By Emily Ruckel, M.A. Public/Applied History
January 6, 2013 marked the 125th anniversary of the Toledo State Hospital (TSH), now known as the Northwest Ohio Psychiatric Hospital. The last 125 years have witnessed many changes including various names, buildings that have come and gone, shifting philosophies of insanity, and a variety of treatment methods and applications. Although it has seen many changes, since 1888 the hospital has consistently provided mental health care to patients.
The Toledo Asylum for the Insane: The Answer to Ohio’s Overcrowded Asylums and Infirmaries (1883-1884)
The hospital initially opened its doors to patients as The Toledo Asylum for the Insane. At the time, Ohio already operated five so-called “insane asylums” including institutions in Cincinnati, Columbus, Cleveland, Dayton, and Athens; however these facilities were not adequate to provide enough space for the number of identified insane people within the state.[1] In 1882 the 7th Annual Report of The State Board of Charities to the Ohio State General Assembly called for “additional accommodations for at least one thousand insane” to reduce the overcrowding in the county infirmaries and existing five state run asylums, as well as those being housed in jails and at home.[2] As a result, in April 1883, the Ohio General Assembly passed House Bill 909 “to provide for additional accommodations for the insane of the state.”[3] The bill created a commission charged with determining and implementing plans for either the expansion of current state asylum facilities or selecting a new site. Further, the bill determined a budget of $500,000 to complete the project. Section five “authorized and empowered” the Commissioners of any county in Ohio to “sell or donate and convey to the state, for asylum purposes, any lands owned by their respective counties.”[4]
On October 17, 1883, Lucas County Commissioners answered that call. They proposed and passed a motion to donate “150 acres of the Infirmary Farm to the State of Ohio for the purpose of erecting thereon an Insane Asylum…”[5] In late 1883, “after much deliberation” the state appointed commission accepted the land donation by Lucas County. The land was rurally located, yet near a major city, ideally suitable to farming with an “even surface” containing dry soil that could be “brought to a high state of cultivation” and its proximity to Swan Creek “afford[ed] ample means for perfect drainage.”[6] Although these features may appear to be minimally important, they were truly the foundation of any 19th century asylum. Form and the function of the facility went hand in hand, with the asylum being the physical embodiment of the psychiatric concepts of the day. Gerald Grob writes that the “ideal hospital had to begin with the selection of an appropriate site located outside a populated urban area, but accessible by trains and roads. Such features as good drainage, an abundant water supply and fertile land were important.” [7] He continues that these features were not just important because they provided function and usefulness to an operational asylum, but also because they provided patients with opportunities both to work and to live in a peaceful, aesthetically pleasing atmosphere.
Drawing from Thomas Krikbride's 1854 book "On the Construction, Organization, and General Arrangements of Hospitals for the Insane"
In addition to selecting the location, the state commission determined the asylum’s architectural design.[8] The five existing Ohio state hospitals, as well as the majority of other asylums across the country, followed the Kirkbride, or congregate plan. The Kirkbride plan, named for Thomas S. Kirkbride, was a linear building design that contained both administrative functions and patient care within one facility. The staff dorms and administrative tasks were contained in the central portion of the building and the patients were housed in wings that extended from both sides of the center building.[9] The design, location, and features of a Kirkbride facility were created with moral treatment in mind which included providing adequate space for patients, treatment areas, and a pleasant, rural atmosphere. During the latter part of the nineteenth century the approach to treating mental health patients continued to change as did the architectural design of institutions. Toledo’s Asylum for the Insane would be the first built completely upon the detached ward, or “cottage” plan. The Second Annual Report of the Toledo Insane Asylum discussed the benefits of the cottage plan as providing a way to sequester and classify patients in detached buildings rather than all under one roof. Additionally, trustees contended that the cottage plan was more humane and therapeutic, compared to the Kirkbride plan and allowed more flexibility as “the capacity of this institution can be increased at any time.”[10] Further, the detached plan provided patients with more independence and a more “social atmosphere.”[11] (Image of Kirkbride Plan - [12])
Cottages at Toledo Asylum for Insane
The story of TSH reflects larger historical trends. The mid to late 19th century gave rise to wide-spread, state operated, specialized institutionalization including hospitals for epileptics, feeble minded, and insane, schools for the deaf and blind, as well as orphanages and penitentiaries.[13] TSH was one, among many institutions built during 19th century within the state of Ohio and across the country to provide treatment for rising populations of the insane. At the same time, TSH is a unique example within this history as the first such asylum built completely on the detached ward or “cottage” plan. Hospital planners designed TSH, both physically and conceptually, based upon a humanistic treatment approach incorporating and implementing the advancing notions of insanity, therapeutic treatment, and humane care for asylum patients. (Image - "Scene at Toledo Asylum for Insane"- [14]
Locally, the state appointed commission organized a Board of Trustees to oversee the construction. By early 1884, the plans for the Toledo Asylum for the Insane were well underway. Trustees projected that the new and innovative hospital would begin accepting patients in 1886, however, construction delays and changes to the original plans caused the hospital opening to be delayed many months.
