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The Almshouse: The History of Alms and How We Developed the Asylum

Table of Contents 

Introduction 

“No one need ever starve or be in want in this fruitful country.”

When William Penn established Philadelphia in 1682 with the Society of Friends, the first almshouse was constructed at Fourth and Walnut streets on the property of John Martin.  

william penn portrait
William Penn (1644-1718).

When a settler was plagued with misfortune and sickness, they received help from a neighbor, but as this became too burdensome on the community, a resolution was made by the Assembly that taxed the wealthy in order to fund to the poor and receive proper treatment from a doctor employed to offer health service.  

This tax was called the “Act for the Better Provision of the Poor,” but was repealed by the Queen of England under her ruling at this time.  

In 1705, the Assembly passed another law establishing the Justices of Peace. These council members were required to elect two ‘Overseers of the Poor’ annually for each township. One penny per. pound on properties of citizens and four shillings per. person were taxed to raise money for the poor in each township. Those who received this aid were listed in the “Poor Book” (F.B.C., 2022).

In 1712, the Council declared that a workhouse should be built to offer the poor jobs. The Overseers were ordered to find a convenient building for this establishment.  

The Friends Almshouse, 1714.

The Friend’s Almshouse was established in 1713 on the property of John Martin. Martin intended his property to be used by the poor.  

Six quaint houses were built standing in a row with entrances from the yard, which had a garden. This establishment was referred to as the “Quaker Nunnery” and it welcomed all denominations.  

In 1717, anyone who was receiving relief from the Overseers had to wear a red or blue ‘P’ along with the initials of their county or city on the right sleeve of their shirt. If anyone refused to comply, they would be denied relief and put to hard labor for twenty-one days (Scharf & Westcott, 1884).  

In 1730, a square of ground in a meadow, bounded by Third and Fourth, Spruce and Pine Streets, were purchased from Aldren Allen for ÂŁ200 to build an Almshouse. The only difference about this building compared to the previous is that it would accommodate the sick and insane as well.  A hospital for the sick and insane was built in connection with the Almshouse. The Philadelphia Hospital is the oldest hospital still in operation in this country.

In 1764, the admissions were too much to handle for the size of the Almshouse and the Overseers turned to the Assembly for assistance. No action was taken as conditions worsened while the building became overcrowded until people were finally forced to be turned away. Those turned away were not receiving any care or work and those who were, received poor care and minimal work.  

In 1766, the Overseers once again turned to the Assembly for assistance. This time they listened. On February 20, 1768, “an act for the better employment, relief and support of the poor within the city of Philadelphia, District of Southwark, the Townships of Moyamensing and Passyunk and the Northern Liberties” passed.

This Act guaranteed any person that contributed ten pounds toward the Almshouse, would become a member of the Corporation with power to elect twelve Managers and a Treasurer. These members were referred to as Contributors to the Relief and Employment of the Poor within the City of Philadelphia.

The Contributors held their first meeting in the Courthouse, on the corner of Second and Market Streets, on May 12.  

philadelphia almshouse aka bettering house on spruce and pine and tenth and eleventh streets
Philadelphia Almshouse aka the Bettering House, 1767.

The land bound by Spruce, Pine, Tenth and Eleventh Streets was purchased with the assistance of Governor John Penn for the location of another Almshouse. The Contributor’s motto for the seal of the Corporation was entitled, “Charity, Justice and Industry”. 

Two buildings opened in October 1767 along with the ‘House of Employment’. This establishment was referred to as the ‘Bettering House’ because the ‘paupers’ made goods of wool, hemp, flax and cotton. 

Poor Conditions 

In 1784, shocking conditions were reported at the new Almshouse. Paupers were served unwholesome food such as outdated butter infested with maggots. There was a severe lack of clothing being worn and the women suffering from disease were placed among the healthy.  

The ‘Managers of the House’ charged the Overseers with irresponsibility in the collection of taxes.  

John Reynolds, a Jailor, was accused of extortion when he was caught charging a half dollar to open the gate to Potter’s Field. Potter’s Field or ‘poor man’s burying ground’ was located on the land known today as Washington Square. This was the burial ground for the paupers who died that could not afford a proper burial. Grave robbers would steal bodies at night and sell the cadavers to medical students.

The paupers would rummage the Almshouse at night and exchange clothing and furniture for rum across the street at the bar. Since the grounds were not enclosed or fenced in, the paupers were free to come and go. 

Yellow Fever 

Bring Out Your Dead!

In 1793, the city of Philadelphia was plagued with yellow fever. The Guardians of the Poor refused to admit newcomers into the Almshouse to prevent the disease from entering the building, but the fever made it in anyway.  

The feverish paupers were sent to the ‘Hospital at Bush Hill’ as panic erupted. The streets were being evacuated while boxes of dead bodies were carried down the streets to the graveyards. Coffins piled, bodies lay rotting on streets, and the cries of “bring out your dead!” could be heard throughout the town.  

Yellow Fever in the Streets of Philadelphia, 1793.

In September, May Clarkson called for volunteers to relieve the Guardians of the Poor by taking on the task of offering aid to the Almshouse during the plague. It’s been said that nearly 17,000 people (Stough, 1939) fled the city of Philadelphia along with 5,000 deaths. In December, admissions reopened when the fever went away.  

In 1798, whopping cough was the latest illness to plague the city of Philadelphia. This time, nearly 50,000 people fled the city.  

