Trenton State Hospital

Trenton State Hospital
Established	March 25, 1845
Construction Began	November 4, 1845
Opened	May 15, 1848
Current Status	Active
Building Style	Kirkbride Plan
Architect(s)	John Notman, Charles F. Anderson
Alternate Names	New Jersey Lunatic Asylum at Trenton New Jersey State Hospital at Trenton

History

The following is from a 1916 treatise entitled The Institutional Care of the Insane in the United States and Canada. The necessity of erecting an asylum for the care and treatment of the insane was advocated by Dr. Lyndon A. Smith, of Newark, in an address read before the Medical Society of New Jersey in 1837, on the occasion of his taking the chair as president of the society. This was the first appeal for the state to assume its duty to this class of unfortunates. The interest of the medical men being aroused by this address, they made their influence felt in the various communities, which resulted in an appeal being made to the Legislature in 1839. A joint resolution was accordingly passed by the Legislature authorizing the Governor to appoint commissioners to ascertain as accurately as practicable the number, age, sex and condition of lunatics in the state; and if, on such investigation being made, a lunatic asylum should be thought the best remedy for their relief, then to ascertain the necessary cost of the establishment of such an institution, the locality for the same, etc. An appropriation of $500 was made to defray the expenses of the investigation. Governor Pennington appointed as commissioners Doctors Lyndon A. Smith, of Newark; Lewis Condict, of Norristown; A. F. Taylor, of New Brunswick; C. G. McChesney, of Trenton, and L. Q. C. Elmer, Esq., of Cumberland County. The fact that four out of five of the commissioners were medical men, one of whom was Dr. Lyndon A. Smith, who first advocated this public measure when president of the State Medical Society, indicates clearly that the Governor was strongly impressed with the idea that the medical men were the most earnest advocates of the movement.

The commissioners met at the office of Dr. Smith in Newark, and Dr. Condict was appointed chairman. They apportioned among themselves different duties and different portions of the state for investigation. They visited the various counties of the state and made careful personal investigation of all cases of insane persons and the manner in which they were cared for by their friends or in the county institutions.

They also enlisted the aid of intelligent and interested citizens in the different parts of New Jersey. Dr. Condict and Dr. Smith visited the McLean Asylum at Charlestown, MA, the State Lunatic Hospital at Worcester and the General Hospital and the State Penitentiary at Boston, in order to obtain information in regard to the management of these institutions, the cost of maintaining them and the result of this method of custodial care and medical treatment of the insane. The commissioners presented a carefully prepared report to the Legislature of the session of 1840-41 showing the result of their investigation, and stated that there were in New Jersey at that time 338 persons who were actually insane, not counting any doubtful cases, and that many of them were suffering for the want of proper care and treatment.

The Governor in his message the following year recommended the subject to the attention of the Legislature and a joint committee was appointed, who reported in favor of an appropriation for the erection of an asylum, and, in order to enlist the sympathy of the Legislature and urge the necessity of this appropriation, reported some cases of suffering and cruelty which had come under their observation. The commissioners closed the report as follows:

Deeply impressed with the conviction that the time has arrived when New Jersey should act promptly upon this subject, and desirous that she should not be behind her sister states in their philanthropic exertions, your committee unanimously submit for the consideration of the Legislature the following resolutions:

• 1st That the confinement of insane persons in jails with criminals is subversive of all distinction between calamity and guilt, and punishes the unfortunate which it is the duty of society to relieve.
• 2nd That as experience has shown that recent insanity, in most cases, is readiry cured, it is highly expedient that the state should provide a suitable institution for the comfort and relief of the insane poor, and to remove them from prisons and poorhouses.
• 3rd That an asylum be erected at the expense of the state, at some proper point, to be selected by commissioners, with the approbation of the Governor, upon such a plan as they shall deem best adapted for the purpose of such an institution.
• 4th That the committee be instructed to report a bill providing for the objects expressed in the above resolutions.

Notwithstanding this report and an urgent appeal of the committee for an appropriation, the Legislature adjourned without having taken any action upon the subject.

During the year 1844 Miss Dorothea Lynde Dix visited all the counties, jails and almshouses in New Jersey in order to ascertain how the insane were kept and cared for. She prepared a memorial for the Legislature, giving a detailed account of the observations she had made and facts collected, to which was added the tabular statement made by the commissioners of 1839. Miss Dix made an urgent appeal to the Legislature to act at once and make the necessary appropriation for the erection of a suitable building for the care and treatment of the insane. She cited a number of cases which came under her personal observation to emphasize the importance of the state assuming its duty to a class of unfortunates which it had up to this time neglected. One of these cases was that of a man who had been an upright and worthy citizen, and who, during his youth and middle age, had been honored by his fellow citizens. He had for many years been a member of the Legislature and his ability as a lawyer had raised him to the bench, where his decisions were marked by clearness and impartiality. This man, who acquired an honest competency for his old age, found it swept away through no fault of his own. In addition to his financial troubles he lost by death an only son, which was more than he could bear. His mind gave way and he became hopelessly insane.

