St. Elizabeths Hospital History

[The Civil War Years] [Railroads] [Not Wedded To Any System] [New Methods Adopted]

Introduction The old and new are combined at Saint Elizabeths Hospital, where for more than one hundred years a Federal hospital devoted entirely to the care of the mentally ill has been graving in size, in curative skills, and in training and research activities. Ground was broken for the first building in 1852, and the first patients were admitted in 1855. In the century since then, more than 125 buildings have been built among the forest trees that cover the 320 rolling acres on a promontory where the Potomac and Anacostia Rivers meet, and in these buildings many new methods of treatment have been initiated and adopted. The Hospital has not always been known as Saint Elizabeths. In the 1840's and 1850's, when Dorothea Lynda Dix was crusading on behalf of the mentally ill and establishing hospitals in various localities both here and abroad, she literally badgered the United States Congress into making an appropriation for a "Government Hospital for the Insane," "...the object of which was to give the most humane care and enlightened curative treatment of the insane...." Land known as "the Saint Elizabeths tract" was selected for the Government hospital. The first building, now called Center Building, was designed over a modified "Kirkbride Plan," a plan widely used for hospitals at that time, and was done in what the architects called "Collegiate Gothic," a castled style complete with battlements and buttresses, popular in Victorian times. The red bricks with which the first building was built were made from the soil of the tract, and woodwork came from the trees of the surrounding forest. Center Building housed the entire Hospital in 1855--wards, kitchen, chapel and an apartment for the Superintendent. Transportation was such at that time that guests who came to the Hospital often had to stay overnight, so seven bedrooms were provided. One rom, known as Miss Dix's room, contained the immense bed she used. The "Director's Room" which was a part of the apartment, now called the Staff Lounge, contains the desk on which Miss Dix penned the basic law adopted by the Congress for the organization of the Hospital. Five Superintendents, beginning with Dr. Charles H. Nichols (1855) and ending with Dr. Winfred Overholser (1962), all lived in this apartment. Now, besides the Staff Lounge, several rooms of the apartment have been made into offices. A new Chapel, built on the grounds, replaced the old 1855 Chapel, and that space is now a gymnasium for the patients. Little scientific knowledge was available regarding mental illness a century ago, but kindness and compassion were present. The so-called "moral treatment," advocated first by Pinel, the great French reformer, in the care of the mentally ill, was being adopted in the United States , when the Hospital was founded. The essence of "moral treatment" was to provide congenial surroundings in which mentally ill patients might learn from the example of normal attendants. This meant that special attention was given to a hornlike atmosphere in the Hospital buildings, and that a real effort was made to have the grounds beautiful. One thousand trees were planted at Saint Elizabeths during the early years. They were brought from countries all over the world and also from many of our own States. In the years that have followed, these trees have become giants, and some of them are surrounded now by their offspring.

The Civil War Years. The changing of the Hospital's name was actually begun during the Civil War. Every available hospital in this vacinity vas pressed into service to receive soldiers wounded on the nearby battlefields. The Minie' ball, used in the guns of that period, shattered the bones so completely that they could not be set, so limbs were often amputated on the battlefield. Many Of these patients who survived were sent to "The Government Hospital for the Insane," so a small factory for making artificial limbs was set up on the grounds, and when the amputees were ready for them, the artificial limbs were fitted. These men, who were here for some time, refused to write home saying they were in a hospital for the insane; they simply wrote they were at "The Saint Elizabeths Hospital." The name was used so frequently that in 1916 Congress officially changed it to Saint Elizabeths Hospital, and for some unknown reason the apostrophe was left out.

Railroads, laundry, Bakery, etc. The Hospital, until 1967, operated a small railroad that was probably the last steam, coal-fed switch engine in the country in regular use. Every fall and winter it ran along its mile of track to the main railroad, bringing the many tons of coal necessary to heat the hundred and twenty-five buildings on the Hospital grounds. A bakery that supplies bread and doughnuts, and the icehouse are still in operation, as are the memmoth laundry, machine, electric, and other shops. Patients who would benefit by working in these various installations are assigned by their doctors to the different activities. Some patients thus learn skills that can be helpful to them when they leave the Hospital.

