January 15, 1999

The Trenton State Hospital was the first hospital of any kind in Trenton, N.J. It owed its establishment to the pioneering efforts of Dorothea Dix and its design to Dr. Thomas Kirkbride of Philadelphia. The author traces the story of its conception and carriage to term in the following account.

-Dilip Ramchandani, M.D.
History Notes Editor

By Michail Rotov, M.D.

The first proposal on record to establish an asylum for the insane in New Jersey was made in 1837 by Dr. Lyndon A. Smith in an address before the New Jersey Medical Society. It was not an original thought because one year earlier the New York Medical Society had made a similar request of its legislature. In addition, several successful private mental hospitals, operating in the East since the early 1800s, gave convincing evidence that a large proportion of the mentally ill could recover under proper treatment.

In 1839 the New Jersey legislature passed a resolution authorizing Governor Pennington to appoint a committee of four physicians and a lawyer to study the problem of the mentally ill in the state. In their report the committee estimated the number of insane in the state to be 800 out of an estimated population of 373,000. In 1841 a joint legislative committee recommended the erection of an asylum, but no action was taken for several years because of the legislature's reluctance to commit state funds.

A few years later, in 1844, at the invitation of various civic leaders, Dorothea Dix mounted her own campaign for a state asylum. As was her custom, she gathered firsthand information about the condition of the mentally ill in the state by visiting poor houses and jails in almost all counties, and she provided anecdotal material about the plight of those treated at home. Her impressions were summarized in a "memorial," which was presented to the legislature by Senator Joseph Dodd of Essex County on January 23, 1845, and resulted in a quick approval for the new asylum.

A commission was appointed that year to select a suitable site for the asylum. The members proceeded according to the principles for site selection established by Dr. Thomas Kirkbride of Philadelphia: easily accessible to the public and located near a town, but not closer than two miles; at least 100 acres of farm land; and an abundant supply of good water. The commission acquired the Titus Farm, consisting of 111 acres. The committee appointed to supervise the construction of the building visited several well-known mental hospitals in the East and eventually approved the design submitted by Dr. Kirkbride, with some modifications. Thus, Trenton Asylum was the first hospital in the nation that reflected Dr. Kirkbride's principles.

Dr. Kirkbride made note of this in his book, although he let it be known that he was unhappy about the changes made to his original proposal. What the changes were is not clear. One possibility is that he recommended eight wards for each sex as a minimum requirement for proper classification of patients, while the Trenton hospital had six.

The center building of the Trenton Asylum was four stories high, not counting the basement. It had a Tuscan portico with six support columns and was topped by a dome. The wings on each side were three stories high and were arranged in a broken line, with each successive block of wards receding from the previous structure and connected to it by a corridor. This arrangement was intended to facilitate the separation of the sexes and the various classes of patients and to provide good natural lighting and ventilation. The building also included offices for the superintendent and others, reception rooms for patients, and the superintendent's apartment.

The building was constructed by W. Philips and J. Whitaker of Trenton, who also built the State House. The architect was John Notman, and the landscaping was done by J. Dowing, known for his work on the White House gardens in Washington, D.C. The total cost was $146,513.58, including the land, building, furniture, and initial officers' salaries. When the construction was complete, the Trenton Asylum truly presented an imposing sight.

The hospital took its first admissions on May 15, 1848. Dr. H. A. Buttolph was appointed the first superintendent at a salary of $1,500 a year. Caleb Sager was the business manager (steward) at a salary of $600, and Dr. Buttolph's wife was the matron at a salary of $300. All received full maintenance.

In its 1848 annual report, the Board of Managers described the hospital as follows:

"Reposing in the midst of the most beautiful scenery in the valley of the Delaware, combining all the influences which human art and skill can command to bless, soothe, and restore the wondering intellect that are gathered in its bosom, the State may proudly point to this Asylum as a notable illustration of that charity, which, born from above, diffuses itself in blessing on the poor and unfortunate."