In 1803, the Almshouse was overcrowded again, and another fever panic broke out. The Guardians attained the building known as the ‘Pennsylvania Arsenal’ as a temporary hospital and another building that belonged to Dr. Curry on the bank of the Schuylkill River near Race Street.  

Meanwhile, patients in the Pennsylvania Hospital were dying of neglect. Mistreatment was prevalent among nurses. Medicine was tampered with, and patients were deprived of their medicine doses. For example, one patient that was supposed to be injected was given pills instead and died from an overdose.  

Poor Conditions Increase

The committee reported that the Almshouse was obviously overcrowded, and the increasing population of Philadelphia would guarantee more overcrowding.  

Another institution was developed. It had a poorhouse, a house for reception of the aged and infirm, an orphan and foundling hospital, a ward for indigent women, apartments adapted to the treatment of the insane, workshops for those who are capable of exercising every species of industry and a hospital for poor patients requiring medical and surgical treatment.  

Here, a man jumped from a window in the male ward. He survived and his legs were chained to his bed to prevent him from jumping again. He was found dead the next morning, still chained to his bed. No one examined him after his fall, and he had sufficient brain injury. which went unnoticed. Iron bars were installed on windows to prevent the men from jumping.

Inmates were sold liquor outside the Almshouse at the Spruce Street tavern. Friends of inmates also smuggled liquors in. The Officials were dumbfounded as to what action to take to prevent this from occurring. So, they decided to prosecute the owners of the tavern and the drunken paupers were punished. Of course, the drunkenness continued anyway.  

Patients were placed in dark, damp cells in the eastern wing. The medical doctors didn’t trouble themselves with them. It appeared to the surgeons, that insanity was incurable, so they were caged like animals and exposed to the gaze and jeers of visitors who laughed at them.  

On September 20, 1811, at a meeting of the Managers, surgeons were very upset. They had to perform difficult operations in darkened, dirty rooms overcrowded with sick patients. They thought the paupers should not be exposed to watching operations because it was too terrible and cruel.

After some complaints, the Board devoted an entire separate building just for surgical operations so the physicians could focus and learn.

Typhus Cartoon.

The war between the United State and Great Britain caused an increase in the population of the Almshouse just as Typhus fever broke out in 1818 and again in 1820.  

In 1822, complaints were made about the way the Almshouse were burying their dead. It is custom to dig a number of pits, say about seven feet by four, at the opening, and nine feet in depth. These pits are wide enough to admit of laying two coffins in the bottom, which they cover with about two inches of dirt, until two more coffins arrive, which they place on top of those already there, when they fill the pit up.  

A New Almshouse 

In May 1826, serious considerations were made to move the entire Almshouse population to a farm of one hundred and fifty acres about one and a half miles away from Broad and Market Streets. The committee was authorized to employ an architect to draw plans and make estimates for this new hospital.  

In the fall of 1827, a large number of patients were transferred from the Almshouse to the newly constructed Smallpox Hospital.  

An Act was passed on March 5, 1828, to establish a new Board called the ‘Guardians for the Relief and Employment of the Poor of the City of Philadelphia, the District of Southwark and the Townships of the Northern Liberties and Penn.’  

Twelve people were elected and called the ‘Directors of the Poor Tax,’ to establish funds for the new hospital. These Directors were ordered to sell the old Almshouse to generate money to put toward the purchase of the new farm site and the new buildings.  

The Commissioners chose the Hamilton Estate along the Schuylkill River in West Philadelphia with the approval of the Guardians. This cost two hundred and seventy-five dollars an acre, which would house 1,250 paupers, divided by sex and classification.  

Altercations 

The Committee investigated a quarrel that took place between the Superintendent, Mr. Hutchinson, and the physicians. Hutchinson made remarks about the physicians not being able to raise money to pay their costs. Dr. Hunt made a comment that a celery glass would make a good hog-trough for Dr. Hutchinson. Dr. Hunt threw the contents of a tumbler at Dr. Hutchinson’s face but missed. Dr. Hutchinson picked up another tumbler and threw it at Dr. Hunt. Then he threw the contents at him one by one. Dr. Hunt grabbed a fire poker from the hearth and approached Dr. Hutchinson. The family had to step in and forcefully remove him.  

At a Board night, the House serves a luncheon at eleven o’clock and supper at nine o’clock. On this evening, Dr. Clarke removed a plate from a servant and said the meat was spoiled, so he placed it on the floor while Dr. Jones kicked it into the passage of the hall. The next day, the piece of meat was served to Dr. Hunt for dinner.  

The Guardians approved the plans that had been adopted for the new buildings, but the members dissatisfied with them. There was constant friction between the two Boards because the Guardians believed the plan was rushed and not perfected. So instead of working together, they drifted apart. This caused delays in the construction work and left the contractors, Corlies & Cowperthwaite, out of work and without pay. The contractors expected the Commissioners to pay the difference. So, the commissioners agreed to purchase the oak plank and nails.  

In 1832, cholera made an appearance in the wards of the Almshouse, so the Sisters of Charity at Emmetsburg took charge of the wards in order to help. These women left a healthy home to inhabit a diseased and infected city to aid strangers back to health.  

On July 30, 1832, the Guardians rented a building on Broad and Vine Streets for people who had Cholera and named it the Broad Street Infirmary. It closed on September 3 when the cholera disappeared.  

On November 12, a report was made by the ‘Committee of the Whole’ that the new Almshouse across the Schuylkill River would be ready for inmates on May 1, 1833.  

When October arrived, the new Almshouse was not ready for occupancy because the budget was less than estimated and funds were required. The Guardians threatened to move all the paupers to the new Almshouse between April 1st and 10th.  