Not Wedded to Any System Saint Elizabeths is known throughout the world for its humane and expert services to more than 5,000 patients, and for its adoption of new methods of treatment as they become known. When the Hospital opened under the leadership of Dr. Charles H. Nichols, the first Superintendent, very little was understood of psychotherapy or psychodynamics. Great emphasis was being placed on the earlier-mentioned "moral treatment," and Saint Elizabeths was built with this idea in mind. Dr. W. W. Godding, Superintendent (1877-1899), began to consider brain surgery, and thought it possible that hypnotism would help the mentally ill. He said, "We undertake to be old fashioned or any fashioned if by any measures we can save some (patients). We are not wedded to any system . . . . " In 1884, re-appointed a pathologist to the Hospital staff, Dr. I. W. Blackburn, who was one of the pioneers in neuropathology in this country. This was hailed as a new departure in this field. Another innovation at Saint Elizabeths was hydrotherapy in 1897. But before that, in 1894, one of the early schools of nursing was begun. Dr. Gadding was succeeded, on his death in 1899, by Dr. A. B. Richardson, who died in 1903. Dr. Richardson's regime is best remembered by the large number of buildings whose construction was begun at that time, a practice he initiated of giving lectures to medical students, and for establishing one of the early photographic departments and pathological museums. When Dr. White succeeded Dr. Richardson in 1903, he established one of the first psychology laboratories in the country. His interest in psychotherapy, and the individual attention to the patient, is illustrated by the fact that in 1917 he named one psychiatrist as clinical psychotherapist, freeing him entirely from administrative duties. Another important innovation made by Dr. White was the establishment in 1920 of the Department of Internal Medicine, now known as the Medicine and Surgery Branch. He also developed the School of Nursing, initiating the three year course, and set up occupational therapy and social work. In 1909, he began publication of The Bulletin, a Medical paper, which appeared at intervals until 1932. These are only a few of the many advances made in treatment at Saint Elizabeths during Dr. White's administration. Dr. White died in 1937, and Dr. Winfred Overholser was appointed Superintendent. Having been Commissioner of Mental Diseases for the Commonwealth of Massachusetts, supervising 16 State hospitals and numerous private hospitals, Dr. Overholser was already widely experienced in the field of mental health. According to Dr. Zigmond M. Lebensohn, the cause of forensic psychiatry could not have been better served than by President Roosevelt's appointment of Winfred Overholser, who became known as the "Dean" of forensic psychiatry. To the present day, every type of psychotherapy, from the original milieu therapy to psychoanalysis, has been used at Saint Elizabeths--group therapy, occupational therapy, recreational therapy, dance therapy, etc., as well as new medication as it became available. When Dr. Overtholser retired in October 1962, Dr. Dale C. Cameron, who had been Director of Medical Services for the State of Minnesota, was appointed Superintendent. His tenure was notable for administrative progress including decentralization, delegation of patient treatment, authority and outplacement. The patient population began to decline despite increased rate of admissions. He also was responsible for significant enlargement in the Hospital research and training programs. In August 1967, Secretary John W. Gaxdner announced the transfer of Saint Elizabeths Hospital to the National Institute of Mental Health (NINH), effective August 13. In the following month, Dr. Cameron retired as Superintendent to become Chief, Drug Abuse Unit, World Health Organization in Switzerland, and Dr. David W. Harris was appointed Acting Superintendent. On November 8, 1968, secretary Wilbur J. Cohen and Dr. Stanley F. Yolles, Director of the National Institute of Mental Health, announced plans for the National Center for Mental Health Services, Training, and Research, with three divisions, one of which is the Saint Elizabeths Hospital - Division of Clinical and Community Services, with Dr. Louis Jacobs as Superintendent of the Hospital and Director of the Division of Clinical and Community Services. Dr. Harris was at that same time appointed Assistant Superintendent. Dr. Harris, on January 31, 1969, resigned to become Chief of Staff at the Veterans Hospital in Montrose, New York. During the period of the National Center for Mental Health