As there was no place where he could be cared for, he was first confined in the county jail, but was afterwards removed to the county almshouse. When Miss Dix visited him he was a feeble old man lying on a small bed in a basement room destitute of necessary comforts. Miss Dix in her appeal said: "This feeble and depressed old man, a pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past—this feeble old man, who was he?" This was a most urgent appeal for the pauper jurist who was well known to many members of the legislature. This memorial was presented to the Legislature of New Jersey, January 23, 1845, by Joseph S. Dodd in the Senate, who was Miss Dix's supporter and himself an earnest advocate of the measure.

Mr. Dodd's resolution calling for a joint committee of both houses for further consideration of the subject was passed the day following. The first committee made their report February 25, and declared that it was unnecessary for them to occupy further time as they could only repeat what is better said in the memorial of Miss Dix, "which presents the whole subject in so lucid a manner as to supersede the necessity of any remarks from us." They then concluded their report with a fervent appeal to the Legislature to act at once in the matter. While the higher-minded members of both houses were genuine converts to the measure and anxious for its adoption, there were a larger number of small politicians secretly opposing it because they were afraid they might lose some votes on account of increased taxation. One of these fellows spoke of this plan as " An Egyptian Colosseum," and declared that a most popular act would be "to appropriate money sufficient to fill up the cellars and sow them over with grass seed, so that the spot may not be seen hereafter."

After this setback Miss Dix was up every morning before sunrise, writing letters and editorials. During the session she held frequent interviews with the members and in the evenings as often as possible she would argue a company of 15 or 20 whom were specially invited to her parlor. It was by such arguments with individual members that the measure was carried through. If Miss Dix had not remained on the ground and championed the cause it would have probably failed as it had at previous sessions of the legislature. The act of authorization was taken up March 14, 1845 and read for the last time. The proposition to postpone action till the next session of the legislature was voted down in the Senate and on March 25 the re-engrossed bill passed.

At the close of the session in 1845 the legislature made an appropriation of $10,000 to pay for ground and $25,000 toward the erection of a building. The following commissioners were appointed for selecting a suitable site: Daniel Haines, Thomas A Smith, John L. Condict, Joseph Saunders and Maurice Beesley. After visiting various localities in the state the commissioners determined on the site on which the building now stands. The location was on the bank of the Delaware River, almost two and a half miles northeast of the City Hall. The buildings are constructed of reddish sandstone, obtained from the quarries near the hospital, and are located on an elevation about 75 feet above the river. The commissioners had some difficulty in agreeing upon a site from the many that were offered in the various sections of the state and the selection of the one chosen was determined by a large spring of excellent water near the present building. This spring would provide a daily supply of about 500,000 gallons of pure water for many years. During the summer of 1845 Eli F. Cooley, Calvin Newell, and Samuel Rush were appointed building commissioners by Governor Stratton and were given the responsibility of constructing the new hospital building. They visited various institutions in other states and examined a number of plans. They finally decided upon the design by Dr. Thomas S. Kirkbride who was superintendent of the Pennsylvania Hospital for the Insane at Philadelphia.

Architect John Notman was selected to make some changes in the plans and oversee the erection of the building. The work was done by William Phillips and Joseph NVhitaker, builders of the old New Jersey State House. Construction of the new hospital commenced on November 4, 1845 but the work was delayed due to the lack of necessary appropriations. The hospital finally opened for the reception of patients on May 15, 1848. The main building which was the first erected following the plans of Dr. Thomas Kirkbride consisted of physician apartments, officer quarters, offices, a chapel, kitchens, and six wards for male, and six for female patients. Total accommodations for about 200 patients. The plan was such that additions could be made to the building for the accommodation of more patients when required.

The various appropriations of money up to the time the building was opened for the reception of patients amounted to $153,861.90, which included the original cost of the farm, the erection and furnishing of the building, grading and improving of grounds, stock for farm and all necessary expenditures.

An act to provide for the organization of the State Lunatic Asylum and for the care and maintenance of the insane was passed by the Legislature and approved by the Governor February 28, 1847. This act provided for the appointment of ten managers, and invested the power of filling vacancies in the Supreme Court of the state. This board was authorized to elect a medical superintendent, a treasurer, steward and matron. The salaries of the officers were to be approved by the Governor and paid from the State Treasury. Patients were to be admitted to the asylum in due proportion from each county, by the court or any judge of the Common Pleas; it was made the duty of the overseers of the poor to make application to any judge, in case of an insane pauper, for authority to commit such pauper to the asylum; it was also made a duty of said judge to summon at least two respectable physicians and to investigate the case; and if the person examined was found to be a suitable patient for the asylum he was to be removed to and retained there at the expense of the county to which he belonged. No patient was to be admitted for a shorter period than six months. The managers were to receive no compensation, their traveling expenses only being allowed them. All purchases for the asylum were to be made for cash, and the managers were bound to make all needful rules to enforce this provision. At a meeting of the Board of Managers held in the spring of 1847 they appointed Dr. Horace A. Buttolph medical superintendent. He had for some years been an assistant of Dr. Brigham at the State Insane Asylum at Utica, N. Y., and had visited some of the institutions for the insane in England and other countries. They appointed Caleb Sager, a business man from Mount Holly, steward. Subsequent events proved that the managers made no mistakes in these appointments. Dr. Buttolph was a master of details, a great organizer, a good disciplinarian, well posted in his specialty and was highly respected by the medical profession, being an honorary member of the State Society. Mr. Sager was an exceptionally good business manager, as was evidenced by his being one of the organizers and the first president of the First National Bank of Trenton. Under the management of Dr. Buttolph the buildings were improved and enlarged from time to time and new ones were erected to meet the requirements of the increasing population according to the finances of the institution or the appropriations from the legislature. The grounds in front of the main building were laid out, graded and planted with trees, shrubbery, evergreens and flowering plants under the direction of A. J. Downing, a landscape gardener.

