessary for the conduct of a hospital of the first class.

The physical plant and grounds of the Hospital for the Insane were indeed "of the first class."  So too was the number of staff and the staff’s care of the patients.  It seems clear that as the 19th century progressed the Hospital for the Insane increasingly became an elite institution.

West Philadelphia, however, was growing up all around the Hospital and between 1886 and 1891 the Managers of the Pennsylvania Hospital took four actions which demonstrated the extent of the city’s presence.  The first was perhaps the most significant.  In May 1886 the Contributors to the Pennsylvania Hospital authorized the Managers "to purchase such area of land, within a reasonable distance from the city, not exceeding 500 acres, in order to prepare a site for such future adjuncts or additions to their Hospital as may hereafter be required or found desirable."131 In June of that year, the Managers formed a committee which began buying land in Newtown Square, Delaware County.  By May 1891, five years later, the purchases totaled "607.94 acres."132 The land was designated for the future of the Hospital for the Insane and in 1892 the Managers announced tentative plans for building on the acreage.

Then, in 1888 and 1889, the Managers clashed with the City of Philadelphia over the issue of exemption from taxation.133 In the summer of 1887 the Managers authorized the construction of a "Cottage House or Villa" for women patients at the Hospital.  The new structure opened in June 1888.  The municipal government made a claim against the Hospital for water supply to the new building, justifying its assessment on the argument that the rates for occupancy of the Cottage House were such as to guarantee a profit to the Hospital.  The Managers sued the City and the case was appealed to the Pennsylvania Supreme Court.  The Court ruled in favor of the Hospital.  Morton and Woodbury, writing in 1894, trumpeted the decision:134

The Supreme Court very clearly stated the facts that all the income of the Pennsylvania Hospital is expended in charitable work, and it cannot be regarded as a money-making institution, for any excess over maintenance which is paid by rich patients is used to support others who are destitute of means to make any pecuniary acknowledgment.

In 1890 the entrance to the Department for Women was moved from 44th Street and Haverford Avenue to the junction of Powelton Avenue, 44th Street and Market Street.  A gate and building were constructed at the new entrance.  The change was deemed necessary to "render the Hospital more accessible to lines of travel and centres of population."135 Market Street, rather than Haverford Avenue, had become the principal thoroughfare of West Philadelphia.  Finally, in 1891, "the Managers made a concession of a strip of land extending from Market Street to Haverford Avenue, 80 feet wide, to the City, on condition that a sewer should be constructed without cost to the Hospital, along the course of Mill Creek, to connect at both points with sewers already prepared.  This construction divides the 113 acres of the Hospital property into two nearly equal parts of upwards of fifty acres each."136 With this gift to the City of Philadelphia, the Managers allowed 46th Street to become the first thoroughfare to cut through the land of the Department for the Insane.  By the 1890s the immediacy of the urban area surrounding the Hospital had become a major factor in its operations.

• 53. The Pennsylvania Hospital published at least four volumes of institutional history in the nineteenth century.  They were:
  • William G. Malin, Some Account of the Pennsylvania Hospital, Its Origin, Objects and Present State (Philadelphia: Published by the Board of Managers of the Pennsylvania Hospital, 1831);
  • George B. Wood, An Address on the occasion of the Centennial Celebration of the Founding of the Pennsylvania Hospital (Philadelphia: Published by the Board of Managers of the Pennsylvania Hospital, 1851);
  • J. Forsyth Meigs, A History of the First Quarter of the Second Century of the Pennsylvania Hospital (Philadelphia: Published by the Board of Managers of the Pennsylvania Hospital, 1877); and
  • Thomas G. Morton and Frank Woodbury, History of the Pennsylvania Hospital: 1751 – 1895, Revised Edition (Philadelphia: Published by the Contributors to the Pennsylvania Hospital, 1897). 

