a Kirkbride hospital were each twenty feet square. Patient bedrooms were kept small enough (about a hundred square feet) so that their dimensions would not encourage placement of two patients in the same room:
The single chambers for patients should be made as large as can be well brought about, provided their dimensions are not so great as to lead to two patients being placed in the same room, which ought not to be allowed. Nine feet front by eleven feet deep will probably be adopted as the best size, although eight by ten is admissible, and has the advantage that when not larger than this, two patients are not likely to be put into one room. If the rooms are larger, this is almost certain to be done whenever a hospital becomes crowded, and it is really never either proper or safe, to have two insane patients sleep in the same room without an attendant in it, or in an adjoining one. Great convenience will be found in having in each ward at least one chamber of the size of two single rooms, for the use of a patient with a special attendant, or in cases of severe illness.19
Compassionate, supportive treatment of those with mental illness was a sea change, a manifestation of the great Victorian impulse to provide systematic, decent public care for vulnerable individuals—those with mental illness, orphans, the poor, and persons in need of medical care.20 The nineteenth century in America ushered in a national outpouring of support for social institutions: medical hospitals, mental hospitals, universities, public schools, penitentiaries, YMCA and YWCAs, the Red Cross, orphanages, settlement houses, schools for blind persons, and schools for deaf persons. This groundswell of support rose in response to the needs of family, community, and industry. With postwar industrialization, the decline of an agrarian economy, and the rise of cities, asylums and other institutions were expected to serve a humanitarian function and also to provide a measure of social stability. By today’s standards, this charity movement led by social reformers, many of them women, was paternalistic, selective, and moralistic. Many of the major community institutions in America today were invented in the nineteenth century to bring order to or meet social needs created by industrialization and urbanization of American life.21 Orphanages, libraries, public schools, colleges and universities, health clinics, penitentiaries, parks, hospitals, and asylums for those with mental illness were among the institutions developed by states working with networks of community organizations and social reformers to alleviate poor living conditions in nineteenth-century American towns and cities.
Discussion among asylum scholars, former asylum patients, historians, and sociologists about the role and function of asylums has historically been dominated by debates about whether asylums were built to serve a humanitarian purpose or to act as an instrument of social control. Andrew Scull has recentered the hundred-year debate by describing asylums as a means for reinforcing social conformity while acknowledging the very real needs experienced by families attempting to cope with mental illness.22
FIGURE 1.4 Front entrance to the administrative wing in the central part of the asylum. The photograph was taken before the portico was added in 1892. Courtesy of the Mahn Center for Archives and Special Collections, Ohio University Libraries.
The movement for humanitarian care and public services blossomed in Ohio in the mid-nineteenth century, a response to the humanitarian impulse and the needs of a rapidly industrializing state. Across Ohio, public schools were established, libraries were begun, institutions were founded to serve orphans and persons with physical disabilities, and state hospitals were established for those with mental illness. Ohio built five Kirkbride hospitals in the nineteenth century, more than any other state except Massachusetts, which also had five. Ohio was the second state (after Massachusetts) to establish a Board of State Charities to provide oversight over Ohio’s state benevolent and correctional institutions. Charged with investigating and reporting on the condition of state benevolent and correctional institutions, the board, whose members served without compensation, was an advocate for persons with mental illness. The board routinely investigated complaints about asylums and documented conditions for the mentally ill who resided in jails or county infirmaries or, in some tragic cases, were kept naked in barnyards or locked in family basements. Governor Rutherford B. Hayes praised the board’s efforts, noting that “they have faithfully performed the thankless task of investigating and reporting the defects in the system . . . of our charitable and penal laws.”23
The Athens Lunatic Asylum was the last built of Ohio’s Kirkbride hospitals. Its architecture reflected its dedication to the national moral treatment experiment. Featuring a central section with a two long stepped-back wings, the asylum had three levels with a central administrative core of four levels, an attic, and a cellar. Male patients were housed in the east wing, women in the west wing. The central section housed offices and living quarters for professional staff, storerooms, visiting rooms for patients to receive visitors, a parlor, and a ballroom. The original structure (completed in 1874) contained 544 rooms. Patients were housed in 450 rooms; the asylum was designed to accommodate 252 patients in single bedrooms and an additional 290 in dormitory-style rooms. Food was transported from the kitchens along a small basement railroad and lifted upstairs by dumbwaiters to individual wards. The facility was heated by six coal-fired steam boilers in a separate rear building.24
FIGURE 1.5 Map of Athens, Ohio (1875), showing the location of the asylum southwest of the Hockhocking River. The asylum is labeled “S.E. Ohio Hospital for the Insane.” The South Bridge, northeast of the hospital, connected the village and the asylum. Originally published in D. J. Lake, Atlas of Athens County, Ohio. Courtesy of the Mahn Center for Archives and Special Collections, Ohio University Libraries.
The site, which eventually encompassed over a thousand acres, began in 1867 with 150 acres on a bluff across the Hockhocking River from Athens. Eighteen and a half million bricks used for construction of the huge building were made by hand on the site using clay from the asylum’s grounds. Its hundreds of windows featured protective bars disguised as ornate wrought iron circles. The asylum was “situated upon a high plateau of land about a mile distant from the town of Athens, the river Hockhocking winding in its circuitous course through the valley between the asylum and town. The farm belonging to it comprises about one hundred and fifty acres, broken in its surface, somewhat wooded.”25
FIGURE 1.6 Map of Ohio University (1911) showing the South Bridge, northeast of the hospital, connecting the village of Athens and the asylum. In 1889, the asylum and the village collaborated to build Hospital Street (upper left) to provide paved access to the train depot. The road was built entirely by asylum employees and patients on right-of-way acquired by the village. Fred Lee Tom, topographic map of Ohio University and vicinity (hand-drawn map, 1911), used with permission courtesy of Fred C. Tom. Courtesy of the Mahn Center for Archives and Special Collections, Ohio University Libraries.
Humanitarian Need and Social Control
On New Year’s Day in 1874, the asylum opened its doors to patients, six months later than had been planned. Built to care for 542 patients, within six years it housed 633 patients from twenty-nine counties in southeastern Ohio, as well as “overflow” patients from Columbus State Hospital, which was destroyed by fire in 1868. Rebuilt along the Kirkbride plan, the Columbus asylum reopened in 1877, relieving some of the crowding at Athens. From its beginning, though, the asylum at Athens was built to accommodate twice the number of patients recommended by Kirkbride: “Two hundred and fifty will be found about as many as the medical superintendent can visit properly every day, or nearly every day, in addition to the performance of his other duties.”26
Patients came from all walks of life. Most of the men were farmers from southeastern Ohio. There were also miners, machinists, railroad hands, school superintendents, schoolteachers, physicians, lawyers, engineers,