Six loans were taken out to continue the construction.  

The first meeting of the new Almshouse was held July 28th, 1834, four years after the beginning of construction and the name ‘Blockley’ was established.  

The adult paupers were moved into the new Almshouse while the old Almshouse was auctioned off in order to allow the children to be moved over to join the adults.  

A ferry carried passengers over the river from South Street to the wharf on the Almshouse grounds for a small fee. There was a bridge at Market Street that could be used as an alternative.  

Sluice gates were placed in the bank over the river to harvest a crop of ice in the winter.  

The grounds were fenced off and a small house was constructed near the gated entrance that housed the gatekeeper.  

The graveyard was under the watch of the ferryman and was the center of a scandal. The Guardians were often nicknamed the ‘Board of Buzzards’.  

The new Almshouse attained the name ‘Blockley’ because it was located in Blockley Township, in the unsettled ‘Liberty Lands’. Today, this area is known as Northern Liberties.  

William Warner 

William Warner was a Puritan who lived in Blockley, England. He was the first white settler to enter the unsettled land in 1677, naming his plantation after his home in England, hence the name Blockey.  

William Warner was a captain in the army of Oliver Cromwell who was obnoxious to the Royalists. After the death of Cromwell in 1658, fearing his life, Warner fled his homeland and came to the American wilderness, as many hunted lovers of liberty did. He lived here for many years communicating with the Indians and telling them tales of civilization in England until he met William Penn, when he was Governor, in 1684.  

Captain Warner had a lot of money and social and political influence. He took an active part in the organization of the first provincial government of Pennsylvania, when he served as a justice of the court and was elected as a member of the first Assembly, which was chosen under the rule of William Penn. Warner expressed his beliefs in the peace principles of the Society of Friends.  

Blockley 

There were more foreigners in Blockley than Americans. Many detested the idea of countries dumping their paupers on our shores. Many districts, with increasing populations during this time, established their own poorhouse. The Guardians charged foreign emigrants two and a half dollars when they entered the Port of Philadelphia. This was called head money.  

Mr. Hutchinson, the man attacked with pens a few years ago, was under investigation for taking too many supplies from Blockley to use at home. He was discharged.  

There were eight young resident physicians who were under the direction of the Visiting Staff who were not allowed to prescribe medication except in an emergency. These rules were never followed.  

Physicians used rude and abrasive language in the presence of women during dining hours. A dozen physicians were discharged because of this. The physicians wanted their job back, but the Board refused to re-instate them, so they published a statement in the Ledger to justify their actions and assailed the Guardians.  

A guard was employed to safeguard the dead and meet with their friends and family so they can remove the body. One day, two Board members entered an unoccupied portion of the building to discover the mutilated remains of a human body that were there for several months. The explanation was that the remains were “overlooked”. A Chief Resident Physician and his assistants were elected to have ruling over the Medical Department to prevent these this from happening again.  

On November 10, 1845, college students held a protest over the restrictions placed for obtaining corpses from the Blockley Almshouse. Students regularly removed bodies for study. They claimed any obstacle placed in their way of obtaining these bodies would be injurious to the interests of science.  

The students stated that the paupers were of no use to society while living and there was nothing wrong with making them useful while dead.  

The Board was outraged.  

Few, and perhaps none, are so deadened in feelings as not to desire the rites of Christian burial, for who would not revolt at the idea, if they were consulted on the subject, of permitting their bodies to be exposed in the lecture room, cut to pieces for the benefit of the schools and then thrown into a pit containing the remains of hundreds of others. All look to the Guardians for protection; no distinction is practical or expedient. To trifle with or disregard these feelings is a cruelty altogether unjustifiable. Burial here, during the lecture season, is a mockery, and to be buried elsewhere is sometimes asked as the last and greatest favor. It is not to be supposed that these fears and exciting anxieties do not produce evil effects on the sick and often diminish the chances of recovery, for they haunt them until the last house of life and increase in terror as the moment of dissolution approaches. And may not this anxiety to have the remains cared for and protected after death be partly produced by the idea that the spirit may continue to be cognizant of what is done to the moral part? That death does not mean a total disconnection? No immediate action was taken. The majority of the Board agreed that colleges must have subjects and if the supply were cut off, the bodies would be stolen from their graves, so it was better for those who died without friends or relatives to go to the dissecting rooms.  

Scandals 

Nurse Welsh left the House on August 15, 1848 and returned four days later leaving with two boxes. Items were missing and unaccounted for and it was assumed that Nurse Welsh had stolen them. The Board dropped the matter. Shortly after she left her duties, she was sent to the Penitentiary for throwing vitriol in a man’s face that destroyed his eyesight.  

In 1849, the heating in the Insane Department was very poor. Stoves were used in the halls and congregating rooms but not in the sleeping quarters. Inmates suffered through the cold winters with temperatures below freezing. A nurse was using a wet cloth to wipe a frail female inmate down as it froze in her hands. An inmate was found under her bed wrapped in her bedclothes; the water in her room was frozen and the thermometer read 13 degrees.  

To solve this problem, the buildings were going to be heated by steam.  

The female lunatic department was under the charge of a male superintendent who slept with the paupers. The most violent patients destroyed their clothing and stripped themselves naked in a fit and were taken advantage of.  

A female superintendent was hired, and the male was removed.  

In May, cholera raised its head again.  

The gutters of the city were flushed with water, the schools were given vacations and many buildings were used as temporary hospitals. City hospitals were now open in Cherry, Pine and South Streets, Bush Hill, Moyamensing, Southwark, Northern Liberties, Kensington, Richmond and West Philadelphia.  

