Pennsylvania Hospital for the Insane
The Pennsylvania Hospital for the Insane, opened in 1841 on a rural site on the west side of the Schuylkill River near Philadelphia, was considered one of the premiere mental asylums during the nineteenth century. In accordance with the institution’s “moral treatment” philosophy, many patients were granted daily access to the hospital’s pleasure grounds and working farm. The institution’s superintendent, Dr. Thomas Story Kirkbride, believed that regular access to the outdoors was an essential component of therapeutic treatment for his patients.
Alternate Names: Kirkbride’s Hospital; Pennsylvania Hospital for Mental and Nervous Diseases; The Institute of the Pennsylvania Hospital
Site Dates: 1841–1997
Site Owner(s): Pennsylvania Hospital
Associated People: Thomas Story Kirkbride (superintendent and chief physician, 1841–1883); Isaac Holden (architect, c. 1835–1838); Samuel Sloan (construction manager and architect, 1838–1841 and 1856–1859)
Location: Philadelphia, PA
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The Pennsylvania Hospital for the Insane was one of the premiere facilities for treating mental disorders during the nineteenth century, drawing residential patients from across the United States. It opened under the direction of the superintendent Dr. Thomas Story Kirkbride (1809–1883), a Quaker physician who advocated for “moral treatment” therapeutic principles, arguing that patients should have regular schedules to encourage self-control, eat healthy food, exercise, and have frequent access to the outdoors. The facility’s surrounding landscape became an essential component of therapeutic treatment for patients at the Pennsylvania Hospital for the Insane, and the hospital’s design, which was popularized by Kirkbride’s 1854 treatise On the Construction, Organization and General Arrangements of Hospitals for the Insane, influenced the designs of asylums subsequently constructed across the United States
The original hospital building opened in 1841 on a 111-acre site near the village of Blockley, located on the west side of the Schuylkill River approximately two miles outside of the city of Philadelphia [Fig. 1]. This facility, located at the intersection of 44th and Market streets, took advantage of the inexpensive land, fertile soil, and increased privacy that the rural location afforded. It also provided more space and better conditions for treating mental health patients who were previously housed at the Pennsylvania Hospital in Center City Philadelphia.
The first hospital building, designed by the English architect Isaac Holden (d. 1884), accommodated 160 patients. The building’s design took advantage of the site’s wooded landscape by framing picturesque views through the wards’ windows and the stone Doric porticoes erected on the eastern and western facades. As seen in this plan [Fig. 2], two smaller buildings flanked either side of the main building’s wards. These u-shaped wards were reserved for the most violent and disruptive patients, who gained access to the outdoors in interior courtyards that were surrounded on three sides by the building. Flower gardens were visible (but not physically accessible) from the fourth side.
Kirkbride, who was hired by the Pennsylvania Hospital’s Board of Managers to run the new facility shortly before it opened, “played no part in the preliminary planning for the institution,” according to the scholar Nancy Tomes. Because of this, the hospital did not align closely with Kirkbride’s philosophy for treating mental disorders or provide the institutional environment that he felt best served these goals. Kirkbride objected, in particular, to the layout of the hospital’s wards, and he attempted to make some modifications to the building’s design, overseeing an expansion that increased the hospital’s capacity to 250 patients by the late 1840s. 
Despite his disappointment with the hospital’s built-environment, Kirkbride saw a great deal of potential in improving the grounds. He considered the landscape to be an essential component of therapeutic treatment, an idea that he drew from British models that adapted “the aristocratic landscape park” to suit patients’ medical needs, as well as from the example of the Worcester State Hospital in Massachusetts. As depicted in detailed plans and described by Kirkbride in his writings, he quickly laid out separate pleasure gardens for male and female patients; constructed walks, flower gardens and a vegetable garden, summerhouses, and a deer park; and oversaw the construction of a greenhouse [Fig. 3]. A ten-and-a-half-foot wall enclosed the gardens, shielding patients from the prying eyes of curious visitors and preventing patients from escaping the facility. Access to the landscape was dictated, to some degree, by a patient’s social class. More affluent patients frequently spent their days taking carriage rides through the grounds, while working-class male patients often labored in the hospital garden in exchange for reduced room and board payments. Of the 111-acre farm purchased by the hospital’s Board of Managers, approximately forty-one acres were transformed into gardens, and the remaining seventy acres of land became the hospital’s farm, where fields of grains and vegetables were cultivated to feed the inmates and a large dairy supplied the hospital with milk and cream (view text).
In 1856, due to overcrowded conditions in the existing facility, Kirkbride commissioned the architect Samuel Sloan (1815–1884) to design a second, slightly larger hospital less than one mile away from the first building on the grounds of the hospital farm at 49th Street.Male patients moved into the new building [Fig. 4] in 1859, and the first hospital became dedicated to the treatment of female residents. The two hospitals were separated by a creek, and each had pleasure grounds and vegetable and flower gardens laid out in close proximity to the wards, [Fig. 5]. Outdoor space remained an essential component of psychiatric therapy at the Pennsylvania Hospital for the Insane.Many patients had regular access to pleasure grounds, gardens, and a deer park, and they were encouraged to walk the grounds or take carriage rides daily.Those who were deemed too disruptive to access the grounds without constant supervision could only glimpse the pleasure grounds from behind bars, as shown in this illustration of patients housed in the seventh ward of the Department of Males [Fig. 6].