Two wings were added to the main building in 1855. New additions were estimated to afford easy accommodation for 250 additional patients and their attendants. The Randolph museum and reading room was erected the same year. This structure, built of brown stone in the octagon form, was 32 feet in diameter, surrounded by a wide portico and lighted from the top. The interior was in one room with octagon sides and ceiling, fitted with cases for containing curios and interesting objects, furnished with tables for books, pamphlets, papers, games, etc. Stewart F. Randolph, of New York, made the liberal donation of $3300 for the erection of the Randolph museum and he and his brother contributed more than $300 in money and engravings for the furnishing of the museum; other friends of the institution also contributed liberally. Morris, Tasker & Morris, of Philadelphia, gave a "self-regulating hot water furnace" for warming the museum and reading room, the listed price of which was $675.

An exercise room, 20 by 60 feet in extent, for the use of female patients and also a ten-pin alley for the men were built adjoining the airing courts of the convalescent patients. The exercise room was erected and furnished by the contributions of various benevolent individuals at a cost of more than $1700.

During the year 1856 the steam boilers used for heating the house and other purposes were removed from beneath the central building and placed in a newly erected steam boiler house, for which a special appropriation of $6000 had been made by the Legislature.

During the year 1858 a new building for a laundry was erected and supplied with improved fixtures and machinery. Several new billiard tables were purchased and those intended for the men were placed on the convalescent wards and the one for the women in the new exercise room. The medical superintendent stated "that he thought this game to be among the most useful for insane patients, by supplying healthful exercise to the body and limbs and thoroughly arousing and concentrating the attention of the mental faculties of many spectators, as well as those directly engaged in it." Also that year a system of forced ventilation similar to that in use at the Utica, Worcester, Northampton, and Taunton asylums was introduced. A large fan was set up in a room adjoining the boiler house which was run by a small Corliss engine so as to force fresh air through the warm air chambers and flues into every part of the building and foul air through the ventilating openings and flues outwards.

In 1863 an extension to the center of the main building was made and completed by a legislative appropriation. It was built of brown sandstone to correspond with the rest of the structure, 40 by 65 feet in extent and three stories high, with half octagon projection in front. A part of the lower story was used for store rooms and a part was added to the kitchen. The second story was devoted to offices and reception rooms. The upper story was converted into a chapel with a seating capacity for about 300 persons. It was furnished with a pipe organ, purchased by a bequest of a friend of the institution, Mrs. Elizabeth Dale Reade, of Philadelphia. In 1864 the bakery was greatly improved and enlarged and an apparatus for making aerated bread was installed. In 1866 two wings, one for men and the other for women, were added to the building. It was estimated that these additions would accommodate about 200 additional patients and their attendants. The appropriations for these buildings, with lighting, heating, drainage, plumbing and furnishing, amounted to about $135,000.

As the number of insane had greatly increased in the state and this institution was overcrowded, the Legislature of 1871 appointed a commission to select a suitable site and build a hospital in the northern part of the state. The present location near Morris Plains was chosen and work on the buildings commenced. Dr. Buttolph, who was a member of the commission, took a great interest in aiding the architect in preparing the plans for the building and seeing that all the specifications were carried out, and in order to do this had to spend considerable time at the institution. He was elected superintendent to open and organize the new institution and assumed the duties of his office April 1, 1876.

Dr. John W. Ward, who had been a member of the medical staff since May, 1867, and for the three preceding years first assistant physician, was appointed medical superintendent to fill the vacancy created by the resignation of Dr. Buttolph. Dr. John Kirby was chosen as first assistant physician to fill the vacancy created by Dr. Ward's promotion and Dr. Charles P. Britton was chosen for the position of second assistant physician in place of Dr. Macdonald, who had been appointed to a similar position in the Morristown Asylum. In accordance with the law authorizing a division of the state to be made by the Board of Managers of the Trenton Asylum and the Commissioners of the Morristown Asylum, and to be sanctioned by the Governor, the division was made and approved July 26, 1876. This division assigned to the Morristown Asylum the counties of Bergen, Essex, Hudson, Morris, Passaic, Sussex, Union and Warren. Under this arrangement 292 patients—139 men and 153 women—were removed from the care of this institution during the month of August to the asylum at Morristown. After the removal of these patients on October 31, 1876 there remained 251 men and 221 women for a total number of 472 inmates.

The institution again became overcrowded and the Board of Managers asked the Legislature for an appropriation for the erection of a building to afford additional accommodation for the patients. In 1887 the Legislature passed an act appropriating $100,000 for this purpose. The plans were drawn by Charles F. Anderson, an architect of Trenton, assisted by Dr. Ward, who made suggestions in regard to the style and general arrangement of the building. It is a handsome structure of red sandstone, three stories in height and capable of accommodating 300 patients. This building was intended for the chronic or incurable class and was opened for the reception of patients in October, 1889.

