48 the PENNSYLVANIA GAZETTE Jan|Feb 2018 48 THE

Of Benefi cent Buildings and Bedside Manners 48 THE PENNSYLVANIA GAZETTE Jan|Feb 2018 Thomas S. Kirkbride M1832 wrote the book— literally—on the housing and treatment of the mentally ill in the 19th century. BY JOANN GRECO Jan|Feb 2018 THE PENNSYLVANIA GAZETTE 49 alking along Philadelphia’s Race Kirkbride called the chance meeting Street one summer day in 1840, “one of those incidents that seem be- Thomas Story Kirkbride M1832 yond the control of men, and which happened to encounter a friend changed the whole course of my life.” It who was on the Board of Manag- certainly had a profound eff ect on the Wers of Pennsylvania Hospital. His inter- course of mental health treatment over locutor relayed news of a position about much of the 19th century, as Kirkbride’s to open at the prestigious institution. At ideas shaped the construction and man- fi rst, the young physician assumed this agement of hospitals for the insane must be the post of attending surgeon across the country, leaving behind as at the hospital, which (as he later wrote) well a rich architectural legacy that, af- he had coveted as “one of the most hon- ter decades of neglect, is at last being orable and useful that could be held by preserved and turned to fresh uses (see any individual.” Kirkbride had been page 53). Kirkbride’s long tenure as the given to understand—by the incumbent head of the Hospital for the Insane of Thomas Story Kirkbride surgeon, no less (John Rhea Barton, for the nation’s oldest medical institution, whom Penn’s fi rst endowed professor- along with his infl uential writings, have ship in surgery was named)—that he assured him a permanent place among “should be the successful candidate” “He was fi gures to be reckoned with by any stu- upon Barton’s resignation from the post, dent of the history of treating mental which had recently been announced. illness or early American medicine. But to Kirkbride’s surprise, his friend instrumental in Tomes—now a SUNY Distinguished had in mind another proposal entirely, Professor of History at Stony Brook Uni- asking instead “with apparent interest, advancing the versity—fi rst encountered the ground- what would induce me to go over the breaking physician in the course of her river, to take charge of the new Hospital doctoral research in Penn’s history de- for the Insane,” which Pennsylvania idea that the partment. She views his legacy as three- Hospital had recently established in fold: “Along with a few other contempo- West Philadelphia. insane deserved raries, he was instrumental in advanc- Although he wrote that his “profes- ing the idea that the insane deserved sional friends regarded such a change care and not disdain or fear or curiosity,” in my plans as ill-advised,” since surgical care and not she says. “Secondly, the treatise he de- openings were rare, Kirkbride was veloped on the design of mental institu- tempted by the fact that the asylum post disdain or fear tions, which came out of these beliefs, off ered the “opportunity of starting a infl uenced asylums for years to come; new institution, and developing new and fi nally, there’s the fact that he was forms of management, in fact giving a or curiosity.” one of the founders of what became new character to the care of the insane, known as the American Psychiatric As- and possibly securing for myself a repu- sociation,” the Association of Medical tation as desirable as that which I might Kirkbride’s wife, the former Ann Jenks, Superintendents of American Institu- obtain by remaining in the city.” wasn’t keen on the idea of a surgical ca- tions for the Insane (AMSAII). Historian Nancy Tomes Gr’78, author reer, either, fearful of the long hours Tomes, who won the 2017 Bancroft of The Art of Asylum-Keeping: Thomas away from home that the job would en- Prize in American History and Diplo- Story Kirkbride and the Origins of tail, while the care of the Hospital for the macy for Remaking the American Pa- American Psychiatry, lays out the terms Insane would be sure to keep him some- tient: How Madison Avenue and Modern of his dilemma. “Surgery was growing where on its premises. Kirkbride’s par- Medicine Turned Patients into Consum- into a prestigious specialty, and the de- ents, too, were on board, favoring “my ers, has a personal fondness for the good cision wasn’t easy for him,” she explains. accepting this new offi ce as being a cer- doctor, too. “I owe him my tenure,” she “He had always been frail, though, so tainty in place of an uncertainty.” And the says with a laugh. “As part of my re- ultimately he feared that he didn’t have position promised “a comfortable resi- search, I was taken to the West Philly the stamina for surgery.” dence [and] a rather liberal