Pennsylvania Hospital

Pennsylvania Hospital
Established	May 11, 1751
Construction Began	1752
Opened	1752
Current Status	Active
Building Style	Single Building
Architect(s)	Samuel Rhoads / David Evans Jr.
Location	Philadelphia, PA
Peak Patient Population	562 in August 1987

Pennsylvania Hospital was founded, in what is now Southeastern Philadelphia, on May 11, 1751 by founding father Benjamin Franklin and Thomas Bond, as the first medical hospital in the United States of America. New York Hospital in Manhattan would take the honor of being the second of such hospitals. Pennsylvania Hospital, also known as "Pennsy" locally, continues to treat both somatic medical conditions as well as an array of psychiatric disorders. It is also home to the first surgical amphitheater and first medical library for public use in the Americas. It has been continuously active for clinical purposes since its initial opening some three centuries ago, and is now affiliated with the much larger University of Pennsylvania Health System, which services the greater Philadelphia area. It should not be confused with the Institute of the Pennsylvania Hospital, which was a facility in West Philadelphia employed as a psychiatric annex of the primary medical campus of Pennsylvania Hospital. The seal of the hospital, chosen by Franklin and Bond themselves, incorporates the biblical parable of the Good Samaritan and the employs the phrase "Take Care of Him and I will repay Thee" (Luke 10:35) taken from the New Testament.

Founding

In 1752, the first temporary building was opened on High (now Market) Street in Philadelphia for the treatment of the ill in Philadelphia. Elizabeth Gardner, a Quaker widow well known in the city, was appointed it's Matron. Prior to this time, medical treatment was reserved to private doctor visits to houses regional, no such professional medical facility had been established in colonial America. Much of the original funding for the site and its maintenance came from the Society of Friends, better known as the 'Quakers', who stressed the importance of public facilities in the young city.

In 1755, the cornerstone was laid for the East Wing of what would become the hospital's permanent location at 8th and Pine Streets. Patients were first admitted to the permanent hospital in 1756. The site continued to grow through the years with the addition of more wings, such as the West Wing of the building which was built in 1796. In 1762, the first book for the hospital's medical library was donated by John Fothergill, a British friend of Benjamin Franklin. In 1847, the American Medical Association designated the library as the first, largest, and most important medical library in the United States. The collection now contains over 13,000 volumes dating back to the 15th century--including medical and scientific volumes as well as books on natural history. The library includes the nation's most complete collection of medical books published between 1750 and 1850. The collection also contains several incunabula, books written before 1501, when the printed process was invented.

The top floor of Pennsylvania Hospital is the home of the nation's oldest surgical amphitheater. The amphitheater served as the operating room from 1804 through 1868. Surgeries were performed on sunny days between 11:00 am and 2:00 pm since there was no electricity at the time. The surgical amphitheater seats 180 and with those standing, up to 300 people might be present during any given surgical operation. It is open to the public for tours at certain hours of the weekday.

The Physic Garden is the jewel in the crown that makes up the greater part of the grounds of Pennsylvania Hospital gardens. The Board of Managers first proposed the Physic Garden in 1774, to provide physicians with ingredients for their prescribed medications. The idea was approved, but financial circumstances intervened and the project was delayed for two centuries. In 1976, the planting of the garden was the bicentennial project of the Philadelphia Committee of the Garden Club of America and the Friends of Pennsylvania Hospital. Located in front of the Pine Building's West Wing, the garden has plants that were used for medicines in the 18th century. Once used to stimulate the heart, ease toothaches, relieve indigestion and cleanse wounds, now their shaded respite provides healing of a more spiritual kind for patients and visitors alike.

Pennsylvania Hospital gained a reputation as a center of innovation and medical advancement, particularly in the area of maternity. In its early years it was also known for its particularly advanced and humane facilities for mentally ill patients at a time when mental illness was very poorly understood and patients were often treated very badly.

In 1950 Pennsylvania Hospital was recognized for becoming more highly specialized as it established, in addition to its sophisticated maternity programs, an intensive care unit for neurological patients, a coronary care unit, an orthopedic institute, a diabetes center, a hospice, specialized units in oncology and urology and broadened surgical programs.

The hospital was also a center through the years for treating the war wounded. Patients were brought to the hospital for treatment in the Revolutionary War, the American Civil War and the Spanish American War, and units from the hospital were sent abroad to treat wounded in World War I and in World War II (to the Pacific theater).