Four weeks later the first attack of cholera at the Almshouse was reported. William Jones was admitted into the black male medical ward and died with the disease that night. The mortality rate was high, death was common and the “death book” overflowed with charts and notes.  

In 1853, tracks were laid for the Philadelphia and West Chester Railroad, which ran right through Blockley.  

The Consolidation Act 

On February 2nd, 1854, the ‘Consolidation Act’ was passed by Legislature, which abolished the government in the districts, boroughs and townships. They were forced to turn their power over to the government of the city of Philadelphia.  

The Guardians lost their power and authority but were chosen to create a new department that came under the same rules and regulations as all the other departments in the city. This change caused friction and took many years to bring both bodies of ruling into harmony.  

Cholera made another appearance in Blockley on July 7th, 1854. There were 300 cases reported; half resulted in fatality. 

Scandals Prevail 

Scandals were reported left and right. Men were accused of spending the night in the female ward. Items were purchased for the benefit of the purchaser’s home-life instead of putting them to use in Blockley.  

In December 1854, 150 paupers were moved from New York to Philadelphia to be admitted to Blockley. The Guardians refused to admit them and were furious that New York threw these people at the taxpayers of Philadelphia as a way of getting rid of their undesirable burdens.  

On September 1st, 1856, an article in the Daily News accused a member of the Board with prostituting his office by selling the bodies of the deceased paupers. The editor was called upon to investigate the allegations. Apparently, no account was kept at the graveyard on the number of burials and the only real records were the small pieces of paper tacked on the heads of the coffins and were removed from various coffins between reaching the grave and had been found blowing around on the grounds of the Alms.  

Dr. Smith, the Chief Medical Officer and member of the Board of Guardians, admitted he preserved two dead bodies for obtaining two rare specimens of disease and claimed his status gave him the right to exercise this act for the advancement of medical science. Dr. Smith and his assistant were equally anxious to obtain the fractured arms of a female who died of consumption to obtain specimens of morbid anatomy. Dr. Smith had trouble preparing the body to prevent decomposition and took the aid of another physician, outside the Alms, who procured them. The Committee was very ‘anxious’ themselves to find out how on earth Dr. Kelly removed the body parts from the Alms. They asked if he simply walked out with them by concealing them in his vest pocket or if the body simply walked out.  

In the winter, medical students were charged ten to fifteen dollars for each human subject, of which died at the Almshouse without friends or family, for the dissecting tables. The ferryman in control of these transactions simply pockets the money along with the Superintendent.  

In 1861, prisoners were sent to the State Insane Asylum at Harrisburg under the act which established the State Asylum admit the criminally insane. Those who were deemed incurable were sent back to the prison or to the Almshouse. A committee of three were appointed to examine and report the number insane, epileptic and idiotic patients that the Almshouse will have to provide space for.  

In 1862, the roof was in poor condition and needed new covering. The old copper was removed and replaced with tin. The copper was sold for a whopping $35,070.78 and the tin cost $12,496.28 and the balance was put toward the children’s asylum. It was said for years that “the ‘Board of Buzzards’ stole the roof off the Almshouse.”  

A vault was built for the safe keeping of dead bodies from those who died in the Alms. It cost only $100.00 to erect such an encapsulation. It was 25X20 feet and held forty-two coffins. An inmate committed suicide by drowning herself in the bathtub.  

The colleges were entitled to the bodies of the paupers and were thought to be able to get them without paying a fee, similar to the ways in New York. The vault was used as a temporary storage area for the bodies in case family claimed them or they were far too decomposed to be used in dissection.  

When the vault was not used during warm months, the students would steal the bodies. The watchman on the bridge reported seeing bodies being taken over the bridge every night. Three weeks prior, a body had been found lying near the fence and it was assumed a student was disturbed and fled without the body.  

The body would be prepared by injecting the proper substance into the veins and preserving the body in whiskey for lectures in the fall.  

At six o’clock in the morning on July 20, 1864, as breakfast was being prepared, the foundation of a pier which supported the arches and upheld a chimney stack and walls that rested on the joists of the second, third and attic stories of a tier of wards in the woman’s insane department, collapsed without warning as the chimney fell in burying the patients. Seventeen were killed and twenty-three were injured.  

It was discussed whether to purchase Treaty Island, otherwise known as Petty’s Island for a County prison, penitentiary, Almshouse and house of correction and refuse. No action was taken.  

On June 12, 1882, the special committee investigated the management of the Almshouse during which 90 witnesses had been heard and 1,450 pages of type-written testimony were taken.  

In their findings they state:  

The House kept no commercial account books and purchases are made without detailing the goods and their quantity. The Storekeeper never balanced his books nor were they ever audited.  

The inmates complained the food was insufficient and of bad quality and poorly cooked.  

The flour was unfit for human beings to eat.  

Patients were only given bread and coffee, without milk or sugar and at times were given butter during breakfast. For dinner they had tea and soup without meat. The bread was sour, the babies’ bottles were unwashed and the fresh and old milk was mixed and skimmed.  

Some inmates were without bedding and clothing.  

Richard Penn, a policeman and attendant in the insane department testified that he had seen Michael Houten who was in charge of the sixth ward knock over the elderly insane and that Penn was only discharged for complaining while no action was ever taken against Houten.  

The children were rumored to have been drugged or diseased when they could not be kept alive any longer.  

