111 North 49th Street
also known as Institute of Pennsylvania Hospital
Placed on the National Register of Historic Places July 24, 1975
The movement to improve the treatment of the insane during the nineteenth century is an outstanding chapter in the history of American social and humanitarian developments. Dr. Thomas Story Kirkbride occupies a prominent position in that story, for he built a hospital for the mentally ill in Philadelphia prior to the Civil War that influenced the construction of similar institutions in thirty-one other states. Furthermore, the concept behind Kirkbride's hospital, that the insane should be treated with the same personal consideration as other ill people, motivated a new understanding of, and regard for the mentally ill.
His hospital, constructed from 1856–59 at 49th and Market Streets in Philadelphia, introduced many innovations for the day, primarily in terms of spaciousness, airiness, and light. The hospital was composed primarily of wings extending off from the main central building. Despite modern additions, the original structure remains much as it was when built.
Thomas Story Kirkbride apparently desired a career in medicine from early youth. Born on July 31, 1809, he began a study of medicine under a Dr. Nicholas Belleville, of Trenton, New Jersey, when he was eighteen. One year later, he entered the Pennsylvania Hospital, in 1828, to study, and received his degree in 1832.
Although not primarily interested in psychiatry during his training, Kirkbride gained some experience then concerning the insane. While studying under Dr. Belleville, he read and was impressed with Benjamin Rush's volume, Rush on the Mind. Between 1812 and 1880, Rush's volume constituted the only American book on the subject that stemmed from psychiatric work in the United States. From it, Kirkbride learned that the considerate treatment of insane people could be effective, much more so than the generally barbaric mode of treatment then current. Before starting his residence at the Pennsylvania Hospital in 1833, he spent some time as a resident physician at the Friends' Asylum at Frankford, now a part of Philadelphia, and participated in the advanced techniques of treatment followed there. Once he had begun his residency, he again came into contact with the insane, and while at the Pennsylvania Hospital again treated them with personal concern and interest.
Upon completing his residency, Kirkbride established his own office and concentrated on what had been his main preoccupation, surgery. Between 1835 and 1840, he maintained his own practice. But when offered the superintendency of a new hospital for the insane in West Philadelphia, the Pennsylvania Hospital for the Insane, he accepted the job on October 12, 1840.
Seemingly fated to treat the insane, Kirkbride devoted the rest of his life to the mentally ill. Shortly after accepting his new position, Kirkbride visited similar institutions in New York and Massachusetts. He found most stimulating the practices of the Worcester State Hospital in Massachusetts, where in addition to medical treatment, patients received therapeutic treatment. They worked out of doors, in gardens, and could take rides and walk. Upon returning to Philadelphia, the new superintendent brought all of his experience into play. Essentially, his program endeavored to handle the patients as any sick people would be. Furthermore, in order to aid recovery he encouraged them to work in the gardens or shops; he organized a museum and library; and he provided lectures on a variety of subjects. He also sought to discover the causes of insanity, and he began to consider that for:
the most influential causes of mental trouble in adultswe would have to go back to a defective early education the want of proper parental discipline, which in … (his) mind was always linked to deep parental affection.(1)
The inadequacy of his hospital became of greater and greater concern to Kirkbride as he labored in behalf of the insane over the years. He, therefore, initiated a campaign for a new institution, one which would be based on his philosophy, individual treatment. Finally, on July 7, 1856, the cornerstone for a new hospital was laid, and by 1859 the structure had been completed.
This new hospital introduced innumerable innovations for its day. And as Dorothea Dix waged her struggle to stimulate the humane treatment of the insane, state after state adopted Kirkbride's basic plan. Those states were helped in that respect by Kirkbride's volume, On the Construction, Organization, and General Arrangements of Hospitals For the Insane With Some Remarks on Insanity and Its Treatment. Published in 1854, and again in 1880, it enjoyed a remarkably influential career.