  A more recent – and more objective – history is William H. Williams, America’s First Hospital: The Pennsylvania Hospital, 1751 – 1841 (Wayne, Pennsylvania: Haverford House, 1976).  All five works have proven useful in preparing the narrative which follows here.

• 54. Wood, An Address, at page 43.
• 55. See Malin, Some Account of the Pennsylvania Hospital, at page 3: "The design of the Hospital is general, its charter providing for the reception of insane persons, and those afflicted with all other maladies, not infectious."
• 56. See the Philadelphia Weekly Aurora for 26 May 1817 (Vol. 8, Issue 16), at pages 124-25.
• 57. In 1800 the U.S. census enumerated 69 men and 42 women in Pennsylvania Hospital (these numbers probably included both resident staff and patients); in 1810, 100 men and 57 women; in 1820, 27 men, 15 women, and 202 "others;" and in 1830, 161 men and 112 women.  The enumeration for each census year may be found at the personal name of the Steward of the Hospital.  For 1800, see United States of America, Bureau of the Census.  Second Census of the United States, 1800.  Washington, D.C.: National Archives and Records Administration, 1800.  Microcopy M32, Roll 43, at handwritten page 280 (City of Philadelphia, Cedar Ward, see entry for "Pennsylvania Hospital, Francis Higgins"); for 1810, see United States of America, Bureau of the Census.  Third Census of the United States, 1810.  Washington, D.C.: National Archives and Records Administration, 1810.  Microcopy 252, Roll 55, at handwritten page 618 (City of Philadelphia, Cedar Ward, again, see entry for "Francis Higgins"); for 1820, see United States of America, Bureau of the Census.  Fourth Census of the United States, 1820.  Washington, D.C.: National Archives and Records Administration, 1820.  Microcopy M33, Roll 108, at machine-stamped page 219 a (City of Philadelphia, Cedar Ward, see entry for "Saml Mason"); for 1830, see United States of America, Bureau of the Census.  Fifth Census of the United States, 1830.  Washington, D.C.: National Archives and Records Administration, 1830.  Microcopy M19, Roll 159, at handwritten page 31 (City of Philadelphia, Cedar Ward, see entry for "Isaac Bonsall, Pa hosp").
• 58. Williams, America’s First Hospital, at page 151.  Williams based his information on statistics compiled in the 1840s by George Robert Smith, one of the Managers of the Hospital.
• 59. Ibid.  Williams based his information on the minutes of the Board of Managers and the Hospital’s annual reports.  See also, Malin, Some Account of the Pennsylvania Hospital, at page 18.  Malin stated that the number was 120.
• 60. For a comprehensive, scholarly account of the founding and first decades of the Friends Asylum, see Patricia D’Antonio, Founding Friends: Families, Staff, and Patients at the Friends Asylum in Early Nineteenth-Century Philadelphia (Bethlehem, Pennsylvania: Lehigh University Press, 2006).
• 61. Williams, America’s First Hospital, at page 134.  Williams traces the "moral treatment of the insane" to European origins, in France and England.
• 62. John Welsh Croskey, History of Blockley: A History of the Philadelphia General Hospital from its Inception, 1731 – 1928 (Philadelphia: F.A.Davis Company, 1929), at pages 12-15.
• 63. The full and proper name of the Almshouse corporation was the "Guardians for the Relief and Employment of the Poor of the City of Philadelphia, the District of Southwark, and the Townships of the Northern Liberties and Penn."  The directors of the corporation were commonly known as the "Guardians of the Poor."
• 64. D. Hayes Agnew, et al, History and Reminiscences of the Philadelphia Almshouse and Philadelphia Hospital, reprinted from Philadelphia Hospital Reports (Philadelphia: Detre & Blackburn, 1890), at page 89.
• 65. Ibid.