On the night of February 12, 1885, around eight o’clock, a fire broke out in the main building of the Insane Department and nineteen patients died. The Pennsylvania Railroad Company offered one of their vacant depots at Thirty-second and Market Streets as a temporary asylum and was accepted until patients could be send to the State Hospitals.  

In the late 1800’s, advancements in medicine and psychiatry created Blockley into a traditional hospital. A nursing school was opened in 1885. In 1903, operations of the hospital were turned over to the Bureau of Hospitals in the Philadelphia Department of Public Health. In 1906, the insane were moved to the Philadelphia State Hospital. In 1919, Blockley was renamed the Philadelphia General Hospital and slowly replaced with more modern construction.  

In the 1930’s, portions of the hospital were turned into an electrical plant and demolished in the 1970’s, creating a parking lot. 

Shocking Findings 

In 2001, construction began on the location of the parking lot to build a parking garage. Excavations exposed portions of the soil which also exposed graves. Dozens of boxes of autopsied skeletal remains, from cadavers that had been used to train the Almshouse’s medical staff were disposed of in the landfill on property, not far from the cemetery. Fragments, loose bones, and 450 bodies were found and relocated to the Woodland Cemetery.  

If you would like to see photos of the grave, check out this site.

References

First Baptist Church (Philadelphia, Pa.), “Poor book: 1767-1769,” Philadelphia Congregations Early Records, accessed July 19, 2022, https://philadelphiacongregations.org/records/item/ABHS.FBCJoshuaMoorePoorBook1767.

Scharf, J. T. & Westcott, T. (1884). History of Philadelphia: 1609-1884. https://books.google.bj/books?id=w0sOAAAAIAAJ

Stough, M. (1939). THE YELLOW FEVER IN PHILADELPHIA 1793. Pennsylvania History: A Journal of Mid-Atlantic Studies, 6(1), 6–13. http://www.jstor.org/stable/27766332

columbus state hospital
Sarah educational

Comprehensive Mental Health Timeline

An Early Response to Mental Illness

a lunatic in the early nineteenth century chained to a bed and a pipe on the wall in a basement room
a lunatic in the early nineteenth century

The United States has been struggling since its founding to care for its mentally ill. The earliest response to mental illness were to chain inmates to damp underground cells where they were hidden from the public.

Often families were responsible for finding their own solution and would lock their loved ones in a room in their house where they received absolutely no treatment whatsoever.

When the public learned about how many sick people were being mistreated, they were shocked and outraged. Those in charge of their care were limited in their means and ignorant to illness. The government needed to step in and take responsibility.

As we began to see the sick as patients instead of inmates, they were removed from attics, jails, almshouses, etc. and admitted to small hospitals that became overcrowded faster than expected. Professionals drafted treatment plans instead of punishments, and newer, better, bigger institutions designed specifically for the housing and treatment of the mentally ill were constructed.

Given Credit for Trying

historic newspaper clipping from october 23 1918 with the heading saying, "extract teeth, cure insanity." -the richmond virginian newspaper
New Clipping. October 23, 1918. The Richmond Virginian. “Extract Teeth, Cure Insanity.”

By the early twentieth century, although legislation had made some positive changes, terrifying treatments such as lobotomies, sterilization, electro-shock therapy (without the use of a sedative), and tooth extraction (without the use of a sedative) were unnecessarily performed. Fact: Trenton State Hospital’s Superintendent, Dr. Cotton, pulled almost all of his patient’s teeth because cavities were believed to be the cause of their psychosis. Let’s just say, cavities weren’t the only infection unnecessarily removed and most of the patients died after their operation. (This article will tell you all you need to know).

News Clipping. July 24, 1920. The New York Tribune. “Woman is Made Sane by Removal of Teeth.”

Oddly enough, one of the very first patients this procedure was tried on, was made completely sane after the removal of her front teeth; even though she murdered her own child.

Esther Miller Blake, a Philadelphia real estate operator, was sent to the State Hospital at Trenton after she threw her son, Buddy, from the Ventnor pier. With the removal of her teeth and an injection of a “special serum,” (possibly the antistreptococcous serum) she was healthy enough to go back into society. The newspaper reads that the unknown physicians were “confident a permanent cure would be effected.” The unknown physicians were probably none other than Dr. Cotton and his colleagues.

If you can’t tell, there’s some subtext of criticism and mockery. I mean, come on – how can a woman who commits a crime so horrendous, suddenly become sane over night with the removal of a few bad teeth? It’s not possible. Of course, we know this now. But, back in the 1920s, even though absolutely no scientific data was extracted from these procedures, they made it seem like it was a cure to insanity and forced it upon maybe of their patients with great praise from the public. Similarly, the lobotomy emerged like this and was given the same praise and push.

By the time psychiatric medication was discovered (chlorpromazine), a noticeable change in the demeanor of patients was seen. Pharmaceuticals were on the rise and barbaric treatments lessened. (a timeline of psychiatric medication). But there was a stigma to mental illness that never went away, and the large institutions were once again overcrowded, under-funded and poorly staffed.

Terrible Conditions Re-emerge

Most of the patients never communicated with their families and were treated terribly by the staff. Patients were neglected, abused, experimented upon, etc. The hospitals once built to resolve the over-population were once again heavily populated and under-staffed. No one knew how to properly care for this many people, let alone one single person. The staff was usually poorly trained, underpaid, and overworked. Patients would sit naked in their own filth, were strapped to beds and chairs, and/or walked in circles with nothing to occupy themselves with. Roland Johnson, a former patient at Pennhurst State School and Hospital, was forced to do the work of the staff because he was able-bodied, and they were short staffed. He also claimed that at night, he would be sexually abused. “They did awful things to me,” he said. Johnson eventually discovered that he was HIV positive (Rifkin, 2020).

