Patients at the Friends’ Asylum, 1817-1833

On May 15, 1817 the Friends’ Asylum for the Relief of Persons Deprived of the Use of their Reason opened its doors to patients. Over the previous three and a half years the board of local, influential Philadelphia Quakers had raised money to purchase land, had overseen the design and fabrication of every aspect of the project, and had contracted with local craftsmen to build the Asylum.

In early 1817 the first superintendent, Isaac Bonsall, and his family moved into the Asylum buildings and completed the final preparations for its opening. When the Asylum opened its doors for patients, Bonsall with some disappointment noted in his daybook that no patients turned up:

Fifth 15
This day the House is considered as open for reception of Persons deprived of the use of their reason but none came. 17 other persons were here—

Bonsall had little reason for concern. Five days later the first patient arrived, a 48 year-old woman who had “been 11 Years insane—She appears to be of the Melancholy cast.” People continued to bring patients to the Asylum, entrusting family members to the care of Bonsall and the Asylum’s staff. Over the first 15 years the Asylum would admit more 350 patients. Here is an initial overview of those patients, compiled largely from the Patient Register.

Over the first 15 years more men than women were admitted to Friends’ Asylum. Most (just over half) of the people admitted were single, a third were married, and about ten percent were widowed (the numbers don’t add up to the total (363) because the Patient Register doesn’t record marital status for every patient).

General Summary of Patients
(admitted through 1833)

	Total Number	Total Percentage	Single	Married	Widowed
Men	194	53%	106	79	7
Women	169	47%	84	52	28
Total	363 (100%)		190	131	35

These rough numbers obscure the 51 patients who were admitted more than once, one as many as 10 times. Removing these, 280 unique patients were admitted to the Asylum.

Of the total number of patients admitted, almost half were considered “Restored” when they left the asylum.

Patient Condition on Leaving the Asylum

	Total Admissions	Restored	Much Improved	Improved	Stationary	Died
Men	194	82 (42%)	30 (15%)	18 (9%)	26 (13%)	38 (20%)
Women	169	70 (41%)	26 (15%)	21 (12%)	16 (9%)	36 (21%)
Total	363	152 (42%)	56 (15%)	39 (11%)	42 (12%)	74 (20%)

What exactly “Restored” meant, however, is unclear. The patient who was admitted 10 times was released the first 8 times “Restored,” the ninth “Much improved.” When he was admitted the last time, he spent more than two years there before finally dying in the Asylum “of Inflammation of the Stomach” (in total he spent three and a half years in the Asylum).

Patients stayed in the Asylum anywhere from 2 days to more than 40 years (14724 days). The average length of stay is 27 months. Patients who were there only a couple days as well as those who were there for years tended to die in the Asylum (probably from different causes—the former probably suffered from some acute illness, the latter from some chronic condition or simply old age). The median length of stay was 155 days.

Although the founders of the Asylum might have had a preference for “recent, curable patients,”[1] in fact it seems that many of the patients admitted over the first 15 or so years had been insane for more than two years. One patient was listed as having been insane for 44 years (another twenty or so had been insane for more than 20 years). At the other extreme, about 30 patients were listed as having been insane for fewer than 10 days.

Patients ranged in age from 16 years to 93 years. The average age for both men and women was 40.

Most patients were local. 122 were from Philadelphia and another 136 from Pennsylvania. 68 came from New Jersey. After that numbers dropped off quickly: e.g., 11 from Delaware; 7 from New York. A few came from as far away as Virginia and Rhode Island. In one case, a patient had previously been a patient in the York Retreat in England.[2]

This aggregate survey of the patients at the Friends’ Asylum, drawn largely from the Patient Register, raises all sorts of interesting questions, e.g., Why were some patients readmitted so many times? What did they mean by “Restored” or “Much Improved?” What symptoms were considered evidence of insanity, especially in the cases where a patient had been insane for 2 or 3 or 4 days? Because it effaces the individual patients, this survey of the Patient Register also raises questions about the stories of those individual patients, such as the young woman, patient #33, whose family brought her to the Asylum late one Saturday. She had been insane for six days….

Her story will be the subject of a future post.