salary.” hospital, and as I dug through boxes and 50 THE PENNSYLVANIA GAZETTE Jan|Feb 2018 Portrait by Howard Russell Butler boxes of archival material, it became own practice. Dubbed the “moral treat- so as a teenager, he was set early on a clear that Kirkbride was the star. Those ment,” this approach had been devel- path that would lead to that career. materials became my doctoral disserta- oped independently in France—where Kirkbride wrote of his education that tion, which turned into the book, which the physician Philippe Pinel experiment- his father was his fi rst teacher, and he started me on my path.” ed with releasing the insane from their then attended local schools for several And a star he was. Kirkbride took up his shackles and straitjackets—and in Eng- years: “2d, Morrisville; 3d, Fallsington, post as superintendent of Pennsylvania land by the Quaker William Tuke, who three miles distant, often walking in both Hospital’s asylum on January 1, 1841, and believed that if the insane were treated directions.” For four years, he received a served until his death, shortly before mid- as friends and brethren, they would classical education at a Trenton, New Jer- night on December 16, 1883. In a com- start acting like friends and brethren. sey, school run by “the Rev. Jared D. Fyler, memorative volume issued by the AM- “The patients’ minds were to be con- a very accomplished scholar, and a teach- SAII—which includes a “Memoir” mostly stantly stimulated by amusements such er of rare ability,” and followed that up written in the third person relating Kirk- as games, lectures, and parties [and] with a year in “the study of the higher bride’s life story but incorporating numer- regular physical exercise would tone mathematics, under the care of John Gun- ous direct quotes as well, including those their bodies and calm their minds,” mere, at Burlington, New Jersey.” above—it was noted that his 42-year ten- writes Tomes. “If moral measures were He then spent the better part of a year ure proceeded “without suggestion or carefully and diligently implemented,” on his father’s farm, “in the practical pur- thought, either on the part of the Manag- she summarizes Tuke and Pinel’s conclu- suits which I felt in later years to have ers of the Hospital or the public, that a sions, “no restraint or harsh treatment been a permanent advantage to my more effi cient or faithful administrator of would be needed to control the insane.” health”—an appreciation of the benefi ts the duties of this important place could Kirkbride would never advocate the of outdoor activity that would inform his be found.” The board also resolved, with complete lack of restraint—indeed, he treatment ideas. He took a special interest no small fl ourish, that Kirkbride’s works wrote in his 1877 report to the hospital in his father’s herd of sheep, he added, and contributions to the subject of insan- board, “It is an error leading to wrong and “became so familiar with them as to ity “entitle him to rank very high among popular impression, to speak of any hos- recognize them by their physiognomy.” the benefactors of his race.” pital for the insane as being conducted At age 18, Kirkbride entered into a without restraint. There is no such thing, brief apprenticeship with Nicholas Bel- espite Kirkbride’s initial reported and cannot be,” noting that even control leville, an old-school physician—in Kirk- doubts, it wasn’t entirely out of left of the “gentlest kind” constitutes some bride’s accounting, he’d come to Amer- fi eld that the hospital board would form of restraint. But his whole approach ica originally with Lafayette’s forces at D have thought of him to head its new was aimed at limiting such restraints the time of the American Revolution, asylum. While serving a two-year term through the design of the physical envi- but was so seasick on the voyage that he as resident physician at Pennsylvania ronment and by keeping patients use- never made the return trip to France— Hospital before opening his own medi- fully occupied. Sounding a note that runs with connections to Philadelphia medical practice on Arch Street, he had had through all his writings, he added, “The cal pioneers Thomas Bond, Benjamin “opportunities of studying the subject only persons who can properly decide Rush, and Phillip Syng Physick. of mental disorders in the department just how far restrictions shall be carried, In 1828, Kirkbride gained admission to of that Hospital which, for eighty years, and freedom be granted in an institution, the University of Pennsylvania, where he had been specially set apart for that are its medical offi cers.” “learned a much milder course of thera- class of disorders,” as the “Memoir” puts peutics than that advocated by his precep- it.

Load more