The state asylums at Trenton and Morristown had their own Boards of Managers until the legislature passed an act, approved March 17, 1891, abolishing their boards and appointing a single board of seven members in their place to perform their duties. This board was organized at Trenton on Monday, March 19, 1891, with James N. Pidcock, of Hunterdon County, as president. The board at this meeting reappointed the medical superintendent and all of the assistant physicians. At a subsequent meeting Edmund White resigned his position as steward and William H. Earley, of Trenton, was appointed in his place. One of the first acts of this Board of Managers was to order the erection of a stone building, a part of which was to be used for cold storage and a part for the manufacture of artificial ice in sufficient amount to supply the hospital. This supplied a much-needed want and has up to the present time met all necessary requirements.

By an act of the legislature which was approved March 11, 1893, the title of "The State Asylum for the Insane at Morristown " was changed to the title of " The New Jersey State Hospital at Morris Plains," and the title of "The New Jersey State Lunatic Asylum " was changed to the title of " The New Jersey State Hospital at Trenton." The management was changed to correspond with that of Morris Plains. The administration was divided into a medical and a business department. The medical director was " to have charge, direction and control of all patients and of all persons engaged in the care of patients." The warden was to be " general manager of the buildings, grounds, farms and to make all purchases for the hospital and patients." Under this act John W. Ward, M. D., was appointed medical director, and William H. Earley warden.

In the month of November, 1893, two additions to the main building, each containing congregate dining rooms, were completed and opened for use at a cost of about $50,000. The additions are of stone and correspond in their general structure with the building of which they now form a part of. They are three stories high, 40 feet wide and 172 feet in length. There are three dining rooms for the men and three for the women, which are connected with the upper, middle and lower floors of the hospital by enclosed corridors. The better class of patients, including the convalescents, take their meals in the upper dining rooms, those more excited in the middle and the worst class in the lower dining rooms. By this arrangement neither of the three classes of patients comes into contact with any other at meal time and the greatest objection to congregate dining rooms is thus avoided. This plan has proved to be very satisfactory in this hospital.

During the year 1896 a modern laboratory building of pressed brick was erected and equipped for scientific work. Two additional green-houses were built, as the one in use up to this time were not large enough to meet the requirements of the hospital. In 1897 the Legislature created "two asylum districts" within this state, returning the management of each state hospital to a separate board as it had been up to the year 1891. In accordance with this act the Board of Managers of the New Jersey State Hospital at Trenton was organized on June 20, 1897. G. D. W. Vroom, of Trenton, who for several years had been a member of the previous board, and who also had been a member of the board which had been abolished in 1891, was elected president and continued to serve in this position until the time of his death, which occurred March 4, 1914. Mr. Vroom took a great interest in everything connected with the hospital and for many years gave his valuable time and services gratuitously to what he considered a great public charity.

In 1897 extensive improvements and additions which had been in progress during the two previous years were completed and paid for from the accumulated earnings of the hospital. These improvements consisted of a residence for the medical director, a new water supply, including a standpipe with a capacity for over 500,000 gallons, macadamized roads, a complete system of drainage, the laying out and grading of the grounds in front of the annex and around the medical director's residence, and the planting of trees, plants and shrubbery on what is now considered the most attractive part of the grounds around the institution. The medical director's house was built of pressed vitrified brick. It is of good size and the rooms are finished in hard wood, large, airy and comfortable. The standpipe is large enough to supply the wants of the institution and is so connected with the different buildings as to be of great service in case of fire. The water, which is of excellent quality, is supplied from six artesian wells and pumped into the standpipe by hydraulic pumps. During the year the laundry was improved by changes in the building and machinery, at a cost of $6000.

An extension to the center of the main building was also completed and furnished. It was built of brown stone and corresponds in structure with the rest of the building of which it now forms a part. The first floor was used for a large store-room for all kinds of clothing for the hospital. The second floor was furnished for offices; one side of the wide hall was to be used by the warden for his private office and the other rooms for his assistants. On the other side of the hall there was a private office for the medical director, a room for the stenographers which more recently has also been fitted up with steel cases for the keeping of the records of cases and one for the medical library which was started at that time, but has been greatly improved by the addition of new standard works on medicine in recent years. The third floor was fitted up for a chapel. It was furnished with quartered-oak seats, handsome stained glass windows, was carpeted, and has a seating capacity for about 500 persons. The pipe organ which had been in the old chapel was taken apart, thoroughly renovated and was set up in the new chapel. The old chapel was repainted, furnished with a metal ceiling and turned into an amusement hall for entertainments, such as dances, stereopticon lectures, theatrical performances and concerts by the hospital orchestra.

The old amusement hall was thoroughly renovated, furnished with chairs; tables and new book cases were built around the room. It was converted into a library, to which the books which had been kept in book cases on the convalescent wards were transferred. Anne Robinson, who for many years had been an attendant and nurse in this hospital, died and left by will the savings of a lifetime, which amounted to $5000, the interest of which was to be used by the chief executive medical officer " for the purchase of books and for no other purpose, to be used for the pleasure and benefit of those to whom she had for so many years endeavored to minister." The Anne Robinson Library now contains over 4000 volumes, with a librarian in daily attendance. It is doubtful if any other hospital for the insane in this country has so large a library for the use of the patients and employees.