Services, Training, and Research, with Dr. Sherman N. Kieffer as its Director and Dr. Jacobs as the Hospital Superintendent, a new era of community based psychiatry began at Saint Elizabeths. The Hospital established its first comprehensive Community Mental Health Center in April 1969. Between late 1969 and early 1970, all 19th Century patients' buildings were evacuated by relocation-approximately 1,200 patients were moved to newer buildings or outplacement in the community. Dr. Jacobs retired on November 3, 1969, to become Chief, Division of Mental Health, Montgomery County Health Department, Maryland, and Dr. Luther D. Robinson was designated Acting Superintendent. On May 26, 1972, Elliot L. Richardson, Secretary of Health, Education, and Welfare, approved an organizational change within the National Institute of Mental Health, the effect of which was to deactivate the National Center for Mental Health Services, Training, and Research, and to transfer to the Hospital those training and research activities of the National Center which are integrally related to its clinical operation. Emphasis on community service continued. By the time of the close of the National Center, the Hospital's inpatient population had decreased from 5,474 to 3,583, and the outpatient rolls had expanded from 1,675 to 2,437. By 1978, the number of inpatients had been reduced to approximately 2,200 and the number of outpatients expanded to approximately 3,300. On June 29, 1972, Dr. Robinson, the Acting Superintendent, was appointed Superintendent of Saint Elizabeths Hospital. Dr. Robinson had been on the staff since 1955 and in 1963 had founded the Hospital's Mental Health Program for the Deaf. During his superintendency, progress continued in Saint Elizabeths' programs. Dr. Robinson was a frequent visitor in the wards and earned the confidence of patients, many of whom he knew by name He continued his research on mental health in deafness, and expanded the Hospital's program for deaf people. When in July 1975 he moved to another position in the Hospital after 5 years in the Superintendent's office, the Director of NIMH, Dr. Bertram S. Brown, expressed thanks for the stability and leadership Dr. Robinson had provided during very difficult years in the mental health field. Dr. Roger Peele, Assistant Superintendent, served as Acting Superintendent until October 1977, when Dr. Charles Meredith becomes the Hospital's ninth Superintendent. He served from October 1977 to December 10, 1979 as Superintendent. William H. Dobbs, M.D., was appointed as Acting Superintendent. He served as Acting Superintendent until he was appointed as the Hospital's tenth Superintendent on January 14, 1981. Dr. William G. Prescott was appointed as the Hospital's eleventh Superintendent on January 1, 1984, replacing Dr. Dobbs who asked to be relieved of the Superintendency. As a result of changing Federal priorities and the increasing mental health capabilities of other governmental agencies, some categories of Federal beneficiaries eligible for admission to Saint Elizabeths, including: members of the Army and Navy, beneficiaries of the Veterans Administration, Merchant Seamen and Indians from the reservations, have been eliminated. As the proportion of Federal beneficiaries at the Hospital has decreased over the years, the proportion of D.C. residents has increased to approximately 90% of admissions. The high proportion of D.C. residents, coupled with the stated desire of the Federal government to get out of direct treatment services, and most recently the advent of D.C. Home Rule, have been the catalysts for intense negotiations by the Federal government to encourage the District of Columbia to assume responsibility for the operation of a unified mental health system for the city. The culmination of these negotiations is Public Law 98-621, which mandates that the District assume full responsibility for providing mental health services effective October I., 1987.

New Methods Adopted Saint Flizabeths was the first public hospital to have psychodrama, and in 1944, what is now the largest clinical pastoral training program in the Nation was begun. In 1957, the Saint Elizabeths-National Institute of Mental Health Collaborative Program was initiated--the Neuropharmacology Research Center in that year, followed by the Behavioral and Clinical Studies Center in 1961. Many prominent professional people have trained at Saint Elizabeths Hospital; and visitors from all over the world come to the Hospital. Overlooking the Capital City of the Nation, the Hospital is close to one of the great cultural centers in the world, as well as one of the most beautiful cities