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In 1876 Governor John Hartranft formed a commission to study the need for a state-owned hospital
in southeastern Pennsylvania. A 200-acre tract in the northern part of Norristown borough was chosen for the hospital and work began on March, 21, 1878. Upon completion on February 17, 1880 there were only two other state-owned hospitals, one in Danville that opened in 1872 and one in Harrisburg that opened in 1851. Plans were underway to construct another at Warren. Norristown was built to alleviate the overcrowding in the psychiatric wards of the Philadelphia Almshouse and other hospitals in southeastern Pennsylvania. In 1880, the hospital was turned over to the Board of Trustees for operation. It operated under the "cottage plan," using small cottage structures to house patients instead of one large facility.