• 66. 1 January 1829.  Henry Beckett, and Mary, his wife, to the Guardians for the Relief and Employment of the Poor of the City of Philadelphia, the District of Southwark, and the Townships of the Northern Liberties and Penn.  187 acres, 60 perches (187.375 acres).  $51,528.12.  Recorded in Philadelphia Deed Book GWR.26.675.
• 67. Agnew, et al., History and Reminiscences, at pages 90-92.
• 68. It is important to note that prior to 1854 the City of Philadelphia extended only from Vine Street on the north to South Street on the south and from the Delaware River on the east to the Schuylkill River on the west.  In 1854 the City limits expanded to include all of Philadelphia County, but in 1830 there were a number of independent townships in the County.  Blockley Township, across the Schuylkill River from the City, was considered "the country."
• 69. Wood, An Address, at pages 43-44.
• 70. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 3 May 1830 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at pages 277-78.
• 71. Ibid.
• 72. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 3 May 1830 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at pages 277-78.
• 73. Ibid., at page 505.
• 74. Ibid., at page 517.
• 75. 7 February 1831.  The Guardians for the Relief and Employment of the Poor of the City of Philadelphia, the District of Southwark, and the Townships of the Northern Liberties and Penn to John Savage, "of the City of Philadelphia, merchant."  2.15 acres.  $50,400.  Recorded in Philadelphia Deed Book AM.9.222.
• 76. In order to develop the land the new owner offered an exchange with the Pennsylvania Hospital which granted the southern part of the square to the Hospital, if the Hospital would trade its northern part at Ninth and Spruce Streets.  This would enable the developer to build along the south side of the entire block of Spruce Street between Ninth and Tenth Streets.  On 31 January 1831 the Managers agreed to this proposal.  See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 31 January 1831 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 8 (1804 – 1833), at pages 519-20.
• 77. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 31 January 1831 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 8 (1804 – 1833), at page 522.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at page 115.
• 78. Williams, America’s First Hospital, at page 151, confirms the accuracy of this statement.  Using the minute books of the Board of Managers and the annual reports of the Hospital, Williams compiled information which showed that the average number of mentally ill patients steadily increased from about 55 in 1806 to 70 in 1814 to about 85 in 1822 to about 115 in 1830.  The number decreased after 1830 to about 100 in 1838 and remained steady at that level until the early 1840s.  It is interesting to note, however, the contrast with the Philadelphia Almshouse.  The U.S. Census for 1830 enumerated 283 total resident staff and patients at the Pennsylvania Hospital and 1,010 total for the Philadelphia Almshouse.  Since the Almshouse was located just two blocks away from and on the same size city square as the Pennsylvania Hospital, this suggests that the Hospital may not have been as crowded as the Managers’ statement suggests.  It is unfortunate that the 1830 U.S. census schedules do not distinguish between sick and injured patients on the one hand and the mentally ill on the other.  Reference may be had to the United States of America, Bureau of the Census, Fifth Census of the United States, 1830, Washington, D.C.: National Archives and Records Administration, 1830, Microcopy M19, Roll 159, at machine-stamped pages 31a-b (Pennsylvania Hospital) and 34a-b (Philadelphia Almshouse).  Both institutions were located in the City of Philadelphia, Cedar Ward.