During the year 1900 the warden's residence was completed, furnished and occupied by the warden and his family. The house is a handsome brick structure situated near the main entrance from the road to the hospital grounds. A dormitory for the accommodation of women attendants and nurses was also completed, furnished and ready for occupancy. It is a handsome building of Stockton brown stone, three stories high and contains 60 sleeping rooms, with ample bath, toilet and wash rooms on each floor, and suitable reception and reading rooms. The building is conveniently situated between the main building and the annex. The cost of this building and furnishings was in excess of $22,000. In 1901 the wiring of the several buildings of the hospital for electricity and the erection of a suitable number of arc lights on the grounds were completed and electric lighting put in operation. This improvement involved an expenditure of $15,000. The Public Service Corporation furnishes the electric current by contract.

The first class of the training school for nurses was graduated June 2, 1904, when diplomas were conferred on 8 men and 14 women who had successfully passed their examinations in May. The course of training has been improved and widened in recent years by lessons in practical nursing and each nurse being obliged to have several months' experience in Mercer Hospital before graduation.

In 1905 by an act of the Legislature the sum of $12,500 was appropriated for the construction of fire escapes. Thirteen Kirker-Bender fire escapes were erected at the most suitable points of exit from the main building and annex. An appropriation of $250,000 was made for the erection of two additional wings at the "annex" which was intended to accommodate 400 more patients and their attendants. These additions were completed, furnished and opened for the reception of patients in February, 1907.

Dr. John W. Ward was an assistant physician at this institution from May, 1867, until he succeeded Dr. Buttolph as medical superintendent April 1, 1876. He continued in this position until 1893, when the title of the office was changed to that of medical director, in which capacity he served until July, 1907, when he retired to private life, after more than 40 years of continuous service. It is doubtful if any physician has ever been connected for so long a time with a state institution for the care of the insane in this country in an official capacity. Dr. Ward was a man of unusual ability, in his day a good executive officer, who had many friends among the public men and physicians of the state. He served as president of the State Society for the term 1887-1888.

William P. Hayes resigned the office of warden and was succeeded by Samuel T. Atchley, of Mercer County, September 1, 1907. On October 18 Henry A. Cotton, M. D., of the Hospital for the Insane, Danvers, Mass., was appointed medical director.

Dr. Cotton entered upon his duties as medical director in November, and at once proceeded to organize the medical department along the lines of progressive, up-to-date hospitals for the insane. He adopted the method of examination outlined by Dr. Adolf Meyer for the New York State hospitals. The records of cases, instead of being kept in the old style case books, are put in separate envelopes and filed in cabinets for reference. All the changes in the conditions of patients are noted by the physicians under whose care they may be, who make notes, which are typewritten along with the histories of the case of which they form a part and are available as records for the hospital. Staff meetings were instituted and held every day. At these meetings the members of the staff report anything that is unusual or sufficiently important in the part of the hospital in which they may be on duty. Each physician receives the cases when admitted in rotation and finds out all the history of each case possible and then makes a physical and mental examination, a synopsis of which he reads in the staff meeting. The case is then presented for observation, discussion and diagnosis. A stenographic report is kept as a permanent record of these discussions, which are really clinics of mental and nervous diseases. The staff meetings enable the medical director to keep himself well informed about what is occurring in the hospital as well as to supervise the work of his assistant physicians and to see and examine each new patient soon after admission to the hospital. It is a valuable school of instruction for new members of the staff, who at once realize its advantage. The patients themselves are usually anxious to appear before the whole staff and make known their real or imaginary troubles. They think their cases are receiving more consideration and that they will more likely get justice.

The change in the manner of receiving new cases and the new methods of medical work rendered the quota of physicians too small, so that it was necessary to increase the staff, and a woman physician was included among the number to care especially for a certain class of female patients. A consulting staff, composed of the prominent physicians and surgeons of Trenton, was appointed in order that the best medical and surgical advice might be had in special cases. One of the most important changes made by Dr. Cotton was the abolition of all forms of mechanical restraint. This was accomplished in a period of less than three months without any very great inconvenience and added much to the comfort of the excited class of patients. All restraint apparatus, including chairs, jackets, muffs, etc., was entirely removed from the wards and there has been no restraint employed in the hospital up to this time.

Dormitories for the reception of new patients were established in both the male and female departments. All new cases are received in these dormitories, where they are kept in bed for a time while they are under observation, or so long as their condition renders it necessary and they require special care and treatment. Sick or infirmary wards for old and feeble cases were established in the annex. The patients in these dormitories are kept in bed when necessary and are under the constant care of competent nurses, day and night, thereby avoiding accidents or any just cause for complaint. Patients suffering from pulmonary tuberculosis were isolated and placed in special dormitories as far as possible. A modern, up-to-date operating room was installed as well as a sterilizing room and bath room. The rooms have tiled walls and floors, with modern sanitary arrangements. An anaesthetizing room and a ward for post-operative cases are included in this department. The cost of fitting up these rooms for apparatus, instruments, tiling, plumbing, etc., was $2500.