Endnotes
[1] Archival Search at OHS - Longview Hospital in Cincinnati Ohio, Columbus State Hospital, Cleveland State Hospital, Dayton State Hospital, and Athens State Hospital, http://collections.ohiohistory.org/starweb/l.skca-catalog/servlet.starweb.
Toledo Asylum for the Insane: The plans expand (1884-1887)
In early months of 1884 progress and planning were well underway for the new Toledo Asylum for the Insane. By January 10, 1884, thirty bids for the erection of the Asylum buildings were received and under review. The Governor-appointed Board of Trustees elected a Board President, George L. Johnson and Secretary J.W. Nelson on February 11, 1884.[1] The initial construction timeline projected a completion date of October 1886, however the job would face a number of setbacks that would eventually delay the opening of the Asylum until January of 1888.
The first of many delays occurred early on when the validity of the initial building contract awarded to Miles, Cramer, and Horn was questioned. Consequently, the Board was required to re-file all appropriate paperwork with the Auditor and once again accept bids for construction. By June of 1884 the second round of bids collected totaled to forty-four.[2] Within the next month, a contract was signed with Michael J. and William Malone for a sum of $441,163.92 and the architects E.O. Fallis of Toledo and JW Yost of Columbus were selected for the job.[3]
Initially, section four of House Bill 909 required that any new facility should accommodate a “… capacity of not less than six hundred and fifty inmates”[4] However, the 1882 Board of State Charities report confirmed that over 1100 people entitled to State care were currently housed in county infirmaries and jails. The report classified 166 as violent and dangerous, 217 as filthy and requiring constant care, 147 were locked in cells, 10 hand-cuffed, 9 hobbled, and 84 restrained by straight-jackets or other similar means.[5] In particular, the report drew attention to the inhumane treatment of the insane residents at these institutions. The investigating commission described the conditions for those living in seclusion as so appalling “where, but for the insensibility of the inmates, the condition would be absolutely insufferable.” By the late nineteenth century, both the concepts of humane treatment and the medical treatment of mental health were at the forefront and as a result, the planning commission determined that it was necessary to providefor not less than one thousand patients. [6]
The building contract with Michael J. and William Malone would involve the construction of thirty-four structures with amenities including water main pipes, gas lines, steam heating, sewer and drainage.[7] Of the thirty-four buildings planned for construction, twenty-six were intended for patient accommodations with the capacity to house a total of 1060 patients.
A second setback occurred in late July of 1884, during the early days of excavation when “a vein of ‘quicksand’ varying in depth and thickness, underlaid [sic] the whole site.”[8]For two full months, the construction was halted while the plans were modified to accommodate this unforeseen landscape characteristic. Soon afterwards, work was again delayed, this time by the cold winters of Northwest Ohio. By late November in 1884, the architects suspended all masonry work until the temperatures were steadily above freezing.[9] Construction would not resume for nearly six months.
Despite the major delays occurring in 1884, by publication of The Second Annual Report in November of 1885, the masonry related work was complete on thirty four of the thirty six buildings and twenty-five of these structures were roofed.[10]Contained within the report of 1885 were multiple recommendations from both the Board of Trustees and architects. These involved additional structures as well as overall improvements to the plans such as a bath house to be used for treatment purposes, an amusement hall for residents, supplementary employee quarters and fire department quarters, physicians residences, a mortuary, electric lighting and a clock and bell for the administration building . These recommendations, although increasing the overall cost of the asylum, were proposed with the intention to “make it one of the best, for the care of the insane, in this country.”[11] Many of these improvements would come to fruition in 1886, causing delays in the original projected completion date of October 1886.