There’s always more to learn, but the following is a basic timeline of major events that impacted the evolution of mental health care in the United States.

18th Century

  • 1713 – The Friends Almshouse was constructed in Philadelphia.
  • 1732 – The Philadelphia Almshouse was constructed. This would later be known as the Philadelphia General Hospital.
  • 1751 – The Pennsylvania Hospital in Philadelphia was constructed. They admitted a small population of patients with mental illness, but this population was greater than most hospitals and almshouses.
  • 1767 – The Philadelphia Bettering House was constructed.
  • 1773 – The first patient is admitted to the Public Hospital for Persons of Insane and Disordered Minds in Williamsburg, Virginia.

19th Century

  • 1827 – Louis Dwight, a congregationalist minister in Massachusetts, was shocked by the conditions of mentally ill prisoners when he began taking bibles to prisoners in jails.
  • 1827 – the state investigated and said the confinement of mentally ill persons in jails in to be made illegal and to transfer current inmates to hospitals.
  • 1835 – The patients from the Philadelphia Almshouse were moved to the Blockley neighborhood of Philadelphia where a four-building “hospital” was built. One of those buildings was an insane asylum. It was later named Philadelphia Almshouse and Hospital, then just simply known as Blockley. In 1919, it was renamed the Philadelphia General Hospital.
  • 1841 to 1842 – Dorothea Dix visited every jail in Massachusetts and documented the mistreatment of mentally ill prisoners. She presented her findings to the state legislature.
  • 1847 – Dorothea Dix had visited 300 county jails and 18 state prisoners. Her efforts are why we began building State Hospitals.
  • 1850 – There was 1 psychiatric bed available for every 5,000 people.
  • 1864 – The female building at Blockley burns down.
  • 1880 – Less than 1% of mentally ill persons were incarcerated.
  • 1887 – On assignment for New York World, Nellie Bly feigns lunacy in order to be admitted to the Women’s Lunatic Asylum on New York’s Blackwell’s Island. Her exposĂ©, “Ten Days in a Mad-house,” detailing the appalling living conditions at the asylum, leads to a grand jury investigation and needed reforms at the institution.

20th Century

  • 1907 – Indiana is the first of more than 30 states to enact a compulsory sterilization law, allowing the state to “prevent procreation of confirmed criminals, idiots, imbeciles and rapists.” By 1940, 18,552 mentally ill people are surgically sterilized.
  • 1936 – Dr. Walter Freeman and his colleague James Watt perform the first prefrontal lobotomy. By the late 1950s, an estimated 50,000 lobotomies are performed in the United States.
  • 1938 – Italian neurologist Ugo Cerletti introduces electroshock therapy as a treatment for people with schizophrenia and other chronic mental illnesses.
  • 1939 – Lionel Penrose called the relationship between jails and hospitals the “balloon theory” – push in on one side and the other side bulges out.
  • 1942 – George Elder was taken to Byberry for hitchhiking and an expired draft card. He was released 26 years later and 5 months later, he checked himself back into Byberry because he felt he was too institutionalized to cope with the world.
  • 1946 – President Harry Truman signs the National Mental Health Act, calling for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems.
  • 1947 – Joseph P. Kennedy Jr. Foundation.
  • 1950 – State and county mental hospitals housed approximately 48,000 people with developmental disabilities.
  • 1954 – Marketed as Thorazine by Smith-Kline and French, chlorpromazine is the first antipsychotic drug approved by the Food and Drug Administration. It quickly becomes a staple in asylums.
  • 1955 – There are 560,000 people in state hospitals.
  • mid 1950s – Governor Goodwin Knight began the emptying of State Hospitals.
  • 1957 – Eunice Kennedy Shriver directs the foundation.
  • 1958 – The Special Olympics was founded.
  • 1960 – Governor Edmund “Pat” Brown continued the emptying of State Hospitals.
  • 1962 – JFK establishes the National Institute of Child Health and Human Development to research intellectual disabilities
  • 1962 – The decision of the United States Department of Health, Education, and Welfare (DHEW) made financial aid available to former state hospital patients under the Aid to the Permanently and Totally Disabled program, which is now known as a Social Security Income under the Social Security Act. It was intended to support patients in community settings and offered a stimulus to private business owners who offered room and board to the mentally ill.
  • 1963 – President John F. Kennedy signs the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities. Between the Vietnam War and an economic crisis, the program was never adequately funded.
  • 1965 – With the passage of Medicaid, states are incentivized to move patients out of state mental hospitals and into nursing homes and general hospitals because the program excludes coverage for people in “institutions for mental diseases.” Nursing homes were less expensive, and they often underreported psychiatric conditions.
  • 1967 – The California Legislature passes the Lanterman-Petris-Short Act, which makes involuntary hospitalization of mentally ill people vastly more difficult. One year after the law goes into effect, the number of mentally ill people in the criminal-justice system doubles.
  • 1970 – It had become evident that deinstitutionalization resulted in an increase in the number of mentally ill in jails and prisons.
  • 1972 – Marc F. Abramson, a jail Psychiatrist from San Mateo County, California, published a study reporting a 36% increase in mentally ill prisoners in county jails and a 100% increase in mentally ill persons judged incompetent to stand trial.
  • 1972 – Marc F. Abramson published The Criminalization of Mentally Disordered Behavior: Possible Side-Effects of a New Mental Health Law.
  • people with serious mental illnesses being criminalized.
  • 1973 – San Joaquin county Sheriff said, “a good deal of mental illness is now being interpreted as criminality.”
  • 1975 – The Education for All Handicapped Children Act (EAHCA) allocates federal money to states for the education of children with disabilities in the “least restrictive environment,” and preferably integrated into a public school. The act is renamed the Individuals with Disabilities Education Act (IDEA) in 1990.
  • 1977 – There are 650 community health facilities serving 1.9 million mentally ill patients a year.
  • 1980 – President Jimmy Carter signs the Mental Health Systems Act, which aims to restructure the community mental-health-center program and improve services for people with chronic mental illness.
  • 1980 – Gary Whitmer, a San Franciscan social worker, published a study of “500 defendants in need of psychiatric treatment.”
  • 1980 – a Philadelphia newspaper headline read, “Keeping the Maniacs off the Streets.” It told the story of James Jimbo Willis, whose story fueled anxiety about mental illness, especially at a time when crime was the city’s number one priority.
  • 1981 – Under President Ronald Reagan, the Omnibus Budget Reconciliation Act repeals Carter’s community health legislation and establishes block grants for the states, ending the federal government’s role in providing services to the mentally ill. Federal mental-health spending decreases by 30 percent.
  • 1982 to 1983 – Dr. Richard Lamb and his colleagues published 2 studies of mentally ill inmates in the Los Angeles county jail and cited multiple other studies indicating that the problem of mentally ill patients in jails and prisons was getting worse.
  • 1983 to 1984 – Dr. Linda Teplin from Chicago’s Cook County Jail cited that 6.4% of her the inmates had a mental illness.
  • 1984 – An Ohio-based study finds that up to 30 percent of homeless people are thought to suffer from serious mental illness.
  • 1985 – Federal funding drops to 11 percent of community mental-health agency budgets.
  • 1989 – The number of persons with development disabilities living in state hospitals declined by 97% to only 1,605 persons.
  • 1990 – Clozapine, the first “atypical” antipsychotic drug to be developed, is approved by the FDA as a treatment for schizophrenia.
  • 1992 – Based on a jail survey sent to 3,353 institutions in the United States, the average number of mentally ill was 7.2% (based on usable data from 1.391 replies).
  • 1994 – There are 71,619 mentally ill patients.
  • 1996 – the United States has spent more on corrections than it did on social welfare programs like food stamps and welfare grants.
  • 1998 – the United States Department of Justice issued a study reporting 16.3% of inmates in jails are mentally ill and 16.2% in state prisons.