Special attention was paid to the laboratory and the number of autopsies greatly increased over the years. In 1908 a number of changes were made in the fixtures and interior arrangement of the building in order to accommodate a greater number of workers and the installation of new testing apparatus. The installation of a telephone exchange with 82 local stations proved to be of inestimable benefit to the institution. A watchman's clock was installed, with stations on each ward, so that accurate information of night nurses and attendants could be obtained. The fire apparatus on the wards was overhauled and new fire mains and plugs were placed around the grounds and buildings in order to afford more ample fire protection. The old machinery in the bakery building was removed and new machinery and ovens installed at a cost of $5000. In 1909 continuous baths were installed. They consisted of four tubs in the female department and eight tubs each in the male department. Also this year the tuberculosis building for male patients was completed and occupied. There were also a number of changes made in the rooms and wards of the hospital. The wards were remodeled and painted and in many instances rooms were torn out and alcoves made, thereby allowing more air and sun-light to reach the wards.

During the year 1910 many of the strong rooms were torn out and the space turned into sitting rooms. The $3000 appropriated for furniture for the wards was judiciously expended and they were made more homelike and comfortable. The Legislature appropriated $2000 to make day spaces or sitting rooms on several of the wards. Sixteen strong rooms were abolished on the women's side of the house and the space turned into sitting rooms. This included six rooms on Ward 9, on which were confined the worst class of women patients in the hospital. It was formerly thought necessary to have these patients sleeping in " strong rooms," with guarded windows and double doors, but since the rooms have been removed they have not been missed. The appropriation of $17,000 for renewing the plumbing in the annex was expended and the sanitary conditions of the building thereby greatly improved. The Legislature of 1910 made an appropriation of $3000 for remodeling the wards and this money was spent in tearing out rooms, making open spaces and more day spaces on the wards in order to admit more light and air. Owing to this appropriation the same improvements were made in the male department corresponding to those which had been made in the female department. A fireproof steel filing cabinet, for which money was appropriated, was installed for keeping records.

Two thousand dollars appropriated for furniture for the wards was expended and used to advantage on the men's side of the hospital. During the hospital year terminating November 1, 1910, there were 100 state hospital autopsies, 20 autopsies in the general hospitals and 1545 bacteriological, histological and clinical examinations. These autopsies represent a ratio of almost 75 per cent of the total number of deaths within the year. The autopsies obtained in 1908 were 62 per cent and in 1909 73 per cent. Through the efforts of the medical director the Legislature in 1911 passed a voluntary commitment act. During the year 21 men and 6 women availed themselves of the opportunity to come voluntarily for treatment. Many of these patients were in the early stages of their mental trouble and at a period when they were more amenable to treatment, thereby increasing their chances for recovery. A regular course of lectures and special instruction in practical nursing was given to the members of the nurses' training school during the year. As a consequence there is a marked improvement in the nursing of the patients in the sick dormitories. At the annual commencement of the training school, held June 7, 1911, two men and nine women received diplomas.

The Legislature of 1911 appropriated $3000 for remodeling the wards. The money was spent in tearing out rooms, making open spaces and more day spaces on the wards where very little light and air penetrated before. These improvements were made in the male department corresponding with those made in the female department a year previous. One thousand five hundred dollars was appropriated for completing the plumbing of the annex, and the hospital now throughout may be classed with the best in the country in regard to its sanitary, hygienic and bathing facilities. Two thousand dollars appropriated for furniture for the wards was expended for the men's side of the house. During the summer of 1911 a room was fitted up and furnished with all the necessary apparatus and equipment for a dental office. The tuberculosis building for female patients, for which $3000 was appropriated, was completed and occupied. It is able to accommodate from 25 to 30 patients if necessary.

The hospital had on October 31, 1911, in its possession accurate and complete histories of nearly 1800 cases. There was issued during the year the first volume of collected papers written by members of the medical staff, consisting of 14 original articles. An out-patient department was established in 1911 in connection with the Mercer Hospital in the City of Trenton. The out-patient department is so organized that the medical director spends one morning a week at Mercer Hospital, to which indigent patients suffering from nervous and mental diseases can go for the necessary advice and consultation without any cost to the patients themselves.

The Legislature of 1911 appropriated $2800 for field work and the hospital at present has two trained women engaged in this special work. These field workers go into the families and communities of patients admitted to this hospital and learn the facts regarding heredity, environment, domestic relations, and causes of mental diseases. They also carry with them a list of the names of the discharged patients when they visit a certain community and ascertain all the facts obtainable concerning these discharged patients, such as their mental and physical condition, their environment, and detailed accounts of their investigations are made in writing when they return to the hospital. These reports not only enable the medical director to keep in touch with discharged patients and know whether they recover or relapse, but the families, through the visitations of the field workers, are able to keep in communication with the hospital and obtain the necessary advice concerning their friends or relatives who have been discharged.

The Legislature of 1911 appropriated money to purchase 254 acres of farm land in the vicinity of the hospital for the purpose of producing milk and raising vegetables for the needs of the institution. A large new laundry sufficient to meet the requirements of the institution has been completed and is in operation. The installation of modern machinery and the increase in the amount of room have greatly improved this important work of the institution.