  Overcrowded facilities is repeated by Hospital historians as the rationale for separating the mentally ill from the sick and injured.  See, for example, Morton and Woodbury’s History of the Pennsylvania Hospital.  At page 122 of this volume, the authors wrote, "One-half of the buildings at the Pine Street Hospital and two-thirds of the adjacent grounds were appropriated to the insane, and when they were removed to West Philadelphia, they vacated to the Pine Street Hospital for the sick and injured, one-half of all the Hospital buildings, and two-thirds of the entire square of ground upon which they stand."  This may be an accurate statement, but it is worth noting that in October 1840, when the 1840 U.S. Census was recorded, the total number of resident staff and patients in Pennsylvania Hospital was 272 and just 100 of that number or 36.76% were described as insane.  Reference may be had at the United States of America, Bureau of the Census, Sixth Census of the United States, 1840, Washington, D.C.: National Archives and Records Administration, 1840, Microcopy M704, Roll 484, at machine-stamped pages 251a-b (City of Philadelphia, Cedar Ward, see entry for "Allen Clapp," who was then Steward of the Hospital).

• 79. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 25 April 1831 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 8 (1804 – 1833), at page 527.
• 80. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 2 May 1831 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at page 115.
• 81. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 28 November 1831 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 8 (1804 – 1833), at page 538.
• 82. Wood, An Address, at pages 45-46.
• 83. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 7 May 1832 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 84. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 16 July 1833 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at page 4.
• 85. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 30 September 1833 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at pages 6-7.
• 86. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 27 January 1834 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at pages 10-11.
• 87. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 24 February 1834 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at page 11.
• 88. There is the possibility that the Board of Managers delayed taking action in the hope that they might yet purchase the buildings and grounds of the Pennsylvania Almshouse at Tenth and Spruce Streets.  The minutes of their meetings, however, make no suggestion that this was the case and the Managers did not make the acquisition.  The Guardians of the Poor, meeting on 23 February 1835, selected a committee of three to sell the "square."  Just three days later, on 26 February, the Guardians convened a special meeting and voted unanimously to sell the vacated property to Charles F. Lex and John Grigg for $130,000.  The deed described Lex as a "sugar refiner" and Grigg as a "book seller and stationer."  The terms of their partnership are unknown, but clearly, the two men were rich and the resources available to them must have exceeded what the Hospital’s Board of Managers was willing to pay.  The Pennsylvania Hospital was thereby denied what must have been seen as another desirable option for expansion.  1 March 1835.  Guardians for the Relief and Employment of the Poor of the City of Philadelphia, the District of Southwark, and the Townships of the Northern Liberties and Penn, acting under and by virtue of an Act of the General Assembly of the Commonwealth of Pennsylvania  …  passed the fifth day of March Anno Domini one thousand eight hundred and twenty eight to Charles F. Lex, of the City of Philadelphia, sugar refiner, and John Grigg, of the said City, Book seller and Stationer.  4.3 acres.  $135,000.  Recorded in Philadelphia Deed Book AM.64.319.
• 89. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 8 May 1835 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at page 33.
• 90. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 8 June 1835 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at page 115.
• 91. See the minutes of the Managers of the Pennsylvania Hospital for their meeting of 4 August 1835 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975; Vol. 9 (1833 – 1858), at pages 37 – 43.
• 92. Ibid., at page 44.
• 93. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 14 September 1835 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 94. Ibid.
• 95. Ibid.
• 96. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 8 February 1836 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 97. Shortly after the September 1835 meeting of the Contributors, the Board of Managers surveyed Philadelphia County for suitable properties and quickly settled on the handsome 101-acre estate in Blockley township purchased by Matthew Arrison just a few months earlier. At a meeting of the Board held on 12 October 1835, the Managers approved the purchase of the Arrison property. Settlement was made on 13 November 1835. Matthew Arrison and Maria, his wife, to the Contributors to the Pennsylvania Hospital. $28,000. 101 acres, "more or less." Recorded in Philadelphia Deed Book SHF.1.20.
• 98. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 8 February 1836 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 99. Morton and Woodbury, History of the Pennsylvania Hospital, at page 120.
• 100. Ibid., at page 123.
• 101. The first purchase took place on 26 June 1838.  Executors of the Will of Henry Pratt, deceased, to the Contributors to the Pennsylvania Hospital.  $3,350.  9 acres, 92 perches (9.575 acres).  Recorded in Philadelphia Deed Book SHF.25.505.  The second purchase took place on 18 May 1839.  Henry Connelly and Ann, his wife, to the Contributors to the Pennsylvania Hospital.  $350.  62.5 perches (0.39 acres).  Recorded in Philadelphia Deed Book GS.5.122.

