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Turning Points: The Transition of the Treatment of the Mentally Ill from late 18th century to early 20th century

Prepared by: Lauren Plested, Temple University

This website was created to help explain the reasons for the founding of the first hospital in the nation, and how the treatment of the mentally ill was transformed through the great pioneers in the field, Dr. Benjamin Rush and Dr. Thomas Story Kirkbride. The idea of "Turning Points" is the theme of National History Day 2013. National History Day is national academic competition for students in grades 6-12. The competition is focused on historical research, interpretation, and presentation and can be presented through five different categories: Essay, Documentary, Exhibit, Performance, or Website

The Founding of the First Hospital in the Nation

Pennsylvania Hospital was the first hospital in the nation (original thirteen states), built in 1752, to help the poor, sick, and those of "distemper’d in Mind and Deprived of their rational Faculties." It was the goal of the co-founders Dr. Thomas Bond (1712-1784) and Benjamin Franklin (1706-1790) that everyone in the colony of Pennsylvania, despite the circumstances of their class, to have the opportunity to seek medical help.


While there was an Almshouse in this period to care for the poor and sick, like the Blockely Almshouse in Philadelphia, there was not a "permanent, public provision" for the care of the physically ill and mentally ill. Pennsylvania Hospital was modeled after the hospitals in Great Britain "that were established and maintained by voluntary contributions, existing for the purpose of providing care for the poor"[1]. From the beginning of its formation, Pennsylvania Hospital took in those labeled "insane" regardless of their ability to pay or not, and provided what they at the time believed to be the best care possible. The goal of the hospital was to cure people, and thus did not take upon those deemed incurable. This being said, with the housing of the mentally insane, it was thought that there was a cure available, bringing upon hope for people who were without hope for a cure.

Treatment of the Mentally Ill in the early days of Pennsylvania Hospital

In the early days of the hospital, it was very easy to have someone committed and his freedom taken away; if the patient was not passive then he, or she, would be chained, using manacles on the floor or walls of the room. There were large number of scraps of papers found, from a friend (or at times an enemy), writing to have a person committed. It was said that at the time of the conception of the hospital, there were a large number of the insane "terrorizing" their neighbors and wandering the streets of Philadelphia. These were people who may have truly had some variety of mental illness, the homeless, the friendless, or geriatrics with dementia.

When the patients were taken to Pennsylvania Hospital, they were placed in the "temporary hospital", the dark, dank basement. The other areas of the hospital were reserved for those with other health illnesses. It was there that they were chained to the wall and sometimes made to wear "madd-shirts", which restrained the movement of their arms.

For the people of Philadelphia, it was considered a pastime to come to the hospital and peer into the rooms of the insane to witness their episodes. The patients were douched alternatively with warm and cold water, their scalps shaved and blistered; they were bled to the point of syncope (transient loss of consciousness due to inadequate blood supply to the brain), purged until the alimentary canal failed to yield anything but mucus, and, in the intervals, were kept chained. The keepers were given whips and they were allowed to use them on patients that were not passive. These methods were not meant to be cruel to the patients; they were what were deemed necessary to help them in their recovery. It was the goal of the hospital to cure the ailments of the insane patients that was under their care. The matters of the brain and other neuropsychology disorders were not known to scientists and doctors, and so the methods of treating these diseases were puzzling as well. It was later deemed that these methods induced violence and violent behavior among the insane.

The rooms were cold, with no effective heating technique for the cells. Different heating methods were used, but did little to penetrate the rooms. In 1822, Joseph Hewes bequeathed $400.00 to the improvement of the institution, especially on the methods of warming it. The cells themselves, in the early days of the hospital, had weak bars on the windows and there were occasions that the patients would escape. One patient had even tunneled her way out from her cell to the outside. The bars were later strengthened to prevent further escape.

Dr. Benjamin Rush and Dr. Thomas Story Kirkbride transform the treatment of the Insane

Dr. Benjamin Rush (1746-1813) was from the Byberry section of northeast Philadelphia and he was involved with the treatment of the mentally ill. He wrote a book called Medical Inquires and Observations upon the Diseases of the Mind, containing his beliefs on the treatment and management of the insane. Dr. Rush was an early advocate for looking at mental health as a medical disorder not based on superstitions such as a demonic possession.