Even today, the volume is of great interest. There is nothing that is not covered by it as far as the construction and administration of hospitals for the insane are concerned. More important than the practical details, however, is the spirit of the volume. Kirkbride's deep concern for those suffering from the tragedy of insanity permeates his book. The first sentence reads, in part:
The proper custody and treatment of the insane are now recognized as among the duties which every State owes to its citizens … (2)
and the book ends with this sentence:
It is only by a constant remembrance of the principles of an enlightened religion, and by untiring efforts to elevate, in every rational mode, and character of all these institutions, and by leaving nothing undone to extend and improve their facilities for treatment, that we shall be found practically to adopt that golden maxim which should be seen, or if not seen, at least practiced in hospitals for the insane everywhere,all things whatsoever ye would that men should do to you, do ye even so to them.(3)
The construction of the Institute of the Pennsylvania Hospital was begun in 1854 and completed in 1859. Once surrounded by 130 acres of grounds it is now contained in approximately 27 acres bounded on the North and South by Haverford Avenue and Market Street, and on the East and West by 48th and 49th Streets respectively. Built of stone and brick, the hospital was laid out, as Kirkbride expressed, "in echelons."(4) A large rectangular building, 3 1/2 stories tall, with gable roof and central dome, and a 2 story pedimented portico on its western facade, provided the central focus of the hospital and also housed its administrative offices. Extending from the center of this building to the north and south are two symmetrical wings about 250 feet long, 3 stories tall with gable roofs and ventilation cupolas at their furthermost termini. These wings were in turn connected to another pair, which extended to the east approximately 230 feet, paralleling each other, and of the same general appearance. At each terminus of the these rear wings was a final E-shaped wing which extended out approximately 250 feet. The north E wing housed troublesome patients, and the south E wing has since been removed. No wings are exactly in line, thus allowing fresh air to reach each wing on all four sides. Each of the patients' rooms in the wings had its own fresh air duct, the air being driven in from the towers at the terminus of each wing. There were 16 wards in the hospital, one for each of 16 distinct classes of patients, and each ward had its own parlor, dining room, and bathroom. Outside, there were gardens, shops, and walks for the patients.
The hospital has continued to expand, and many new buildings have been added. Two additions have been made to the original structure. The auditorium on the northern side of the north wing which runs east to west is one addition, the other is the wing which extends back from the present entrance building (built in 1929) and connects with the northern extension off the original central building. The land to the north of the original structure is now occupied by a series of maintenance and hospital buildings constructed in 1929 And 1959. The grounds to the south and east are still open. The interior of the original structure has been altered as well. The 22 foot high ceilings have been lowered, many of the halls have been interrupted by partitions, and most of the patients' rooms are now converted into offices. Portions of the hospital are no longer in use. The ventilation towers are sealed shut, and the ductways in the attics are no longer in use.
Beginning at the NW corner of the intersection of Market and 48th Streets, proceed North along the west curb of 48th Street approximately 1000 feet to the SW corner of the intersection of 48th Street and Haverford Avenue thence West along the south curb of Haverford Avenue approximately 900 feet to the SE corner of the intersection of Haverford Avenue and 49th Street, thence South along the east curb of 49th Street approximately 1200 feet to the NE corner of the intersection of 49th Street and Market Street, thence East along the north curb of Market Street approximately 500 feet to the point of origin. These boundaries enclose the western end of the original hospital grounds, now the full extent of the hospital grounds, the original hospital building with its two post-historic additions, and the four other post-historic hospital structures. The post-historic structures are not contributory to the national significance of the landmark.
This National Register nomination was prepared by Richard E. Greenwood, based on an earlier report by S. Sydney Bradford.
- Earl D. Bond, Dr. Kirkbride and His Mental Hospital (Philadelphia, 1947), p. 63.
- Kirkbride, On Hospitals, p. 2.
- Ibid., 300.
- Dr. Thomas Kirkbride, On Hospitals (Philadelphia, 1880).