  It should also be noted that the Pennsylvania Hospital continued purchasing small parcels of land adjoining the grounds of the Hospital for the Insane well into the 1850s.  Five of these purchases were as follows:
  24 November 1843.  Henry Connelly to the Contributors to the Pennsylvania Hospital.  $20.  420 square feet.  Recorded in Philadelphia Deed Book RLL.15.45.

  9 January 1845.  William Carey, and Elizabeth, his wife, to Thomas S. Kirkbride.  $1,000.  A house and lot on the north side of the "West Chester Road."  0.5625 acres (90 perches).  Recorded in Philadelphia Deed  Book RLL.33.76. See also, 26 December 1845, Thomas S. Kirkbride, and Ann W., his wife, to the Contributors to the Pennsylvania Hospital. $1,000 for the same house and lot. Recorded in Philadelphia Deed Book DWH.1140.88 (deed not recorded until 18 January 1941).

  26 September 1845.  John Sloan, and Martha, his wife, to the Contributors to the Pennsylvania Hospital.  $1,350.  A lot on the north side of the "West Chester Road," described, but not measured as to acreage.  Recorded in Philadelphia Deed Book RLL.50.255.  

  6 February 1849.  Samuel Elliott Harlan to the Contributors to the Pennsylvania Hospital.  $200.  A "lot or piece of land" on the south side of Haverford Avenue, described, but not measured as to acreage.  Recorded in Philadelphia Deed Book GWC.6.463.

  20 January 1852.  The children of Henry Connelly, deceased – Patrick Comber and Mary, his wife; James McCullough and Margaret, his wife; Henry Connelly; and Julia Ann Connelly – to the Contributors to the Pennsylvania Hospital.  $4,000.  1.61 acres.  Recorded in Philadelphia Deed Book TH.5.255.