The Pennsylvania Hospital for the Insane remained an influential medical institution in Philadelphia well into the twentieth century. The original 1841 hospital building, located on 44th Street, shuttered its doors in 1957, and the 49th Street facility, which is still extant, was sold when the institution ceased operations on the site in 1997.
- Kirkbride, Thomas S., 1841, describing the Pennsylvania Hospital for the Insane (1841: 17–19) 
- “PLEASURE GROUND AND FARM.—Of the one hundred and eleven acres in the farm, about forty-one around the Hospital are specially appropriated as a vegetable garden and the pleasure ground of the patients, and are surrounded by a substantial stone-wall. This wall is five thousand four hundred and eighty-three feet long, and is ten and a half feet high.
- “Owing to the favourable character of the ground, the wall has been so placed that it can be seen but in a very small part of its extent, from any one position; and the enclosure is so large, that its presence exerts no unpleasant influence upon those within. Although it is probably sufficient to prevent the escape of a large proportion of the patients, that is a matter of small moment, in comparison with the quiet and privacy which it at all times affords, and the facility with which the patients are enabled to engage in labour, to take exercise, or to enjoy the active scenes which are passing around them, without fear of annoyance from the gaze of idle curiosity or the remarks of unfeeling strangers. Our location gives us the many advantages afforded by a thickly settled district, and proximity to a large city, and the wall obviates most of its disadvantages.
- "Immediately in front of the Hospital, is a lawn forming a segment of a circle, in which is a circular railroad. To the east of this, and passing into the woods, is the deer-park, surrounded by a high pallisade, and forming an effectual and not unsightly division of the ground appropriated to the different sexes; from various points of which, and from the whole eastern front of the building, it is seen to much advantage.
- “The pleasure ground is beautifully undulating, interspersed with clumps and groves of fine forest trees, and from every division of it, as well as from every room in the main Hospital, is a handsome view; either of the surrounding country and villages, the rivers in the distance, or the public roads in its immediate vicinity.
- “The groves are fitted up with seats, and are the favourite resort of the patients during the warm weather. That on the west, from the position of the wall, does not appear to be inclosed [sic], and offers full views of two public roads, of the farm and meadow, a mill race, a fine stream of running water, and two large manufactories. The grove on the east is not less pleasant, and the views from it are equally animated. This last surrounds the pond, in which is found a variety of fish.
- “On the north and south side of the building are private yards, one hundred and seventeen feet wide, and extending two hundred feet from the return wings which form one of their sides. These yards are enclosed by a tight board fence seven and a half feet high, and are surrounded with a brick pavement, which affords a fine promenade at all seasons.
- “The fences around these yards, like the wall itself, have been constructed, not so much to confine the patients, as for the sake of privacy, and to protect them from the gaze of visters [sic].
- “The remaining seventy acres, outside the wall, are cultivated by the farmer, and, with the grass obtained within it, furnish pasture and hay for the large dairy, which supplies both Hospitals with cream and milk during the whole year. From the source are also obtained some grain, and all the potatoes and other vegetables that are required in large quantities.
- “The possession of this property is of great importance to the Hospital, for the purposes just indicated; but its principal value consists in giving control of a body of land always in view from the western side of the building; and above all, in affording ample opportunities for agricultural labour to those patients who have been accustomed to such employment before entering the Hospital. Without a small farm, an insane hospital, receiving all classes of patients, cannot be perfect in its arrangements.
- “The buildings which were on the farm at the time of purchase, (in addition to the residence of the Physician within the enclosure) consist of a comfortable house for the farmer, an adjoining one for the gardener, a spring-house, an ice-house, coach-house, barn, &c., outside of the wall, and near the public entrance.” back up to History
- “Moral treatment” grew out of asylum reform movements in England and France during the late eighteenth century. It advocated “freeing chronic patients from physical restraint and treating them as capable of rational behavior.” Nancy Tomes, A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883 (Cambridge: Cambridge University Press, 1984), 21, View on Zotero. See also Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007), 38, View on Zotero.
- Thomas Story Kirkbride, On the Construction, Organization and General Arrangements of Hospitals for the Insane (Philadelphia, 1854), View on Zotero.
- Tomes 1984, 1, 5–6, 19, View on Zotero; and Yanni 2007, 38, View on Zotero.
- Holden oversaw the beginning of the building’s construction before he returned to England in 1838. After Holden’s departure, Samuel Sloan oversaw the rest of the building’s construction until its completion in 1841. Yanni 2007, 38–39, View on Zotero; and Tomes 1984, 37, View on Zotero.
- Kirkbride was named superintendent on October 12, 1840. Tomes 1984, 149, View on Zotero.
- Tomes 1984, 150, View on Zotero.
- Tomes 1984, 151, View on Zotero.
- Sarah Rutherford, “To Soothe and Cure Troubled Minds,” Historic Gardens Review 10 (Spring/Summer 2002): 2, View on Zotero.
- Tomes 1984, 154, View on Zotero. This later building, known as the “Kirkbride Building” and located on Forty-ninth street between Haverford and Market streets, is still extant.
- Yanni 2007, 71, 73, View on Zotero.
- See the “Historical Timeline” on the Penn Medicine’s History of Pennsylvania Hospital Website, https://www.uphs.upenn.edu/paharc/timeline/1951/.
- Thomas S. Kirkbride, Report of the Pennsylvania Hospital for the Insane: for the Year 1841 (Philadelphia: Board of Managers, 1841), View on Zotero.