21st Century

  • 2000 – the American Psychiatric Association estimated that roughly 20% of prisoners were mentally ill.
  • 2002 – the National Commission on Correctional Health Care said 17.5% of inmates in state prisoners were severely mentally ill and are placed in isolation.
  • 2004 – Studies suggest approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people. This year, there are about 100,000 psychiatric beds in public and private hospitals. That means there are more three times as many seriously mentally ill people in jails and prisons than in hospitals.
  • 2005 – There is 1 psychiatric bed for every 3,000 persons.
  • 2006 – the Department of Justice issued a survey reporting that 24% of jail inmates were mentally ill and 15% of prison inmates were mentally ill.
  • 2008 – 1.6% of persons with developmental disabilities are living in state hospitals.
  • 2009 – a survey among 822 jail inmates determined 16.6% of prisoners met the criteria for mental illness.
  • 2009 – In the aftermath of the Great Recession, states are forced to cut $4.35 billion in public mental-health spending over the next three years, the largest reduction in funding since deinstitutionalization.
  • 2009 – President Obama declared 2009 as the “Year of Community Living”, which also celebrated the ten year anniversary of the Olmstead Act in 1999.
  • 2010 – There are 43,000 psychiatric beds in the United States, or about 14 beds per 100,000 people – the same ratio as in 1850.
  • 2015 – 3 bioethicists from the University of Pennsylvania published a paper saying how deinstitutionalization shifted people from hospitals to carceral institutions such as prisons. They called for the return of rehabilitative institutions like asylums to treat people. It was highly controversial and received a lot of criticism. They said the older institutions are in need for a revival. They were looking for a solution to the prison problem.

Reference

Rifkin, G. (2020). Overlooked No More: Roland Johnson, Who Fought to Shut Down Institutions for the Disabled. The New York Times. Retrieved from https://www.nytimes.com/2020/07/31/obituaries/roland-johnson-overlooked.html

willowbrook photograph
Sarah educational, video

New York’s Willowbrook State School

Willowbrook State School opened in 1947 by the New York State Department of Mental Hygiene. It had multiple brick buildings on 300 acres of Staten Island. In 1972 there were 6,000 residents, which meant it was 2,000 over capacity.

vintage photograph of willowbrook state school's administration building (retouched)
Willowbrook State School Administration.

Human Experiments

Saul Krugman was an infectious disease expert at NYU. He used mentally deficient children at Willowbrook State School to show that hepatitis A and hepatitis B are distinct diseases. In 1974, the National Research Act was signed into law. It created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The results of the studies are published in The Willowbrook Letters: Criticism and Defense. (1)

Advocacy

new york's willowbrook state school children laying on beds with wheels in a black and white photograph
Willowbrook State School adolescent patients

Donna J. Stone, an advocate for mentally disabled children and member of the Association for Retarded Children, gained access to the school. Stone posed as a social worker so she could walk around undetected. When she was finished with her self-guided tour, she shared her harrowing observations with the press.