• 102. Morton and Woodbury, History of the Pennsylvania Hospital, at page 124.
• 103. Ibid.
• 104. Ibid., at pages 196-200, for biographical information on Thomas Story Kirkbride.
• 105. See, for example, Nancy Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-keeping, 1840 – 1883 (New York: Cambridge University Press, 1984).
• 106. Morton and Woodbury, History of the Pennsylvania Hospital, at page 122.  On the same page, Morton and Woodbury also wrote, "One-half of the buildings at the Pine Street Hospital and two-thirds of the adjacent grounds were appropriated to the insane, and when they were removed to West Philadelphia, they vacated to the Pine Street Hospital for the sick and injured, one-half of all the Hospital buildings, and two-thirds of the entire square of ground upon which they stand."  This may be an accurate statement, but it is worth noting that in October 1840, when the 1840 U.S. Census was recorded, the total number of patients in Pennsylvania Hospital was 272 and just 100 of that number or 36.76% were described as insane.  Reference may be had at the United States of America, Bureau of the Census, Sixth Census of the United States, 1840, Washington, D.C.: National Archives and Records Administration, 1840, Microcopy M704, Roll 484, at machine-stamped pages 251a-b (City of Philadelphia, Cedar Ward, see entry for "Allen Clapp," who was then Steward of the Hospital).
• 107. Transcribed from the North American for 1 March 1841 (Vol. 2, Issue 602), at page 2.
• 108. Transcribed from the Public Ledger for 29 May 1841 (Vol. 11, Issue 54), at page 2.
• 109. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 3 May 1841 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 110. Note that the former requirement of $70,000 in capital to fund the continuing operations of the Hospital for the Insane seems to have been dropped.  The minutes of both the Managers and the Contributors are silent on this point.
• 111. See the minutes of the Contributors to the Pennsylvania Hospital for their meeting of 3 May 1841 at the Pennsylvania Hospital Historic Collections, Section I, Series 1; Board of Managers, 1751-1975.  The volume is titled "Minutes of the Contributors’ Meetings, 1814 – 1917," but is not paginated.
• 112. Morton and Woodbury, History of the Pennsylvania Hospital, at pages 123-24.
• 113. Transcribed from the Public Ledger for 20 February 1844 (Vol. 16, Issue 127), at page 2.
• 114. Meigs, A History, at page 38.
• 115. Ibid., at pages 38-39.
• 116. Ibid., at pages 41-43.
• 117. Ibid., at pages 43-45.  See also, Morton and Woodbury, History of the Pennsylvania Hospital, at pages 175-77.
• 118. Ibid., at page 45.
• 119. Ibid., at page 51.
• 120. Ibid., at pages 49-51.
• 121. United States of America, Bureau of the Census.  Seventh Census of the United States, 1850.  Washington, D.C.: National Archives and Records Administration, 1850, Microcopy M432, Roll 824, machine-stamped pages 43a – 46b (County of Philadelphia; Blockley Township; Pennsylvania Hospital for the Insane).
• 122. United States of America, Bureau of the Census.  Eighth Census of the United States, 1860.  Washington, D.C.: National Archives and Records Administration, 1860.  Microcopy M653, Roll 1175, machine-stamped pages 792 – 802 (City and County of Philadelphia; Ward 24; Precinct 5).
• 123. United States of America, Bureau of the Census.  Ninth Census of the United States, 1870.  Washington, D.C.: National Archives and Records Administration, 1870.  Microcopy M593, Roll 1411, machine-stamped pages 412b – 419b (City and County of Philadelphia; Ward 24; District 78).
• 124. United States of America, Bureau of the Census.  Tenth Census of the United States, 1880.  Washington, D.C.: National Archives and Records Administration, 1880.  Microcopy T9, Roll 1183, machine-stamped pages 311a – 314b and 360a – 362b (City and County of Philadelphia; Ward 24; Enumeration Districts 504 and 508).
• 125. United States of America, Bureau of the Census.  Twelfth Census of the United States, 1900.  Washington, D.C.: National Archives and Records Administration, 1900.  Microcopy T623, Roll 1465, machine-stamped pages 255a – 262a (City and County of Philadelphia; Wards 24 and 34, but all in Enumeration District 548).
• 126. United States of America, Bureau of the Census.  Thirteenth Census of the United States, 1910.  Washington, D.C.: National Archives and Records Administration, 1910.  Microcopy T624, Roll 1397, machine-stamped pages 138a – 141a and 142a – 146a (City and County of Philadelphia; Wards 24 and 44, but all in Enumeration District 498).
• 127. By comparison, the resident staff and patients at the Pennsylvania Hospital at Eighth and Spruce Streets increased from totals of 43 and 174, respectively, in 1850 to 139 and 247, respectively, in 1900 (sick and injured patients were no longer considered resident and therefore not enumerated beginning with the 1910 U.S. census).  The patient to staff ratio was four to one in 1850 and narrowed to 1¾ to one by 1900.  For the 1850 statistics for Eighth and Spruce, see United States of America, Bureau of the Census.  Seventh Census of the United States, 1850.  Washington, D.C.: National Archives and Records Administration, 1850, Microcopy M432, Roll 813, machine-stamped pages 419a – 421b (City of Philadelphia; Spruce Ward; Pennsylvania Hospital).  For the 1900 statistics for Eighth and Spruce Streets, see United States of America, Bureau of the Census.  Twelfth Census of the United States, 1900.  Washington, D.C.: National Archives and Records Administration, 1900.  Microcopy T623, Roll 1454, machine-stamped pages 42a – 45b (City and County of Philadelphia; Ward 7; Enumeration District 1045; Pennsylvania Hospital).
• 128. Meigs, A History, at pages 83-84.
• 129. Morton and Woodbury, History of the Pennsylvania Hospital, at pages 194-95.
• 130. Ibid.
• 131. Morton and Woodbury, History of the Pennsylvania Hospital, at page 193.
• 132. Ibid.
• 133. Ibid., at pages 188-89.
• 134. Ibid.
• 135. Ibid., at pages 190-91.
• 136. Ibid., 192.