Famous Staff

Effects of spirituous liquors by Dr. Benjamin Rush, circa 1790

• Benjamin Rush (1746-1813), who remained on the hospital staff from 1783 until 1813. Dr. Rush was a medical doctor, alienist, social reformer and signer of the Declaration of Independence. His family home in Byberry, PA stands adjacent to the former Philadelphia State Hospital. In 1812, Dr. Rush published the first textbook on the subject in the United States, 'Medical Inquiries and Observations upon the Diseases of the Mind'. He undertook to classify different forms of mental illness to theorize as to their causes and possible cures. Like many physicians at the time, Rush believed that many mental illnesses were caused by disruptions of the blood circulation, and treated them with devices meant to improve circulation to the brain, such as a restraining chair and a centrifugal spinning board. While Dr. Rush was uncertain what to do clinical for the mentally ill, he knew that chains and dungeons were not the answer. He took patients from that drudgery and placed them in a regular medical hospital setting. For this reason his approach is officially referred to as the 'Moral Therapy'. In honor of his service to the field of mental health care, the American Psychiatric Association uses Dr. Rush's image as part of their seal,as he is often regarding as the father of American Psychiatry, along side of Dr. Thomas Kirkbride.
• Philip Syng Physick (1768-1837), who remained on hospital staff 1794 until 1816. He achieved fame through his surgical prowess, but had little to contribute to the field of psychiatry. He became a surgeon for many famous Americans through the 18th and 19th centuries.

History of the South Philadelphia Campus: 1752-1840

Early Psychiatric Treatment

When Pennsylvania Hospital was originally envisioned by its founders, their concerns were two fold. First, that the public health could be preserved through a public facility to aid the poor and sickly within Philadelphia itself. Secondly, that the issue of the city's growing Lunatick population could be addressed through a medical resolution to hospitalized those so afflicted. Of the first six patients brought in for inpatient care, four of them were being treated for "diseases of the mind". For much of its early history, the hospital maintained a patient census that was one-third psychiatric, something that was unthinkable in contrast to European hospitals of the time. However, much like it's European counterparts, Pennsylvania hospital housed much of its early psychiatric patients in the cellar, in conditions that have been described as "damp and unwholesome". It was customary clinical procedure at that time to chain patients to the wall as a preventative measure. Many of these chains are currently on display in the museum present on the grounds of the modern Pennsylvania Hospital.

Conditions, as reported, were poor at best, and many of those who were received at the hospital for this type of treatment inevitably succumb to pulmonary disease. In 1758, two male patient succeeded in parting the iron bars of their cells, and escaped into the Philadelphia night. They accomplished this seven times before significant alterations were made to prevent their reoccurring elopement. Escapes were common in this early period, and moreover, often prompted by the poor conditions of the psychiatric ward. In August of 1773, seven elopements were recorded alone. Following careful consideration, the Board of Manager of Pennsylvania Hospital stated that they would permit wealthier patients to have private quarters, that would be clean and removed from the general public. This they offered for an additional fee of ten dollars per week. Private orderlies were also available upon the request of the patient or the patient's family. The general psychiatric unit, however, remained unaltered by this decision. This feature of private, specialized care for the affluent and powerful would remain a special feature of the Department of Psychiatry within Pennsylvania Hospital until 1997.

Lunaticks as a public curiosity

For many centuries prior, in France and England in particular, incarcerated Lunaticks were regarded as somewhat of an amusement by local denizens, who frequently would laugh and jeer at them behind their bars. This was also the case of Pennsylvania Hospital during the 18th century, and there are many reports of local residents agitating those confined and hurling insults at them from the street. In 1763, this problem was alleviated when a hatch door was installed leading from the street to the 'lunatick ward'. Admission was offered for the price of four pence to help offset the clinical expenses of running the hospital and its various charity cases. This practice continued for an unspecified amount of time. It was still in place in 1784, when the resident alienists stated that firmer regulations should be put on hospital visitors, as they discovered that this practice in many cases further exacerbated patients' conditions. Public visitation was limited to two persons at a time, and they are to "go into the cells and those persons to be attended by the cell keeper, and not suffered to speak with such patients." This perspective of psychiatric patients as being sub-human, while out of place in modernity, was part of the zeitgeist of that age. The ability to reason, and have possession of one's one reason, was considered the acid test of humanity. Those who ignored, violated, or were otherwise unable to come to their senses by their own volition were therefore deemed to be outside humanity.

Some of the patients would rise to become local celebrities within Philadelphia itself during the 18th century. One such patient, only known to history as the "lunatic hermit", who was a "remarkably neat and tidy sailor". He was admitted in 1765, during which time he actively fought with patients and staff alike, refusing to sleep in his room. He eloped into the cupola over the east wing on the hospital, where he demanded to take up residence. The tired and frustrated staff yielded to this demand, and he remained a permit resident of the cupola for the next ten years, until her died in 1774. The local residents often spoke of the stranger, who paced the cupola with his long fingernails and matted beard.

Shifting clinical population

Within its first thirty years as a public institution, the demographics of the hospital changed considerably. By the close of the American Revolution the greater majority of the patients were committed as Lunaticks, rather than for a medical illness. The reason for this shift is debatable. However, the most likely reason is the practical economics that the Board of Managers faced. Those patients who were committed for somatic ailments were often from the poorer classes, and frequently relied on charity care. In contrast, psychiatric cases were commonly from wealthier families who helped fund the hospital and made its continued expansion possible. With all due consideration, the inpatient population of the mentally ill continued to expand progressively, year after year. While no hospital record stating this as official policy has ever been found, the census record certainly suggest it as a certainty.