On October 31, 1912 the hospital had a total of 1451 patients— 742 men and 709 women. During the year 488 patients were admitted—282 men and 206 women. In addition to these two men who escaped were returned, and adding the 11 patients nominally admitted for discharge at the end of their four-months' visit, the number of admissions would be 501, making the total number under care 1952.

During 1912 Dr. Turner, ophthalmologist, visited the hospital weekly and not only examined the eyes of all new patients, but thoroughly examined the eyes of many of the old patients with special reference to organic brain disease and dementia praecox. The care of the patients' teeth having proved so beneficial, it was decided by the managers of the hospital to employ a resident dentist who could devote all of his time to the work. In order to bring the physicians in closer touch with the hospital, the custom has been established of inviting the various county medical societies to hold one of their monthly meetings at the hospital during the year. The counties of Somerset, Middlesex, Burlington and Gloucester accepted the invitation and the attendance at these meetings was exceptionally good. Usually a whole day was devoted to their meetings. The hospital was inspected and cases having different forms of mental disease presented and symptoms explained.

The micro-photographic apparatus, obtained by a special appropriation, was installed in temporary quarters and special work in colored micro-photography, the first undertaken in this country, was conducted. Five thousand dollars appropriated for screening the windows was expended, and the hospital equipped with permanent copper screens. Fifteen hundred dollars appropriated for new furniture was also expended. Five thousand dollars was appropriated during the year for the overhauling of the heating system in the main building.

Special attention was paid to the occupation and amusement of patients. The attendants orchestra affords the patients much pleasure by furnishing daily concerts on the lawn during the summer season and in the chapel during the winter months. Many of the men patients among the chronic cases work on the farm or around the buildings. A welfare worker spends her time among the women patients, reading to the patients, playing games and taking them out for walks and does all she can to keep them from brooding over their mental troubles. A woman in charge of the choir drills the patients in chorus work and also arranges for amateur theatricals, in which the nurses and patients take part. A teacher of dancing from Trenton conducts two classes a week for the patients.

On October 31, 1913, there were 1547 patients—781 men and 766 women. During the year 488 patients were admitted—280 men and 208 women—making the total number under care during the year 2035. There were 496 dismissed during the year—274 men and 222 women—leaving the total number of patients under care November 1, 1914, 1539—787 men and 752 women.

A physician who is a psychologist was appointed in 1912 as a research worker, more especially to work up a complete history of alcoholic patients, of their constitutional make-up, heredity, and environment. Dr. Frederick S. Hammond, pathologist, was granted a leave of absence for a year in order to visit the psychiatric clinic at Munich. Dr. Edgar B. Funkhouser was granted a leave of absence for six months, which time he spent in psychiatric clinics of Munich, Vienna and Zurich.

Owing to the number of requests made by the members of the medical profession in Trenton and the vicinity for a post-graduate course of nervous and mental diseases at the State Hospital, it was decided to give such a course during the month of July, 1912. A number of physicians in the vicinity responded to the invitation and the clinics were well attended. The course was intended to give a practical outline of the fundamental principles of nervous and mental diseases, both from a clinical and pathological standpoint. The course was given without charge to the physicians and the members of the staff who gave the lectures felt amply repaid by the attendance and the interest manifested.

The annual commencement of the training school was held on the third Friday in June. Dr. William L. Russell, superintendent of the Bloomingdale Hospital, White Plains, N. Y., delivered the address and the president of the Board of Managers presented diplomas to eight women graduates. The majority of these nurses went to New York hospitals, where they continued their work as post graduate nurses. The scope of the training school for nurses has been enlarged and a three-years' course inaugurated, of which two years and a half will be spent in this hospital and each nurse will spend six months in Mercer Hospital in the City of Trenton before her graduation. Through this arrangement the graduates of the training school will be able to qualify as registered nurses.

An appropriation of $10,000 received from the Legislature for a new laboratory was found to be too small to erect an entirely new building, and it was decided to add to the hospital laboratory a building 70 by 40 feet, which will afford ample accommodations for the increasing amount of work. An X-ray apparatus, for which $2000 was appropriated by the Legislature, has been purchased and installed. The Legislature made in appropriation of $50,000 for a central power plant, which is intended to meet the requirements of the whole institution. The Legislature appropriated $15,000 for the purpose of building two cow stables, a dairy house and three silos.

For years the criminal insane of the State of New Jersey have been confined in the two state institutions, Morris Plains and Trenton, and for at least 25 years the authorities of these two institutions annually petitioned the Legislature for a separate institution to take care of the criminal and convict insane, but without result. The Board of Managers of Trenton finally decided to ask for an appropriation for a suitable building to be erected on the grounds of the New Jersey State Hospital at Trenton which would be large enough to accommodate the criminal and convict insane from both state hospitals. This seemed to be the easiest solution of the problem and in 1913 the Legislature appropriated $150,000 for the construction of the center and one wing of a detention building for the criminal insane. Fifty thousand dollars of this was later diverted towards a central power plant and the money re-appropriated by the succeeding Legislature. One wing and the center building are now under construction and when this unit is completed the building can be occupied. The Legislature of 1915 appropriated $85,000 to complete the central power plant, which equipment was necessary to occupy the criminal insane building.