In 1886, members of the Board of Trustees as well as the Architect and Superintendent of Construction visited Willard Asylum in Seneca County, New York, the State Hospital for the Insane in Norristown, Pennsylvania and the Asylum for the Insane in Buffalo, New York. These trips were conducted with the intention of gathering ideas on how to best furnish and decorate the various structures of the asylum. Additionally, the group was accumulating details on the optimal use of electric lighting for both the buildings and grounds. Although the construction of the originally proposed structures was mostly complete by the end of 1886, delays in making decisions and appropriates for the suggested improvements caused setbacks during the year. The Board of Trustees could not decide on the preeminent way to include electric lighting and therefore delayed offering contracts.[12] The State Legislature did not make appropriations for furnishings during their January session and as a result further delayed the opening of the institution by six months.[13]Furthermore, various contracts were made throughout the year for “changes, improvements, and additions.”[14]The revised opening date was changed to February 1887, but this date too would come and go before the asylum doors were opened to patients.[15]
In the year proceeding the institution’s opening, much progress was made, both in the general construction of the facility and the overall preparation to receive patients. In December of 1886, Dr. Henry Archibald Tobey was appointed Superintendent of the Toledo Asylum. Dr. Tobey came highly recommended to the Board by many fellow physicians and “other persons of high stating in civil life.”[16] Dr. Tobey was an Ohio native with prior experience in the treatment of insanity. His previous appointments as assistant physician at the Columbus Asylum for the Insane from 1877 – 1880 and then as Superintendent at the Dayton Asylum for the Insane from 1880-1884 provided him with ample experience in asylum care and management.[17]Further employment selections were made throughout 1887 including the appointment of Mrs. Minnie Conklin Tobey, Dr. Tobey’s wife, as Matron of the complex, as well as Dr. Henry C. Eyman and S.W. Skinner as Assistant Physicians, and Mr. Alfred Wilkin as Steward.[18]
The thirty-four originally contracted buildings were completed, tested, and officially turned over to the care of the State in 1887. By the end of this reporting period, many projects had made much progress and were near completion. Over 60,000 square feet of stone walkways were laid, with more to be installed, multiple buildings were fitted with telephone exchanges, as well as electricity that would illuminate over 1700 fixtures among the buildings and grounds. Additionally, the decision to use natural gas in heating, rather than coal, called for the fitting of pipes and fixtures to transport the gas throughout the campus.[19] Once appointed, Dr. Tobey was highly involved in the multitude of decisions, oversaw many of the projects and managed the many purchases that needed to be made before the facility was open to patients, such as the purchase of furniture and furnishings, laundry machinery, kitchen appliances and tools, and the on-site production of nearly 700 hair mattresses and over 400 hair pillows. In his report to the board, Dr. Tobey commented on each of these successful bits of process made throughout the year, but also suggested many improvements he wished to make. His considerations were generally practical, but always patient centered. For example, he recommended sheltered walks to connect the cottages to the dining halls and protect the patients from unfavorable weather conditions, an amusement hall which he considered an absolute necessity, a greenhouse, industrial and shop buildings where patients could be employed, more land that could be farmed, as well as an iron fence to surround the property with the purpose of providing protection to “the inmates against the intrusion of curious, malicious or designing persons.”[20]
The summer of 1887 would bring another setback in the institution’s progress. In August, “a violent tornado” would make its way across Northwest Ohio and through the asylum grounds.[21] Initial reports printed in the New York Times indicated that several buildings were torn down by the tornado and the Assistant Superintendent and his wife were thrown from their carriage, but miraculously escaped with their lives. Further, the article estimated damages as severe as $10,000, however actual damages were slightly less and repairs were able to be made for $1,200.[22]
Although the project faced a multitude of obstacles, the Toledo Asylum for the Insane opened to patients on January 6, 1888, less than five years after House Bill 909 called for the expansion of the State’s care of the insane. By the end of 1888, over 1000 patients would be admitted to the care of the asylum.
Endnotes