Modernization and the roots of Psychiatry

One of Rush's Tranquillizing Chair

More than any other single individual, Dr. Benjamin Rush was responsible for advancing the clinical knowledge and practice of behavioral healthcare. Like Galen, Rush died a superstitious origin to behavioral problems, claiming that moonbeams, Daemons, foul odors, celibacy, excessive tobacco use, did not cause psychiatric issues. Rather, that these behavioral disturbances were caused by "diseases of the brain", and should be treated properly with medical attention. Rush was also an advocate of the humane treatment of his patients, rejecting their previously held social status as unreasonable, and therefore sub-human. He proposed, that since these issues were disease of the mind, patients should be treated with the same care as those who suffered from a somatic malady. While the ethical nature of this claim was questioned in later century, for the 18th and early 19th century it was perceived as a peculiar formal method. This medical and metaphysical dogma dogma stood against common perceptions, as well as the formal education Rush received at the hands of psychiatric experts, such as Dr. William Cullen of Edinburgh.

Additionally, Rush is remembered for a new therapeutic apparatus that he employed on his patients. Commonly known as the "Tranquilizing Chair", Rush designed this machine to help reduce the flood of blood toward the brain. This was considered to make reasonable sense under the medical logic of the time, as it was thought that "the blood is the life" (Lev. 17:14). Ergo, by slowing done the 'force of life' within a Lunatick patient, their manic features might be reduced as well. In practical application this device certainly reduced psycho-motor activity of the confined patient, as well as their muscular tension, and the frequency of the pulse, but it became abundantly obvious to other alienists that it did not reduce the presenting symptoms of the patient. Regardless, Rush thought that this device was preferable to the "Mad-coats" (better known as a straightjacket) that most Lunatick were restrained in at the time.

Rush postulated that Insanity could be caused by physiological issues, or because of a moral failing in the individual. For this reason, Rush drew upon the centuries old Thomistic philosophy of Western Europe, that health required moderation in all things. Therefore, those individuals who engage in: excessive drinking, strange preoccupations, sexual or religious fervor, all lacked the moderation necessary to maintain mental health, and subsequently fell into bouts of insanity. This belief in the moral basis for the development of insanity was a common belief within the professional psychiatric community well into the 20th century. For better clinical care Rush deemed that these patients could attain homeostasis if they were simply given the opportunity to live a moderate and well-balanced lifestyle. For this reason, in 1798, he ordered that those patients who had the physical capacity to work should do so, to assist as part of their recovery. He proposed spinning, sewing and churning for his female patients, and for men, gardening and mill-grinding. This theory of recovery through work would be the roots of Occupational Therapy, which is still employed by many inpatient and outpatient clinics as a means of assisting with psychiatric recovery.

The Institute of the Pennsylvania Hospital

The Hospital's Board of Managers voted to expand their facility for care of the mentally ill in 1840, as much of the original Pennsylvania was occupied by psychiatric patients. A site was select in, what was then, rural West Philadelphia in 1841 with the construction of the Pennsylvania Hospital for the Insane, later known as The Institute of the Pennsylvania Hospital. The Board also elected to hire Thomas Story Kirkbride as its first superintendent. This new separate facilities developed a treatment philosophy that became the standard for care of the insane in the 19th and early 20th centuries. This facility remained in operation for the next century and a half. However, the changing economics of psychiatry in the later half of the 20th century made inpatient care expensive and difficult to obtain. In 1997, Pennsylvania Hospital's Board of Managers made the decision to merge with the much larger University of Pennsylvania Health System, this also meant the closure of the Institute as an independent facility. All operation of psychiatric care resumed at Pennsylvania Hospital's primary location following its closure. The large Penn Health System continues to help to support the Pennsylvania Hospital as a stand-alone hospital with its vast regional network of resources.

The current psychiatric services of the University of Pennsylvania Health System are divided by several sites within the Philadelphia area. There are two inpatient units at Pennsylvania Hospital, '4-Spruce' containing 24-beds, and '6-Spruce' containing 18-beds. Penn Presbyterian Medical Center also holds two inpatient units, 'Wright 4' containing 18-beds, and 'Wright 5' containing 22-beds. A Psychiatric Emergency Evaluation (PEEC) is also on site at the Hospital of the University of Pennsylvania, which is contracted with the City of Philadelphia to handle 302 commitment petitions.

Images of Pennsylvania Hospital

Main Image Gallery: Pennsylvania Hospital

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Other Historic Adjacent Facilities

• Friends Hospital
• Episcopal Hospital
• Harrisburg State Hospital
• Institute of the Pennsylvania Hospital
• Philadelphia State Hospital
• Horsham Clinic
• Brooke Glen Hospital
• Norristown State Hospital
• Philadelphia Almshouse

Additional Information & Links

• Pennsylvania Hospital Website
• History of the hospital
• Historical Image Gallery
• Library of Congress Photos & Drawings

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