In 1914 $60,000 was appropriated for a psychopathic building for the female department. The plans and specifications having been drawn, the construction will be begun this summer (1915). The building will be a modern fireproof structure. The first floor will contain the doctors' offices, reception rooms, occupation rooms, and hydrotherapeutic equipment. The second and third floors will consist of private rooms or dormitories and day rooms. The fourth floor will provide an operative department with a fully equipped room for post-operative cases. There will also be a roof garden in order to obtain the maximum fresh air treatment. The dormitories and day rooms will be connected by sliding doors to large porticos in order to give the patients the benefit of as much outdoor treatment as possible. A similar building is planned for the male department.

The amount of money spent in remodeling the building, the new equipment, farm lands, dairy barns, etc., is about $850,000 in the last eight years. In order to completely modernize the hospital a new psychopathic building for the male department, a home for the male attendants and a congregate dining room for the annex are needed. About $250,000 will be required before the board will feel satisfied that the hospital is fulfilling its duty to the community in the care and treatment of the mentally afflicted.

The managers have adopted a very progressive and enlightened policy regarding the institution and exhibit a personal interest in the advancement of the hospital work. For many years the president of the board was Garrett D. W. Vroom, of Trenton, who devoted considerable time to the management of the hospital and exhibited a progressive spirit and hearty cooperation in the attempts of the medical director and warden to improve conditions existing at the time of their appointment in 1907. His time was given willingly and his counsel and advice were an immense benefit to the hospital and those engaged in the duty of reorganization. Too much credit cannot be given to him individually for his influence in the board and his practical, modern policies in all matters connected with the institution. He lived to see the institution changed from an asylum to a modern hospital, but unfortunately he did not live to see all his plans carried out, and his death on March 4, 1914, was a tremendous loss to the institution and officers connected with it.

Dr. Luther M. Halsey succeeded him as president of the Board of Managers, as he was the oldest member of the board and the only surviving member of those who were on the board when the reorganization took place in 1907, having become a member of the board in 1906. It was through the active interest of Dr. Halsey that a complete reorganization of the hospital was possible at that tune. He, with Judge Vroom, made a careful study of the situation and decided that only by adopting the newer methods and obtaining men familiar with such methods would they be able to carry out the plans of reorganization. Dr. Halsey has always taken a most active interest in the management of the hospital and has devoted a great deal of his time to his duties as manager, and it is to him that the largest part of the credit for the present situation is due.

The present Board of Managers consists of five physicians and three business men. It is a harmonious and well-balanced board, who fully realize that the greatest function of the hospital is the care and treatment of the patients and that every other interest must be subservient to this one. The medical men on the board who have contributed much to the improved conditions and who manifest the greatest interest in the welfare of the hospital are Dr. Stewart Paton, of Princeton; Dr. Joseph Raycroft, physical director of Princeton University; Dr. George T. Tracey, of Beverly, N. J., and Dr. Alfred L. Ellis, of Metuchen, N. J. The other members of the board are men of wide business experience, who are intensely interested in the welfare of the hospital and include Arthur D. Forst, of Trenton, N. J.; William L. Black of Hammondtown, N. J., and Joseph L. Moore, of Hopewell, N. J.

Aside from the monthly meetings, which are always well attended, hardly a week goes by that the hospital is not visited by members of the Medical Committee or of the House and Grounds Committee. The board not only maintains a close supervision over the best interests of the hospital, but the medical and scientific work also receives its closest attention, and fortunately politics have as yet had no influence in the selection of the managers or the work in the hospital.

Over the years, new treatments such as hydrotherapy, occupational therapy, heavy metal therapy, insulin, and metazol became available. In 1940 ECT and in 1947 psycho-surgery became available. Trenton Psychiatric Hospital also continued to expand its training program from nursing to social work, occupational therapy, and psychiatric residency.

The development of tranquilizing drugs in the mid-1950s brought about important changes in the hospital treatment programs. Under proper medication, many patients who had been hospitalized for years were able to return to the community, while others became more amenable to psychotherapy and other treatment methods. For the first time in 100 years, the doors of many wards were unlocked, giving patients a degree of freedom in keeping with their progress toward recovery.

The remarkable success of the comprehensive program of services that has evolved is measured by a significant reduction in patient population. On June 1, 1954, 4,237 persons were hospitalized at Trenton Psychiatric Hospital. In 1968, 14 years later, there were under 2,800 patients in residence (this reduction occurring in the face of an ever-increasing admission rate), and today the hospital has a capacity of 376 beds. The various names given to the hospital over the years define its changing role. In 1848, it was the New Jersey State Lunatic Asylum. In 1893, the name was changed to New Jersey State Hospital at Trenton. In 1971, it received its current name, Trenton Psychiatric Hospital. Overcrowded, understaffed, and without public support, both moral and financial, Trenton Psychiatric Hospital was for years little more than a custodial institution. But as more modern treatment methods were devised and community supports and services for rehabilitated patients were put in place, the hospital became part of a therapeutic community.

Images of Trenton State Hospital

Main Image Gallery: Trenton State Hospital

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Books

• Madhouse: A Tragic Tale of Megalomania and Modern Medicine, By Andrew Scull

The Architecture of Madness-Insane Asylums in the United States, Yanni, Carla, University of Minnesota Press (2007)

Links

• Official hospital website
• Present Day Photos