Jane Kurtin was the first reporter to write a story about Willowbrook. Kurtin attended a demonstration and met 2 social workers. Their names were Elizabeth Lee and Ira Fisher and they brought her inside the building.

Sen. Robert F. Kennedy shocked us all and showed up to the hospital unannounced in 1965. Kenndy was shocked by what he saw and said, “I’ve visited the state institutions for the mentally retarded, and I think particularly at Willowbrook, we have a situation that borders on a snake pit.”

Senator Robert F. Kennedy at Willowbrook State School, 1965.

In 1971, a mother named Victoria Schneps Yunis, whose daughter was a resident of Willowbrook’s infant rehabilitation ward, organized a picket-line to protest deplorable conditions and budget cuts.

When Dr. Michael Wilkins was fired from his position at Willowbrook State School, he wanted to blow the whistle on the school. He gave his employee key to Geraldo Rivera who accessed the building. On February 2nd, 1972, from 7:30 to 8:00 p.m., WABC-TV aired a 12-minute exposĂ© by Rivera who managed to sneak in a camera. It was shocking for viewers to see. “It smelled of filth – It smelled of disease, and it smelled of death,” Rivera said. The documentary is called “Willowbrook: The Last Great Disgrace.” It earned a Peabody Award along with a public and political outcry.

Willowbrook: The Last Disgrace, 1972.

David Rothman, Professor of Social Medicine and History at Columbia University, published The Willowbrook Wars, which he coauthored with his wife Sheila Rothman. Rothman also published the controversial book, The Discovery of the Asylum, which tells a factual story about the history and origins of the asylum and prison systems of the United States in the eighteenth century.

Lawsuits & Closure

Thankfully, the New York Civil Liberties Union and the Legal Aid Society filed class-action lawsuits in 1972 which led to the landmark 1975 Consent Decree under U.S. District Judge John Bartels. This settlement would implement some much-needed guidelines and requirements for operating the institution and the care of its residents, which would be cut to 250 beds. The federal Civil Rights of Institutionalized Persons Act of 1980 was also passed. This Act reinforces the rights of residents in state or local correctional facilities, nursing homes, mental health facilities and institutions for people with intellectual and developmental disabilities.

“Willowbrook: If they cause trouble, cage them…”

Despite this ruling, the parties would see each other in court several more times until Gov. Mario Cuomo ordered the school’s closure in 1984 when the population was 1,000. Just 1 year later, the population would have shrunk to 250. Willowbrook officially closed its doors on September 17, 1987, after its last 30 residents were transferred to other facilities.

Miscellaneous Facts

The school was the first of the state’s seven developmental centers to close.

The institution was built in 1942 but was taken over by the federal government and used as a hospital for returning World War II veterans.

The facility opened as a State Hospital on April 1, 1951.

In 1993, the Willowbrook Permanent Injunction was signed which represents the current standard of services for class members. The 380-acre site is now rededicated for use as a college campus and the New York State Institute for Basic Research in Developmental Disabilities.

For more publications, pamphlets, and images see A Guide to Willowbrook Resources.

I think that at the state institution for the mentally retarded, and I think that particularly at Willowbrook, we have a situation that borders on a snake pit, and that the children live in filth, that many of our fellow citizens are suffering tremendously because lack of attention, lack of imagination, lack of adequate manpower. There is very little future for these children, for those who are in these institutions. Both need a tremendous overhauling. I’m not saying that those who are the attendants there, or who run the institutions, are at fault – I think all of us are at fault and I think it’s just long overdue that something be done about it.
—Sen. Robert F. Kennedy

Citations

(1) Valdés, E. (2021). Biolaw: Origins, Doctrine and Juridical Applications on the Biosciences. Germany: Springer International Publishing. L-G-0016153483-0054423980.pdf (e-bookshelf.de).

Sarah byberry, educational, time machine

July 13th 1958

TIME MACHINE

‘Just Snack,’ Cook Calls Stolen Food – The News and Courier

PHILADELPHIA (AP) – “I was just going home to fix a snack,” Wainwright McJetters told police at dawn Saturday when they stopped him for passing a red light.

Inside the car were 60 lemons, 20 pounds of ham, 100 pounds of sugar, 12 pounds of coffee, 15 pounds of assorted cuts of beef, 144 eggs, 100 pounds of potatoes and 20 pounds of macaroni.

McJetters finally told police he was a cook at the Philadelphia State Hospital – and the food belonged there.

He was jailed on a charge of burglary and receiving stolen goods.

Source

Sarah byberry, educational, time machine

June 9th 1975

TIME MACHINE

Body Found in Air Duct at Hospital – Observer-Reporter

PHILADELPHIA (AP) – Authorities at Philadelphia State Hospital at Byberry are trying to determine how Mary Ann McGrath, a patient, whose body was found in a heating duct, got into an area that is usually locked and inaccessible to both staff and patients.

The 32-year-old woman had been missing for nine months before maintenance men found her body Friday. Miss McGrath had been at the hospital since she was 13. She was described as being retarded.

Source

Sarah educational

1717 Philly

In 1717 Philadelphia, those who commit a felony who could not read were hanged on the corner of 3rd and High Street (Market Street). Those who commit a felony who could read fell under the Benefit of Clergy, sent before a Church Court, and branded with an ‘M’ for murder or ‘F’ for felony at the base of their thumb.

It is the voice of ages that are gone, They pass before me with all their deeds
-Ossian

Joyce, John St. George. The Story of Philadelphia. Philadelphia, 1919