He also contributed the cause of insanity as disappointed love, excessive drinking, lead poisoning, measles, and religious fervor[2] Dr. Rush felt that the patients should be cared for with compassion and that "mental illness be freed from moral stigma and be treated with medicine rather than moralizing."[3] He developed many different treatment methods to help those that were deemed insane. One such treatment was "bloodletting"; with the idea that insanity was a "grade of madness" through arterial disease, thus bloodletting "to be attended with extraordinary success." Dr. Rush also had a device called the "tranquilizing chair" which was believed to be able to control the flow of blood to the brain and regulate circulation in the patients, which was to help the "madness" in the arterial disease.

"I have contrived a chair and introduced it to our [Pennsylvania] Hospital to assist in curing madness. It binds and confines every part of the body. By keeping the trunk erect, it lessens the impetus of blood toward the brain. By preventing the muscles from acting, it reduces the force and frequency of the pulse, and by the position of the head and feet favors the easy application of cold water or ice to the former and warm water to the latter. Its effects have been truly delightful to me. It acts as a sedative to the tongue and temper as well as to the blood vessels. In 24, 12, six, and in some cases in four hours, the most refractory patients have been composed. I have called it a Tranquillizer"[4]

Dr. Rush also prescribed a low diet, purges, and emetics(an agent that induces vomiting) – salt water and mustard were used as emetics, )though excess salt water may be harmful and fatal), copper sulfate was also used as an emetic, though it is now considered too toxic for use. Cold showers and baths were also prescribed for the patients. Dr. Rush did believe in a treatment called "occupational therapy" and allowed patients to complete small jobs, although the environment of the hospital did not promote many activities for the patients. While these methods may seem cruel to a person today, Dr. Rush did what he believed was the best way to help the patients.



The harsher practices of Benjamin Rush were later discontinued when in 1841 the Institute of Pennsylvania Hospital, formerly known as the Pennsylvania Hospital for the Insane, was founded under the direction of Dr. Thomas Story Kirkbride (1809-1883) The Institute had moved from the Pine Building on 8th and Spruce to the area between 44th and 49th Street. This move provided more room for the over 100 patients that did the initial move to the new building. Dr. Thomas Kirkbride was born in 1809 to Quaker parents in Pennsylvania. He studied at the University of Pennsylvania became Superintendant of the newly formed Institute. He was the founding member of the Association of Medical Superintendents of American Institutes for the Insane (AMSAII). Dr. Kirkbride developed what was known as the "Kirkbride Plan", which was the blueprint used in the building of most of the asylums in American during his time. Under Kirkbride, it was deemed that mild kindness and sympathy should be used in the treatment of the mentally ill. Dr. Kirkbride believed that it was vital to place patients in a more natural environment away from the pollution and chaotic energy of the urban setting, previously housed on 8th and Spruce Sts. The Institute was an idyllic place for the patients, with trees planted throughout the property and pleasant walk ways constructed. Dr. Kirkbride also has an item called a "magic lantern" that he would use for entertainment and educational purposes. The magic lantern was an image projector used by a lit candle behind the slides, which would project the images on a screen. "The use of photographic materials at the Pennsylvania Hospital for the Insane... represented (I) a major advance in the expansion of the principles of moral treatment, then the major modality of treatment in psychiatric hospitals, (II) very early use of photography in psychiatry, and (III) the first documented practical use of photographic slides anywhere." The attendants of the patients were no longer called keepers but rather as companions. The Institute housed the mentally ill for 125 years before it was closed in 1997.

References:

  1. Kristen A. Graham, A History of Pennsylvania Hospital, 18
  2. Pennsylvania Hospital Library, "A History of the Institute of Pennsylvania Hospital ." http://www.uphs.upenn.edu/paharc/timeline/1801/tline13.html.
  3. Francis J. Braceland, “A Bicentennial Address: Benjamin Rush and those who came after him.” The American Journal of Psychiatry, CXXXIIII, No. 11 (1972), 1252
  4. Dr. Benjamin Rush to James Rush, The Letters of Benjamin Rush, (Princeton University Press, 1951)

For further readings on the mentally ill and Pennsylvania Hospital from 1700- 1960s click on the link for a list of books.

For more information on National History Day, please visit the National History Day website.

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